30 YEARS 1988 - 2018

QUARTERLY MAGAZINE OCTOBER EDITION 2018

Congratulations to this year’s Honorary Fellows, Professor Harminder Dua, Miss Marcia Zondervan and the diplomates receiving their award at the RCOphth Admissions Ceremony in September.

PAGE 4

A SAS perspective Jugnoo Rahi Trainee Knowledge PAGE 6 New PAGE 15 New PAGE 18 How to to the NHS Chair, Academic mix research with subcommittee clinical training college news

Dear fellow members, “Treating clinicians can lawfully choose Avastin for ophthalmic use on grounds of cost” Contents The 21st of September 2018 will live long in the memory of those who have campaigned 3 Awards galore! to be allowed to use Avastin (bevacizumab) 5 2018 Admissions as treatment for wet age-related macular Ceremony degeneration (ARMD). The landmark ruling by 6 New to the NHS - A Mrs Justice Whipple has brought clarity to the SAS Perspective interpretation of the national and European 7 Focus Managing legislation and should be read in full by all refractive surprise ophthalmologists. The College has issued a briefing note via Eye- 11 Museum Piece Mail to help answer some of the comments Births and Books in Whilst some may consider this a victory and concerns raised by members and I wish Ophthalmology 1818 over ‘Big Pharma’, we must not forget that members to continue to contribute to the 15 Jugnoo Rahi pharmaceutical companies are responsible discussions around Avastin. - New Academic for the development of the drugs we now use subcommittee chair to prevent blindness. It is essential that we Please do contact me at president@rcophth. 17 Ophthalmologists in recognise their vital role in eye health and ac.uk and I will do my best to answer your Training continue to work closely with them in future. enquiries on this matter. 23 Diary Dates The judgement allows clinicians to offer Avastin alongside other NICE approved, licensed treatments for wet ARMD. It does Don’t forget to not permit Clinical Commissioning Groups follow us on Twitter: (CCGs) to insist that Avastin is used exclusively. Mike Burdon, President rcophth @ It is widely recognised that ophthalmology [email protected] departments are under-resourced and are For the full landmark ruling and press release struggling to meet the increasing demands for Articles and stories to be visit the RCOphth website. considered for publication their services. Understandably, following this should be sent to: ruling, many ophthalmologists will expect their www.rcophth.ac.uk/2018/09/the-royal-college- Jack Bellamy CCGs and other healthcare funders to invest a of-ophthalmologists-is-delighted-that-the- Communications significant proportion of the money saved by a high-court-has-found-in-favour-of-the-use-of- Co-ordinator switch to Avastin in eye care. avastin-for-wet-amd/ [email protected] Copy deadlines January 2019 edition: 23 November 2018 April 2019 edition: 1 March 2019 July 2019 edition: NEWS events 31 May 2019 October 2019 edition: 30 August 2019 comment AWARDS courses Editor of Focus: Mr Andrew Tatham Advertising queries should be directed to: Robert Sloan eep up to date ith the atest nes ro the oee and oin in 07963 187 583 discussion ith coeaues ooin us on titter... [email protected] Contact Details: The Royal College oin the conersation at iero of Ophthalmologists 18 Stephenson Way London, NW1 2HD T. 020 7935 0702

2 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

Awards Galore! Prime Minister recognises CBM UK’s Andy Pyott with a Points of Light award

In between trips he organises visits by other UK medics, including experts from The Royal College of Ophthalmologists and specialists in retinoblastoma and diabetic retinopathy. He is also the driving force behind a programme linking the eye departments at the University of Dundee and Hasanuddin University Hospital in Makassar. Andy is the latest recipient of the Points of Light award, which recognises outstanding volunteers who are making a change in their community and inspiring others and a personal letter from Prime Minister Theresa May noted, ‘By lending your expertise to medics in Indonesia, you are ensuring the care and support local people receive is improving for the long term. Your ability Andy Pyott, consultant at Raigmore Hospital, Inverness to inspire other experts to join this important mission is a wonderful achievement.” and RCOphth Council Member, volunteers his time for Christian Blind Mission UK (CBM) to train local medics Andy said of the award, ‘I am still a bit overwhelmed by this across some of the poorest communities in Indonesia. award, but it is really a recognition of the fantastic work that Andy visits the country twice a year, to carry out CBM does in the elimination of avoidable blindness. My role has been to enable and encourage others, to take on and develop training, complete vital evaluation of new projects and services in a way that even they would have not thought advise the Ministry of Health. possible twelve years ago.’

Two UCL Institute of Ophthalmology Christopher Liu receiving his OBE from professors win prestigious Prince Charles at Buckingham Palace international vision award

This year’s prestigious Champalimaud Vision Award ceremony took place in Portugal in September. The award, worth €1 million in total, recognised the development of a successful gene therapy treatment for a genetic retinal disorder, a form of Earlier this year, Christopher Liu was appointed by Her Majesty Leber Congenital Amaurosis, which causes childhood blindness. Queen Elizabeth II as an Officer of the Most Excellent Order of Professors Robin Ali and James Bainbridge, UCL Institute the British Empire for Services to Ophthalmology. of Ophthalmology researchers, were among the seven Christopher said, “I am overjoyed with being appointed OBE international winners. The award is the largest in vision research and humbly accept the honour bestowed upon me on behalf and highlighted the potential for future developments in gene of my team, my teachers, my colleagues, my many fellows and therapy to cure inherited diseases. students, and my family.” “Ophthalmology is an exciting place to be at the moment with an abundance of developments and innovations. We feel very honoured to be recipients of the award,” said Professor Ali.

3 college news 2018 sees another great Admissions Ceremony

On Friday 7 September, the Royal College of Obstetrics Edited versions of the citations given in respect of and Gynaecologists hosted another two sessions of the Honorary Fellows are published in this article, but the Admissions Ceremony. full citations can be read online: Some 112 delegates and 320 proud family and friends www.rcophth.ac.uk/about/rcophth/rcophth- gathered to share the hugely successful and enjoyable honorary-fellowships/ occassion. Marcia Zondervan citation Professor Harminder Singh Dua presented by Professor Allen citation presented by Professor Foster Stephen A Vernon, Vice President

Marcia was born into a farming family at Guelf, near Toronto RCOphth in Canada, the 3rd. of 6 children. She trained as a nurse being awarded a Diploma in Nursing and then a Diploma in Tropical It is highly appropriate that, during the College’s 30th Diseases. anniversary year, we recognise one of the truly influential leaders in world ophthalmology by bestowing on him the I first met Marcia in 1984 when she came to Tanzania to gain highest award the College can give – an honorary fellowship. experience in Tropical Ophthalmology. After an internship with It is my pleasure, both as Vice President of the College but us she went to The Gambia and worked for 3 years at a rural also as one who has been fortunate to have been a consultant clinic being responsible for the diagnosis and management of colleague of the recipient for many years, to present to you patients with eye diseases. Professor Harminder Singh Dua as one of this year’s recipients The aim of the VISION 2020 LINKS Programme is to increase of our honorary fellowship award. the quality and quantity of eye care training in Africa through Many doctors, and particularly ophthalmologists it seems, who establishing long-term, mutually beneficial health partnerships. have reached Professor Dua’s age (and I am not going to tell The first step is to define the priority need of the African you that of course!) have either already retired or are about institution and then match them with an appropriate NHS to retire. It is a testament to his continuing enthusiasm and hospital. Joint visits are then undertaken at the end of which zest for the subject that when I asked him about retirement a a detailed Activity Plan and Memorandum of Understanding few years ago, he looked at me in a way that only he can and between the partner hospitals is agreed and signed by senior said “Ophthalmology is my hobby as well as my life’s work – I management in the UK and African hospitals. shall never retire!”... and this is clearly the main reason for Marcia has been responsible for and led the UK International him continuing at the ferocious pace that has characterised Eye Health Partnership programme over the last 14 years, and his career to date. In fact if I could divide and package his she is now assisting Australia and the USA to develop similar dedication, drive, commitment, determination and creativity programmes respectively in the Pacific and Latin America. and distribute it in equal measure to all who are receiving their fellowship certificates today, I would guarantee the success of Marcia combines passion for the cause, which is good accessible British ophthalmology for the next decade at least. eye care for people living in low income settings, together with professionalism and hard work. She has great diplomacy skills, Ladies and gentlemen and particularly our diplomates who a “never give up” attitude, and humility, which colleagues in the have their whole career as a consultant ahead of them, UK and Africa find persuasive, motivating and inspiring. Professor Harminder Dua demonstrates that individuals can make a huge difference to those they come into contact with, Having explained to you who Marcia is and what she has done whether they be patients, relatives, colleagues or students, to justify an Honorary Fellowship let me close by mentioning sometimes the world over. Diplomates, remember fondly why? Marcia’s driving force is her strong Christian belief. This this day for many years for your own success, but also for she upholds in word and deed while never being judgemental the achievements and qualities of the person your College or critical of those with other beliefs or none. For her to share honoured on the same day. As he has done, make your life’s God’s love with those who are marginalised from mainstream work the pursuit of excellence in Ophthalmology - Mr. President development is her motivation for life. I present to you Professor Harminder Singh Dua – Honorary I am delighted that the College has decided to recognise an Fellow of The Royal College of Ophthalmologists. amazing lady who passionately, yet humbly, continues to improve the eye care of literally millions of people around the world.

