college news

QUARTERLY BULLETIN JULY EDITION 2017

2017 Annual Congress captured in images PAGES 4-5

Alström Syndrome New Award Museum Piece PAGE 12 Advancing PAGE 21 New Primer PAGE 11 diagnosis, care, Fellowship Awards The Olympian treatment and support of £60,000 Ophthalmologist college news

Dear fellow members,

It is a great honour to have been elected as the twelfth Contents President of The Royal College of Ophthalmologists, and I am very 4 Congress in images grateful for this opportunity to lead 7 Focus Complications of strabismus surgery our College for the next three years. 11 Museum Piece Whatever challenges we face, whether Capturing the Past they be to the NHS or to our Profession, I 12 Alström Syndrome Advancing diagnosis, intend to continue to deliver the resolute care, treatment and leadership of my predecessor, Professor support Carrie MacEwen, who has been an 14 Eye journal Editor’s inspirational leader of our College. I was There are no easy solutions to these issues. Choice from second quarter 2017 fortunate to have the opportunity to work We can begin by sharing and adopting with Carrie at the College in my previous best practice in order to optimise care 18 Ophthalmologists in Training Indirect role as Chair of the Scientific Committee, and minimise inefficiency. This includes Laser - Top Tips and I believe that we share the same core working collaboratively with our nursing, 23 Diary Dates values and beliefs. optometric and orthoptic colleagues. We have to justify and campaign for both Those of you who attended Congress will additional manpower and the space be aware that my children, influenced by Don’t forget to to work. The latter is now the major recent world politics, felt it appropriate follow us on Twitter: constraint on service development in to present me with a red baseball cap @rcophth many eye departments. I believe that embroidered with the words ‘Make our College has a pivotal role in raising Ophthalmology Great Again’. Grateful these issues nationally and in developing Articles and information to though I was for this unexpected gift, be considered for publication solutions. should be sent to: I believe that they were misinformed. Ophthalmology is already great. Despite I encourage you all to become more Liz Price Communications Manager the pressures we work under, it remains a involved with your College. By doing so [email protected] privilege and joy to restore sight to you will help to maintain and develop Copy deadlines the blind. our profession. You will also gain a wider October 2017 edition: perspective of ophthalmology throughout 22 September 2017 Unfortunately, we are all too aware of the the UK and abroad. Let us work together January 2018 edition: challenges to our profession. Traditional 24 November 2017 to shape the future. NHS hospitals appear unable to respond April 2018 edition: 2 March 2018 sufficiently rapidly to the growing July 2017 edition: demands of an increasing and aging 1 June 2017 population. New and ever more effective Editor of Focus: treatments are always welcomed, but Mike Burdon, President Mr Andrew Tatham require additional resources. In many [email protected] Advertising queries should areas of the country outside agencies are be directed to: Robert Sloan being recruited to provide eye care. Whilst 07963 187 583 they may help to address the immediate [email protected] service pressures, they frequently have Contact Details: a long-term impact on existing eye The Royal College of Ophthalmologists departments and their ability to train the 18 Stephenson Way next generation of ophthalmologists. London, NW1 2HD T. 020 7935 0702

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

The Lay Advisory Group sends their Chairman Tom Bremridge their warm thanks and very best wishes as he leaves the RCOphth in July

Tom had a distinguished career in the Army, retiring as a Brigadier, before joining the Macular Society as CEO and then as the Lay Advisory Group (LAG) Chair in 2013. Tom has been a very popular and hard-working Chair and a strong figurehead for the LAG, evidenced by the amount of work that the group now covers, which takes a good degree of co-ordinating!

His contribution has been considerable in making LAG into what our former President Carrie MacEwen described as ‘a model of how patients and lay members can contribute meaningfully to College work that will always remain as my gold standard.’

Tom also helped to develop and support the RCOphth’s Strategic plan, represented LAG and patients’ interests at Council, as a part II examiner, whilst continuing to lead and motivate the LAG by example and with his particular blend of intelligence and charm.

Much good work for the RCOphth has been completed by the LAG in the last four years, including writing the response to the AoMRC consultation ‘Doctors working for the wider NHS’ which is very supportive of ophthalmologists. Tom’s humour and energy will be much missed by the lay group members, as well as his occasional stern moments which kept us in line!!

The Lay Group

CVI has been updated – important changes that all ophthalmologists should be aware of

Working in partnership with The Royal College of This allows consultant ophthalmologists flexibility in their Ophthalmologists, RNIB and others, the Department of Health professional judgement whether to certify a person as sight has updated the Certificate of Vision Impairment and revised impaired or severely sight impaired. The Notes also explicitly the Explanatory Notes. The key objectives have been: remind doctors that patients who are certified must not drive and of their duty to take action where patients continue to drive • To simplify the form, collecting only essential information when they are not safe to do so. • To make it easier and quicker for ophthalmologists and eye The RCOphth encourages all ophthalmologists to familiarise clinic staff to complete themselves and their teams with the revised guidance, to use • To have a single CVI form for both adults and children only the updated form and to destroy stocks of the old form.

• To provide better information to patients and their carers Please look out for the CVI update in the regular members’ about sources of support e-newsletter Eye-mail and on the RCOphth website.

For England, Wales and Northern Ireland, it has been Nick Wilson-Holt acknowledged that the previous ‘work test’ is no longer Consultant Ophthalmologist, Royal Cornwall Hospital relevant or appropriate, and the criteria for certification, based on visual acuity and visual field have been clarified in the Explanatory Notes, emphasising importantly that these are for guidance only.

3 college news

1,486 Delegates across all four days of Congress

303 Individual talks and lectures

An excellent Over 211 3,450 posters showcased lunches were served

1,400 Tweets using #RCOphth2017, increase of 60% on last year

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

Thank you to all 259 speakers

40 Number of exhibitors

1,787 Unique visitors to the Congress app

Thank you to our 22 poster judges

5 college news Make your clinical practice more evidence-based

Book a place now at the first ‘Research Changes Jugnoo Rahi commented, ‘Many aspects of eyes and vision Lives’ two-day seminar that will help you learn how to research in the UK is world leading but The Royal College of both generate and apply high quality research evidence Ophthalmologists recognises the need to strengthen academic to your clinical practice and your eye services. ophthalmology in all its forms. This seminar is a College initiative to enable clinicians to engage in research and to use research The seminar programme has been organised by Phillippa evidence more effectively to improve care and services.’ Cumberland and Jugnoo Rahi, GOS Institute of Child Health Research changes lives – How to generate and apply high- UCL. This has been in response to the need for training in these quality evidence to your practice - 15 & 16 November 2017 skills and is tailored to the needs of ophthalmic clinicians. Day one: Practice changing research: An overview of research The vital role of research in underpinning service provision design and implementation, evidence appraisal and synthesis and planning in the NHS is well established, with a recognition that patients have better outcomes when managed in NHS Day two: The ABC of ophthalmic statistics: An overview of the services or organisations that have a strong research profile. role of statistics in ophthalmic research and use of appropriate As well as providing the evidence that allows those working approaches to statistical analysis in health and healthcare policy to make better choices and decisions, research provides key information for the public and Book your place soon to avoid missing out via www.rcophth. our patients. ac.uk/events-and-courses/ NIHR Clinical Research Network Ophthalmology Symposium, ARVO 2017, Baltimore, USA

research networks, and how this can specifically facilitate international research collaboration.

