specialities

I Specialise in the following...

Services

General adult ophthalmology:
Ophthalmology, like all clinical disciplines, has continued to become more and more sub-specialised.
Despite this, most ophthalmologists can deal with some of the more common and less serious
conditions such as dry eyes and a number of causes of gradual blurring of vision (such as cataracts).
Where a particular problem is too severe, or too sub-specialised the patient will be advised of this
and the options of where to seek further treatment. I continue to offer cataract surgery with
monofocal lens correction.
I do not consult for eye problems in children (defined in the UK as under the age of 16 years) as I feel
this is best dealt with by paediatric ophthalmologists. Likewise, where a particular eye condition has
been identified as needing a particular subspecialist, such as squint, double vision or inflammation
inside the eye, it is best for the patient to see a consultant with this subspecialist experience to
minimise any delay in dealing with their condition.

MEDICAL RETINA:
This is the area of my sub-specialist interest and experience. This is a group of conditions that affect
the retina (the lining inside the eye converting light to electrical impulses which then proceed to the

brain). This is distinct from surgical retina (commonly referred to as vitreoretinal surgery) as medical
retina conditions are treated medically typically with injection procedures not requiring surgery. The
commonest of these are wet age-related macular degeneration, retina vein occlusions and diabetic
retinopathy. Where appropriate, they are treated with injections into the eye, given in an out
patient setting but under sterile conditions. Occasionally, I will see patients to confirm the diagnosis
which may be a condition that requires vitreoretinal surgery, in which case I refer the patient to a
colleague who carries out these sub-specialist surgical procedures. Modern practice requires the use
of optical coherence tomography (OCT). This is a scan of the retina that allows the clinician to
visualise details otherwise not seen by clinical examination alone. This is required to confirm the
diagnosis as well as to monitor the condition, with or without treatment. There are other tests that
are used, but OCT is by far the commonest in medical retina is also carried out in the outpatient
setting, typically as the same visit as the consultation.

Age-related macular degeneration (AMD):

Resource:

https://www.rcophth.ac.uk/patients/patient-information-booklets/

The macula is the central area of the retina which sees the detail in any image focused onto it. The
very central area, the fovea, is the size of a pinhead. This is the area affected by aging and leading to
the condition that is AMD. This is broadly divided into a dry type and a wet type. I use an analogy of
a wall paper in a room: as the house gets older, the wall paper frays and starts to slowly flake off
(dry AMD). Alternatively, the pipework may leak leading to a quick onset of an area of damp in the
wall (wet AMD); this may be mild enough (or caught early enough) to only cause the surface wall
paper to be wet. Or, it may be severe enough to damage the wall paper, all layers of the lining paper
and perhaps even the plasterwork. The use of injections into the eye is currently available to help
treat the wet AMD by speeding up the drying of the leakage, thereby limiting the damage. The main
aim is to limit the damage as the quality of vision may not return to how it was before the problem
started. It is currently not possible to predict in advance how many injections are needed, over how
long and what the long-term vision will be. Guided by the past 20 years of using these (anti-VEGF)
injections, we know that they play an important part in preventing sight loss, hence patients are
referred urgently by their opticians if the condition is suspected.
Although there is currently no approved treatment for dry AMD in the UK, this is expected to change
in the near future as two different injectable drugs are being evaluated for this.
In terms of prevention, the advice is to ensure eating a healthy diet rich in fruits and vegetables
(especially dark green vegetables), to stop smoking (for those who smoke), take up regular exercise
(please ensure this takes account of your ability and health) and protecting the eyes from over
exposure to sun light.

Diabetic Retina:

Resources

https://www.rcophth.ac.uk/patients/patient-information-booklets/

https://www.nhs.uk/conditions/diabetic-retinopathy/ 

The presence of a high level of sugar in the blood damages the small blood vessels of the retina and
makes them leak. This leakage can damage the retina without the person knowing that this is
happening. It is therefore important that a person who knows they are diabetic attends the diabetic
retina screening visits provided outside of a hospital setting by their local diabetic retina screening
service. If this service detects changes caused by the diabetes damaging the retina, they will make a
referral to the hospital eye clinic accordingly. In addition, if they detect an unrelated finding which is
felt to require the advice of the hospital eye clinic, they will also make this onward referral.
Diabetic damage to the macula may require injections in the same way as AMD. However, diabetes
may also result in the abnormal growth of retinal blood vessels which can go on to bleed and cause
scarring of the retina, the treatment for which would usually be fine laser burns to the retina. These
burns reduce the production of the excessive chemicals that lead to the abnormal growth of the
retinal blood vessels, and that it is how the condition is stabilised. In more advanced cases, it may be
necessary to refer to a vitreoretinal surgeon depending on the exact condition of the retina.

