college news

QUARTERLY BULLETIN JANUARY EDITION 2017

Bayer Awards PAGE 14 Bayer ophthalmology awards 2016 again showcases the outstanding work of teams and individuals working in hospital eye services across the UK. The event was hosted by Paralympian Danny Crates, pictured here with Anne- Marie Lacey, Nurse Practitioner from the Royal Bournemouth Hospital.

Volume 30 Number 11 November 2016 Museum Piece Focus Eye Journal www.nature.com/eye PAGE 5 British PAGE 7 PAGE 11 Editor’s Ophthalmic Acanthamoeba choice from fourth Journals in 1917 update quarter 2016 Music for cataract surgery Endonasal DCR success rates Adjustable vs non-adjustable sutures for strabismus Jalili Syndrome Complement and uveitis college news

Dear fellow members, At the start of my presidency in 2014, a membership survey provided very useful feedback suggesting that members considered that the College was performing well in our Contents core business of education, training, exams 3 Ophthalmology and setting guidelines. It also identified that Workforce Census members considered the College performance 2016 in engagement with policymakers was deficient. 5 Museum Piece Developing communications and influencing treatment’ for ophthalmology patients. This British Ophthalmic health policy has been high on the College has been followed by a great deal of interest in Journals in 1917 agenda ever since – while still continuing to ophthalmic patient services at local and national 7 Focus Acanthamoeba deliver and develop our other key areas. levels and has produced a number of one to one update – an illustrative meetings with MPs. Many members may have case While there is still some way to go, the College noticed that there have been several questions 11 Eye Journal Editor’s is now better connected than previously, having asked in both Houses about ophthalmology- Choice from fourth worked over the past two years to develop quarter 2016 related issues – rationing, patient delays, constructive relationships with macular degeneration and so 18 Ophthalmologists civil servants, politicians and in Training on – following these meetings. An A to Z of Ocular peers; particularly those with “It has been very important Infections direct influence on health It has been very important that the College has a clear 23 Diary Dates policy. The aim has been to that the College has a clear ensure that the relevance and message to deliver which is and consistent message to importance of eye health and backed by strong evidence” deliver which is supported by Don’t forget to ophthalmology is highlighted strong evidence. Members have follow us on Twitter: at every opportunity. We contributed to the assimilation of good data by participating in a number of @rcophth are not a large organisation, but we are now gathering traction within this public affairs and projects – the NOD, the workforce survey, the media arena. BOSU study about patient harm caused by Articles and information to delays and The Way Forward survey (TWF) which be considered for publication Much of this work has taken place last year. In addresses service-related issues. More than 200 should be sent to: October I met with the Secretary of State for clinical leads participated in TWF to provide Liz Price Health, Jeremy Hunt, to discuss the importance information about new ways of delivering care Communications Manager of monitoring review out-patient appointment that have worked well in their departments in [email protected] times as a matter of patient safety, and to raise the UK. Please do take time to read the summary Copy deadlines the underlying problem of insufficient capacity reports included in your College News (overseas April 2017 edition: within the hospital eye service to meet demand. members can access all the information from the 24 March 2017 Actively engaging with MPs and ministers to RCOphth website). They are meant to be shared July 2017 edition: improve their knowledge of eye health and the with others who are looking to redesign services 16 June 2017 overall benefits of good vision on a population and can be used as a means to open discussions October 2017 edition: – keeping people at work, reducing isolation, 22 September 2017 with managers and those commissioning services. improving independence and benefiting mental January 2018 edition: 22 December 2017 and physical health – has proved useful as few Another new year is upon us and no doubt had previously recognised the scale of surgical will continue to be extremely busy for both Editor of Focus: and out-patient work that we deliver as a consultants and College staff; but I hope 2017 Mr Andrew Tatham specialty. Attendance at All Party Parliamentary will be successful professionally and personally Advertising queries should Groups (APPGs) and inclusion in parliamentary for everyone. be directed to: Robert Sloan round table discussions has provided further 07963 187 583 opportunities to share our concerns and solutions. [email protected] The College held its first parliamentary reception Contact Details: The Royal College of in the House of Lords at the start of November, Ophthalmologists which was attended by more than 40 MPs Carrie MacEwen, President 18 Stephenson Way and peers who pledged to support ‘timely London, NW1 2HD [email protected] T. 020 7935 0702

2 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

Workforce Census 2016

The census was undertaken to establish a clear picture RCOphth is grateful to all Clinical Directors, Heads of Service, of the size and shape of the UK ophthalmic medical College Tutors, departmental administrators and other workforce and was coordinated by the Medical personnel who took time and care to participate in the census. Workforce Unit of the Royal College of Physicians on Thank you also goes to Jane Harcourt who analysed the data and provided the Workforce Census report which will be behalf of The Royal College of Ophthalmologists. published in early 2017. Census forms were sent electronically to all Ophthalmology Beth Barnes Clinical Leads in the UK on 25 February 2016, reaching the 139 Head, Professional Support known NHS Trusts and Health Boards in the UK that provide ophthalmology services. Of these, 106 responses were received in total with an overall response rate of 76%. 89 responses (84%) were from Trusts and Health Boards in England, two (2%) from Northern Ireland, 11 (10%) from Scotland and four (4%) from Wales.

Summary of the census findings • 76% response rate from 106 Ophthalmology Departments across the UK Number of responses • 74% of consultants are male and 26% female 12 89 • 55% of SAS doctors are male and 45% female 2 • 23% of consultants and 19% of SAS doctors are aged 55 years 11 and older i.e. nearing probable retirement 4 2 • 52% of consultants and 53% of SAS doctors work less than full 0% 20%40% 60%80% 100% time (9 or less Programmed Activities) % of total responses • 51% of units in the UK have unfilled consultant posts (73% in Scotland) • 47% of units in the UK have unfilled SAS doctor posts • 42% of units are using locums to cover unfilled consultant posts 7 118 • 91% of units stated a need to increase consultant numbers by 1-5 over next 2 years to meet demand • 8% of units stated a need to increase consultant numbers by 5-10 over the next 2 years • 91% of units are undertaking waiting list initiatives Number of known NHS Trusts and Health Boards in the UK • 71% of waiting list initiatives are undertaken by responding units rather than by other independent providers

Focus: Change of Guard

It has been an honour to be the editor of the Focus for is taking over the editor’s role. I wish him great success. the last few years and a privilege to work with many Andrew brings his enthusiasm and keen eye for details and brilliant contributors over this time. Focus has found its am sure he will take Focus to new heights. web presence and through that a new identity and global appeal. The Scientific committee has been very helpful in Faruque Ganchi selecting subject matter and suggestions for authors. Consultant Ophthalmologist, Bradford Infirmary Hospital I am pleased to have had the opportunity to see Focus flourish but it is time for new editor to develop this further. I am pleased that Dr Andrew Tatham from Edinburgh

3 college news Common Clinical Competency Framework launched at Stephenson Way

The new Common Clinical Competency Framework The Framework benefits the non-medical HCP workforce within was launched at a RCOphth-hosted evening event on a hospital setting so they can continue to take on expanded Thursday 1 December 2016. roles to help manage demand and to continue to provide safe and efficient care for patients with competencies that are The event was attended by individuals and organisations across transparent, transferable and based on recognised training. The the ophthalmic sector and invited guests had the opportunity Framework will also improve opportunities to recruit more non- to put questions to a panel about “Multidisciplinary Working medical healthcare professionals to take on expanded roles. – What are the barriers?” On the panel were Dr Mary-Ann Sherratt, President of the College of Optometrists; Tracy Luckett, Director of Nursing and allied health professions A recurring theme of the evening was the need at Moorfields Eye Hospital; Rowena McNamara, President, for good communication between the different the British and Irish Orthoptic Society and Professor Carrie professional groups. MacEwen, RCOphth President.