Douglas Jabs, Professor and Chairman of the Department of Ophthalmology, Mount Sinai Medical School (New York, USA), spoke next, giving a personal insight of his positive experience of collaboration with the NIHR in delivery of the Multicenter Uveitis Steroid Treatment (MUST) trials. He explained that UK sites had proved highly efficient in achieving their recruitment targets, and expressed a strong desire to continue his collaboration with NHS eye departments for future research.

After a short break for lunch and networking, there were further presentations from Professor Sobha Sivaprasad, Mr Praveen The National Institute for Health Research (NIHR) held a Patel, Mr Philip Hykin and Professor Simon Harding, each lunchtime meeting at the recent Association for Research in discussing their own experiences of NIHR-supported clinical Vision and Ophthalmology (ARVO) conference in Baltimore, research within the NHS. Finally, Mr Richard Lee introduced USA, to promote the UK as a site for international research Dr Henry Wiley, staff clinician at the National Eye Institute collaboration. This was an event to showcase the wealth of (NEI, Bethesda, Maryland, USA) to discuss his experience of opportunities for clinical research within the NHS, and highlight collaboration with NHS sites in delivery of a randomised trail of the invaluable support offered to research groups through bevacizumab and ranibizumab for diabetic macular oedema. the NIHR. Members of the international ophthalmic research community were invited to attend, including delegates from In the discussion that followed, delegates remarked that the countries including the UK, USA, India, Singapore and Australia, potential size of patient cohorts accessible through the NHS, along with industry representatives from companies including and the comprehensive level of support and guidance offered Bausch & Lomb and Novartis. by the NIHR impressed them, and that such opportunities are often not present in their home countries. It thus appears The event was hosted by Professor Rupert Bourne, chair that the NHS and NIHR are indeed attractive prospects to the of the NIHR Ophthalmology Clinical Research Network, international research community, and it is hoped that events who commenced the session with a brief introduction to such as this will encourage increased collaboration in the future. the scope of NIHR-led research within the NHS. This was followed by a presentation from Faruque Ghanchi, Professor Robert Barry, NIHR Clinical Lecturer and ST5 of Ophthalmology at the University of Bradford, who further Ophthalmology University of Birmingham and West discussed the role of the NIHR, organisation of the clinical Midlands Deanery

6 An occasional update commissioned by the College. focus The views expressed are those of the authors. Complications of strabismus surgery

John Bradbury the least common reported complications (Figure 2). Anterior segment Consultant Ophthalmologist ischaemia was not reported in the BOSU study, but has previously 2 Bradford Teaching Hospitals NHS Foundation Trust been reported to occur in approximately 1:13, 000 operations. Each complication is discussed in more detail below. 1. Globe perforation Complications of strabismus surgery are uncommon but Globe perforation is the commonest severe complication of strabismus when they occur can be devastating. Many complications surgery, reported in 0.13% to 1% of cases. In the BOSU study, the require urgent treatment and although problems are often incidence was 1:1,000. Globe perforation appears to be more common detected intraoperatively, it is important all ophthalmologists in children, perhaps due to difficult surgical access. Although globe are aware of the possibility of such complications occurring. perforation is not infrequent, a poor or very poor outcome is extremely This article discusses the frequency and management of rare. 18 of 19 patients with globe perforation in the BOSU survey had a severe complications that may be encountered. good outcome (grade one or two) with only one patient suffering a very poor outcome. This patient developed endophthalmitis and eventually Incidence needed evisceration. Complex surgery, e.g. Faden procedures, may have The incidence and outcomes described are largely from a 2-year a higher incidence of globe perforation. prospective survey of severe complications of strabismus surgery carried In the BOSU study, globe perforation sometimes occurred when out by the author through the British Ophthalmic Surveillance Unit placing a traction suture. This resulted in penetration into the anterior (BOSU).1 Approximately 12,000 strabismus procedures are performed chamber and a soft eye making strabismus surgery difficult. Most cases annually in the UK. The BOSU survey revealed an incidence of severe of posterior segment perforation were identified peroperative and complications of strabismus surgery of 1 per 400 operations, with equal treated, usually with cryotherapy or laser. There was one case of retinal frequency in adults and children (Figure 1). Outcomes were graded by detachment in a high myope who had bilateral globe perforation from severity from good to very poor, with the definitions for each category bilateral Harada-Ito procedures. shown in Figure 1. Overall, 16% of patients experiencing a complication (1 in 2,400 of total operations) had a poor or very poor outcome, defined as Management of globe perforation is not evidence based. Ninety diplopia in the primary position or loss of at least one line of Snellen acuity. percent of cases are treated with cryotherapy and/or laser.7 In children, where globe perforation is more likely, retinal detachment is unlikely Grade 1 Good outcome as they have formed vitreous. If globe perforation is suspected Grade 2 Surgical or medical intervention good outcome during surgery, we perform a dilated fundus examination to confirm the diagnosis and seek a vitreo-retinal opinion, if available, before Grade 3 Surgical or medical intervention asymptomatic but considering treatment. In adults, we perform a fundus examination compromised outcome and, in patients with a high risk of retinal detachment (i.e. high Grade 4 Surgical or medical intervention but poor outcome myopes), perform peroperative treatment of the hole and then seek e.g. double vision or up to 2 lines of loss of vision on vitreo-retinal opinion. We do not treat those at low risk, but would seek a Snellen chart a later vitreo-retinal opinion. All patients have systemic antibiotics to Grade 5 Very poor outcome, greater than 2 lines of visual reduce the risk of endophthalmitis. Rathod et al, reported two cases loss on a Snellen chart of endophthalmitis, two retinal detachments, one suprachoroidal haemorrhage, and one choroidal scar following globe perforation.3 Figure 1. Severity of outcomes reported in the BOSU survey Strategies to prevent globe perforation include:

12 1. Avoiding suturing in areas with scleral thinning. 2. Techniques (i.e. hang-back procedures) that do not involve direct 10 scleral suturing in thinner areas or where access is difficult.