4 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

5 college news New to the NHS - A SAS Perspective

I completed my initial medicine and post graduate This attachment was my first stepping stone towards a career in qualifications in Ophthalmology in India and it was the NHS. To truly effect change and improve the quality of care with a combined work experience of 15 years in India for our patients, we need to go beyond our clinical training and and then Nigeria that I came to the UK when we learn to engage with the organisations, systems and processes that define and regulate the NHS. I felt I had a moral and moved here as a family. professional responsibility to understand the system in which I While in Nigeria after practise. successfully completing the Simultaneously, I passed the International English Language MDCN assessment examination Testing System (IELTS) and MRCOphth examinations and got my and getting their registration GMC registration. Each success gave me a sense of achievement to practice in Nigeria, I decided and brought me closer to my goal of working in the NHS. to pursue further qualifications with The Royal College of The GMC registration opened up two options namely applying Ophthalmologists in the UK. for a training post and working towards becoming a Consultant The subsequent visit here to sit or to go down the route of a non-training post ie Specialty the Part 1 FRCOphth was my Doctor (Staff Grade) and work towards CESR. With the advice of first exposure to the NHS and this sowed the seeds of a dream to colleagues, I chose to pursue the latter route. In due course and a one day become part of the NHS. couple of applications later I secured a job as a Specialty Doctor and subsequently regraded as an Associate Specialist. This opportunity arose in 2003 and needless to say I grabbed it with both hands. Having moved here lock, stock, and barrel, the Every country has its own unique delivery system of medical first priority was to settle down as a family in a new environment, services to the community and so is the case here in the UK before I could focus on pursuing a career in the NHS. when compared to India and Nigeria. I can’t say that it has been smooth sailing all the way but with hard work and an eagerness I still remember the early days when I would be on my computer, to learn and achieve the competencies set out in a well drafted, looking at the GMC, RCOphth and BMA websites to understand continuous improvement programme, there is a definite sense of the process of registration and accreditation for doctors with satisfaction in what one is able to contribute to the system. overseas qualifications. During this period I reached out to my friends and colleagues from the medical fraternity who had The route was a long and arduous one and many a time fraught already made the move to the UK and were now well settled with frustration. It is a delight and a great sense of pride being a in different parts of the country, to get their advice and gain a part of our NHS which is rightly regarded as one of the best in the better understanding on working in the NHS. world and continues to attract doctors and nursing staff globally to be a part of its success. A break came my way when I met a Consultant Ophthalmologist and was able to secure an honorary attachment with her. That Here’s to all my SAS colleagues and wishing our NHS even more gave me an invaluable insight into the working of the NHS such success in the years to come. as interaction with patients, colleagues and managerial staff, Haseena Sadhwani, Associate Specialist, London Royal Free record-keeping, letters to GP’s and much more. SAS Ophthalmologists: Supporting a Key Workforce

SAS doctors are traditionally support. And identified five distinct groups of SAS doctors at the mainstay of ophthalmic different stages in their career, facing different professional services in numerous hospital challenges. Lack of recognition from colleagues and support units. The RCOphth wishes to were recurring themes. better engage and support On the back of the survey findings we wish to work actively with SAS ophthalmologists, with the SAS doctors, their colleagues and external organisations to bulk of this work done through develop actions for improvement. Any thoughts or feedback on the College’s SAS Group, to work undertaken in your area to support SAS doctors would be ensure greater understanding useful in enabling us to follow-up on the themes identified in of their contributions and their our survey. Please get in touch at [email protected] concerns to help unlock their full potential. We are very grateful to all the SAS ophthalmologists who took the time to complete the survey and provide their views and In 2017, the RCOphth undertook its first national survey of suggestions. SAS ophthalmologists, the results of which have now been published. The survey asked questions in three main categories: www.rcophth.ac.uk/2018/08/sas-ophthalmologists- workforce, training and future career plans, and professional supporting-a-key-workforce/ 6 An occasional update commissioned by the College. focus The views expressed are those of the authors. Managing refractive surprise

Zaid Shalchi, Marie Restori, Declan Flanagan, Repeating biometry Martin Watson Consideration should be given to repeating biometry when findings Moorfields Eye Hospital differ significantly from the population mean. The NICE guidelines do not stipulate when biometry should be repeated but the 2010 College guidelines recommended this should be done for: Cataract surgery is increasingly a refractive procedure • Axial length under 21.2mm or over 26.6mm that aims to reduce spectacle dependence and the majority of patients with no ocular comorbidity achieve • Mean keratometry under 41D or over 47D unaided driving vision (6/12 in the UK).1 A refractive • Corneal astigmatism over 2.5D surprise is the failure to achieve the intended post- • Difference in axial length between fellow eyes over 0.7mm operative refractive target. It can cause anisometropia • Difference in mean keratometry between fellow eyes over 0.9D or dominance switch and is a source of patient Avoiding wrong IOL implantation dissatisfaction due to unmet expectations. Preventing wrong IOL implantation requires compliance with Preventing refractive surprise standard operating procedures (SOPs) and the WHO Surgical Safety Checklist modified to include cataract surgery checks.6 The best way to manage refractive surprise is to prevent it. The Most cases of insertion of an incorrect IOL are due to human 2017 NICE guidelines on the management of cataracts provide error and failure to adhere to SOP. advice on prevention of refractive surprise through accurate biometry, A-constant optimisation, intraocular lens (IOL) formula Refractive reconciliation selection and avoiding wrong lens implant errors.2 Benchmark Common sense is essential in IOL selection. The biometry should standards for NHS cataract surgery dictate that 85% of eyes be consistent with the refractive history. As a rule of thumb, a should be within 1D and 55% within 0.5D of target spherical 3D difference in the IOL power equates to a 2D change in the equivalent refraction following surgery.3 refraction. Measuring the eye Identifying the cause of refractive surprise Partial coherence interferometry (PCI) is the most common way 1. A formal subjective refraction is essential as auto-refraction is to determine axial length. This is better than ultrasound A-scan prone to error. as it has greater precision, is not affected by velocity estimates 2. A thorough dilated examination is necessary to identify (e.g. in silicone oil-filled eyes) and measures along the visual surgical causes such as tight corneal sutures , placement of the axis. In eyes with dense cataract, PCI may not be possible and IOL in the sulcus or subluxation. Look for a distended capsular A-scan becomes necessary.4 Cross-checking this with B-scan helps bag due to retained viscoelastic that can cause a myopic shift. identify the presence of posterior staphyloma. The presence of corneal pathology such as corneal scarring or Keratometry is a frequent source of biometry errors. Contact oedema can influence the refractive outcome. Post-operative lenses wearers should not wear them before biometry (typically cystoid macular oedema can cause a hyperopic shift. 1 week for soft lenses and 2 weeks for rigid gas-permeables). 3. Review the refractive history as well as the biometry, the IOL Patients with prior corneal refractive surgery, keratoconus, selection process and the surgical records. Wrong patient corneal scarring or corneal graft require additional corneal biometry, transcription errors, selecting the lens from the topography. Different IOL formulae are required for prior myopia ACIOL column, incorrect A-constant or incorrect formula can or hyperopia (e.g. Haigis-L). all lead to insertion of the wrong IOL.6 IOL Formulae 4. Check the axial length by repeating the biometry. PCI may not Most modern formulae are good at predicting post-operative have been possible prior to surgery due to a dense cataract. refraction in standard eyes (axial length of 22-26mm), with the Ultrasound measurements are prone to error as contact with NICE guidelines recommending Barrett Universal II or SRK/T. In the cornea may compress the eye and lead to underestimation of axial length. short and long eyes there is greater variability primarily due to the post-operative effective lens position (ELP). The NICE guidelines 5. Check for abnormal keratometry. The presence of high recommend using Haigis or Hoffer Q if the axial length is less than Ks or astigmatism can indicate pre-existing undiagnosed 22mm and the Haigis or SRK/T if the axial length is greater than keratoconus. Previous refractive surgery is not always 26mm. OKULIX ray-tracing software and the Hill-RBH calculator volunteered by the patient. LASIK flaps can be hard to detect also show promise in improving biometric calculations. A-constant and absent in previous LASEK/PRK. optimisation further improves post-operative refraction prediction 6. If there has been no error, the refractive surprise can be and is readily available via the website of the User Group for Laser attributed to effective lens position and a similar error is likely Interference Biometry (ULIB).5 to occur in the fellow eye. FOCUS - THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

Clinical management of refractive surprise L-HYPEROPIC formula. Her original hyperopia was predictable If IOL selection error is detected, report it using the hospital from her short axial length, steep keratometry and age of LASIK incident reporting system. This is essential to learn from mistakes (refractive surgery in late 40s/50s/60s performed when reading and avoid repetition. Explain the error openly and offer an glasses become heavier). The patient was happy with her new apology. This is essential to comply with the statutory duty of ability to read unaided and decided against further surgery. candour. This is not a declaration of guilt but an acknowledgment that you have not achieved the desired target refraction. Offer a second opinion. This in itself can help diffuse a confrontational Biometry in previous refractive surgery situation and allow meaningful dialogue to take place. • Patient to provide pre-refractive surgery data where The error needs to be graded within days to determine the level possible of severity, whether a formal root cause analysis is required and whether the incident is a NEVER event.7 • Helpful clues: Doing nothing is always an option Average eye Myopic Hyperopic Many refractive surprises do not require further surgery. Low treatment treatment myopia may give useful monovision and the ability to read Axial length 22.5 – 24.5 Long eye Short eye unaided. A patient who has worn glasses all their life may be (mm) willing to continue wearing them, and some patients do not mind wearing contact lenses. Time spent speaking candidly to the Keratometry 43.27 Flat K Steep K patient is time well-spent and helps prevent dissatisfaction later. (D) readings readings The benefits and risks of further intervention should be explained. Age at time 20s & 30s Late 40s, of refractive 50s & 60s Retained viscoelastic surgery Early laser capsulotomy can disperse the viscoelastic and allow the anteriorly displaced IOL to move posteriorly. Corneal refractive surgery Biometry in keratoconus8 Laser refractive surgery (PRK or LASIK) is a good option after refractive surprise. It can treat a large range of refractive error • Biometry in keratoconus typically overestimates corneal including astigmatism although care should be taken with power and leads to hyperopic surprise pre-existing ocular surface disease such as dry eye. It should • Recommendations only be performed once the refraction is stable, typically after 3 months. This additional time allows some patients to become K ≤ 55D (mild/moderate) accustomed to their new prescription and they may decline • Use actual K values; target –1 D (K ≤ 48); -1.5 D further intervention. Cost and access may be prohibitive. (48 - 55 D) IOL exchange • Toric IOLs only if spectacle corrected pre-op IOL exchange is possible and ideally undertaken soon after the K > 55D (severe) initial surgery before capsular fibrosis has occurred. IOL exchange, • Use standard K values 43.25 D; target -2 D however, carries the risk of capsular damage and vitreous loss. (more if scleral lens wearer) Piggyback sulcus IOL • No toric IOLs in RGP/scleral lens wearers A sulcus IOL inserted as an additional (piggyback) lens to the original IOL is another option. As this corrects the manifest refractive error, the power of the original IOL does not need to be Andrew Tatham known. Piggyback lenses are less accurate than laser refractive Editor, Focus surgery but good for higher degrees of refractive error and avoid the risks of IOL exchange as well as those with ocular surface References: disease where laser is not suitable. 1. Day AC, Donachie PH, Sparrow JM, Johnston RL: The Royal College of Ophthalmologists’ National Ophthalmology Database study Conclusions of cataract surgery: report 1, visual outcomes and complications. Advances in biometry as well as adherence to SOP mean that Eye (London, England) 2015, 29(4):552-560. refractive surprises are thankfully becoming less common. As with 2. NICE guideline 77. Cataracts in adults: management, October all surgical complications, the best way of managing refractive 2017. surprise is to prevent it in the first place. This requires a systems 3. Gale RP, Saldana M, Johnston RL, Zuberbuhler B, McKibbin M: approach to reduce human error. When refractive surprises Benchmark standards for refractive outcomes after NHS cataract do occur, be open with patients and discuss the options for surgery. Eye (London, England) 2009, 23(1):149-152. effectively managing the refractive error. 4. National Institute for Health and Care Excellence: Clinical Guidelines. Cataracts in adults: management. 2017. Case example: 5. ULIB: http://ocusoft.de/ulib/ 2018. A 66-year-old female underwent bilateral sequential cataract 6. UK Ophthalmology Alliance, The Royal College of opthalmologists: surgery aiming for emmetropia. She had a history of bilateral Quality Standard: Correct IOL implantation in cataract surgery. LASIK in India 15 years earlier but no access to her refractive 2018. history. After cataract surgery, the patient was found to be -3D 7. NHS Improvement: Never Events policy and framework. 2018. myopic in both eyes. A review of her biometry shows the Haigis 8. Watson MP, Anand S, Bhogal M, Gore D, Moriyama A, Pullum K, Hau L-MYOPIC formula was used for IOL power calculation instead S, Tuft SJ: Cataract surgery outcome in eyes with keratoconus. of the correct Haigis The British journal of ophthalmology 2014, 98(3):361-364. The John Weiss range of ophthalmic surgical instruments is supported by a number of carefully selected brands