The chair for the evening event, Don Grocott, Master of President Carrie MacEwen said, “As an ophthalmologist, I the Worshipful Company of Spectacle Makers, skilfully know how crucial an upskilled team is in delivering care for encouraged the guests to make thoughtful and sometimes ophthalmology patients. The purpose of the Common Clinical controversial contributions to the debate. Competency Framework is to clearly define the knowledge and skills required by healthcare professionals to perform expanded A recurring theme of the evening was the need for good roles and ultimately for the benefit of patients.” communication between the different professional groups. It was noted that high-quality care was most likely to be delivered The Framework covers four clinical areas; acute and where there was a culture of respect for different disciplines, but emergency eye care, cataract assessment, glaucoma and sometimes extended roles were viewed with suspicion. There medical retina and is for use in all the four home nations of was general assent that all professionals need to be trained the UK and more information can be found on the RCOphth for the job they are doing as a minimum but that there was website. www.rcophth.ac.uk/professional-resources/new- also an appetite to maximise the skills of the work force. This common-clinical-competency-framework-to-standardise- would require initial resource and a commitment to continuing competences-for-ophthalmic-non-medical-healthcare- professional development. You can view a report on the professionals/ evening event and the themes of discussion at www.rcophth. ac.uk/2016/12/multi-disciplinary-working-what-are-the- barriers/

The new Common Clinical Competency Framework provides standards of knowledge and skill required for non-medical eye healthcare professionals to deliver patient care. The traditional eye health care team has changed and continues to develop to meet the demands on the hospital eye service due to an increase in successful, but recurrent, treatments and the increase in chronic disease management due to the aging population in the UK.

4 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

Museum Piece British Ophthalmic Journals in 1917

At the end of 1916 there were three Ophthalmic The Ophthalmic Review 1881-1916 Journals in Britain. By the middle of the following year There were two periodicals under this title. The first, a quarterly there was just one. The stress of the First World War journal of Ophthalmic Surgery and Science, was published in had created shortages and difficulties in many spheres 1864 but only survived until 1867. The editors were J Zachariah of life including publishing. Laurence (1829-1870), founder of the Royal Eye Hospital and Thomas Windsor (1832-1910) whose gift of his extensive library The British Journal of Ophthalmology (BJO) came into being formed the basis of today’s US National Library of Medicine. as a result of the merging of three periodicals, Royal London It was in this journal that the paper on the Laurence-Moon Ophthalmic Hospital Reports, Ophthalmic Review and The syndrome was published. The second Ophthalmic Review, a Ophthalmoscope. The original suggestion for creating a new monthly record, was published in 1881 with Karl Grossman of journal came from Professor Straub of Amsterdam but it was Liverpool and Priestley Smith of Birmingham as editors. Its Walter WH Jessop (1853-1917), President of the OSUK, (Fig.1) purpose was to present critical notices and abstracts of current who was the motivating spirit in its implementation. He was ophthalmic literature including those from abroad and to provide probably the best-known British ophthalmic surgeon due to his a channel for the prompt publication of short original papers. The assiduous attendance at all the international ophthalmological editor at the time it ceased publication was J.B Lawford. congresses. He lived just long enough to see the launch of the venture. The new journal (Fig.2) was a limited liability Company The Ophthalmoscope 1903-1917 with a capital of 1,000 shares at £5 each. Every British-born This monthly review of current ophthalmic surgeon was invited to be a shareholder as well as ophthalmology commenced in July becoming a subscriber to the journal at an annual subscription 1903 under the editorship of Sydney of £1.11s.6d. Sydney Stephenson, (Fig.3) who was well Stephenson. (Fig.3). Apart from experienced from his work as editor of The Ophthalmoscope, publishing to a wider audience than was appointed editor supported by an impressive, internationally the Moorfields Reports the journal represented, editorial committee provided a complete bibliography, under the chairmanship of Sir John with English abstracts, of work and Herbert Parsons. literature from other countries. The The oldest British periodical to be Ophthalmoscope published original papers on important special subjects part of this amalgamation was Figure 3 the Royal London Ophthalmic and brief clinical or pathological Hospital Reports (Moorfields) which memoranda. Books were reviewed taking care that “naught commenced in 1857. In Europe is extended and naught set down in malice”. A note in the last only Cunier’s Annales d’Oculistique edition refers to the “somewhat melancholy satisfaction” of (1838) and Albrecht von Graefe’s feeling that the journal was to be replaced with a periodical more Archiv fur Ophthalmologie (1854) widely representative of British interests. preceded the Reports. Figure 1 Congratulations to the British Journal of Ophthalmology on its Royal London Ophthalmic Reports 1857-1917 Centenary, 1917-2017. This quarterly journal, whose full title was Ophthalmic Hospital Richard Keeler, Honorary Curator Reports and Journal of the Royal London Ophthalmic Hospital [email protected] (Fig.4) had J.F Streitfeild as its first editor. Its raison d’être was to preserve valuable information gained and lost at the hospital and elsewhere. Unlike other journals, the Reports consisted of articles on clinical and operative experiences as well as research carried out at the hospital reported by present and past members. However it was read widely by the ophthalmic profession. An interesting editorial appeared in the October 1859 edition which stated that it was printed on tinted rather than very white paper. Charles Babbage, the mathematician famous for his analytical machine, had printed his Logarithmic Tables on ochreous yellow paper (selected out of 117 trial samples) in order to make the tedious checking of figures less of a strain on the eyes. Readers preferred the new paper and the printers remarked that it “takes the ink” particularly well which useful for finer illustrations.

When the Reports ceased publication they filled 20 volumes. Figure 2 Figure 4 5 college news Moorfields in the Middle East

Moorfields Eye Hospital NHS Foundation Trust was first the telephone service. I am pleased to report that the results founded in 1804. In 2007, more than 200 years later, of this survey were outstanding with 94% of patients being Moorfields moved beyond the United Kingdom and satisfied with the current service. The results also revealed some areas for improvement which, along with observations I had opened its first overseas branch in Dubai. Moorfields Eye made during my visit, I compiled into a collection of short term Hospital Dubai has quickly become one of the leading and longer term improvement strategies. I presented my overall eye care institutions in the United Arab Emirates. findings to the clinical and administration teams, as well as the Outpatients Manager, Business Manager and Medical Director, In May 2016, Moorfields further extended its borders by opening Professor Robert Scott. These suggestions were well received; a partnership in the neighbouring Abu Dhabi. Both Moorfields some of which have already been implemented and others Dubai and Abu Dhabi are private hospitals, but are owned and being discussed further for consideration. managed by the UK NHS Foundation Trust. This ensures that all branches of Moorfields practice according to our UK expertise and The project has changed my practice on two levels. Firstly, I guidelines, and ultimately patients receive Moorfields’ leading have gained an appreciation for ensuring that all aspects of standards of eye care. communication are to the highest level as this has a huge effect on the overall patient and staff experience. Secondly, I have a More recently, Moorfields Dubai has formed an official better understanding of the Arabic culture which directly impacts international partnership with Al Jalila Children’s Hospital to on my clinical care, as our patient population involves many provide paediatric ophthalmic services within the dedicated, patients from the UAE who now live in the UK. state-of-the-art, 200-bed children’s specialist hospital. Reporting about my time at Moorfields Dubai I can share with I was privileged to be invited over to Moorfields Dubai this the reader that the unit provides incredibly supportive and summer to complete a project in communications management, valuable learning opportunities, in both the management and primarily to ensure that the call centre would remain accessible clinical arenas. It is an exciting time for Moorfields both in with the increasing demand as the service continues to expand. London and in the Middle East, as the standards of care that we provide become internationally recognised and practiced. I spent two weeks in Middle East, mainly within Moorfields Clinicians and Managers worldwide are following our footsteps Dubai but also Moorfields Abu Dhabi. I firstly spent time and it is now that we all can receive the practical and cultural reviewing telephone call data; looking at why people call, how benefits of learning from each other. many calls are made and timings of calls throughout the day. I then carried out a patient survey in the waiting room to Emily Cabourne determine what thoughts the patient population had about ST4 London Deanery

Moorfields Dubai team Emily with Medical Director Professor Robert Scott

Entrance Moorfields Eye Hospital Abu Dhabi Moorfields Eye Hospital Dubai 6 An occasional update commissioned by the College. focus The views expressed are those of the authors. Acanthamoeba update – an illustrative case