8 2. Slipped muscle

00 In the BOSU study, slipped muscle was defined as the patient ,0 6

r 10 presenting with an overcorrection and 50% or more reduction in Pe movement in the action of a previously operated muscle. There were 18 4 cases, and it was slightly more common in children. In three of these,

2 the slipped muscle resulted from a muscle insertion infection. Three of 18 had a poor or very poor outcome; all were children. 0 Globe Slipped Infection ScleritisEIntra-operative RD ndophthalmitis Slipped muscles take two main forms. A true slipped muscle is similar Perforation muscle lost muscle to a lost muscle and is usually due to a problem with the sutures or insertion soon after the operation. The suture fails and the muscle Figure 2. Frequency of severe complications slips. One deals with this like with a lost muscle. The more common Globe perforation was the most common complication with an presentation occurs many weeks to even years later, with a gross incidence of almost 1:1,000, followed by slipped muscle with an limitation of action of the muscle that has slipped. Exploration often incidence of 9 in 10,000. Retinal detachment and endophthalmitis were finds the muscle on a large pseudotendon. The pseudotendon is FOCUS - THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JULY EDITION 2017 removed and the muscle re-attached to the globe. Shortening of the beware of anterior segment ischaemia in adults. A more experienced antagonist may require recession of it and the conjunctiva. strabismus surgeon may be able to find the muscle at a subsequent exploration. Postoperative investigations may include MRI or CT scans. 3. Orbital infection An orbital approach may help with a posteriorly situated muscle. Orbital infection following strabismus surgery tends to be equally either diffuse orbital cellulitis or an abscess at the muscle insertion. 6. Endophthalmitis In the BOSU study there were 14 cases, with only 3 cases reported in There was one case of endophthalmitis in the 2 years of the BOSU adults. Three muscle insertion abscesses developed a slipped muscle giving an incidence of 1:24 ,000 cases. requiring surgical exploration. Management depends on whether the 7. Other complications infection is diffuse orbital infection, in which systemic antibiotics are usually curative, or a muscle insertion abscess with a slipped muscle, Adherence syndrome which requires surgical exploration, drainage and systemic antibiotics. This is a restrictive condition, often progressive, caused by orbital fat Histology of endophthalmitis cases following strabismus surgery has coming through a surgical disruption of posterior Tenon’s, as a result of shown that infection can gain access to the eye from a postoperative strabismus surgery, commonly to the inferior oblique. Occasionally it is muscle insertion infection, suggesting an aggressive approach to caused by trauma or lid surgery. To prevent adherence syndrome, care postoperative muscle insertion infections is warranted. must be made to visualise the posterior edge of the inferior oblique 4. Surgically induced necrotizing scleritis so only the muscle (and not posterior Tenon’s) is hooked. Sometimes excessive bleeding leads to poor visualisation and contributes to Surgically induced necrotizing scleritis (SINS) is a rare but serious the scarring process. If orbital fat prolapses at surgery the fat can complication of strabismus surgery. SINS is exceptionally rare in children, be excised and the posterior Tenon’s repaired. Often, however, the with only one reported case in the literature, however in the BOSU study problem is found postoperatively as the patient develops progressive six adult cases were reported, presenting 1–6 weeks postoperatively, hypertropia and limitation of elevation. Surgical options are to explore usually with ocular pain. They were treated usually with topical and the inferior fornix, excise any orbital fat, repair the posterior Tenon’s systemic non-steroidal anti-inflammatory drugs (NSAIDs) or steroids. One capsule defect, and then recess the inferior rectus, Tenon’s, and severe case required treatment with cyclophosphamide and developed conjunctiva followed by an amniotic membrane graft. posterior synechiae and a cataract reducing the vision to log MAR 0.60 (6/24, 20/80, 0.25) another patient, who presented 14 days following Anterior segment ischaemia surgery, had a corneal melt and required a conjunctival auto graft nearly Two anterior ciliary arteries (branches of the ophthalmic artery) 2 years later with good visual acuity. Fifty percent of cases had a poor or supply each rectus muscle apart from the lateral rectus which has very poor outcome. Most patients were elderly but two were in their 20s. only one: the obliques have no anterior ciliary arteries. The incidence of significant anterior segment ischaemia (ASI) is around 1:13 ,000 Presentation of postoperative scleritis can be delayed (up to 40 years). As cases.2 It was not surveyed in the BOSU study because ASI would be the BOSU study follow up period was only 6 months the incidence reported grossly underreported especially in children where postoperative slit- may represent an underestimation. Also, although we did not collect lamp examination is not normally performed. Severe outcomes are rare information on pre-existing conditions that might predispose to scleritis although there is a report of phthisis bulbi. Risks factors for ASI include such as systemic autoimmune conditions and ischaemia, O’Donoghue et increasing age, previous rectus surgery, operations on multiple muscles al.4 reported a high prevalence of collagen vascular disease in postoperative (especially recti) in the same eye, circulation problems (i.e. hypertension scleritis. This, together with the poor prognosis, suggests patients with SINS or diabetes), similar surgery on adjacent rectus muscles, surgery on may best be seen by an inflammatory disease specialist. vertical rectus muscles, and a limbal incision. Mild scleritis may be common following strabismus surgery, presenting In children, although it may be safe to operate on more than two recti with pain, more severe and deep-seated than normal, with diffuse muscles at once: most surgeons avoid operating on all four recti muscles scleral inflammation requiring oral NSAIDs. Risk factors include older simultaneously. If it is necessary to operate on more than two recti age, poor circulation, scleral diathermy, and ischaemia. muscles in an adult or if the patient has a very high risk of developing 5. Lost muscle ASI, ciliary artery sparing surgery can be performed by dissecting out In the BOSU study, lost muscle was defined as a muscle lost one of the anterior ciliary arteries. Symptoms and signs of ASI can vary peroperatively. There were six lost muscles, five in adults. Most were in from mild uveitis and reduced iris perfusion to corneal clouding. elderly patients, four of whom had had previous strabismus surgery. Grade 1 ASI can only be detected by iris angiography. Four were medial recti, two were lateral recti. Medial recti are the most common muscles lost during surgery. This may relate to how Grade 2 ASI is associated with areas of iris hypoperfusion, and frequently the muscle is operated on, or to its anatomy. The other recti sometimes an abnormally shaped pupil. It rarely requires treatment. have attachments to the oblique which prevent the muscle retracting Grades 3 and 4 ASI usually require treatment with topical or systemic into the orbit. All patients in the BOSU study had the muscles found corticosteroids. Unusual treatments include hyperbaric oxygen. The peroperatively: only one had a poor or very poor outcome. vast majority recover with only minor sequelae including iris atrophy, corectopia, or a poorly reacting pupil. Should a muscle be lost peroperatively it is best to find the muscle immediately. A common mistake is to look for the muscle around Summary the globe when in fact the recti muscles lie slightly away from the Although severe complications occur more frequently than was thought globe. Seek help from an experienced surgeon, use suitable retractors (1 in 400 cases), few have poor or very poor outcome (1 in 2,400 cases). for exposure, and control haemostasis. Careful exploration usually If a strabismus surgeon performs 150 operations per year for 30 years finds the muscle sheath and the muscle within. Some authors have he/she would expect to see about 11 cases of severe complications of suggested using the oculo-cardiac reflex as a way of finding the which one, or if unlucky two, may have a poor or very outcome. muscle as pulling on the muscle would slow the heart rate but this is only partially useful. If the muscle cannot be found, suture the check Andrew Tatham, Editor, Focus ligaments and Tenon’s surrounding the muscle to the original muscle References can be accessed via the online copy of College News in the insertion as some muscle action may be transferred though these members’ area of the website tissues to the eye. A muscle transposition could be performed, however, www.rcophth.ac.uk/standards-publications-research/focus-articles/ Extra long jaws help to advance the IOL deep into the cartridge