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It’s black and white Museum Piece Births and Books in Ophthalmology 1818

Births one hundred books and papers were Atlases demonstrating with a splash what could be seen of the nervous system of the eye with The first human blood transfusion was successfully performed the ophthalmoscope. George Wilson (d.1859) was not an in the year 1818. The year was also auspicious for the birth of ophthalmologist but he was the first Englishman to urge of colour two of the greatest ophthalmologists of the nineteenth century, the authorities to screen military and railway personnel for Eduard Jaeger and Frans Donders. Jaeger (d.1884) adopted with colour blindness on which he wrote a number of papers. great skill Helmholtz’s invention of the ophthalmoscope in 1851 Maximilian Langenbeck (d.1877) of Hannover re-invented the and produced the definitive fundus atlas of the 19th century. Vitreoretinal interface RNFL fixation forceps and was influential in establishing cataract He was also known for his work on refraction and the Jaeger extraction over the needling operation. He was the son of test chart. Donders (d.1889) became known as the Father of Konrad Langenbeck, a surgeon of great skill and dexterity, who Practical Ophthalmology with the publication On the Anomalies published Neue Bibliothek fur die Chirurgie und Ophthalmolgie of Accommodation and Refraction 1864. This work is one of the in the same year, 1818, that his son was born. most important books on physiological optics ever written. Books However there were others who also made significant The year 1818 produced some interesting ophthalmological contributions to the profession. publications. Sir Astley Cooper and Benjamin Travers published SVP ICP For instance Alfred Smee born a two volume book of Surgical Essays. In volume 1 Travers in 1818 (d.1877) founded the wrote a chapter on Iritis. A Parisian optician by the name of Central London Ophthalmic Chamblant wrote Nouveaux verres d’optique, a surfaces de Hospital in 1843. This hospital cylinder, de l’invention de M Galland , in which he was one of was finally amalgamated with the first to describe a plano-cylindrical glass for astigmatic Moorfields Eye Hospital in patients. A pamphlet published in 1818 by John Vetch (1783- 1948 and the hospital in Judd 1835) Observations relative to the treatment by Sir William Street was taken over by the Adams of the ophthalmic cases of the army, brought to a head a bitter public argument on the MultiColor newly established Institute of Ophthalmology. Smee wrote best way to treat trachoma. DCP Alfred Smee books on the Eye and Vision Vetch condemned Adams for his in health and Disease but became famous in a very different so-called secret cure for trachoma field, electricity, with the invention of a superior battery to the which included emetics. Volta cell. He also had the position as Surgeon to the Bank of England. In 1818 James Wardrop (1782- 1869) wrote a pamphlet, On David Agnew (d.1892) of Philadelphia became Professor of the effects of evacuating the surgery at the University of Pennsylvania after practicing aqueous humour in the different Visualise four vascular plexuses with the highest at Wills Eye Hospital and wrote a 3 volume book on surgery species of inflammation of the resolution in any field of view devoting a part of volume 3 to eye surgery 1878-1883. This eyes; and in some diseases became a valuable reference book for American general of the cornea, in which he surgeons who performed Samuel Soemmerring recommends paracentesis eye surgery. for increased pressure in the eye. In 1818 Antoine Demours Another ophthalmologist published a translation of born in 1818 was Austin Samuel von Soemmerring’s Prichard (d.1899) of (1755-1830), Icones oculi humani Bristol. He was the 1804. Soemmerring’s greatest MultiColor inventor of several achievement was in the field of ophthalmic instruments neuroanatomy. His anatomical and was the first to

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Eye Journal - Editor’s choice Selected papers from 3rd quarter 2018

1. Space flight-associated neuro-ocular syndrome retinopathy. The authors highlight the need for screening (SANS) for this condition to enable early diagnosis and treatment of this condition. In addition the review highlights the urgent In the July issue, Lee at al, Eye volume 32, pages 1164–1167 need for contemporary epidemiological studies, clinical (2018), reviewed the space flight associated neuro-ocular trials and improved resources in terms of equipment and syndrome (SANS). Astronauts many manifest several signs manpower to enable timely management of these cases. during and after long duration space flights. These include unilateral and bilateral optic disc edema, globe flattening, 3. Facing up to gender inequality in ophthalmology choroidal and retinal folds, hyperopic refractive error shifts and vision science and nerve fiber layer infarcts (i.e., cotton wool spots). As more of these space travels are planned, it is useful to In the September issue, Khan and Moosajee, Eye volume prospectively continue to report these observations. 32, pages 1421–1422 (2018) highlighted the gender inequality in ophthalmology and vision science. They 2. The past, present and future management of sickle commented that in The Ophthalmologist’s 2018 Top 100 cell retinopathy within an African context most influential people in the world of ophthalmology consisting of only 13 women, up by four since the 9% In the August issue, Kwesi Nyan Amissah-Arthur and Evelyn female representation in 2016. In order to address this Mensah Eye volume 32, pages 1304–1314 (2018), reviewed inequality, a Women in Vision UK (WVUK) network has been the temporal trends of sickle cell retinopathy since first established and this manuscript describes the current roles reported in early 20th century. The authors present the of this network that includes an ambition to increase the heterogeneity of presentation of this complex condition. number of female speakers at conferences and on expert Although previously reported to be a benign and self- panels, and provide a network of support, mentorship, limiting disease in most affected individuals, this review collaboration and leadership to enhance the profiles and highlights the presence of aggressive phenotypes especially careers of women in this speciality. in Sub-Saharan Africa and the Carribean countries. For example, in Togo, 16% of the retinal detachments that Sobha Sivaprasad present to the Ophthalmologists are due to sickle cell Editor in Chief, Eye

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Life 2.275sciences Volume 32 Number 8 pages 1293–1420 1293–1420 pages 8 Number 32 Volume in Nature Reviews 1421–1552 pages 9 Number 32 Volume

The official journal of The Royal CollegeEditor-in-Chief: of Ophthalmologists Professor Sobha Sivaprasad Eye is the official journal of The Royal College of