Hamed Anwar, Consultant, Moorfields Eye Hospital, Dubai Mark Wilkins, Consultant, Moorfields Eye Hospital A monthly soft contact lens wearer presented to Moorfields Eye Hospital eye casualty, having been seen elsewhere and treated unsuccessfully for herpes simplex keratitis over the past 1 month. At the time, she had a spectacle corrected visual acuity of 6/12 which pinholed to 6/9 in her right eye. A corneal epithelial defect with underlying haze, anterior chamber cells and conjunctival injection was seen. A diagnosis of herpes simplex keratitis with secondary uveitis was Figure 1 made. Ganciclovir eye ointment 5 times daily and Dexamethasone eye drops were prescribed. The patient was discharged and instructed to be followed up at her local eye unit. Over the next month, her symptoms apparently improved on the above medication, however she was referred back to Moorfields Eye Hospital with a recurrence of her condition. This time the visual acuity in the affected eye had deteriorated to hand motions only, while examination showed a very large epithelial defect with an underlying Figure 2 Figure 3 ring infiltrate (Fig 1). At this point, the underlying history of soft contact lens use and long duration of the problem In the United Kingdom AK is more common than fungal keratitis raised the possibility of acanthaemoeba keratitis. Cultures and probably more common in contact lens wearers than HSV for acanthamoeba were negative, but confocal microscopy keratitis. AK should always be considered in contact lens patients showed the presence of numerous cysts in the corneal presenting with what appears to be HSV keratitis. stroma (Fig 2). Treatment with hourly PHMB was initiated, Learning point 2: Early diagnosis is crucial with good effect, causing a reduction in the number of stromal cysts (Fig 3). Had treatment been initiated sooner the final outcome would have been far better. Always consider AK in the event of failure to She has had a stormy clinical course since then, having respond to first-line therapy for bacterial or HSV keratitis. Studies have shown that if effective treatment is delayed for 3 weeks or multiple episodes of Acanthamoebal reactivation. Three more the prognosis deteriorates. 2,3,4 months on, the epithelial defect still persists while her visual acuity remains at the hand motion level. A failure to consider Acanthamoeba as a cause of progressive keratitis is negligent. Discussion Learning point 3: Acanthamoeba keratitis may be coinfected This case is an unfortunate one, which should not have happened with another pathogen and could have been prevented. This case provides us with some key learning points which will be the subject of this Focus article. Always consider AK even when there has been a positive culture for another organism as 10-23% of AK cases may be polymicrobial, 5,6,7 Learning point 1: Acanthamoeba keratitis (AK) is easily or co-infected with HSV.8 misdiagnosed in contact lens wearers Learning point 4: Advances in laboratory techniques have The most important step in making a diagnosis of AK is to think of it. improved AK diagnosis

Approximately 50% of AK cases are misdiagnosed as herpes Though the diagnosis in this case was established using confocal simplex keratitis1 due to its earliest clinical signs taking the form microscopy, it is important to realise its limitations (50% sensitivity of an epitheliopathy closely resembling the pseudodendrites of and 65%-81% specificity in experienced hands).9 It is, at best, a herpes simplex infection. useful adjunct to diagnosis. FOCUS - THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

In recent years, PCR testing for acanthamoebal 18S rRNA has sped References: up the process of obtaining a diagnosis. A result can be obtained 1. Robaei D, Carnt N, Minassian DC, Dart JK (2014a) The impact within 3-4 days with a sensitivity of 90% and a specificity of of topical corticosteroid use before diagnosis on the outcome of 90.8%.10 A single PCR swab can be tested for bacterial, fungal and Acanthamoeba keratitis. Ophthalmology121(7): 1383–8. viral pathogens which increases its utility in the clinical setting. 2. laerhout I, Goegebuer A, van Den BC, Kestelyn P. Delay in diagnosis and outcome of Acanthamoeba keratitis. Graefes Arch Clin Exp Learning point 5: Steroids can make things worse Ophthalmol 2004;242:648–653.37. In this case, topical corticosteroids were initiated before the 3. Bacon AS, Dart JK, Ficker LA, Matheson MM, Wright diagnosis of AK was made, largely due to the misdiagnosis of AK P.Acanthamoeba keratitis. The value of early diagnosis. Ophthalmology 1993;100:1238–1243.38. as herpetic keratitis. The initiation of steroids before making a diagnosis of AK has been shown to be highly predictive of a poorer 4. Tu EY, Joslin CE, Sugar J, Shoff ME, Booton GC. Prognostic visual outcome.11 factors affecting visual outcome in Acanthamoeba keratitis. Ophthalmology 2008;115:1998–2003. Learning point 6: Acanthamoeba keratitis is on the rise 5. Sharma S, Garg P, Rao GN. Patient characteristics,diagnosis, and treatment of non-contact lens related Acanthamoeba keratitis. Br J In 2003, the incidence of AK in soft contact lens wearers was Ophthalmol 2000;84:1103–1108. calculated to be approximately 21 per million per year compared 6. Bacon AS, Frazer DG, Dart JK, Matheson M, Ficker LA,Wright P. to 17 per million in hard contact lens users.12 Since then, there has A review of 72 consecutive cases of Acanthamoeba keratitis, 1984– been a gradual increase in the number of reported cases of AK 1992. Eye 1993;7:719–725.40. throughout the United Kingdom, possibly due to two reasons. 7. Sun X, Zhang Y, Li R, et al. Acanthamoeba keratitis: clinical characteristics and management. Ophthalmology 2006;113:412– Firstly, contact lens solutions have low concentrations of PHMB 416 (<0.0001%), lacking adequate amoebicidal activity.13 8. Mathers WD, Goldberg MA, Sutphin JE, Ditkoff JW, Folberg R. Secondly, more silicon hydrogel extended wear contact lenses are Coexistent Acanthamoeba keratitis and herpetic keratitis. Arch being fitted to patients than in previous years. In 2015, 64% of Ophthalmol 1997;115:714–718. all new soft contact lens fittings and 69% of all soft contact lens 9. Hau SC, Dart JK, Vesaluoma M, Parmar DN, Claerhout I, Bibi refittings, were silicone hydrogel lenses.14 In 2004, Silicone hydrogel K, Larkin DF. Diagnostic accuracy of microbial keratitis with in materials accounted for 6% of new fits and 16% of refits. 15 vivo scanning laser confocal microscopy. Br J Ophthalmol. 2010 Aug;94(8):982-7. The fact that more patients are using silicone hydrogel contact 10. Boggild AK, Martin DS, Lee TY, Yu B, Low DE. Laboratory diagnosis lenses is concerning as studies have shown these materials to be of amoebic keratitis: comparison of four diagnostic methods “stickier” to acanthamoeba.16,17 for different types of clinical specimens. J Clin Microbiol. 2009 May;47(5):1314-8. Learning point 7: An ounce of prevention is worth a pound 11. Robaei D, Carnt N, Minassian DC, Dart JK. The impact of of cure topical corticosteroid use before diagnosis on the outcome of Acanthamoeba keratitis. Ophthalmology. 2014 Jul;121(7):1383-8. The only truly effective way of ensuring that this story does 12. Radford CF, Minassian DC, Dart JK. Acanthamoeba keratitis in not happen again, is to make AK teaching mandatory for all England and Wales: incidence, outcome, and risk factors. Br J doctors prior to starting a new job, and at regular intervals during Ophthalmol 2002; 86(5): 536–542. employment. Formal pathways must also be put into place, 13. Chawla A, Armstrong M, Carley F. Acanthamoeba keratitis - an escalating patients with non-resolving keratitis attending accident increasing incidence. Cont Lens Anterior Eye. 2014 Apr;37(2):120. and emergency on multiple occasions for the same problem. 14. Morgan et all. Trends in UK contact lens prescribing 2015. Optician, Opticians must also be involved in this effort, particularly in terms 2015. of stressing the importance of good contact lens hygiene to 15. Morgan PB and Efron N. Trends in UK contact lens prescribing patients. For example, many contact lens users tend to “top-up” 2004. Optician 2004; 227(5950): 16-17. solution in their cases rather than replace the solution completely, 16. Beattie TK, Tomlinson A, McFadyen AK, et al. Attachment of promoting biofilm formation. This alone can cause a four-fold Acanthamoeba to first- and second-generation silicone hydrogel increase in the likelihood of contracting acanthamoeba keratitis. contact lenses. Ophthalmology. 2006;113:117–125. 17. Beattie TK, Tomlinson A, Seal DV, et al. Surface treatment Conclusion or material characteristic: the reason for the high level of Acanthamoeba attachment to silicone hydrogel contact lenses. AK is a visually devastating condition, which can be detected early Eye Contact Lens. 2003;29:40–43. if clinicans have a high degree of suspicion while treating contact lens wearers with atypical looking infections. Failure to do so is negligent and can have disabling and life changing effects on patients lives.