Angled and straight IOL loading forceps

John Weiss IOL loading forceps have extra long jaws that enable the IOL to be advanced deep into the cartridge, the smooth atraumatic rounded tips help reduce risk of damage to the IOL. When closed, the tips form a ‘v’ shape, facilitating better engagement with the IOL. www.johnweiss.com

ANGLED STRAIGHT 0109448 Titanium 0109449 Titanium 0101610 Stainless Steel 0101609 Stainless Steel

If you’d like to arrange to see them please contact us on +44(0)1908 340000 or email [email protected] It’s black and white

RNFL GCL IPL/INL INL/OPL

Visualise four vascular plexuses with the highest resolution in any field of view

High Res: High Speed: Full Field: 10˚ x 10˚ 5.7µm 15˚ x 15˚ 11µm 15˚ x 30˚ 11µm

Experience dynamic high resolution, high speed and full field multi-modal imaging

OCT Angiography Module

There are no shades of grey when isolating flow. With SPECTRALIS it is black and white and you know with TruTrack Active Live Eye Tracking that you are always scanning in the exact same location for reliable flow data. High contrast SPECTRALIS OCTA images enable you to make fast clinical decisions with confidence.

www.HeidelbergEngineering.co.uk 313193-001 UK.BE17 © Heidelberg Engineering GmbH THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JULY EDITION 2017

It’s black and white Museum Piece Capturing the Past

What is the connection between Casanova, Squint and an 2009 The Olympian Ophthalmologist Olympic medal? This is the story of the world-famous The answer is 12 years of dedicated work by Hugh Williams ophthalmologist, scientist, army and his production engineer Alan Lacey to produce a trio of doctor, author and athlete Henry educational films on these three diverse subjects. Casanova is Stallard. (Fig 3) the story of the invention and development of the intraocular The film starts with Stallard’s lens. Squint is an explanation of strabismus for the layman and extraordinary athletic career with RNFL GCL IPL/INL INL/OPL the Olympic Medal is an illustrated biography of Henry Stallard, original footage of his heroic run in ophthalmologist and Olympic runner. (Fig 1) the final of the 1,500m at the Paris Olympics in 1924 when he won a Figure 3. Henry Stallard bronze medal. He ran five races in five racing days, the last three with a broken foot. The film details the period before the Second World War with Stallard’s early career in medicine and his chosen speciality, ophthalmology. His early work on retinoblastoma rapidly made him the world’s authority on the treatment of this rare disease. Visualise four vascular plexuses with the highest resolution in any field of view He distinguished himself in the war serving as a surgeon in North Africa and Normandy. He was stationed in Cairo where he repaired hundreds of ocular wounds. It was here that he started the draft of his famous book Eye Surgery, first published in 1946 and which is still in print. High Res: High Speed: Full Field: 10˚ x 10˚ 5.7µm 15˚ x 15˚ 11µm 15˚ x 30˚ 11µm After the war, Stallard had to rebuild his career in Figure 1. Illustrated DVD boxes of first three films ophthalmology. He became one of the country’s outstanding A fourth film, just launched, is an update of Casanova and the ophthalmologists and was fêted wherever he travelled. He Spitfire Pilots was awarded many distinctions and late in his career in 1972 he became President of the Ophthalmic Society of the United Casanova and the Spitfire Pilots. (2017 Edition) Kingdom. He died of bone cancer the following year.

This hour-long film fills in the 12 years since Hugh Williams’ first 2013 Turning a Blind Eye venture into film making since the 2005 version of Casanova. This film was issued as a tribute to the work and life of John Lee, It tells the story of the birth of the intraocular lens up to the late President of The Royal College of Ophthalmologists. Experience dynamic high resolution, high speed and full field multi-modal imaging very latest technology in lens design and cataract surgery. Hugh was witness to the people who invented the first IOLs It is a story about strabismus, omitting any didactic surgery but and is ideally placed to give a detailed account of how cataract introducing unusual illustrations associated with squint. surgery has changed so dramatically from the 1950s. The film commences with Theodor The connection between Casanova and Spitfire Pilots Ruete’s ophthalmotrope of 1857 is painstakingly explained with Harold Ridley’s (Fig 2) which he designed to demonstrate the experimentation of making a lens with the same inert material movements of the eyes and interaction found lodged in the eye of a Battle of the muscles. (Fig 4) The various of Britain pilot. forms of squint, social stigma and some myths about cures are explored. His work and those of his colleagues met fierce resistance from the The emergence of the Synoptophore OCT Angiography Module Figure 4. Ruete’s and the role of the Orthoptist are profession. Today there are Ophthalmotrope thousands of different designs highlighted. The film ends with the There are no shades of grey when isolating flow. of IOL and with the change therapeutic use of computer games for children with amblyopia With SPECTRALIS it is black and white and you know in technology and the use of and of the injection of Botox for the surgical alleviation of with TruTrack Active Live Eye Tracking that you are always biomaterials there will be many squint introduced by John Lee in his clinic at Moorfields. scanning in the exact same location for reliable flow more. Nowhere else is the story All three films are available to view from the members’ area data. High contrast SPECTRALIS OCTA images enable of cataract extraction, phaco- of the RCOphth website. you to make fast clinical decisions with confidence. Figure 2. Harold Ridley emulsification and IOLs to be found. while at St Thomas’ Richard Keeler, Honorary Curator www.HeidelbergEngineering.co.uk 313193-001 UK.BE17 © Heidelberg Engineering GmbH Hospital [email protected] 11 college news Advancing Diagnosis, Care, Treatment and Support for those living with Alström Syndrome in the UK

‘Health, Happiness and Wellbeing’ Conference Aston Conference Centre, Birmingham

Scientific Symposium Friday 6 October 2017 at 2pm followed by an informal networking and buffet supper at 6:30pm

Family and Professional Conference Saturday 7 October 2017 9am-5pm We would like your help! The conference brings together renowned Alström Alström Syndrome is an ultra-rare genetic condition; experts from around the globe including clinicians, for many the first noticeable symptoms are nystagmus, educationalists, academics, individuals affected, and photophobia and cone-rod dystrophy which may lead their families to share and discover research and clinical to progressive blindness. advancements; as well as stimulating thought provoking discussions and enabling like-minded people to network The condition is complex and may affect all the main organs and collaborate together. including sight and hearing loss, heart and kidney failure, type 2 diabetes and liver dysfunction. Diagnosis can be extremely ASUK is delighted that Dr Pietro Maffei from AS Italy difficult. Symptoms present at different stages and even amongst and Professor Colin Johnson from the Institute of siblings the symptoms can vary. Many health professionals may Molecular Medicine at St James’s University Hospital, never have seen the syndrome and with Ophthalmologists being have agreed to speak about their current research and at the forefront of eye health services, your expertise could be key clinical developments. in helping us improve rates of diagnosis. This offers an opportunity for members from The Royal ASUK have produced a short animation to raise awareness and College of Ophthalmologists to learn more about this improve diagnosis, enabling people affected to seek expert ultra-rare condition and share their own expertise. The advice and treatments from the Alström Syndrome multi- conference is free to attend and venue details can be disciplinary medical clinics, run in partnership with the NHS at found at www.conferenceaston.co.uk/guestinfo the Queen Elizabeth Hospital in Birmingham and Birmingham For bookings and enquiries contact Catherine Lewis on Children’s Hospital. The animation can be viewed on our 01803 613117 or email [email protected] website, please share with your networks www.alstrom.org.uk/ awareness-animation-is-launched/