oue3 Nme pages 1157–1292 Number 7 Volume 32 Ophthalmologists. It aims to provide the practicing ophthalmologist with information on the latest clinical and laboratory based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science. • Oculo-plastic surgery *In the FAME study, 76.1% of chronic DMOFor patients more receivedinformation 1 implant visit: in www.iluvien.co.uk3 years, the remaining patients received 2 or more impl Areas that are covered include: Prescribing Information UK. ILUVIEN implant in applicator. Refer to the Summary of Product Characteristics • External eye disease ® Cancer | Drug• Neuro-ophthalmology Discovery | Genetics | Immunology(SmPC) before prescribing. | Microbiology190 micrograms intravitreal | applicator. Each implant containsPresentation: 190 micrograms of fluocinolone suspected ocular or periocular infection including most viral diseases of • Orbital and lacrimal disease • Glaucoma acetonide. Light brown coloured cylinder, approximatelyIntravitreal 3.5mm implant x in the cornea and conjunctiva, including active epithelial herpes simplex 0.37mm in size. Implant applicator with 25 gauge needle. keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, • Medical and surgical retinaMolecular Cell Biology | Neuroscience ILUVIEN is indicated for the treatment of vision impairment associated and fungal diseases. Hypersensitivity to the active substance or to any As a precautionary measure it is preferable to avoid the use of ILUVIEN with chronic diabetic macular oedema, considered insufficientlyIndication: of the excipients. during pregnancy. Although systemic exposure of fluocinolone is very • Cataract and refractive surgery • Ocular oncology responsive to available therapies. injections have beenSpecial associated warnings with endophthalmitis, and precautions: elevation in low, a risk benefit decision should be made prior to use of ILUVIEN administration: intraocular pressure, retinal detachments and vitreous haemorrhagesIntravitreal or during breast-feeding. ants3 • Ocular surface and corneal disorders • Ophthalmic pathology in the affected eye. TheAdministration recommended in both dose eyes Dosageis one concurrently ILUVIEN and method implant is not of detachments. Patients should be instructed to report without delay any minor influence on the abilityDriving to drive and andusing use machines: machines. Patients may Adverse events should be reported. Reporting forms recommended. Each ILUVIEN implant releases fluocinolone acetonide symptoms suggestive of endophthalmitis. Patient monitoring within two experience temporarily reduced vision after administrationEponymous of ILUVIEN ILUVIEN has and women information can be in found ophthalmology at • Pediatric ophthalmologyNatur and strabismuse Reviews: Contentfor up to 36 months. An additional includes: implant may be administered after to seven days following the injection may permit early identification and and should refrain from driving or using machines until this has resolved. www.mhra.gov.uk/yellowcard. Adverse events 12 months if the patient experiences decreased vision or an increase in treatment of ocular infection, increase in intraocular pressure or other Undesirable effects: should also be reported to Alimera Sciences Limited retinal thickness secondary to recurrent or worsening diabetic macular complication. It is recommended that intraocular pressure be monitored cataract, increased intraocular Very common pressure; (>1/10) Facing up to gender inequality in ophthalmology and vision science • Editorial independence and excellence •oedema. Authoritative, Retreatments should not be administered unlesscomprehensive, the potential at least quarterly thereafter. Use of intravitreal corticosteroids may cause glaucoma, trabeculectomy, eye pain, vitreous haemorrhage,Management: cataract operation, conjunctival (telephone: of 0800 sickle 148 8274) cell retinopathy in Africa benefits outweigh the risks. Only patients who have been insufficiently cataracts, increased intraocular pressure, glaucoma and may increase haemorrhage, blurred vision, glaucoma surgery,Common reduced (>1/100 visual to acuity,<1/10) [email protected] Antibiotic prophylaxis for preventing endophthalmitis after intravitreal injection: a systematic review responsive to prior treatment with laser photocoagulation or other the risk of secondary infections. The safety and efficacy of ILUVIEN vitrectomy, trabeculoplasty, vitreous floaters; : • High-impact accessible Reviews and Perspectives Torpedo maculopathyFor medical enquiries please email: in a paediatric population available therapies for diabetic macular oedema should be treated administered to both eyes concurrently have not been studied. It is <1/100): endophthalmitis, headache, retinal vascular occlusion, optic with ILUVIEN. recommended that an implant is not administered to both eyes at the nerve disorder, maculopathy, optic atrophy, conjunctivalUncommon ulcer, (>1/1,000 iris to [email protected] Comparison of glaucoma-diagnostic ability between wide-fi Children under 18: Submit your next manuscript to Eye and benefit from: • Filtering the vast research literature No dosage adjustments are necessary No relevant in elderly use. patients, or those with same visit. Concurrent treatment of both eyes is not recommended until neovascularisation, retinal exudates, vitreous degeneration,Sphincterotomy vitreous References: for small pupil phacoemulsifi and spectral-domain OCT renal• orComment, hepatic impairment. AnalysisSpecial populations: andthe patient’s Progress systemic and ocular response articles to the first implant is known. detachment, posterior capsule opacification, iris adhesions, ocular cation 1. ILUVIEN • Wide exposure and article visibility via nature.com administered by an ophthalmologistMethod experiencedof Administration: in intravitreal injections. There is a potential for implants to migrate into the anterior chamber, hyperaemia, sclera thinning, removal of extruded implant from sclera, ®, Summary of Product Characteristics. June 2016. Evaluation of eLearning for the teaching of undergraduate ophthalmology at medical school: a randomised • High production values and quality Educational• Research Guidance: HighlightsDiabetic ILUVIEN should retinopathy be writtenespecially in patients with byand posterior endothelincapsular abnormalities, such as system: eye discharge, microangiopathy eye pruritus, extrusion of implant, implantA in 10-year versusline of sight, 2.endothelial Campochiaro analysis PA, dysfunctionof microbiological profi should familiarise themselves Prior with to administering the ILUVIEN AdministrationILUVIEN, physicians Guide. tears. This should be taken into consideration when examining patients procedural complication, procedural pain, device dislocation. Consult 2132. 3. Cunha Vaz, etet al.al. Ophthalmology Fluocinolone Acetonide 2012; 119: Implant 2125- for les of controlledmicrobial crossover keratitis study • Inclusion in leading abstracting and indexing services 2018 September eld swept-source OCT retinal nerve fi Contraindications: Space fl ight-associatedcomplaining of visual disturbance afterneuro-ocular treatment. syndromethe SmPC for full2018 August details (SANS)of undesirable effects. Chronic DME. Ophthalmology 2014; Oct; 121(10): 1892- 903. • Automated PubMed Central deposition for original researchartwork papers in-house The presence of pre-existing editors glaucoma or active or interaction studies with other medicinal products have been performed. overdose has been reported. Management of anterior capsular contraction syndrome: pitfall of circular capsulotomy technique with the Pregnancy and lactation: Interactions: NHS list price Legal classification:Overdose: © 2017 Alimera Sciences Limited No : £5,500.00 (ex VAT) for each ILUVIEN 190 micrograms No case of neodymium YAG laser ber layer maps The Royal ofCollege intravitreal administered of fluocinolone ThereOphthalmologists are no acetonide adequate in data pregnant from thewomen. use intravitreal recommendations implant in applicator. POM. on Pack screening size and UK-ILV-MMM-0991. for hydroxychloroquine Date of preparation: August 2017. • Rapid decision and publication times PL 41472/0001. Marketing Marketing Authorisation number and chloroquine users in the United Kingdom:Limited, Royal Pavilion, Wellesleyexecutive Authorisation Road, Aldershot, Holder: Hampshire,summary GU11 1PZ, • Open Access option available for authors United Kingdom. Alimera Sciences The ROYAL COLLEGE of Date of preparation of PI: • SharedIt - Springer Nature’s SharedIt content-sharing initiative allows authors and How do paper and electronic records compare for completeness?October 2015. A three centreOPHTHALMOLOGISTS study subscribers to share links to view-only, full-text articles from this journal. nature.com/reviews Trabeculectomy training in England: are we safe at training? Two year surgical outcomes The ROYAL COLLEGE Learn more at: springernature.com/sharedit OPHTHALMOLOGISTS of of

July 2018 The ROYAL COLLEGE Find out more: nature.com/eye OPHTHALMOLOGISTS

Follow the journal on Twitter! @Eye_Journal

*Data is taken from the 2016 Journal Citation Reports® (Clarivate Analytics, 2017)

A49662 12 college news The RCOphth at the forefront of Clinician to Clinician Learning

Having done a lot of work Shortly, NHS Resolutions will be providing me with information on this topic I am proud to about all clinical litigation cases in Ophthalmology. I will assess say that our College does an these and determine if there are any common themes or learning excellent job of facilitating points. Via College communications we will try and disseminate these learning points to all Members. But how about the 10% of learning. From the Annual Consultants and 50% of Middle Grades who are not members? Congress and Eye, to Focus Do we accept these individuals will be left out? Do we not have we have lots of guidance a duty to the patients seeing them too? To address this, I am on learning to work with. working with the GMC and NHS Improvement to try and develop However, there is a gap a process whereby speciality specific learning messages can which needs addressing. be emailed directly into clinicians in boxes whether they are members of their College or not. I have a Masters in Medical Law and through my litigation work I see the same clinical errors happening again and again and some Once we prove the model we hope to expand it out by asking of you may have read my Learning from Litigation segments. all medical experts to submit a small clinical learning point It is disheartening to see the same mistakes happening and abstract which can be reviewed by a clinician in that field and patients coming to the same harm. The lessons are not being then that learning information can be disseminated directly to learnt. Hundreds of NHS man hours are spent investigating an front line clinicians via the GMCs database of email addresses error and a learning point determined and implemented locally and specialities. Remember these are not official guidelines but there is no robust mechanism to disseminate this to other but simply areas for practice reflection. It would be expected front-line clinicians. I see the same mistake resulting in visual loss that these are discussed as part of the appraisal process and a few miles down the road in the next Trust. the clinician would have responsibility for ensuring their team/ trainees also reflected upon them. The College tries to disseminate patient safety information and alerts but there is no efficient mechanism for data collection We are a small College/speciality but I hope to put us at the and when the data is assessed the safety message can get forefront of this and hold us up to the Academy of Medical Royal lost as another bit of the College email. These messages are Colleges as an example to follow. too important to be missed and I am working with Melanie Amar Alwitry FRCOphth MMedLaw Hingorani, Chairman of the Professional Standards Committee, Consultant Ophthalmologist, Loughborough Hospital to make this process more robust. Congress 2018

Thank you to all price as 2018 and all trainees will pay the trainee rate, not just of those that gave those that have yet to pass their Part 2 exam. Congress is very feedback on the 2018 expensive to run and the number of UK venues big enough to Congress. We thought host it is very small so we are restricted in where we can go. However, the College is always looking at ways to ensure the it would be useful to best value for delegates. let you know how the College will be acting Catering on that feedback. One of the main challenges with Congress is that each day over 1,000 delegates and exhibitors need to be fed in 90 minutes, Programme food needs to be kept hot without losing flavour, served quickly 89.88% of respondents rate Congress as either excellent or and eaten standing up, so there are challenges in the variety good. The programme sessions also rate highly. For 2019 the that can be offered. The College has met with the SEC, Glasgow College asked members for session suggestions, this was very who are hosting Congress 2019 and we have given them popular and will be repeated for 2020. The College is very keen feedback on previous catering. In 2019, there will be improved to involve the membership in the Congress planning. refreshments during breaks and variety in lunches. Costs Congress will be held at the SEC, Glasgow 20 – 23 May 2019. 61.5% of respondents thought that Congress was good value Registration will open in early February 2019. If you have any for money, however the College is aware that the delegate fees queries or suggestions about Congress please email are a major concern. For 2019, the fees will be kept at the same [email protected]