Andrew Tatham Editor, Focus Our website just got even better

Announcing the new John Weiss website

Whether you’re browsing on your PC, laptop, tablet or smartphone – with the full range catalogue and comprehensive search and filtering features, you’ll be sure to find the products right for you. Each instrument has a detailed specification as well as an image and illustration of the tip detail where necessary.

Go explore at www.johnweiss.com

If you’d like a copy of the John Weiss printed catalogue please contact us on +44(0)1908 340000 or email [email protected] If only I had a

In uncertain times, one thing is certain. With a robust multimodal approach, SPECTRALIS fosters a diagnostic confidence that inspires clinical certainty.

Call us on 01442 502 330 www.HeidelbergEngineering.co.uk

MultiColor • Infrared • BluePeak • FA • ICGA • Widefield • Stereo • Anterior • Perimetry • OCT Angiography 313153-001 UK.BE16 © Heidelberg Engineering GmbH THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017 If only I had a Eye Journal – Editor’s choice Selected papers from fourth quarter 2016

1. Subfoveal choroidal thickness as a predictor of central 3. Ocular injuries from fireworks: the 11-year experience serous chorioretinopathy of a US level I trauma center

In the December issue Ambiya et al Eye (2016) 30, 1623– In the October issue, Chang et al Eye (2016) 30, 1324–1330 1629 evaluate the role of subfoveal choroidal thickness (CT) characterize ocular trauma and visual outcomes from measurements as a predictor for the course of central serous frework injuries at a level I trauma center. They performed chorioretinopathy (CSC). Thirty-eight eyes of 33 patients with a retrospective review of all frework injuries at Harborview CSC were analyzed retrospectively. Key inclusion criteria were Medical Center between 2003 and 2013. They found that naive (acute or recurrent) CSC; a minimum of 12 months of three hundred and twenty-seven patients sustained frework follow-up; and the availability of good quality enhanced depth injuries, of which 100 (31%) sustained ocular injuries. The imaging SD-OCT images at each visit. Eyes with changes average age of all patients who sustained freworks injuries suggestive of chronic CSC and history of any treatment were was 24.2 years, 89% were male and 54% of injuries occurred excluded. Collected data included demographic profile, visual within 48 h of 4 July. Ocular injuries were most commonly acuity, subfoveal CT, central macular thickness (CMT), and caused by mortars (24%) and rockets (22%). Rockets were treatment details. The 38 eyes were divided into two groups: associated with four times the frequency of ocular injuries as Group A (subfoveal CT ≤ 356 μm) and Group B (subfoveal compared with non-ocular injuries (P<0.001). Spectators were CT4356 μm). They found that the need for treatment had more likely to sustain ocular injuries than non-ocular injuries significantly positive correlation with duration of symptoms (P (P=0.001). The most common injuries sustained were corneal = 0.02), negative correlation with the baseline CT (P<0.01), and abrasions (67%), hyphemas (42%), eyelid injuries (39%), and no significant correlation with CMT (P = 0.13). They concluded ruptured globes (17%). Twenty-eight percent of patients that CSC with a subfoveal CT ≤ 356 μm is of a chronic nature with ocular injuries required surgical intervention. Ruptured and is more likely to require treatment rather than observation. globes occurred in 17% of patients, with the majority being complex corneoscleral lacerations. Fifty-eight percent of 2. The effect of music with and without binaural beat patients who sustained ruptured globes were left with no audio on operative anxiety in patients undergoing light perception in the affected eye. Average follow-up was cataract surgery: a randomized controlled trial 188 days. Average visual acuity signifcantly improved from logMAR 1.8±1.6 at presentation to logMAR 1.3±1.8 at last In the November issue, Wiwatwongwana et al Eye (2016) follow-up. They concluded that frework-related ocular trauma 30, 1407–1414 investigate the anxiolytic effects of binaural frequently results in vision-threatening pathology. Prompt beat embedded audio in patients undergoing cataract surgery referral to and treatment by ophthalmologists is critical. This under local anesthesia. This prospective RCT included 141 study documents the dangers inherent in the personal use of patients undergoing cataract surgery under local anesthesia. freworks and provides data that may help guide public policy The patients were randomized into three groups; the Binaural to decrease the frequency of these devastating injuries. beat music group (BB), the plain music intervention group (MI), and a control group (ear phones with no music). Blood Andrew Lotery pressure (BP) and heart rate were measured on admission, at Editor in Chief, Eye the beginning of and 20 min after the start of the operation. Peri-operative anxiety level was assessed using the State-Trait Anxiety Inventory questionnaire (STAI). The BB and MI groups Volume 30 Number 11 November 2016 Volume 30 Number 12 December 2016 www.nature.com/eye comprised 44 patients each and the control group 47. Patients www.nature.com/eye in the MI group and BB group showed signifcant reduction of STAI state scores after music intervention compared with the control group (P<0.001) but the difference was not signifcant between the MI and BB group (STAI-S score MI group −7.0, BB group −9.0, P=0.085). Systolic BP was signifcantly lower in both MI (P=0.043) and BB (0.040) groups although there was no difference between the two groups (P=1.000). A signifcant reduction in heart rate was seen only in the BB In uncertain times, one thing is certain. group (BB vs control P=0.004, BB vs MI P=0.050, MI vs control

P=0.303). They concluded that music, both with and without Music for cataract surgery With a robust multimodal approach, SPECTRALIS fosters Endonasal DCR success rates binaural beat, was proven to decrease anxiety level and lower Adjustable vs non-adjustable sutures for strabismus Afl ibercept and diabetic macularJalili Syndrome edema a diagnostic confidence that inspires clinical certainty. Depression and dry eye diseaseComplement and uveitis systolic BP. Patients who received binaural beat audio showed Smoking and thyroid eye disease ow and glaucoma Microvascular endothelial blood fl additional decrease in heart rate. Binaural beat embedded Multimodal imaging and choroidal nevi Call us on 01442 502 330 www.HeidelbergEngineering.co.uk musical intervention may have beneft over musical intervention alone in decreasing operative anxiety.

MultiColor • Infrared • BluePeak • FA • ICGA • Widefield • Stereo • Anterior • Perimetry • OCT Angiography 313153-001 UK.BE16 © Heidelberg Engineering GmbH 11 college news Part 2 FRCOphth Mark Tso Golden Apple Oral Birmingham Award The November 2016 Part 2 FRCOphth Oral The Mark Tso Golden Apple Award is presented to an ophthalmologist examination took place in Birmingham at the doing outstanding work in regional training who is recognised for Edgbaston Stadium and the Queen Elizabeth innovation and leadership in ophthalmic education within each Hospital. The clinical OSCEs were hosted by Lt of the four supranational regions. The Award is presented to an Col Andrew Jacks and the wonderful team at the ophthalmologist every other year at the Supranational Congress. Queen Elizabeth Hospital eye department. We Mark Tso was the International Council of Ophthalmology Vice are grateful to Anne Burdon who coordinated the President 1998-2006 and served as Director for Education until 2012. recruitment of over 400 patients for the three His dedication to ophthalmic education is honored through this award. days of clinical examinations.

I have had the privilege of representing our College on the European Once again we are truly thankful to the 50 Board of Ophthalmology (EBO) and the Union Europeenne de consultant and lay examiners who examined 107 Medecins Specialistes (UEMS). I chaired the Residency Review candidates over five days. committee that inspects Units across Europe and was later elected President of the EBO. I am Vice-President of our section of the UEMS and on the Executive of the SOE. I have found it very rewarding to be Diploma able to play a substantive role in enhancing Ophthalmology training across Europe through those various roles and this has culminated into examination the innovation of the subspecialty exams. The greatest satisfaction is to be able to achieve something that hopefully will have a positive impact on training and subsequently on patients care. Being The Diploma examination was held once a year recognised for it through this award is the icing on the cake. but unfortunately candidate numbers were consistently low. In 2015 the Examinations Wagih Aclimandos Committee set up a small working group to consider how candidate numbers could be increased. In July 2016, the Examinations Committee agreed that the Diploma examination Clinical Excellence Awards 2017 was no longer viable due to its low candidate numbers, and regrettably decided to permanently discontinue the Diploma examination. The Advisory Committee on Clinical Excellence Awards has announced that the 2017 round will open in early spring 2017. The last Diploma examination took place in September 2015 at the James Paget Hospital These awards recognise NHS consultants in England and Wales who perform University Hospital in Great Yarmouth. The ‘over and above’ the standard expected of their role; competition is tough Examinations team would like to thank Mrs and getting tougher. Members considering applying for RCOphth support Bridget Hemmant and her team for being should monitor the ACCEA website for further information. excellent hosts.