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

13 college news

Eye Journal - Editor’s choice Selected papers from 2nd quarter 2017

1. Assessment of the Apple iPad as a low-vision reading aid a concomitant upregulation of the complement regulators FH (P=0.02) and FI (P=0.04). They concluded that these In the June issue, Morrice et al, Eye (2017) 31: 865-871, findings provide strong evidence for a local complement assessed the Apple iPad as a low-vision reading aid. They dysregulation in nAMD patients. did this because low vision clients frequently report having problems with reading. Using magnification, reading 3. Caffeine intake is associated with pupil dilation and performance (as measured by reading speed) can be enhanced accommodation improved by up to 200%. Current magnification aids can In the April issue, Abokyi et al, Eye (2017) 31, 615–619, however be expensive or bulky; therefore, they explored if assessed whether caffeine, an autonomic stimulant, the Apple iPad offers comparable performance in improving affects visual performance by assessing whether caffeine reading speeds, in comparison to a closed-circuit television intake was associated with changes in pupil size and/ (CCTV) video magnifier, or other magnification devices. or amplitude of accommodation. In a double-masked, They found that all assistive devices improved reading rates crossover study of 50 healthy subjects of age range 19 to in comparison to baseline but there was no difference in 25 years subjects were randomized to treatments such improvement across devices. When experience was taken that subjects consumed either 250mg caffeine drink or into account, those with iPad experience read, on average, vehicle on separate days. They found that amplitude 30 words per minute faster than first time iPad users, of accommodation and pupil size after caffeine intake whereas CCTV experience did not influence reading speed. were significantly greater than vehicle (P<0.001) at each They concluded that the Apple iPad was as effective as time point with significant increases in amplitude of currently used technologies for improving reading rates. accommodation and pupil size with time (P<0.001). Moreover, exposure to, and experience with the Apple iPad Andrew Lotery might increase reading speed with that device. Editor in Chief, Eye 2. Local complement activation in aqueous humor in patients with age-related macular degeneration Volume 31 Number 7 July 2017

Volume 31 Number 6 June 2017 www.nature.com/eye In the May issue, Schick et al, Eye (2017) 31: 810-813, www.nature.com/eye investigated complement activation in aqueous humor and in plasma of patients with neovascular age-related macular degeneration (nAMD). Aqueous humor and plasma of 31 nAMD patients and 30 age-matched controls was collected. The levels of the complement factor 3 (C3), the regulators factor H (FH), and factor I (FI), and of the complement activation products Ba, C3a, and the terminal complement complex (sC5b-9) were measured. In plasma, no significant differences were found between the nAMD group and the control group. In aqueous humor, significantly increased levels of Ba (P=0.002), and C3a (P=0.002) indicated local

complement activation in nAMD patients and a trend for Microperimetry in AMD Lacrimal scintillography and epiphora Visual dysfunction and Alzheimer´s disease Hydroxychloroquine retinopathyUnexplained visual loss in children Risk factors for AMD Pregnancy and myopia progression Virtual clinics for glaucoma Retinopathy of prematurity Top Tweets Lacrimal scintillography

Carrie MacEwen @carriemacewen May 25 Stella Hornby @HornbyStella Sub-specialty day #rcophth2017 Glaucoma cataract retina, Looking forward to #rcophthcongress2017 now have emergency or neuro-ophthalmology? Take your pick to hear prepared my talk on #eyeemergencies @RCOphth from the experts @RCOphth @EyedoctorReshma #subspecialtyday Johnson Neo @johnsoneo88 May 24 David Probert @probert_david The best neuro-ophthalmology forum I’ve attended. The Delighted @Moorfields is hosting the @RCOphth final enthusiastic panelists definitely made a huge difference! fellowship exams over the next 3 days. Best of luck to all Awesome # RCOphth2017 @RCOphth those involved. Christopher Bentley @EyedoctorLondon May 23 Faruque Ghanchi @ghanchif Congratulations to Carrie MacEwen on a wonderful term as Thank you @Emmykaty, @praveenjpatel for insightful President of @RCOphth talks @RCOphth @NIHRCRN #masterclass today.

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

My Experience at The Royal College of Ophthalmologists Congress 2017

On Monday 22 May, Dr Williams and I travelled to shared with me on my topic of ‘Should the ophthalmoscope Liverpool for the RCOphth Annual Congress. I was be an instrument for the dustbin’. I quickly learned that the nervous and excited on the trip as we were due vast majority of the audience felt it should most definitely be to deliver a talk on Tuesday morning at Congress taught to undergraduate medical students and that newer instrumentation such as fundus photography will never replace on undergraduate education. I had never been to this golden skill. We asked the audience for some feedback and Congress before, never mind spoken at it. they left some really positive comments which really made me On arrival at the convention centre, I explored the exhibition feel the work I had done was definitely worth all the time and site. Many companies displayed their products and explained effort I had put in. After our session, Dr Williams and I and had the intricacies of their equipment. I was enthralled by the level coffee and discussed how we felt the session had went. It was of detail achieved by some of the surgical equipment, and the a great learning experience, I learned ways in which to improve continuous development in technologies for eye examination my delivery and parts of my presentation which worked well. and surgery. After that, I attended a session on ‘Getting involved in medical I then headed upstairs to hear some of the talks that were research’. This was a really informative session for someone ongoing. I heard talks on eyelid surgeries, I then heard cases at my stage as I enter my F1 training this coming July. It is during the paediatric emergencies talk which were really something I am really interested to be a part of but never knew informative and interesting. At 4pm, I headed to the quick fire which route was the best to take to get involved. It highlighted round chaired by Prof Usha Chakravarthy, it was inspiring to see ways to devise good study design, and in being able to read a professor from my own university, Queen’s University Belfast, research critically and identify the substance behind studies. chair such a prestigious session. It really sparked my enthusiasm After this I took a walk around the posters on display. This gave as numerous trainees spoke on their research topics. me some great ideas on research I could carry out that would On Tuesday morning, I started the day with the delivery of be relatively simple to do and give good findings that would be our presentation on undergraduate education. Initially I could transferable to clinical practice. feel my nerves rising at the thought of speaking on such a big The whole experience of the RCOphth Congress was very stage, especially because of my limited experience at medical enjoyable and I would love to be a part of it again in the future. public speaking! However once the session began, I settled into it and really enjoyed it all. I was really surprised by the Katherine McGinnity, final year medical student, Queen’s level of interaction from the audience and the opinions they University Belfast

Ophthalmology in north India 17 February – 2 March 2018 With Holi Extension to Udaipur 17 March – 5 March 2018

This study tour led by Professor Harminder Dua combines a full cultural itinerary with a series of professional visits. The tour visits Delhi, Amritsar, Agra, Jaipur and Jodhpur. There are scientific meetings with the Delhi and Jaipur Ophthalmological Societies and visits to hospitals and charities. There is a full partner program. See the Golden Temple, Taj Mahal and the Amber Fort, have dinner in the Samode Palace and travel by rickshaw through the bird sanctuary of Bharatpur. Following the tour there is the option to witness the colourful festival of Holi in the beautiful city of Udaipur.