14 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

Jugnoo Rahi – new RCOphth Academic subcommittee chair

It is a pleasure to write • Establishing the John Lee Academic Primer Fellowship. Please to you about the work Darren Ting’s reflection as the first awardee on page 19 of RCOphth Academic • Establishing and delivering a unique Evidence-Based subcommittee as its new Ophthalmology course ‘Research changes lives’ providing Chair and to thank Professor training in research design, statistical approaches and evidence Paul Bishop for steering us appraisal. Book your place on 14 March 2019 over the past three years. • Co-establishing the David Owen Ulverscroft Prize for academic paediatric ophthalmology and visual sciences as the first Research lies at the heart of dedicated national prize in this subspecialty within the College’s developing and delivering the portfolio and re-launching the Nettleship Award for the best highest quality clinical and published research in any area of ophthalmology and visual public health care and services in Ophthalmology to ensure that sciences www.rcophth.ac.uk/professional-resources/ patients have the best possible outcomes and the population has awards-and-prizes/ the best possible visual health. In recognition of this, the RCOphth established the Academic Sub-Committee with the dual aims of With the foundation in place and relationships established with the ensuring that all ophthalmologists are competent in participating College’s Scientific Committee, Education Committee and Training in, understanding and applying research and that those who are Committee, we are now thinking about the upcoming challenges clinician scientists have a career framework and opportunities for academic ophthalmology. In particular we will be focussed on that enable them to succeed. ensuring that post-Brexit, ophthalmic research remains integral to the NHS, that academic ophthalmology in all its forms remains an The Committee has tasked itself with raising the profile attractive career path for trainees, and that the broader environment of academic ophthalmology, maintaining and developing in Ophthalmology enables clinician-scientists to succeed. relationships between RCOphth and key external organisations such as academic institutions and funding bodies, building Please do be in touch with questions, comments or suggestions research networks and links with research organisations, and about the future work of the Committee via Beth Barnes, acting as an advocate for academic and research training. [email protected] Our most recent activities have included Jugnoo Rahi • The development of a new Research Hub on the College’s Professor of Ophthalmic Epidemiology and Honorary Consultant website to provide information about research for both clinicians Ophthalmologist and the public www.rcophth.ac.uk/professional-resources/ NIHR Senior Investigator, GOS Institute of Child Health UCL and research-hub/ Institute of Ophthalmology UCL and Great Ormond Street Hospital • Establishing and organising the plenary ‘Horizon Scanning’ NHS Foundation Trust session at Congress A year since publication of new child vision screening resources

Professor Anne Mackie, Director of by Nick, a Public Health England colleague and dad of Cameron, Programmes for the UK National who was diagnosed with severe vision impairment. Cameron’s Screening Committee, reflects a year on dislike of reading had not registered with teachers or the family as from publication of a suite of resources anything to do with his vision. Once diagnosed and placed under the to support the commissioning and care of an orthoptist, Cameron has made a significant improvement. delivery of high quality vision screening We hope that eventually all parts of England will offer the child for 4 to 5 year olds in England. vision screening programme. Lancashire Vision Screening Service I hope that any eye health professional is a success story. Their new county-wide screening service has working with child vision services have been praised by the British and Irish Orthoptic Society as a model found the resources useful. They include a service specification, service. The guidelines and resources developed by Public Health screening pathway, professional competencies, teacher England played an important role in commissioning the service and information sheets and a parent leaflet and letter templates. ensuring that everyone involved knew what their roles were. The The standards for local screening services are taking a bit longer to collaboration of Blackpool Teaching Hospitals NHS Foundation Trust finalise than expected but will be published as soon as possible and and East Lancashire Hospitals NHS Trust enabled a standardised, we are also developing an e-learning module to support people quality service delivery to all the children of Lancashire. delivering child vision screening. This will be available in 2019. If you’d like to get in contact with the fantastic team in Lancashire The importance of having an orthoptist-led vision screening or share other child vision screening success stories, please do get in programme in schools and the impact it has on families is explained touch. https://legacyscreening.phe.org.uk/email_us_form.php 15 Mydrane A4 Advert 6-18.qxp_Layout 1 02/07/2018 14:14 Page 1

INDICATED FOR CATARACT SURGERY TO OBTAIN MYDRIASIS AND INTRAOCULAR ANAESTHESIA DURING THE SURGICAL PROCEDURE

®

Tropicamide 0.2mg/ml, phenylephrine hydrochloride 3.1mg/ml, lidocaine hydrochloride 10mg/ml solution for injection

Speed 95% of pupil dilation obtained within 30 seconds [1,2] Stability 89% have <1mm variation in pupil size throughout surgery [3] Comfort Significantly superior during IOL insertion[1]

Mydrane 0.2mg/ml + 3.1mg/ml + 10mg/ml solution for injection in single dose ampoule (tropicamide, history of acute narrow angle glaucoma. Mydrane produces undetectable or very low systemic phenylephrine hydrochloride, lidocaine hydrochloride). Prescribing Information: Please refer to concentrations of active substances however risk cannot be excluded, therefore: Phenylephrine’s Summary of Product Characteristics (SmPC) before prescribing. Presentation: Box of 20 0.6ml sterile sympathomimetic activity may affect patients in the event of hypertension, cardiac disorders, ampoules along with 20 5micron sterile filter needles, or box of 20 kits containing one 0.6ml sterile hyperthyroidism, atherosclerosis or prostate disorders; Lidocaine should be used with caution in patients ampoule and one 5micron sterile filter needle One dose of 0.2ml contains 0.04mg of tropicamide, 0.62mg with epilepsy, myasthenia gravis, cardiac conduction disturbances, congestive heart failure, bradycardia, of phenylephrine hydrochloride and 2mg of lidocaine hydrochloride. Indication: Use during cataract severe shock, impaired respiratory function, impaired renal function (with creatinine clearance of surgery to obtain mydriasis and intraocular anaesthesia. Posology and Method of Administration: One <10mL/min). Fertility: No data available. Pregnancy and Breastfeeding: Do not use. Interactions: ampoule for single-eye use only. Must be administered intracamerally by an ophthalmic surgeon under Systemic interactions are unlikely. Driving and Using Machines: Mydrane has a mydriatic effect and, sterile surgical conditions. For use in adults only. Only use in patients who have already demonstrated, therefore, moderate influence on the ability to drive and use machines. Do not drive and/or use machines at pre-operative assessment, satisfactory pupil dilation with topical mydriatic therapy. Adults (including while visual disturbances persist. Undesirable Effects: Uncommon: headache, keratitis, cystoid macular the elderly): 0.2ml slowly in one injection at the start of surgery. Do not inject more than the oedema, intraocular pressure increased, posterior capsule rupture, ocular hyperaemia, hypertension. recommended dose. Paediatric population: No data available. Patients with renal impairment and/or hepatic Overdose: Not expected, but cannot be ruled out. Systemic phenylephrine overdose symptoms include impairment: no dose adjustment is necessary. Mydrane is a sterile solution. 5 minutes prior to extreme tiredness, sweating, dizziness, slow heartbeat and coma. Onset is rapid and short lasting. Inject preoperative antiseptic procedure, instil 1 or 2 drops of anaesthetic eye drops. At the beginning of surgery rapidly acting alpha-adrenergic blocking agent such as phentolamine (dose 2 to 5mg intravenously). inject 0.2ml of Mydrane through the side port or principal port. Use immediately after opening. Only for Tropicamide ophthalmic overdose symptoms include headache, fast heartbeat, dry mouth and skin, the presentation in kit: stick the flag label of the blister on the patients file. Discard immediately after unusual drowsiness and flushing. Pilocarpine or 0.25% w/v phytostigmine should be applied to treat administration. Contra-indications: Hypersensitivity to the active substances or any of the excipients, sustained mydriasis. Systemic overdose of lidocaine may cause CNS effects (convulsions, to amide-type anaesthetics or to atropine derivatives. Warnings and Precautions: No additional dose unconsciousness, respiratory arrest) and cardiac reactions (hypotension, myocardial depression, should be injected, no add on effect is demonstrated and increase in endothelial cell loss was observed. bradycardia, cardiac arrest). Treatment consists of arresting the convulsions and ensuring adequate Corneal endothelial toxicity cannot be excluded. No clinical experience in patients with; insulin- ventilation with oxygen. dependent or uncontrolled diabetes, corneal disease, history of uveitis, pupillary abnormalities or ocular Storage: No special storage conditions required Legal Category: POM. Basic NHS Price: £119.95 for a trauma, very dark irides, cataract surgery combined with corneal transplantation, risk of floppy iris box of 20 sterile ampoules & 20 sterile filter needles, or for a box of 20 kits containing 1 sterile ampoule syndrome, or pupil constriction or miosis when treated with topical mydriatics. Not recommended in and 1 sterile filter needle PL Number: PL 20162/0022. PL Holder: LABORATOIRES THEA, 12 RUE LOUIS cataract surgery when combined with vitrectomy or in subjects with a shallow anterior chamber or BLERIOT, 63017 CLERMONT-FERRAND CEDEX 2, France. Date of Preparation: 20/06/2018

Adverse events should be reported. Reporting forms can be found at www.mhra.gov.uk/yellowcard. Adverse events should be reported to Thea Pharmaceuticals Ltd.

