2016 - Bayer Ophthalmology Honours - Home · the 2016 Ophthalmology Honours. The results were announced at the awards ceremony on the 1st December 2016. The Ophthalmology Honours

Further information on the judging panel and each of the finalists can be found at:

www.ophthalmologyhonours.bayer.co.uk

This supplement has been produced on behalf of Bayer and showcases a selection of winning and highly commended entries from the 2016 Ophthalmology Honours. The results were announced at the awards ceremony on the 1st December 2016.

The Ophthalmology Honours is an educational initiative fully funded by Bayer. The awards recognise and celebrate the outstanding work being carried out by multi-disciplinary teams in ophthalmology throughout the UK.

The awards identify exceptional initiatives that demonstrate clinical excellence and innovation in ophthalmology, and recognise outstanding individuals who improve the quality of care provided to patients and the patient experience. The Ophthalmology Honours reflects the mission of Bayer, a leader in ophthalmology, to support science for better lives by improving

patient outcomes and showcasing the very best ophthalmology care in the UK. Supported by the Royal National Institute of Blind People (RNIB) and Visionary, this awards programme demonstrates the commitment of Bayer to support the implementation of good practice in the NHS; resulting in tangible benefits for patients and advancements in ophthalmology care in terms of multi-disciplinary and innovative working.

Although funded and facilitated by Bayer, the awards were judged by a multi-disciplinary panel of experts in ophthalmology care and the decision-making process was wholly independent of Bayer.

In order to help share best practice in the ophthalmology community, details of the winning and highly commended entries are included for select categories as follows; Best ophthalmology team, Best patient support or education initiative, Best care innovation and Judges’ special award.

UKEYL06160038ahDate of preparation: January 2017

Ophthalmology Honours is an educational initiative fully funded by Bayer.The judging process is carried out by a panel of independent judges and is wholly independent of Bayer.

2016WINNERS ANDCOMMENDATIONS

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Ophthalmology Honours 2016

Best ophthalmology team

WINNER Epsom and St. Helier University Hospitals NHS Trust

In the last few years the Glaucoma Multi-Disciplinary team (MDT) working at Epsom and St. Helier Hospitals found it difficult to meet the needs of patients and as a result they identified several important drivers for change in September 2014.

These were:

• Lack of clinic capacity created a waiting list of 550 overdue patients

• Loss of substantive consultant sessions without automatic reappointment

• Poor management of the demand on the clinic with no clear system of identifying high / low risk patients on waiting list

• No failsafe tracking

• Follow-up timeframes requested out of habit not individualised to clinical need

• Low risk patient monitoring was detached from NICE guidance

• No clear discharge protocol

• Poor patient experience due to long wait and cancellation without appropriate rebooking

The need to relocate services from one hospital to two hospital sites to provide care closer to home provided the opportunity to re-organise care provision.

Following this review, the team wanted to offer clinical commissioning groups (CCGs) and patients a cost effective, streamlined service with improved governance and reduced random isolated decision making. They planned to reduce cancellation without rebooking and wanted to ensure that all patients received a positive experience.

The Glaucoma MDT aimed to make sure that patients would be seen within the correct time frame and by the most appropriate clinician, making appointments risk specific. To ensure that all patients were offered individualised care based on national guidance, the team wanted to guarantee that all evidence-based clinical decisions were made by appropriate healthcare professionals.

To make high / low risk patients easily identifiable, the team used the Trust patient admin management system (PAS) to define and allocate patients a numerical code that was entered on the system after each visit. Specific glaucoma clerical staff, active within the wider MDT, tracked patient activity and a specific glaucoma email was set up to help facilitate the tracking of individual patient needs. The team also introduced weekly clinician led waiting list reviews.

Making a Difference for Glaucoma Patients: A ‘Can Do’ Approach

Host Danny Crates, Paralympian and former world record holder and judge Roshini Sanders, Professor of Ophthalmology, University of Edinburgh and Consultant in Ophthalmology, Queen Margaret Hospital, Dunfermline, present the award to the finalist

This supplement has been developed by Bayer

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To accommodate risk-specific patients who were actively being moved across clinics according to their individual needs, the team re-organised and re-defined clinic codes. In addition, clinicians were actively encouraged and reminded to move patients into appropriate clinics through specific rebooking instructions. To support this, updated availability of next appointments were produced for the whole team.