For a full brochure please see www.jonbainestours.co.uk/ ophthal or contact Jon Baines Tours via email info@ jonbainestours.co.uk or call 020 7223 5618.

15 protects1,2 TREHALOSE

hydrates, lubricates3,4 SODIUM HYALURONATE

New on Rx

Clinically proven5,6 - day and night treatment to break the cycle of dry eye

Thealoz Duo and NEW Thealoz Duo Gel harness the unique properties of Trehalose and Sodium Hyaluronate to deliver an artifi cial tear that provides signifi cantly greater improvements in dry eye symptoms than Hyaluronic Acid (HA) alone6.

The addition of carbomer 0.25% in NEW Thealoz Duo Gel signifi cantly extends the duration of the increase in tear fi lm thickness compared to gels containing only Hyaluronic acid (HA) or polyethylene glycol7, meaning less frequent instillation is needed.

Use Thealoz Duo Gel at night and Thealoz Duo during the day to break the cycle of dry eye.

Free from preservatives & phosphates • Hypotonic formulation • Available on the Drug Tariff

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

◆ 1. Hill-Bator A et al. Biomed Res Int 2014(2014):ID 292139 ◆ 2. Hovakimyan M et al. Curr Eye Res 2012;37(11):982-9 ◆ 3. Nakamura M et al. Cornea 1993;12(6):433-6 ◆ 4. Snibson G et al. Cornea 1992;11(4):288-293 ◆ 5. Pinto-Bonilla JC et al. Ther Clin Risk Manag 2015;11:595-603 ◆ 6. Doan S et al. Acta Ophthamologica 2015; 93, Supplement S255 ◆ 7. Wozniak PA et al. Acta Ophthalmol. 2016 Dec 18. doi: 10.1111/aos.13342. [Epub ahead of print]

EyeNewsA4.indd 1 06/04/2017 16:41 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JULY EDITION 2017

Congratulations to Professor Graeme Black on receiving his OBE in the Queen’s Birthday Honours List

Graeme’s strategic leadership has been integral to developing Manchester’s infrastructure and research investment, including The Greater Manchester NHS Genomic Medicine Centre and numerous successful grants from NIHR, Wellcome Trust, Department of Health and national eye charities to fund further research.

Professor Black commented, ‘I am delighted to have received this honour. I am privileged to be part of a team locally and nationally, who over the past decade have progressed from discovering genes linked with inherited retinal diseases, to developing and implementing genetic diagnostics within the NHS. Being able to provide accurate and prompt diagnosis is vital to ensure patients receive the right support and treatment going forward.’

Throughout his career, Graeme has sought to improve the Professor Graeme Black, Honorary Consultant at Central diagnosis, management and treatment of rare genetic Manchester University Hospitals NHS Foundation Trust (CMFT) disorders associated with visual disability. This has involved and Professor in Genetics and Ophthalmology at The University working closely with patient groups and visual impairment of Manchester has been awarded the Order of the British organisations. Most recently, Graeme has overseen a scientific Empire (OBE) in the Queen’s Birthday Honours List. team that provides genetic testing for inherited ophthalmic disease. Having introduced genetic testing for these conditions Graeme, who is also the Strategic Director at the Manchester over the last decade, this can now produce a diagnosis in Centre for Genomic Medicine, has played an integral role in around 80% of children with retinal dystrophies. developing Manchester’s position as a leader in the field of inherited ophthalmic disease, since joining CMFT and University of Manchester in 1995 as a Wellcome Trust Clinician-Scientist Fellow.

A poem in memory of Ida Mann wins a commendation in the international Hippocrates Prize for Poetry and Medicine at Harvard

Mo Abu-Bakra FRCOphth was awarded a Ida’s Light commendation at the awards ceremony for the i.m. Ida Mann Hippocrates Prize in Poetry and Medicine 2017 on This lamp handed down by Ida slits the dark. 6 May at Harvard Medical School. This torch I hold at the keyhole unlocks mysteries. With its sabre light it invades the dark room, Mo trained at Oxford and is a glaucoma fellow of Moorfields where tree branches are crimson, and the ivory trunk Eye Hospital. He said, ‘This poem was inspired in the course a glistening nerve, where carpets are reflexing red, with a central cerulean lake, shimmering. of doing my everyday job by a hero of mine, Ida Mann. It is also homage to the investigative spirit of eye doctors A gleam in the eye uncovers flies, lattice, tobacco dust, discerns the classic from the occult, egg yolk from a bull’s eye, when diagnosing their patients’ eye problems and to the spider webs from a map of North Carolina. Detects holes, tears, profound poetic language handed down by generations of rings, cotton wool, blood, dots, blots, fluid, frost and flames. ophthalmologists when describing eye conditions’. This detective reports to me in clear view, in haze, in fog, hears birdshots, smells bushfires, plays with snowballs, devours honeycombs, The Hippocrates Initiative for Poetry and Medicine provides tracks snails, cattle and bears, runs in a horseshoe, walks on a paving stone, an international forum for people from anywhere in the world swims with salmon in sea fans, finds finger prints in shifting Sahara sand. interested in the interface between poetry and medicine. My trusted side-click moves spotlights in caves and alleys tracing sight-thieves, to steer away from the tunnels, avert the storms and hold up the curtains. http://hippocrates-poetry.org/2017-hippocrates-prize- My storyteller speaks of hot tales, cold memories, images preserved, for/2017-hippocrates-prize-2.html new addresses and old windows. Out of the shadows, the lost messages appear. Come closer. Look here.

17 college news

Ophthalmologists in Training

Author: Lola Lawuyi Indirect Laser - Top Tips Edited by: Mukhtar Bizrah & Prof Lyndon Da Cruz

I was extremely excited about starting my next Therefore, I thought it would be good to share the tips rotation in Vitreoretinal (VR) surgery. However I was that have been taught and learnt. These tips assume that also filled with dread over the prospect of having to you are confident with indirect ophthalmoscopy. (However perform indirect laser ophthalmoscopy on patients if not, a must watch video is Mr Little’s video on indirect referred to the VR emergency clinic. With the stories ophthalmoscopy). of registrars spending hours on only two lasers and the 1. Practice makes perfect. The more you do the easier associated back and neck ache, I secretly hoped that it gets. all my referrals would be posterior tears that could be lasered on the slit lamp (wishful thinking and denial). 2. As one of my consultants said “the laser should be comfortable for you and comfortable for the patient”. However only eight weeks into my rotation I cannot believe You have to find where your preferred position to stand that now I am reaching for the indirect laser. Preferentially for is to enable you to obtain a view. Techniques include the the convenience it has over the slit lamp laser (which happens head prone at the level of the examiner’s waist.1 I found to be placed on a different floor from where the clinic runs). bringing the laser spot just into focus on my hand, (where I position my hand when doing indirect ophthalmoscopy) gave me the height where to position the patient. Indirect ophthalmoscopy offers a brighter illumination for examination through media 3. Lens choice. I use the volk pan retinal 2.2 lens. However, opacities, a wider field of view and the possibility others have found this lens trickier to use perhaps due to to view the anterior retina using scleral indentation. a slightly closer working distance, and so prefer the 20D. Just remember for lenses the higher the diopter power the lower the magnification but the wider the field of view.