1) Labetoulle M, Findl O, Malecaze F, et al. Br J Ophthalmol 2016; 100:976-985. 2)Internal report on phase II clinical study on small pupils. Data summary in Clinical Overview (LT2380-PII-09/12). 3)MYDRANE SPC

Thea Pharmaceuticals Limited IC5 Innovation Way • Keele University Science & Innovation Park • Keele Newcastle Under Lyme • ST5 5NT Head Office: 0345 521 1290 • Medical Information: 0870 192 3283 E-Mail: [email protected] www.thea-pharmaceuticals.co.uk

MYDN0021 JUN2018 Mydrane A4 Advert 6-18.qxp_Layout 1 02/07/2018 14:14 Page 1

INDICATED FOR CATARACT SURGERY TO OBTAIN MYDRIASIS AND INTRAOCULAR ANAESTHESIA DURING THE SURGICAL PROCEDURE THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

Light out of Deep Darkness – A biography of Arthur ® Ferguson MacCallan, the trachoma pioneer

In 1903, Arthur MacCallan was appointed to the post Classification of the stages of trachoma; this he used internally of Travelling Ophthalmic Inspector to establish the first, from 1905. In 1952, the World Health Organisation (WHO) experimental, travelling ophthalmic hospital (TOH) in Egypt, adopted the MacCallan Classification as its then standard. Whilst

Tropicamide 0.2mg/ml, phenylephrine hydrochloride 3.1mg/ml, lidocaine hydrochloride 10mg/ml solution for injection funded by the British philanthropist Sir Ernest Cassel. At that the WHO grading system has subsequently been redefined, the time, ophthalmia was rife within the country; some estimates MacCallan Classification acted as a foundation on which others suggested that over 90% of the population (of some 10 million could build. people) were suffering from this debilitating disease. Arthur In recognition of the moral significance of Arthur’s dedicated himself estimated that between 7% to 10% of the population commitment in battling the plague of ophthalmia, the Egyptians were blind in one or both eyes. Unfortunately, there was little accorded him the rare privilege, particularly as a foreigner, effective ophthalmic treatment in the country at that time. Speed of dedicating a commemorative bust in his honour. This was Arthur attacked this devastating situation with determination and unveiled in 1931 and remains on display inside the MIOR. a clear vision as to what was needed to ameliorate the suffering of 95% of pupil dilation obtained This second edition, now being translated into Arabic, is written the local population. His armoury included surgery and medication [1,2] by me, Arthur’s grandson. It is based on Arthur’s private within 30 seconds (cure), hygiene education (prevention) and securing increased correspondence, documents and over 160 contemporary funding (sourced from Government, local councils and wealthy photographs; the era is set against the backdrop of political individuals) for developing both the permanent and travelling unrest, world war and the rapidly changing relationship between hospital infrastructure. Over the next twenty years, he established Stability Britain and Egypt. The book has been completely revised and 23 ophthalmic hospital units, including five TOHs, attending to 1.5 updated and includes significant new material from Arthur’s million patient visits and performing 76,000 operations, with a 89% have <1mm variation in clinical reports, recently discovered at the UCL Library. These give [3] further two hospitals planned. Furthermore, he trained some 100 pupil size throughout surgery an insightful perspective into the life and work of this exceptional surgeons to resource the expanding hospital network. Arthur also medical and ophthalmic practitioner. founded the Giza Memorial Ophthalmic Laboratory (now known as the Giza Memorial Institute for Ophthalmic Research - MIOR), Michael MacCallan which continues to play a pivotal role in ophthalmic care today. Comfort Second Edition, 2018. Published by The Choir Press; Significantly superior during Arthur is best known within the international ophthalmic ISBN 9781911589440. Available from www.amazon.co.uk profession for developing the world-famous MacCallan IOL insertion[1] Top Tweets Mydrane 0.2mg/ml + 3.1mg/ml + 10mg/ml solution for injection in single dose ampoule (tropicamide, history of acute narrow angle glaucoma. Mydrane produces undetectable or very low systemic phenylephrine hydrochloride, lidocaine hydrochloride). Prescribing Information: Please refer to concentrations of active substances however risk cannot be excluded, therefore: Phenylephrine’s Summary of Product Characteristics (SmPC) before prescribing. Presentation: Box of 20 0.6ml sterile sympathomimetic activity may affect patients in the event of hypertension, cardiac disorders, ampoules along with 20 5micron sterile filter needles, or box of 20 kits containing one 0.6ml sterile hyperthyroidism, atherosclerosis or prostate disorders; Lidocaine should be used with caution in patients Dr Susan Mollan @DrMollan BCPB @BCPB_Charity ampoule and one 5micron sterile filter needle One dose of 0.2ml contains 0.04mg of tropicamide, 0.62mg with epilepsy, myasthenia gravis, cardiac conduction disturbances, congestive heart failure, bradycardia, of phenylephrine hydrochloride and 2mg of lidocaine hydrochloride. Indication: Use during cataract severe shock, impaired respiratory function, impaired renal function (with creatinine clearance of Mike Burdon visiting the MOS discussing strategy for the After visiting the #RCOphthMuseum on a trip to surgery to obtain mydriasis and intraocular anaesthesia. Posology and Method of Administration: One <10mL/min). Fertility: No data available. Pregnancy and Breastfeeding: Do not use. Interactions: demand and capacity in UK Ophthalmology. Important @RCOphth it dawned on me how far research has brought ampoule for single-eye use only. Must be administered intracamerally by an ophthalmic surgeon under Systemic interactions are unlikely. Driving and Using Machines: Mydrane has a mydriatic effect and, sterile surgical conditions. For use in adults only. Only use in patients who have already demonstrated, therefore, moderate influence on the ability to drive and use machines. Do not drive and/or use machines engagement with the regions @RCOphth @RCOphthPres technology for eye care on. Let’s continue to promote best at pre-operative assessment, satisfactory pupil dilation with topical mydriatic therapy. Adults (including while visual disturbances persist. Undesirable Effects: Uncommon: headache, keratitis, cystoid macular practice, training and research so in another 150 years we the elderly): 0.2ml slowly in one injection at the start of surgery. Do not inject more than the oedema, intraocular pressure increased, posterior capsule rupture, ocular hyperaemia, hypertension. RNIB @RNIB recommended dose. Paediatric population: No data available. Patients with renal impairment and/or hepatic Overdose: Not expected, but cannot be ruled out. Systemic phenylephrine overdose symptoms include are further on and saving the sight of 1000’s more people. impairment: no dose adjustment is necessary. Mydrane is a sterile solution. 5 minutes prior to extreme tiredness, sweating, dizziness, slow heartbeat and coma. Onset is rapid and short lasting. Inject Happy birthday NHS! Thank you to all the brilliant preoperative antiseptic procedure, instil 1 or 2 drops of anaesthetic eye drops. At the beginning of surgery rapidly acting alpha-adrenergic blocking agent such as phentolamine (dose 2 to 5mg intravenously). ophthalmologists who are working every day to save Alan Boyd @profalanboyd inject 0.2ml of Mydrane through the side port or principal port. Use immediately after opening. Only for Tropicamide ophthalmic overdose symptoms include headache, fast heartbeat, dry mouth and skin, the presentation in kit: stick the flag label of the blister on the patients file. Discard immediately after unusual drowsiness and flushing. Pilocarpine or 0.25% w/v phytostigmine should be applied to treat people’s sight. #NHS70 @RCOphth Very much looking forward to speaking at today’s Royal administration. Contra-indications: Hypersensitivity to the active substances or any of the excipients, sustained mydriasis. Systemic overdose of lidocaine may cause CNS effects (convulsions, College of Ophthalmology Admission Ceremonies to amide-type anaesthetics or to atropine derivatives. Warnings and Precautions: No additional dose unconsciousness, respiratory arrest) and cardiac reactions (hypotension, myocardial depression, Pearse Keane @pearsekeane should be injected, no add on effect is demonstrated and increase in endothelial cell loss was observed. bradycardia, cardiac arrest). Treatment consists of arresting the convulsions and ensuring adequate @RCOphth and talking about gene therapy and the impact Corneal endothelial toxicity cannot be excluded. No clinical experience in patients with; insulin- ventilation with oxygen. Brilliant talk by Greg Heath @YorkTeachingNHS it will have on treating patients with inherited eye diseases dependent or uncontrolled diabetes, corneal disease, history of uveitis, pupillary abnormalities or ocular Storage: No special storage conditions required Legal Category: POM. Basic NHS Price: £119.95 for a @RCOphth Skills in Retinal Imaging Course trauma, very dark irides, cataract surgery combined with corneal transplantation, risk of floppy iris box of 20 sterile ampoules & 20 sterile filter needles, or for a box of 20 kits containing 1 sterile ampoule #Ophthalmology @FacultyPharmMed #genetherapy syndrome, or pupil constriction or miosis when treated with topical mydriatics. Not recommended in and 1 sterile filter needle PL Number: PL 20162/0022. PL Holder: LABORATOIRES THEA, 12 RUE LOUIS @wellcometrust Autoimmune retinopathy - one of the most cataract surgery when combined with vitrectomy or in subjects with a shallow anterior chamber or BLERIOT, 63017 CLERMONT-FERRAND CEDEX 2, France. Date of Preparation: 20/06/2018 challenging diagnoses in all of #Ophthalmology The Eye Surgeon @The_Eye_Doctor My first council meeting @RCOphth as #Yorkshire Peek Vision @peekteam Jul 14 Adverse events should be reported. Reporting forms can be found at www.mhra.gov.uk/yellowcard. Regional representative. I’d forgotten how much work the Adverse events should be reported to Thea Pharmaceuticals Ltd. If anybody is wondering where the interviews were filmed, it #royalcollege does to support ophthalmologists in the UK. was the wonderful optical museum at @RCOphth who very #visionmatters #eyes 1) Labetoulle M, Findl O, Malecaze F, et al. Br J Ophthalmol 2016; 100:976-985. 2)Internal report on phase II clinical study on small pupils. Data summary kindly let us showcase our modern technology alongside in Clinical Overview (LT2380-PII-09/12). 3)MYDRANE SPC their fascinating displays on the history of ophthalmology. iDoc @idoc_eyes 6 trainees of @ManchesterREH become proud Fellows of Sophia Pathai @drsophiapathai Thea Pharmaceuticals Limited @RCOphth Thanks to all that taught us well. #FRCOphth My @RCOphth fellowship provided unparalleled IC5 Innovation Way • Keele University Science & Innovation Park • Keele #rcophth opportunities to grow in ophthalmology - and beyond! Apply Newcastle Under Lyme • ST5 5NT now! #Ophthalmology Head Office: 0345 521 1290 • Medical Information: 0870 192 3283 E-Mail: [email protected] www.thea-pharmaceuticals.co.uk