Retinal vein occlusion:

The following is quoted from the Royal College of Ophthalmologists Retinal Vein Occlusion (RVO) Guidelines: https://www.rcophth.ac.uk/resources-listing/retinal-vein-occlusion-rvo-guidelines/ 

“Retinal vein occlusion occurs when there is an obstruction to the outflow of blood from the retina.  This can occur in a branch resulting in a branch retinal vein occlusion or centrally resulting in a central retinal vein occlusion. This condition can occur at any age or gender but is more prevalent in the older age groups. The severity of the impact it can have on vision is a spectrum, with some mild cases with minimal visual disturbances while some can be very significant with marked irreversible damage to the retina and vision loss. This condition can be associated with risk factors such as high blood pressure, high cholesterol and diabetes and management is usually targeting at these risk factors to avoid a further episode or a cardiovascular event to another part of the body. Macular oedema or fluid leakage within the centre of the retina is a common complication of this condition and can result in poorer vision. This can be improved with treatment and the first line of treatment are injections of a drug into the eye at regular intervals. Some patients can experience growth of new blood vessels in the eye as a complication of this condition and this will require retinal laser treatment to regress the development of these vessels. If left untreated, this can result in worsening of vision and discomfort. Regular monitoring in hospital is recommended for several years to manage any complication that can arise.”

Cataracts:

Resource

https://www.rcophth.ac.uk/patients/patient-information-booklets/

A cataract is a term that describes the misting up of the eye’s natural lens, most commonly due to age. The lens is the only part of the body that does not shed its waste. As metabolic waste products accumulate, the lens loses its clarity and starts to mist up. This process can be affected by other factors such as diabetes or being on steroid medication for a long time. The treatment for cataracts is surgical removal where the misty lens is replaced with a clear artificial lens. This is done with several different options of anaesthetic. Patients may be away and have the surgery with anaesthetic eye drops (topical anaesthetic); they may be awake and have an injection of anaesthetic underneath or alongside the eyeball (anaesthetic block injection, which aims to paralyse the eye movements for the surgery); they may require mild sedation or they may require, request or be most in need of a general anaesthetic. The options are discussed, along with the pros and cons of each, at the consultation.

Likewise, the option of lens implant is also discussed at the time of consultation, given the variety of implants currently available. It is important to state at this point that I do not use the multifocal lenses (sometimes referred to as premium lenses) given that most of my cataract patients usually have a macular problem, making such lenses unsuitable for them.

Education and Training:

I have a longstanding interest in education and training, as well as workforce development. I have been in a variety of related roles including College Tutor, Clinical Supervisor, Educational Supervisor, College Examiner, College Surgical Skills faculty member and external examiner. I have set up and continue to run practical courses including laser training, OCT interpretation and intra-vitreal injections, with an offering to both medical and non-medical staff. I have taken part in charitable collaborative education and training programs in Tanzania (2010 and 2015) and Cambodia (2017). In February 2019 delivered retinal laser training in the Kenyatta University Hospital in Nairobi under the auspices of the UK Vision 2020 Links program. This ultimately led to being awarded the Masters in Medical Education, from the University of Birmingham (UK) in 2016. More information on some of the courses can be found at:

https://www.ocularsimulationcourse.com/team.html

https://www.eyeteacher.com/

Career Advice/ Mentoring and Coaching

Over the past 20 years, I have gained experience as a trainer and mentor which has benefited me in a pastoral role. This has allowed me to offer career advice that is bespoke to the individual in question. In addition, I have been trained as a coach, to be able to offer that specific service for those seeking it, separate from any advice or mentoring.

For a one-to-one discussion, please contact me.