Top Tweets

Allon Barsam @AllonBarsam The Eye Surgeon @The_Eye_Doctor Great having @SherazDaya from @CentreforSight speak Great work @RCOphth to raise awareness - delay in @RCOphth annual symposium on #cataract & #refractive appointments risks patients losing vision. #timelytreatment surgery for new and return patients SimonKelly @eye_kelly Central Lobby @CentralLobby Nice to note our item on wrong IOLs in journal ‘Eye’ MPs and peers join Lord Patel in pledging to demand selected as Editor’s Choice in ‘College News’ @RCOphth #timelytreatment for all eye patients to save their vision #EyeTip @RCOphth Saurabh Jain @paedsophth Katrina Venerus @KatrinaVenerus Honoured to be at the first parliamentary reception of our Great line up @RCOphth 29 Nov. Professions working college, calling for #timelytreatment of all eye patients together doing things differently http://bit.ly/2ePisKT @Dr_PhilippaW @RCOphth @LOCSU @CollegeOptomUK

12 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

13 college news

2016 Ophthalmology Honours winners announced

The Bayer awards programme, run by Bayer and supported by the Royal National Institute of Blind People (RNIB) and Visionary were celebrated at a ceremony held at the Royal College of Surgeons in London, hosted by Paralympian and former world record holder, Danny Crates.

The awards programme, recognises the outstanding The 2016 winners: work being carried out by multidisciplinary teams in ophthalmology throughout the UK and identifies exceptional • Best ophthalmology team: Making a Difference for initiatives that demonstrate clinical excellence and innovation Glaucoma Patients: A ‘Can Do’ Approach - Epsom and in the area. St. Helier University Hospitals NHS Trust • Best patient support or education initiative: “This awards programme continues to shine a light The Paediatric Intraocular Clinic - Alder Hey Children’s on the fantastic work that we are doing in the UK” Hospital NHS Foundation Trust • Best ophthalmology care innovation: Real-time Patient Journey Assessment Platform - Manchester Royal Eye Commenting on this year’s entries, Augusto Azuara-Blanco, Hospital Professor of Ophthalmology, Queen’s University Belfast and judging panel member, said, “This was another great year • Judges’ special award: Bradford Teaching Hospitals for the Ophthalmology Honours. Not only did we see the NHS Foundation Trust - Bradford Ophthalmology Research same level of high quality entries as last year, we also saw an Network increase in the number of winners as we, as judging panel, had such a difficult job deliberating and selecting the final • Enhancing patient care through research: Cambridge results. This awards programme continues to shine a light on University Hospitals NHS Foundation Trust - Stickler the fantastic work that we are doing in the UK; from providing Syndrome Service invaluable support to patients and their families to being at the forefront of clinical research. All of the winners and finalists • Outstanding ophthalmology nurse or allied health should be extremely proud of their work and other centres professional: Anne-Marie Lacey, Nurse Practitioner - across the UK should look to their colleagues for examples of Royal Bournemouth Hospital best practice and innovation in eye health.” • Ophthalmology unsung hero: Cara Mitchell, Macular The development of the awards programme was guided Service Coordinator - Bradford Teaching Hospitals NHS by a steering committee of experts including consultant Foundation Trust ophthalmologists, specialist nurses and a representative Further information on the results, categories and entry from the RNIB. The large number of entries were judged by a process for Ophthalmology Honours can be found at: total of ten experts in ophthalmology care, with the decision- www.ophthalmologyhonours.co.uk making process being wholly independent from Bayer.

Commenting on the success of the awards, Dr Jackie Napier, Medical Director Ophthalmology, Bayer said: “Our commitment to the ophthalmic community and to improving Have you or your team outcomes for patients is demonstrated via our ongoing support for initiatives such as the Ophthalmology Honours. been nominated for an Not only does this programme support the sharing of best practice at a clinical level, it also recognises excellent patient award? care and support provided by the entire multidisciplinary We would love to hear from members if they, or team. Encouraging innovation and best practice sharing is colleagues, or their teams have been nominated or vital in an ever changing environment and we are committed received awards. This can be for work, research or to delivering this programme so we are able to support the services within ophthalmology. UK clinical community with staying at the forefront of patient care. We hope to see the same level of high quality entries Please send details to Liz Price, Communications next year and encourage the clinical community to share the Manager: [email protected] great work that they are doing across the UK.”

14 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

Bayer Awards ceremony 2 December 2016

Epsom and St. Helier University Hospitals NHS Trust

Manchester Royal Eye Hospital Cara Mitchell, Bradford Teaching Hospitals NHS Foundation Trust

Alder Hey Children’s Hospital NHS Foundation Trust Cambridge University Hospitals NHS Foundation Trust - Stickler Syndrome Service

Bradford Teaching Hospitals NHS Foundation Trust - Bradford Ophthalmology Anne-Marie Lacey, Nurse Practitioner - Royal Bournemouth Hospital Research Network

15 Leading supplier to UK Ophthalmology

Made in Germany

Single-Use

Genius Eye Micro incisional A new benchmark Capsulorhexis Forceps for eye surgery

Single-Use

automated system

A turbine driven

for DSAEK Moria One use Plus Single-use Titanium Single-use Guarded VR Instruments Corneal Punch

Single-Use

iTrace™ Wavefront Single-use & Reusable Aberrometer/ Stainless Steel instruments Topographer

HPMC Single-Use

Trypan Blue Instrument Sets & Packs Viscoelastics

Tel: +44 (0)161 776 7620 www.sdhealthcare.com THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

A very special meeting

visitors. This is followed by the welcoming reception. Each congress has a theme which has included in the past: “Debates in Ophthalmology”, “Management of Complications”, “Anterior meets Posterior” and “New Horizons”.

Recently, a session on medicolegal issues was tentatively introduced which was – surprising to me – a great success. There are few other meetings with such a breadth of topics: medical retina, genetics, neuro-ophthalmology, electrophysiology, paediatrics, along with a wide range of surgical topics. One of the highlights for this writer was a splendid sans slides talk on the “placebo effect”. In 2015 the debate theme pitched speakers against each other on such topics as – “internal vs external DCR”, “Does vitrectomy for Imagine you are an invited speaker at the international macular oedema work?” (yes vs no) and “DSAEK vs DMEK”. Midland Ophthalmological Society (MOS) and Pantheo This writer still smarts from being macerated by Manoj Eye Centre, Annual Congress in Limassol Cyprus, April Parulekar of Birmingham and outvoted by the participants in 2016. You land late on Friday evening leaving the cold, the debate on the “Great paediatric cataract massacre”. wind and rain of the UK behind you.