MYDN0021 JUN2018 17 college news

Ophthalmologists in Training KNOWLEDGE

The Herpetic Keratitis puzzle: Treatment an overview for Trainees There are two guiding principles in treating HSV keratitis: 1) Treating live virus and, 2) Treating immune-mediated disease Dr Edward Ridyard ST4 Ophthalmology, Hull Royal Infirmary Subtypes of HSK keratitis can present together so each case must be Mr Owen Stewart Consultant Ophthalmologist, approached individually. Hull Royal Infirmary Epithelial disease should be treated with either topical or oral antiviral medication. Infected cells are loosely adherent to the Herpetic keratitis, and in particular, Herpes Simplex Virus (HSV) epithelium so performing debridement with a viral PCR swab is both keratitis, is a leading cause of corneal blindness in the UK with an therapeutic and diagnostic. incidence of 5-15 cases in 100,0001. HSV infection has numerous Stromal and/or endothelial disease, as immune-mediated processes, corneal manifestations, the management of which can be challenging should be treated with topical corticosteroids and oral antiviral cover, as for Trainees in an Eye casualty setting. The diagnosis is based primarily steroid immunosuppressive action can lead to further viral replication. on symptoms and slit lamp findings. Symptoms are non-specific and If necrotising interstitial keratitis is suspected, aggressive treatment include erythema, discharge, epiphora, itching, pain and photophobia. with oral and topical antiviral therapy should be commenced. Interestingly, the most common ocular presentation of primary HSV Premature termination of topical steroids greatly increases the chance infection is blepharoconjunctivitis, not corneal disease. It is regularly, of recurrence, so a very slow taper of topical steroid is advised. and mistakenly, diagnosed as adenoviral conjunctivitis at presentation2. As a general rule if immune mediated disease occurs, priority Recurrent HSV infection is most commonly corneal, and can present in should be placed on treating this and preventing its more serious the three forms, epithelial, stromal and endothelial (disciform) keratitis. consequences, when compared to epithelial disease.6 Epithelial keratitis The Herpetic Eye Disease Study (HEDS) I and II, have provided the 7 HSV epithelial keratitis can exist in four forms: evidence base for the treatment of the inflammation in HSV keratitis. One of its main findings was that using Aciclovir 400mg BD PO • Dendritic ulcer (derived from the Greek “dendron” meaning reduced the incidence of recurrent epithelial and stromal disease. “tree”): A stellate epithelial lesion with linear branch-like extensions Long term prophylaxis with Aciclovir should be used for one year if and terminal bulbs, pathognomonic for HSV keratitis and can be there are one or more recurrent episodes in epithelial disease. Due to stained with sodium fluorescein, Lissamine Green or Rose Bengal dye3 the recurrent nature of stromal and endothelial disease, long term prophylaxis should be commenced after the first episode for at least • Geographic ulcer: A larger epithelial defect, so named because 2 years, and can be used indefinitely if further recurrences occur7. it has the appearance of continent on a map. It may start out as a dendritic ulcer and is more common in immunocompromised patients Type Treatment • Marginal keratitis: A limbal lesion which is similar in appearance Epithelial 1) Topical antivirals (Aciclovir 3%/Ganciclovir 0.15%) to a staphylococcal catarrhal ulcer x5/day for 21days • Metaherpetic or trophic ulcer: Recurrent HSV infection causes Or corneal denervation (corneal sensation must always be checked PO Aciclovir 400mg BD for 21 days in a patient with suspected HSV infection) and reduced tear film 2) Debridement/viral PCR swab quality. This means that the epithelium loses its ability to heal 3) Long term prophylaxis with Aciclovir 400mg BD and can lead to a persistent epithelial defect. This may appear PO if recurrent episode similar to a geographic ulcer, however a metaherpetic ulcer can be differentiated by its smooth, elevated border and lack of staining Stromal 1) Topical corticosteroids up to 1 hourly depending with Rose Bengal dye (reverse staining pattern).4 on disease severity Stromal keratitis 2) PO Aciclovir 400mg x5/day whilst on intensive topical steroids This is a CD4 T cell driven immune mediated response to retained HSV 3) Long term prophylaxis with Aciclovir 400mg BD antigens in the stroma5. There may be focal or diffuse stromal infiltrate PO after 1st episode or haze, and long term neovascularisation may develop leading to lipid keratopathy and subsequent scarring. Necrotising interstitial keratitis Disciform/ 1) Topical corticosteroids up to 1 hourly depending is a more severe subtype, believed to be caused by live viral replication Endothelial on disease severity 4 within the stroma, causing necrosis and perforation if left untreated . 2) PO Aciclovir 400mg x5/day whilst on intensive topical steroids Endothelial/Disciform keratitis 3) Long term prophylaxis with Aciclovir 400mg BD Another immune mediated response causing endothelial PO after 1st episode6 dysfunction, leading to ring shaped, disciform lesions (Wessly ring). Keratitic precipitates over these areas are common. Acute, unilateral Table 1: Summary of treatment options for HSV keratitis corneal oedema, as a result of endothelial dysfunction, should be assumed to be HSV in origin until proven otherwise4.

18 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

In summary, the diagnosis and subsequent management of HSV 4. American Academy of Ophthalmologists. Herpetic Corneal keratitis can be challenging as a Trainee. Hopefully this article Infections. Available: www.college-optometrists.org/guidance/ clarifies how to identify and effectively treat each subtype. clinical-management-guidelines/herpes-simplex-keratitis-hsk-.html Last accessed 2nd September 2018. References 1. College of Optometrists. (2018). Herpes Simplex Keratitis. 5. Al-Dujaili LJ, Clerkin PP, Clement C, et al. Ocular herpes simplex Available: www.college-optometrists.org/guidance/clinical- virus: how are latency, reactivation, recurrent disease and therapy management-guidelines/herpes-simplex-keratitis-hsk-.html. Last interrelated? Future Microbiol. 2011;6(8):877–907. accessed 2nd September 2018. 6. Welder JD, Kitzmann AS, Wagoner, MD. Herpes Simplex Keratitis. 2. American Academy of Ophthalmologists. Herpetic Corneal EyeRounds.org. December 31, 2012; Available from: Infections. Available: www.college-optometrists.org/guidance/ http://EyeRounds.org/cases/160--HSV.htm clinical-management-guidelines/herpes-simplex-keratitis-hsk-. 7. Herpetic Eye Disease Study Group. Acyclovir for the prevention html. Last accessed 2nd September 2018. of recurrent herpes simplex virus eye disease. N Engl J Med 1998; 3. Reidy JJ. 2011–2012 Basic and Clinical Science Course – Section 8: 339:300--6. External Disease and Cornea. San Francisco: American Academy of Ophthalmology; 2011. TRAINING

Ophthalmology Trainees in the North East deanery in 2017 to answer How to mix research with clinical this very question, and we have collaboratively published the results, training under our Trainee Network named NETRiON, in the Eye journal this year.1,2 We found that there was a strong positive attitude towards Michelle Attzs Trainee Editor, College News research, but the lack of time, intensity of clinical training and lack of mentorship are the most commonly perceived barriers to participating in research amongst Trainees, which could be potentially address by Darren Ting, a former Northern Deanery Trainee, is one of the first the establishment of Trainee Research Networks.3 recipients of the prestigious Fight for Sight/John Lee RCOphth Primer Fellowship Award. He will be working on a project looking into the What advice would you give to those who are struggling use of antimicrobial peptides for ocular surface infection under the with fitting research into their training schedules? supervision of Professor Harminder Dua and Dr. Imran Mohammed at In addition to the above suggestions, I would recommend Trainees who University of Nottingham. Darren gives us his insight into how to get are interested in research to find a mentor or supervisor who is active involved in research as an Ophthalmic Trainee. in research, so that he/she could get you on the right track. However, When would you say you first realised your interest in you must be ready to commit and devote additional time outside your research? normal working hours. Once you have a flavour of research, you can then decide whether a clinical academic career is the right thing for you. I was a final year medical student working on my first research project on visual neglect following stroke. I learnt that there are still a lot of Any final words of advice? unknowns in medicine, and it was only research that could fill those I think all clinical Trainees should embrace and participate in gaps. This research project did require a lot of hard work; I had to research, regardless of their level of training. Ophthalmology is read over 200 papers and sacrifice a lot of my own leisure time, but I a rapidly-evolving specialty that is heavily evidence-based. Who was very lucky to be guided by two eminent professors, Prof. Dutton knows, perhaps one day you will be that person who develops a new and Prof. Dhillon. The “Hoorayyy!!” moment came a year later when I treatment for a blinding ocular disease that is currently untreatable. received an email saying that “Your article has been accepted in the Survey of Ophthalmology journal”. It was that early positive experience References which had set me off on the pursuit of a clinical academic career. 1. Ting DSJ, Vrahimi M, Varma D, Steel DHW; North East Trainee Research in Ophthalmology Network (NETRiON). Trainee-led How did you juggle research and training, without being research networks in ophthalmology: is this the way forward? Eye an Academic Trainee? (Lond) 2018;32(2):476-7. As protected time for research is limited during clinical training, it 2. Ting DSJ, Vrahimi M, Varma D, Steel DHW; North East Trainee certainly calls for a lot of time management, proactivity, and discipline Research in Ophthalmology Network (NETRION). Research to be able to juggle both spheres. During the first few years of clinical attitudes and perceived barriers to conducting research among training, I maximised all the training opportunities that were available ophthalmology trainees. Eye (Lond) 2018;32(3):653-5. to me so I could quickly build a strong clinical and surgical foundation. I knew I could only focus on research once I was comfortable with 3. Jelley B, Long S, Butler J, Hewitt J; WeGeN. Cohort profile: the Welsh my clinical competences. I dedicated a large proportion of my RSTA Geriatric Registrar-Led Research Network (WeGeN): rationale, sessions to research; but my evenings and weekends were also often design and description. BMJ Open 2017;7(2):e013031. taken up with my research endeavours. I became more innovative, so that whatever was considered mandatory for clinical training, I tried Interested in submitting an article for to transform them into research. For example, audit is a mandatory the trainee page of the College News? ARCP requirement for all Trainees; therefore, I identified and Then please contact: performed audits that had the potential for publication. Collaborating with other trainees is another good way to maximise the output. Michelle Attz, Trainee Editor [email protected] What do you think puts Trainees off participating in research? Interestingly, we conducted a questionnaire-based survey on all our

19 The Fab Four

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For further details please contact Christine Harajda on 01753 827174 or email [email protected] | Buy online at www.keeler.co.uk THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY MAGAZINE | OCTOBER EDITION 2018

The Fab Four A public lecture by eminent ophthalmologist Professor Sir Peng T Khaw The eyes are windows to our future