4. When starting, I found holding the lens closer to the patient (to obtain a magnified non-inverted view of the anterior segment/pupil) and then gently moving the lens towards myself (ensuring the lens stays perpendicular) would provide a fast inverted image of the retina.2

5. Place proxymethocaine drops in both eyes to help patients keep them open and begin with dim light. Gradually increase it once the patient is accustomed. Beware of using tetracaine eye drops, as they are more toxic to the cornea and may blur your view.

6. To start, obtaining the view especially through the laser indirect ophthalmoscope is the hardest due to the filter in the eyepieces. Therefore one of the fellows recommended; start with the indirect ophthalmoscope firstly. Identify the tear and remember some landmarks (retinal vessels, retinal pigment, haemorrhage) to help you identify it again with the laser indirect ophthalmoscope. Then approach the patient with the laser ready but your foot off and away from the foot Image Reference: Vitreoretinal Surgery. An Interactive pedal. Therefore once you view the tear you can start Multimedia Atlas for Ophthalmology Trainees. Paul lasering. Then switch between the two or the slit lamp to Sullivan, 2014. confirm your laser spots are in the correct area.

18 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JULY EDITION 2017

Laser Beam Scleral Laser Beam Indentor

Figure A Figure B

7. Corneal drying makes an already difficult view even 15. Good indentation does not mean pushing the indentor worse so have normal saline drops ready to hand. hard on the globe. If you keep having to do this, it probably because of misalignment. Therefore check 8. Suggested laser settings to start with: Power 200mW that your visual axis and light beam correspond to the and duration 0.2s. area of indentation. Also check that you are indenting 9. Temporal tears are the easiest to indent. the area you are trying to view. For example, to look at the anterior retina, make sure you are indenting at the 10. Irrespective of all the above this procedure is extremely level of the ora serrata rather than the limbus or more patient dependent. It is paramount to inform the patient posteriorly. what to expect. If the patient expects a five-minute job, and 30 minutes later you are still lasering, they are more 16. You can use the scleral indentor to help you move and likely to become more anxious and less co-operative. fixate the patient’s eye. The patient should know what to expect (e.g. scleral 17. Use the central two thirds of the lens to achieve circular indentation) before the procedure starts. burns, as the peripheral third results in aberration and 11. To optimise retinal view, it is vital to minimise ambient elliptical burns. room lights. 18. There is no single trick to make this procedure successful. 12. Difficulty to see the retinal tear with indirect However we hope that with a combination of the ophthalmoscope laser headset, may be over come with aforementioned factors it will become easier! indentation which makes it much easier to visualise the References retinal break. This is because it allows dynamic movement and visualisation of retina anterior to the break. 1. Vitreoretinal Surgery. An Interactive Multimedia Atlas for Ophthalmology Trainees. Paul Sullivan, 2014. 13. Laser is most effective when the laser beam is facing the retina perpendicularly (figure B) rather than at an angle Mr Paul Sullivan. http://eyelearning.co.uk/vitreoretinal- (figure A). To achieve this for retinal breaks anterior to surgery/ewExternalFiles/Vitreoretinal%20Surgery.pdf the equator, scleral indentation is essential. 2. Clinical techniques in ophthalmology Madge, Simon N. 14. The greatest laser energy is delivered when the laser Edinburgh; New York: Churchill Livingstone Elsevier, 2006. spot size is smallest. This is because the laser energy is concentrated over a smaller area.

Interested in submitting an article for the trainee page of the College News? Then contact Mukhtar Bizrah: [email protected]

19 Optical innovation since 1917 www.keeler.co.uk THE ROYAL COLLEGE OF OPHTHALMOLOGISTS QUARTERLY BULLETIN | JULY EDITION 2017

Fight for Sight/John Lee, The Royal College of Ophthalmologists Primer Fellowship Awards of £60,000

Fight for Sight and The Royal College of The research may be self-contained or part of a wider Ophthalmologists are pleased to announce a research programme and capable of being completed new Primer Fellowship Award aimed to support within the year. highly committed and outstanding training The closing date for the application submission is 5pm on ophthalmologists who want to develop their Wednesday 1 November 2017. Interviews will take place careers by undertaking research into the causes on Friday 12 January 2018. Successful applicants will of eye diseases and conditions, their detection be notified Early February 2018 with Primer Fellowship and treatment. Awards expected to start in October 2018.

This year, there will be two fellowship awards available. www.fightforsight.org.uk/apply-for-funding/funding- Each fellowship provides funding for up to one year with a opportunities/ maximum amount of £60,000 per award. If you have any queries, please contact Dr Steven Smith at The fellowships cover salary, on-costs and some running grants@fightforsight.org.uk or on 020 7264 3907. expenses. Applicants are expected to have a nominated supervisor and be attached to a UK university or hospital.

The Frost Charitable Major restructure and Trust offering awards redevelopment of the of up to £40,000 Royal Shrewsbury Hospital Ophthalmology Department The Trust has been established since 1966 to provide grants and scholarships to universities and hospitals for research into eye disease. The Trust which runs Shropshire’s two The Trustees invite applications for two Clinical acute hospitals has invested more than Fellowships or one Clinical Fellowship and one £800,000 to provide new accommodation PhD Studentship, from ophthalmologists currently and equipment for its ophthalmology training in the UK. Projects must be in the field of department, which opened on 26 June 2017. Ophthalmology or visual sciences. The new Eye Department at Royal Awards will be made strictly on merit up to a Shrewsbury Hospital (RSH) by The Shrewsbury maximum of £40,000 in each case. The closing and Telford Hospital NHS Trust (SaTH) brings date is 19 October 2017. several benefits to patients including modern facilities in the Copthorne Building, new Applications should include details of the equipment and increased capacity with proposed research programme, a CV and the more clinical rooms meaning more patients Optical innovation since 1917 amount of funding required. will be able to be treated each year.

The Trustees meeting to consider the applications Mr Prasad Rao, Consultant Ophthalmologist and Clinical Director at SaTH www.keeler.co.uk will be held on the 17 November 2017. said, “It’s fantastic news that a new Eye Department is being created for our Applications should be submitted to holmes_ patients from all around Shropshire, Telford & Wrekin and mid Wales. It has [email protected] or sent to the following been designed with the needs of ophthalmology patients in mind.” address: In addition to this, the department have had a major re-structure of staff, J.R.Holmes FCA, Secretary to the Trustees, T. with a number of band 6/7 nursing staff, specialty doctors and consultants F.C Frost Trust, 10 Torrington Road, Claygate, joining the team. Further building work will take place to prepare the new Esher, Surrey KT10 0SA paediatric ophthalmology area within the new facility.