At 8.15 the next morning you are seated in the conference “A superb balance of reviews and updates, hall with the other 100 participants waiting for the event to undoubtedly by well-established speakers in their commence. Behind the screen, in front of you, the window reveals a panoramic view of a glorious bright blue, absolutely fields, makes it one of the major highlights in the cloudless, sky. Slowly lowering your gaze, branches of palm ophthalmic calendar” trees waft across your view, and then slightly lower... your eyes fall on the most brilliantly blue sea you have ever seen. Now The very last session of the meeting is one of my favourites be honest – it’s not appraisal time after all – what is your only as local trainees, medical and nursing students make thought? Of course - to grab your certificate of attendance, presentations – fresh, excellent and humbling. swimming costume and towel, and dash for the beach. But on approaching the charming and efficient ladies at the At 5.30 pm or thereabouts, the blinds are lifted and at last that registration desk your resolve shrinks, you mumble something glorious view of the blue sky and sea comes again into view - incomprehensible and slink slowly back to the conference room just in time for a short swim and then out for the evening. The where you sit obediently for the next two days. conference meal is held in a different location each year – 2016 in a country winery, 2015 on the beach (with swimming) and The two-day MOS - Pantheo Annual Congress has now been running for 9 years under the aegis of three organisations: on other occasions in various historical locations. Dancing, the Pantheo Eye Centre, Limassol, The University of Nicosia a term used quite improperly, is usually required. The next Medical School (part of St George’s Medical School, London) morning you find yourself at 8.30 back in the conference hall and the Midland Ophthalmological Society. The meeting is ready for action. housed in a splendid Limassol hotel where the delegates can So, how to sum up this meeting? A superb balance of reviews stay, and adding an irrelevant note to the education-hungry and updates, undoubtedly by well-established speakers in their ophthalmologist, there are several superb swimming pools. fields, makes it one of the major highlights in the ophthalmic Miss Marie Tsaloumas from Birmingham and Mr Theo calendar and is registered for CPD. The breadth of topics Potamitis ex-Birmingham and now Cyprus are the makes it ideal for updates on topics away from your own organisational driving forces, massively aided by Dr subspecialty. Above all, the organisers ensure that it is friendly Katia Papastavrou. Participants and delegates include and welcoming at every level. Like every conference not every ophthalmologists from Cyprus, the UK and other European delegate stays the full course, but at this congress, despite countries. Students from The University of Nicosia Medical the external attractions, most do – what better attestation. School also attend as part of their ophthalmic training. The For once, my wife and my appraiser both speak as one – this international group of invited speakers are all well-recognised meeting is a must and the MOS - Pantheo Annual Congress is in their respective fields. already written into my Personal Development Plan for 2017.

The meeting starts at the Pantheo Eye Centre with Professor Alastair Fielder presentations by local ophthalmologists and a quiz for the (delegate and speaker)

17 college news Ophthalmologists in Training An A to Z of Infections present opportunities for examiners to pry into the depths of your knowledge on seemingly useless trivia. Below is an A to Z guide demystifying ocular infections the apparent trivial nature of beloved exam questions.

Acanthamoeba Escherichia coli Jarisch-Herxeimer reaction A Should we blame UK water supplies E This can cause a suppurative keratitis J This transient immunological or unsafe contact lens practices? Consider with hypopyon. Contact lens wearers and reaction and illness is caused by a host this organism before assuming herpetic those with ocular surface disease are at risk. cytokine “storm” arising as a consequence keratitis in contact lens wearers who of dying microorganisms. It follows appear to have dendrites. Confocal Fungal Keratitis initiation of antibiotics and is seen microscopy may help in the diagnosis. F Morphological classification consists particularly with treatment of spirochaetal of Filamentous (Fusarium, Mucor), Yeasts infection (for example Borrelia burgdorferi (Candida), and Dimorphic (Histoplasma) or Treponema pallidum). groups. Filamentous infections may demonstrate feathery edged stromal Klebsiella pneumoniae infiltrates. Commoner in warm humid K A Gram-negative, opportunistic climes, suspicion must remain high when enterobacteria that causes a suppurative there is a history of trauma, LASIK, contact keratitis with a similar presentation to lens wear or topical steroid use. pseudomonal infection (see below). The organism is also a common pathogen in endogenous endophthalmitis associated with concurrent hepatobiliary infections.

Acanthamoeba Keratitis. Courtesy of Loa Loa M.Wilkins, Moorfields Eye Hospital. L This nematode is transmitted via the bite of the female deer fly. Catch it (if you Bartonella henselae can) and extract it. Patients may have been B Cat-scratch disease cause by to West and Central Africa and complain this Gram-negative rod may cause a of seeing or feeling something crawling granulomatous conjunctivitis with firm and Fungal Keratitis. Courtesy of M.Wilkins, around the eye. tender pre-auricular and submandibular Moorfields Eye Hospital. lymphadenopathy. Look for a pustule at Multiple Sclerosis (MS) the site of a scratch. There may be an Geographic keratitis M Multiple neuropathies, optic neuritis, associated neuroretinitis that may be G Very large epithelial defects can intermediate uveitis, and lethargy could self-resolving. For exams, remember that result from the inadvertent use of topical raise the question of MS. The astute farming households may keep cats. steroid therapy for an incorrectly diagnosed Ophthalmologist, however, will ask about epithelial keratitis. Reflection on such a forest walks and bites. Lyme disease Cytomegalovirus (CMV) sequelae often enlightens that the original can mimic MS. Borrelia burgdorferi, the C The retinitis caused by this double- underlying pathology was likely to have causative organism, is transmitted via stranded DNA herpes virus is the most been herpes simplex keratitis. the bite of the deer tick, Ixodes dammini. common cause of visual loss in AIDS Look for erythema migrans, which is patients. It occurs in patients with CD4 Histoplasma capsulatum pathognomic. Lyme disease shows counts of <50cells/mm3. Confluent areas H Histoplasmosis is induced by good response to systemic doxycycline of retinitis progress at a rate of 300μm per infection by this organism. It is endemic treatment; especially if recognized early. week. Highly active antiretroviral therapy in the eastern American River valleys. (HAART) has lessened the burden from this Punched-out chorioretinal scars in the Neisseria gonorrhoeae condition. Oral valganciclovir, intravenous absence of anterior segment or vitreous N These gram-negative, intracellular foscarnet, or their intravitreal equivalents inflammation are characteristic. diplococci can penetrate an intact corneal are effective. epithelium and infection can rapidly to Influenza A perforation and endophthalmitis. Demodex I Uncommonly, and fortunately D Ophthalmia neonatorum Eyelashes surrounded by cylindrical transiently, there can be ocular involvement O dandruff could indicate the presence from influenza A (H1N1) infection or Occurs within the first 28 days of life of a Demodex infestation. Tea Tree Oil vaccination. Reported manifestations and is most frequent caused Chlamydia application has been recommended to help include dacroadenitis, uveitis, uveal trachomatis in the UK. Neonates in whom treat the blepharitis associated with these effusions, retinitis, frosted branch angiitis Chlamydia has been acquired via vertical tiny parasitic mites1. and very rarely optic neuritis2. transmission have a risk of pneumonia. PCR