Cryomatic MK II Ultrasound Easy freezy See it from every angle

Tuesday 4 December 2018 Wellcome Collection, 183 Euston Road, 6.30pm – 7.30pm London, NW1 2BE

in our ability to observe and navigate our surroundings, discern attitudes by facial expressions and body language, colours, light and shade. Professor Khaw will take audiences through an extraordinary journey of the science behind our eyes, from how the visual system takes up more space in our brain than all other senses combined, to how it uses more than 10% of our body’s energy with some retina cells consuming more than heart cells. Slit Lamps Indirect Ophthalmoscopes As the population ages, it is important that research continues to play a vital role in eye disease management. Exceptional optics Flexible and ergonomic Professor Khaw will talk further about how research, advances in gene therapy and the use of microdevices, less than a millimetre in width, are helping to treat eye disease. BY This inaugural public lecture will be delivered by eminent ophthalmologist Professor Sir Peng T Khaw. Tickets are priced at £5. A copy of your booking receipt is required for entry. Please arrive at 5.45pm to get When asked, people will say that eyesight is their most seated in time for the start of the lecture. precious sense. But most people will not understand how complex and vital their eyesight is until things start Places are restricted, so please book early by visiting changing. www.rcophth.ac.uk/christmas-lecture/ As a highly social species, we use all our senses to interact For further details please contact Christine Harajda on 01753 827174 with others. But sight is one of the most effective and useful or email [email protected] | Buy online at www.keeler.co.uk

21 college news Consultant posts

Appointee NHS Trust Hospital or Area Mr Mohamad Abdalla University Hospital Southampton NHS Foundation Trust Southampton Mr Luke Anderson Abertawe Bro Morgannwg University Local Health Board Swansea Mr Walter Andreatta University Hospitals Coventry and Warwickshire NHS Trust Coventry Dr Carmen Baumann Brighton and Sussex University Hospitals NHS Trust Brighton Mr Ryan Davies Aneurin Bevan University Health Board South Wales Mr Mohamed Elalfy Queen Victoria Hospital NHS Foundation Trust + Maidstone and Tunbridge Wells NHS Trust West Sussex + Kent Mr Faisal Idrees Ashford and St. Peters Hospitals NHS Foundation Trust Surrey Mr Ronald Kam Moorfields Eye Hospital NHS Foundation Trust London Mr Charlie Kanawati Western Sussex Hospitals NHS Foundation Trust West Sussex Mr David Lunt South Tees Hospitals NHS Foundation Trust Middlesbrough Mrs Manon Morris Betsi Cadwaladr University Health Board North Wales Miss Sally Painter Birmingham Women's and Children's NHS Foundation Trust Birmingham Dr Saruban Pasu East Sussex Healthcare NHS Trust East Sussex We rely on medical personnel departments to confirm consultant appointments. This does not always happen, so please notify the College via [email protected] if there are any errors or omissions. Membership Subscriptions, Elections and Benefits

Members are reminded about notifying the RCOphth of Membership by Election is now open and members are any changes to their circumstances that will affect their encouraged to apply if they meet the following criteria: membership subscription before 12 November 2018. • a newly appointed Substantive NHS consultant or a SAS doctor in a Substantive NHS post for 5 years Special concessions apply for the following: • a substantive Consultant in a Non-NHS UK Healthcare provider for • retired members who no longer have earnings from any medical 3 years source • an overseas substantive Consultants in a Healthcare provider for • members earning less than £34,061.00 3 years • members going on parental leave Fellowship by Election, has been extended to: The subscription rates for 2019 are now one flat rate for each • substantive Consultants in a Non-NHS UK Healthcare provider for category. 6 years or more Members can now pay subscriptions and access receipts online • overseas substantive Consultants in a Healthcare provider for 6 through the members’ area of the website if you are not on direct years or more debit. More details about membership categories can be found at Trainees should note that once you have pasted the Part 2 www.rcophth.ac.uk/about/membership-overview/ written and Oral examinations, you will automatically be Membership Benefits moved to the UK Fellows rate. There are a number of benefits for members but one of the more Category popular offers is the O.N.E Network, saving $495 and provides access to 12 leading ophthalmology journals and new ones joining soon UK Consultants £515 Exclusive RCOphth Lifestyle Rewards UK Fellows, Members, Diplomates, Affiliates £395 As part of your membership, RCOphth has partnered with Lifestyle (inc SAS doctors) Rewards to provide a wide range of luxury products, services and UK members with gross annual earnings up to £321 experiences at preferential rates from quality brands. Christmas is £34,061 from medical sources coming up, so you will be spoilt for choice for gifts for family and friends. Members have to log into the RCOphth members’ area in Trainee Affiliates (Doctors working in a GMC £263 order to access the Lifestyle Rewards offers. approved training programme who are studying towards a formal College qualification). NUS Student Card UK Seniors (those retired from all medical practice) £183 A reminder to Trainee Affiliates, that as a benefit of membership, you can list the College as a registered training body when purchasing Overseas Fellows, Members, Diplomates, Affiliates - £289 an NUS extra card. Many trainees have taken advantage of this to Band A countries purchase 16 – 25 or mature student rail cards. Overseas Fellows, Members, Diplomates, Affiliates - £227 Appraisals Band B, C and D countries The College has a list of trained appraisers (on the website Overseas Seniors (those retired from all medical £153 under Professional Resources) who are able to offer appraisals to practice) colleagues in an independent capacity.

22 diary dates

RCOphth Seminars Book your place by visiting www.rcophth.ac.uk/events and-courses/

All seminars and surgical skills courses are held at the RCOphth premises unless otherwise specified. Mentoring Skills National Ophthalmology Database (NOD) Audit 8 NOVEMBER & 10 DECEMBER 2018 Workshop Mentoring skills - a one day course. What is a mentor? ‘A wise 26 NOVEMBER 2018 guide’. The quality of everything we do depends on the quality Horizon Leeds Conference Centre of the thinking we do first – enhance it with mentoring. Doctors The NOD team will be hosting a free to attend Quality Improvement make great mentors and naturally have many skills. This course will (QI) workshop for anyone participating or wishing to participate in enhance your skills, give you new techniques, explain the theory the cataract audit. Prof John Sparrow will highlight report outcomes and help you work out how you can mentor individually or set up and recommendations, Mr Chris Heaven, Wrightington, Wigan and mentoring in your department. The course is open to all doctors. Leigh Trust will explain the benefits of auditing cataract data, plus DSEK there will be drop-in sessions with Medisoft and Open Eyes. Please 8 NOVEMBER 2018 register your attendance with [email protected] DSEK surgery has become the standard approach for treating Oculoplastics Curriculum Based Course corneal endothelial failure. Penetrating keratoplasty remains more 29 NOVEMBER 2018 suitable for some patients, while DMEK is coming into increasing A two day course combining lectures and practical work. Suitable for use, especially in patients with Fuch’s dystrophy, and otherwise ST3 and above. excellent prognosis. This course aims to teach the theory and practise of DSEK, with an emphasis on small-group wet-lab surgery. Clinical Leads Forum The course instructors (Leyland and Anandan) each have 10 years’ 29 NOVEMBER 2018 experience in DSEK surgery, and first organised the RCOphth DSEK A practical day to help and support Clinical Leads. Sessions on wet-lab in 2013. Human corneas are provided for donor preparation making sense of NHS finances; the failing consultant - how and and can be used also for DMEK donor preparation practise. when to seek help’; personal experience from someone who Intermediate Phacoemulsification course has been there’ Clinical Leads survival guides from the College; 9 NOVEMBER 2018 the ‘SAFE’ framework and the Clinical Council for Eye Health Commissioning. Most of all, the opportunity to have some time out This course is aimed at those who have performed between 50 and to reflect, discuss problems and even find solutions with colleagues 100 phaco operations independently. Comprising both lecture and from around the country. practical components, the courses concentrate on teaching the skills required for more difficult cases. Inherited Retinal Diseases: Bench, Bedside and Primary Care Ophthalmology Seminar Beyond 12 NOVEMBER 2018 5 DECEMBER 2018 Chaired by Miss Stella Hornby who will cover topics relevant for Inherited Retinal Diseases are the second commonest cause continuing professional development for general ophthalmologists, of childhood blindness, and the commonest cause in working GPs with a special interest in ophthalmology and Optometrists with age adults (UK). They are clinically and genetically highly an extended role as well as for those involved in commissioning. heterogeneous. There have been major developments in terms of Topics this year will include updates on development of a careers for underlying molecular genetics, genetic testing, disease mechanisms, GPs with a special interest in ophthalmology, patient related outcome retinal imaging, models of disease, avenues of intervention and measures (PROMS) for primary care ophthalmology and NICE assistive technology, and Phase I/II and III clinical trials. This guidance for AMD, how to diagnose chronic conjunctivitis, the role of seminar will cover the breadth of these developments with experts OCT in glaucoma management and visual disturbance in children in the respective areas providing a distilled update. Emergency ophthalmology SAS 9th National Eye Meeting 28 JANUARY 2019 16 NOVEMBER 2018 The course is for anyone who sees patients with acute ocular An interactive day with a host of talks on common conditions problems. It covers the basic approach that should be taken when in Paediatric Ophthalmology, Diabetic retinopathy, Thyroid Eye a patient presents with an acute eye problem. It takes delegates Disease, management skills for SAS doctors, and mentoring & through the initial management of these urgent problems. It is a buddying. great update for all ophthalmologists on how to avoid missing the really important sight-threatening problems. Ophthalmologists in Training (OTG) 2018 Annual Symposium Surgical Skills Courses 23 NOVEMBER 2018 The Ophthalmologists in Training (OTG) 2018 Annual Please check the website or contact the Education and Training Symposium consists of a series of lectures with highly-regarded Co-ordinator on 020 3770 5341 or [email protected] speakers giving talks on real-world aspects of ophthalmology to for availability as courses get fully booked quickly. help day-to-day practice. The programme has been designed in consultation with trainees and is tailored to their needs. It is open to all trainees - OST1-4’s are especially encouraged to apply.

Look out for the 2018 seminar programme on the RCOphth website - book early to avoid disappointment. AHOOK

DUAL

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