21 college news Consultant posts

Appointee NHS Trust Hospital or Area

Thomas Betts Hywel Dda University Health Board Wales

Wai-Hong Chan East and North Hertfordshire NHS Trust Stevenage

Robert Cheeseman Royal Liverpool and Broadgreen University Hospitals NHS Trust Liverpool

Sam Evans Hywel Dda University Health Board Wales

Eva Gajdosova Plymouth Hospitals NHS Trust Plymouth

Anna Maria Gruener Nottingham University Hospitals NHS Trust Queen's Medical Centre

Rumana Hussain Royal Liverpool and Broadgreen University Hospitals NHS Trust Liverpool

Gurjeet Singh Jutley Oxford University Hospitals NHS Trust John Radcliffe Hospital

Pei-Fen Lin Moorfields Eye Hospital NHS Foundation Trust Croydon University Hospital

Indira Madgula Lancashire Teaching Hospitals NHS Foundation Trust Royal Preston Hospital

Demetrios Manasses University Hospitals Bristol NHS Foundation Trust Bristol Eye Hospitals

Kinnar Merchant County Durham and Darlington NHS Foundation Trust University Hospital of North Durham

Mariya Moosajee Moorfields Eye Hospital NHS Foundation Trust London

Reza Moosavi Royal Berkshire NHS Foundation Trust Royal Berkshire Hospital

Khin Maung Nyunt Western Sussex Hospitals NHS Foundation Trust West Sussex

Vidya Pulpa Gloucestershire Hospitals NHS Foundation Trust Cheltenham General Hospital

Naz Raoof Moorfields Eye Hospital NHS Foundation Trust London

Guzaliya Safiullina Gloucestershire Hospitals NHS Foundation Trust Cheltenham General Hospital

Malhar Soni Mid Essex Hospital Services NHS Trust Essex

Henry Smith Maidstone and Tunbridge Wells NHS Trust Kent

Peter Thomas Moorfields Eye Hospital NHS Foundation Trust London

Abdo Karim Tourkmani Masri Aneurin Bevan University Health Board Royal Gwent Hospital

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. SAS 8th National Eye Obituary Meeting - 17 November We send our sympathy to the family and friends of members who have passed away since the last edition of College News. Calling all SAS doctors! Previous SAS days have been very well attended and have had good feedback. If you have not Mr Ian David Porteous, Carlisle UK been before, come and join us. It is a whole day of interesting, Mr Andrew Tullo, Oswestry UK interactional education with eminent speakers. The provisional topics will be Keratoconus, Ocular Surface Neoplasia, MIGS, Neuro-ophthalmology and Autonomous working for SAS Your story doctors.

It is also a great opportunity for SAS doctors to meet and If you have a relevant story or news to share with fellow discuss issues. See you all there! Mrs Bronwen Attrup, colleagues and members of RCOphth, please send it to Liz Price, Chair SAS Group Communications Manager, [email protected]

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 Research changes lives- How to generate and premises unless otherwise specified. apply high quality evidence to your practice Can I drive Doc? - Driving Standards in Practice WEDNESDAY 15 AND THURSDAY 16 NOVEMBER FRIDAY 15 SEPTEMBER See the feature on page 6 by Professor Jugnoo Rahi. You can book Covers current regulations, what you should do in clinic, visual fields one or both days of this new seminar. and exceptionality, the concept of full functional adaptation. How to be a great sustainable ophthalmologist Mr Ian Pearce & Mr Bill Newman. in the 21st Century Posterior Vitreous Detachment THURSDAY 23 NOVEMBER TUESDAY 19 SEPTEMBER Designed to get ophthalmologists thinking about their practice Symptoms, pathology, modelling, management and therapy of from the point of view of the sustainability triple bottom line- PVD and encouraging discussion of the condition. Professor Tom environmental, social and economic outcomes. Mr Dan Morris. Williamson. Practical Skills in Retinal Imaging Surgical Skills Courses MONDAY 25 SEPTEMBER The basic principles of retinal imaging modalities and their current Please check the website or contact the Education and Training clinical applications. Mr Pearse Keane. Co-ordinator on 020 3770 5341 or [email protected] CESR Applicants Training Day for availability as courses get fully booked quickly. TUESDAY 26 SEPTEMBER Medical Students Taster Day This training session is packed with information for anyone thinking FRIDAY 8 SEPTEMBER of or in the process of applying for Specialist Registration via the Lectures and practical sessions aimed as an introduction to CESR route. surgical skills including suturing, knots and the use of the operating Training the Trainers – Trainees in Difficulty microscope. MONDAY 2 OCTOBER Ultrasound Course Trainers will develop skills to manage trainees in or heading WEDNESDAY 29 NOVEMBER for difficulty. Blending independent preparatory learning with The course provides opportunity to conduct “hand-on-hand” intensively-facilitated practical sessions. supervised scanning on volunteers. It is suitable for all grades of Paediatric Ophthalmology ophthalmologists and allied professions. WEDNESDAY 11 OCTOBER A one day lecture course incorporating an orthoptic workshop. Suitable for ST3 and above.

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

Eye Development & Degeneration from Genes to THET Annual Conference 2017 Therapy MONDAY 23 – WEDNESDAY 25 OCTOBER MONDAY 4 – TUESDAY 5 SEPTEMBER Venue: Resource for London, London Venue: MRC Human Genetics Unit, University of Edinburgh www.thetconference.org/ www.eye2017.com/ Seeing is Believing III: Looking Forward – UK Eye Genetic Group (UKEGG) and RCN Ophthalmic Nursing Forum Conference International Society for Genetic Eye Diseases Exhibition and Retinoblastoma (ISGEDR) Joint Meeting SATURDAY 4 NOVEMBER THURSDAY 14 – SATURDAY 16 SEPTEMBER Venue: Royal College of Nursing www.rcn.org.uk/ON17 Venue: The Rose Bowl, Leeds, UK https://ukegg.com/meetings/, https://isgedr.com/annual-meeting/ Ophthalmic Imaging Association Annual Ophthalmic Imaging: From Theory to Current Conference Practice FRIDAY 17 NOVEMBER FRIDAY 13 OCTOBER Venue: The Stratford Manor Hotel, Stratford-Upon-Avon www.oia.org.uk/ Venue: CAP Event Center, Paris www.vuexplorer.fr/en/congres 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

Sterimedix Cannula & Handpieces New IOL Cutter Volk Lenses

Altomed can supply all of your requirements Single-use versions of the MST Packer Chang IOL We stock all Volk lenses including single-use laser relating to cannula and handpieces. Cutter, and its twin instrument, the Micro Holder. lenses, plus the new single-use 20D and 28D lenses, The latest soft-sleeve coaxials and an expanded Now everyone can have these useful instruments which are very useful in the surgical environment. range of bimanuals are available for immediate ready and waiting, for those challenging cases. No We oer competitive pricing on slit lamp lenses delivery. Sterimedix products are manufactured risk of cleaning and handling damage. such as the traditional 90D and the ‘Digital’ series. in the UK to the highest quality standards.

Reusable. E ciently 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_090517.indd 1 09/05/2017 16:48