18 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017 tests are 100% specific but enzyme-linked Toxoplasma Gondii Zoster immunoassays or direct immunofluorescent T This ubiquitous parasite is the Z Varicella Zoster, though often monoclonal antibody staining can provide commonest worldwide infectious uveitis. associated with shingles, can cause keratitis rapid diagnosis. Chlamydial conjunctivitis An active retinochoroiditis, for example a or uveitis. However it can also, albeit less should be treated with oral erythromycin. fluffy white edge adjacent to old scars, is commonly, cause cranial nerve palsies and well Systemic therapy and paediatrician review associated with a severe ‘headlight in the as acute retinal necrosis (see images below). is necessary due to the potential risk fog’ vitritis. Although once believed to be In the immunosuppressed, as with Herpes of life threatening pneumonia. Parents the result of congentital transmission, most simplex, this virus can be the cause of the and their sexual partners should be cases worldwide are from the reactivation of devastating progressive outer retinal necrosis. advised of the need for assessment by a disease acquired as a result of ingestion of Genitourinary medicine clinic. A course of contaminated meat or water. Treatment with oral azithromycin can be effective. systemic steroids and antiparasitic agents is most important in sight threatening lesions Pseudomonas aeruginosa or in the immunosuppressed. P This Gram-negative organism is the most common cause of contact lens Uveitic syndrome, Fuch’s associated keratitis. Its ability to produce U Alternatively known as Fuch’s destructive enzymes facilitates its rapid, heterochromic iridocyclitis, this condition extensive and deep and corneal penetration. was previously thought to be idiopathic. There may be a suppurative keratitis, rapid However, PCR findings suggest Rubella virus has a role in its aetiology. stromal infiltration, corneal thinning and Acute Retinal Necrosis – note the white areas a risk of perforation. Do not treat with of peripheral retina. Courtesy of R.Hamilton, Chloramphenicol; resistance is high and the Vitrectomy Moorfields Eye Hospital. prognosis worse if used as initial therapy in V This modality of treatment is contact lens associated keratitis. Consider increasingly considered in the treatment instead intensive treatment with a topical of bacterial endophthalmitis. The quinolone e.g. g.levofloxacin. Endophthalmitis Vitrectomy study demonstrated those patients with only Quarantine light-perception vision benefited from early Q Ophthlamologists have been asked vitrectomy; achieving a 50% decrease in to review patients being quarantined due the frequency of severe visual loss. to Ebola virus infection. The virus has been linked to a severe haemorrhagic Whipple’s disease conjunctivitis. W Tropheryma whippelii is the cause of this multisystem disease that often begins Acute Retinal Necrosis; image obtained using Rhizopus with arthritis and features gastrointestinal Ultra-Widefield imaging. Courtesy of M. Bizrah. R Fungi belonging to this genus upset. There can be central nervous cause the life-threatening infection system involvement with consequent mucormycosis. Diabetic Ketoacidosis ophthalmoplegia, nystagmus and optic Zahir Mirza and immunocompromise are significant nerve disease. Uveitis may be present. ST6 Ophthalmology risk factors. Patients will appear toxic, Neurological signs are often permanent Moorfields Eye Hospital there may be an eschar on the nose and and the disease can be fatal. Mark Westcott multiple, rapidly progressive, cranial nerve Consultant Ophthalmologist X-linked lymphoproliferative palsies. Immediate attention is needed to Moorfields Eye Hospital and Bart’s Health X disorder correct underlying metabolic disturbances. NHS trust Multidisciplinary care (microbiology, ENT, This is an Epstein-Barr virus specific References physicians) should be initiated. Early immune defect that has a poor prognosis intravenous antifungals and extensive and rare ocular manifestations such 1. Cheng AM, Sheha H, Tseng SC. Recent surgical debridement should be anticipated. as cotton wool spots. Primary Epstein- advances on ocular Demodex infestation. Barr infection is rarely, and transiently, Current opinion in ophthalmology Syphilis associated with ocular pathology including 2015;26(4):295-300. S Syphilis, cause by the spirochete uveitis, vitritis, choroiditis, optic neuritis and 2. Khairallah M, Kahloun R, Ben Yahia S, et al. Treponema pallidum, is increasing in cranial nerve palsies. New infectious etiologies for posterior uveitis. incidence. Its ocular manifestations are Ophthalmic research 2013;49(2):66-72. diverse; ranging from a anterior uveitis to Yersinia enterocolitca panuveitis. An interstitial keratitis is often Y This bacteria can cause a severe the result of congenital acquisition. This acute diarrhoeal illness and sometimes Interested in submitting an article for the great masquerader should not deceive the fatal sepsis. It may lead to reactive arthritis trainee page of the College News? Then highly suspicious Ophthalmologist who (formally known as Reiter’s syndrome). contact: There is some suggestion that infection should invariably consider testing for this in Mukhtar Bizrah can increase the risk or severity of Graves’ almost all cases of uveitis. [email protected] ophthalmopathy.

19 celebrate with us

The first C. Davis Keeler Practice was set up in the West End of London in 1917 by American born Charles Davis Keeler, laying the solid foundations for growth and establishing the high standards in product quality and customer care that Keeler is renowned for today. Celebrate with us in 2017.

www.keeler.co.uk THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JANUARY EDITION 2017

SAS doctors 7th National Day report

The programme is always chosen with the practical clinical workplace in mind and this year excelled in this regard. Professor Miles Stanford took us through ‘The Eye in Systemic Vasculitis’ concentrating on the more common conditions, including new insights on giant cell arteritis. Nick George covered paediatric emergencies, often a concern for the non- paediatric ophthalmologist who finds themselves treating children in casualty clinics.

Bill Newman gave us practical advice on dealing with difficult ‘Vision and Driving’ scenarios with a helpful handout providing links for both doctors and patients. Lastly Professor Teifion James provided a rapid fire and very entertaining run through his best Clinical Pearls. Anyone who left early for their train seriously missed out! If you were one of the crowd who attended, I’m sure you’ll Please consider joining us next year – get the date in your agree that this was one of the best SAS meetings ever! Having diary, 17 November 2017 at Stephenson Way, the home of the new College premises as our venue is a great help with the RCOphth. The networking alone is really enjoyable and is accessibility as it is very close to Euston station – there were really a grand day out. delegates from all four home nations this year. It also helps to keep costs to a minimum (£50 and 5 CPD points) and the Anne Sinclair catering was much better than the average conference food. Scotland SAS Representative Calling all SAS doctors The Peter Barry ESCRS The College Staff and Associate Specialist committee is seeking members of the College who work in the SAS grade, to Fellowship - closing be regional representatives to represent all the SAS doctors in their region. The roles have become vacant due to retirement date 1 May 2017 or SAS doctors being successful in becoming consultants. The vacancies are in the following regions: E Anglia, Oxford, SE Applications are invited for this very prestigious Thames, South West, Wessex. fellowship which commemorates the enormous The role involves three meetings per year of the SAS group at contribution made by the late Peter Barry to the RCOphth premises, usually on a Friday afternoon. cataract and refractive surgery and the ESCRS.

The role also involves representing the SAS grade on one of This annual fellowship is for 50,000 euros to allow a the RCOphth sub-committees eg Scientific, CPD, training, trainee to work aboard at a centre of excellence in the education, professional standards, examinations. field of cataract and refractive surgery any where in the world for 1 year. The applicants would also help in the planning of the SAS Applicants must be under 35 years of age and from a forum at the College Congress and the annual College geographic European country and have been ESCRS National SAS day. If you are able to commit your time and members for 3 years by the time of starting the energy to promoting the role of SAS doctors in ophthalmology, celebrate with us Fellowship. They must submit a CV, not more than 2 please contact Bronwen Attrup, Chair SAS Committee pages of A4 outlining where they want to go and why, a The first C. Davis Keeler Practice was set up in the West End [email protected] letter of support from their present Head of Department of London in 1917 by American born Charles Davis Keeler, and a letter from the host institution indicating their laying the solid foundations for growth and establishing the Obituary acceptance if their application is successful. high standards in product quality and customer care that The Fellowship will be awarded at the summer ESCRS Keeler is renowned for today. Celebrate with us in 2017. meeting in Lisbon 2017 to start in 2018. We send our sympathy to the family and friends of members who have passed away since the last edition of College News. Closing date is 1 May 2017. Grosvenor Burfitt-Williams – Sydney, Australia Further details from [email protected] www.keeler.co.uk Joaquin Barraquer Moner – Barcelona, Spain Keith Leslie Batten – Bath, UK 21 college news Consultant posts

Appointee NHS Trust Hospital or Area Allaa Eldin Abumattar Great Western Hospitals NHS Foundation Trust Great Western Hospital, Swindon Philip Alexander Cambridge University Hospitals NHS Foundation Trust Cambridge Rashi Arora Salisbury NHS Foundation Trust Salisbury Alexandra Kate Bush Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust Bournemouth Maria Cordeiro Imperial College Healthcare NHS Trust London Reena Dave The Hillingdon Hospital NHS Foundation Trust Hillingdon Hospital Aruna Dharmasena Central Manchester University Hospitals NHS Foundation Trust Manchester Royal Eye Hospital Ourania Frangouli Imperial College Healthcare NHS Trust Western Eye Hospital Abdul-Jabbar Ghauri Sandwell and West Birmingham Hospitals NHS Trust Birmingham and Midland Eye Centre Amynah Goawalla Imperial College Healthcare NHS Trust Western Eye Hospital Greg Heath York Teaching Hospital NHS Foundation Trust York Victor Hu Mid Cheshire Hospitals NHS Foundation Trust Leighton Hospital Christine Kiire Oxford University Hospitals NHS Trust Oxford Eye Hospital Lei-Ai Lim Taunton and Somerset NHS Foundation Trust Musgrove Park Hospital Colin Murray York Teaching Hospital NHS Foundation Trust York Sengal Nadarajah Surrey and Sussex Healthcare NHS Trust East Surrey Hospital Kapka Nenova Surrey and Sussex Healthcare NHS Trust East Surrey Hospital Clare Roberts Moorfields Eye Hospital NHS Foundation Trust Moorfields Eye Hospital Radua Kamal Salah Torbay and South Devon NHS Foundation Trust Torquay Andrew Scott Moorfields Eye Hospital NHS Foundation Trust Moorfields Eye Hospital and Bedford Hospital Vaneeta Sood University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital Vijay Wagh Guy's and St. Thomas' NHS Foundation Trust London Matthew Wakefield Salisbury NHS Foundation Trust Salisbury Benjamin While Wye Valley NHS Trust Hereford 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. The Royal College of Ophthalmologists Annual Congress 22-25 May 2017 – ACC, Liverpool Conference & Exhibition in the UK