Another main objective was to build a competent multi-disciplinary workforce, reducing sessional locum staff and providing individualised care. By moving funds across professional budgets they were able to create a non-registered Assistant Ophthalmic Practitioner (AOP) team. The AOP team completed a foundation ophthalmic knowledge and competence programme. This initiative enabled utilisation of an existing non-medical workforce to alleviate clinic capacity issues. Identified low-risk patients were redirected into five investigation clinics run weekly by the AOP team. Consultant job plan changes were re-negotiated to facilitate virtual reviews within two weeks of all patients attending the investigation clinics. All clinicians have access to these protocols, which ensured a consistent approach to individualised care according to clinical risk.

Breaking routine practice in clinics was challenging. The team was galvanised with a ‘can do’ attitude; however consistent reminders about new ways of working were required. Posters, a Glaucoma Handbook, regular MDT meetings, waiting list reviews and informal reminders were all introduced or further developed. The value of the virtual reviews was not immediately accepted. However after just two clinics running for 3 months, the waiting list was condensed and the team received feedback from patients stating that the clinic had improved their experience. Team individuals recognised that the initiative freed clinic capacity for consultant-led new and high risk follow up patient assessment, improving economic viability. Lead changers experienced emotional and physical fatigue; however a dogged belief in patient benefit and regular informal discussions provided support when facing quiet opposition.

Following the first year of implementation, the number of patients waiting longer than recommended was reduced to just 37. PAS risk coding had increased to 87% and codes were referenced during clinician-led weekly waiting list review.

Dedicated clerks monitored the specific glaucoma email, ensuring timely appointments and tracking of patients requiring treatment. ‘Ghost’ clinics were introduced, which reduced ‘cancel and rebook’ outside of requested time frames, and follow-up appointments and discharge became aligned to NICE guidance.

Patients were also seamlessly transferred from low to high risk appointments, thus improving face-to-face access to consultants. From January 2015 to August 2016, consultant follow-up times had been reduced from eight to three months. Urgent appointment waiting times had been reduced from five months to four weeks and intraocular pressure checks were available in 12 weeks rather than four months. The AOP clinic appointments for low risk patients are available within three months following consultant request.

Approved appointment of a second consultant together with seven AOPs, who all completed the formal foundation course, theory and competence, has enabled an increase in AOP activity; providing cover for sickness and as a result only one clinic was cancelled unexpectedly in 12 months. Capacity was also increased by an expanded non-medical workforce including Nurse Specialist, Trust Orthoptist and Optometrist review of intraocular pressure alongside Consultant clinics.

The electronic glaucoma handbook collated all glaucoma documents and guidance in one place and mandatory MDT meetings are held three times a year to review the general service and teaching.

Feedback from family and friends attending the clinic became increasingly more positive with 95% of patients stating that they would recommend the service.

Complaints received reduced from six in 2015 to zero in 2016.

“To be recognised by others for this multi-disciplinary approach to revamping the Glaucoma services, with very hard working colleagues, is gratifying; freeing up consultant clinic time to see high-risk patients has followed training and development of non-clinical staff. We have a wonderful team.”

Anne Linnell, Glaucoma Consultant Lead, Epsom and St. Helier University Hospitals NHS Trust

For further information on this initiative, please contact Lynn Ring, Advanced Clinical Nurse Specialist, Epsom and St. Helier University Hospitals NHS Trust at [email protected]

Chris Panos, Consultant Ophthalmologist, Epsom and St. Helier University Hospitals NHS Trust at [email protected]

Retinopathy of prematurity (ROP) is a potential blinding disease that affects infants born at less than 32 weeks gestation or less than 1500g birth weight. Screening and prompt treatment has a significant effect on the quality-adjusted life years of those affected.

The Royal College of Ophthalmologists Screening and Treatment Guidelines for ROP were published in 2008 resulting in a standardisation of care. In 2016 there was a 100% increase in the referrals for treatment of ROP at this Trust.