Make sure you put the dates in your diary! Other highlights include rapid fire sessions, poster exhibitions, DVD presentations and the largest UK commercial exhibition The RCOphth Congress delivers a diverse scientific programme running alongside our unparalleled scientific sessions. In providing delegates with an extensive range of topics delivered addition, there will be a series of courses and workshops. by prominent speakers from the UK and overseas. This year’s Eponymous Lectures are: Subspecialty Day • The Duke Elder Lecture will be delivered by Professor This year delegates will be able to choose from five subspecialty Keith Martin, Professor of Ophthalmology, Addenbrooke’s topics. The ever-popular Retina day and Glaucoma day will be Hospital, Cambridge, UK complimented by a Neuro-ophthalmology day, an Emergency Ophthalmology and Primary Care day and a Cataract and • The Edridge Green Lecture will be delivered by Professor Refractive Surgery day – something for everyone! Delegates Anya Hurlbert, Professor of Visual Neuroscience, University will be free to move between subspecialty days and can tailor of Newcastle, UK their agendas to suit their own educational needs. • The Keeler Lecture will be delivered by Professor Ivan Please visit www.rcophthcongress.com for more information Schwab, Professor of Ophthalmology, University of California Davis School of Medicine, USA • The Optic UK Lecture will be delivered by Professor Kay Dickersin, Professor of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA 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 suitable for all doctors who are responsible for teaching and training premises unless otherwise specified. ophthalmologists, Eye Care Professionals or medical students. This course uses a blend of independent preparatory learning with Paediatric Ophthalmology: The Essentials intensively-facilitated practical sessions on the day. Tuesday 7 March 2017 Neuro-Ophthalmology - The Unmissable Full Synopsis and Programme to follow. wednesday 29 MarCH 2017 Training the Trainer for Trainees Programme to be announced. monday 13 March 2017 This is a new course set up in recognition of the fact that trainees Surgical Skills Courses are involved in delivering training and need these skills before becoming consultants. Please check the website or contact the Education and Training Eye & Vision Research - NIHR Masterclass Co-ordinator on 020 3770 5341 or [email protected] wednesday 15 March 2017 for availability as courses get fully booked quickly. We are delighted to run this popular collaborative seminar with Microsurgical Skills Course NIHR which provides excellent educational content on research set WEDNESDAY 22 FEBRUARY 2017 & WEDNESDAY 15 MARCH 2017 up in the health service. More details and programme to follow. Microsurgical Skills courses, a mix of lectures and practical skills Training the Trainers - Teaching and Enhanced sessions, are run at the College in the state-of-the-art Skills Centre. The courses cover the basic concepts of instrument design and Learning handling, sutures, suturing and knots, wound construction and monday 20 MARCH 2017 closure and the use of the operating microscope. The courses Teaching & Enhancing Learning will help teachers and trainers are three days long, the third day being dedicated to basic develop a variety of educational skills that will engage trainees phacoemulsification training, although the first two days include and help them learn efficiently and effectively. The course is training in microsurgical skills relevant to cataract surgery.

Non-RCOphth Events Book your place by visiting www.rcophth.ac.uk/events-and-courses/non-rcophth-events/ Moorfields Ophthalmic A&E Course 19th Medical Ophthalmological Society Meeting WEDNESDAY 11 JanUARY 2017 ThuRSDAY 16 March 2017 Venue: Moorfields Eye Hospital Venue: The Royal York Hotel, York This comprehensive course is aimed at ophthalmologists and other The meeting will include a Symposium on Mitochondrial Disease and clinical staff involved in assessing patients with acute ophthalmic the Eye, an Update on Imaging, a free paper session and the Annual problems. Organised by Miss Seema Verma, attendees will acquire Guest Lecture on Rheumatology and the Eye. Visit www.mosuk.co.uk the skills needed to manage common and serious eye problems in a practical way. Visit the Moorfields website Cornea and Oculoplastics Course ThuRSDAY 16 March – FriDAY 17 March 2017 One-Day Symposium on Lacrimal Surgery Venue: Corneo Plastic Unit, Queen Victoria Hospital TueSDAY 7 March 2017 Including Clinical Sessions with an opportunity to examine patients Venue: The Ipswich Hospital NHS Trust, IP4 5PD with ‘textbook’ examples of Corneal and Oculoplastics disorders Primarily for ophthalmologists and otolaryngologists who are and diseases. Email [email protected] interested in lacrimal surgery. Would be useful to those in the process of establishing a DCR practice in their department. Course Fee £450. Visit Coventry Advanced Strabismus Cadaveric Course www.ipswichhospital.nhs.uk/ent/teaching-and-education.htm ThuRSDAY 6 April – FriDAY 7 April 2017 The 4th Manchester Oculoplastic, Lacrimal & Venue: West Midlands Surgical Training Centre, Coventry Orbital Dissection Course This course is aimed at specialists in Strabismus at Fellowship or Consultant level. There is the opportunity to perform complex WedNESDAY 8 – FriDAY 10 MarCH 2017 strabismus surgery in a safe environment on cadavers. Venue: The University of Manchester Email: [email protected] This course features speakers with international reputations in their specialist fields. Fresh frozen cadaver dissection in one of the most MOS - Pantheo Annual Congress 2017 advanced skills labs in UK with focus on dissection and surgical SATURDAY 22 – SUNDAY 23 April 2017 techniques. Maximum hands-on experience of surgical techniques Venue: Amathus Hotel, Limassol, Cyprus with a high expert faculty to delegate ratio. Contact Saj Ataullah Theme: “Sleepless nights for the ophthalmologist”. UK Neuro-Ophthalmology Special Interest Group Contact: Dr Katia Papastavrou. [email protected] – 9th National meeting BOPSS 2017 TUESDAY 14 – WEDNESDAY 15 March 2017 WEDNESDAY 21 – FRIDAY 23 June 2017, London Venue: The Royal York Hotel, York Venue: Royal Society of Medicine, London Joint meeting with the Netherlands Neuro-Ophthalmology Society Sessions will include: Ptosis, Lower Lids, Orbits, Lacrimal, Thyroid – consists of interactive case presentations, research and audit Eye Disease, Surgical Tips and there will be free paper and eposter presentations, updates on Electrodiagnostic Assessment and Toxic sessions. The outline programme details and updates can be found and Nutritional Optic Neuropathy. Visit www.UKNOSIG.com on the website www.bopss.co.uk/meetings/bopss-2017-london/ delivering surgical innovation

Altomed not only bring to you its own extensive instrument range, we also deliver to you leading world ophthalmic brands such as Sterimedix, MST, Volk, Labtician and Mani. Ask for a copy of our free colour catalogue and our latest price list. www.altomed.com

Katalyst Instrumentation New IOL Cutter Q-Rinse by Altomed

The expanded Katalyst VR range now include Single-use versions of the MST Packer Chang IOL Altomed now manufacture Q-Rinse in the UK. more laser probes and the unique black silicone Cutter, and its twin instrument, the Micro Holder. It is a convenient simple device, ideal for flushing diamond-dusted membrane polisher tips on the Now everyone can have these useful instruments costly lumened instruments such as phaco Tano Polisher and flute handles. ready and waiting, for those challenging cases. No handpieces. risk of cleaning and handling damage.

Reusable. Efficiently using resources and funds.

Using modern automated decontamination methods and the latest generation of trays such as Altomed Microwash, reusable instruments can be safely cleaned and sterilised without damage.

2 Witney Way, Boldon Business Park Tyne & Wear, NE35 9PE. England Tel: +44 (0)191 519 0111 Fax: +44 (0)191 519 0283 Email: [email protected] Web: altomed.com

altomed_eyecollnews_150616.indd 1 15/06/2016 14:35