The challenge faced by services is that there is a decreasing number of ophthalmologists who are trained in or who have sufficient professional activity sessions allocated to ROP. The reduction in the ability for centres to make a timely diagnosis of ROP requiring treatment has made it essential to use existing ophthalmic expertise efficiently and to look at alternative models of screening.

After three neonates in the region went blind as a result of delayed referral, the main goal for the team at Manchester Royal Eye Hospital and St. Mary’s Neonatal Unit was to provide a safe, patient-centred screening and treatment service for ROP in the region and subsequently a nurse-led ROP digital imaging screening service was developed.

The main aims of the team were to:

• Initiate a nurse-led, consultant supervised, screening service, ensuring that no infant requiring screening missed a review and that no infant lost vision unnecessarily

• Have an innovative nurse-led training system

• Provide a supportive tertiary location, ensuring timely and flexible second opinions and treatment if required and to provide high quality feedback (digital images of referred infant eyes) to the referring units

• Liaise with parents and clinicians about screening and treatment for ROP and to provide support to families when infants required treatment

• Highlight the importance of ROP to the wider ophthalmic and medical community and to raise the profile of this condition in the neonatal department

• Contribute to audit and research in this therapeutic area

• Provide a regional nurse-led mobile telemedicine service for ROP in the future

Central Manchester Foundation Trust Retinopathy of Prematurity Team

HIGHLY COMMENDED

Manchester Royal Eye Hospital


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Best ophthalmology team

Host Danny Crates, Paralympian and former world record holder and judge Roshini Sanders, Professor of Ophthalmology, University of Edinburgh and Consultant in Ophthalmology, Queen Margaret Hospital, Dunfermline, present the award to the finalist

The ROP digital imaging screening service is run by four full-time neonatal nurses. Sister Julie Flanagan has been the lead coordinator of the service on the neonatal unit at the Trust for 16 years and began training using the Retcam (a wide field imaging device which is the gold standard in ROP image acquisition) five years ago under the supervision of the clinical lead for ROP. She is employed to work 30 hours a week running the service with the other nurses rotating onto the service to make up one full-time role. The team also includes two other consultant ophthalmologists and the full support of the team of neonatology consultants.

The nurses screen infants themselves, taking images using the Retcam. The lead nurse grades these images and gives recommendations for follow-up which is then validated by the lead clinician. Each nurse undergoes a formal competency-based training programme to become an independent screener. The training programme was jointly devised by the lead consultant and ROP nurse and has been running since 2013. Formal training programmes such as this did not exist previously.

One challenge faced was ensuring that nursing staff have ample time away from their neonatology duties to gain experience, however with careful planning this has been overcome. The unpredictable nature of screening numbers and treatments can be difficult to manage but everyone in the team is committed and show flexibility in covering these treatments, often staying until midnight to ensure optimal delivery of care.

The latest Care Quality Commission (CQC) report for the Trust highlighted the ROP led telemedicine service as outstanding. The team is screening approximately 150 infants a year and an additional 50 are referred from other units for second opinions. A recent audit of 50 consecutive screens undertaken has shown that nurse screeners produce high quality gradable images in 100% of cases. In 2016, 60% of all screens were undertaken by nurse screeners, thus showing the effectiveness of the training programme and the increased capacity in the service provided. In addition, the number of infants requiring treatments has almost doubled in one year however the team treats the majority of infants within 24 hours and all within 48 hours. This active additional surveillance of at risk babies in the region has resulted in the identification of babies who would have otherwise missed their screening and due to this dedication, the sight of three infants has been saved in the last three years.

Since the initiation of the programme, there has been an increased awareness of ROP in both the medical and nursing staff in the unit and as a result has increased the support given to the team. Sister Julie Flanagan has also been invited to lecture about the service and her

role as a nurse screener at numerous conferences in Eastern Europe as part of a World Health Organisation initiative to improve ROP services worldwide.

In addition, the service leads regional audits for the area and in the past year the team has taken part in two studies. They were the first to recruit in the Rainbow study and recruited the largest number of patients in the UK for the ROPP study. The team aim to contribute to the evidence on which clinical practice is based.

This is a unique team in the UK offering a first-rate service to premature infants and their families. The nurses feel passionately about this disease and the infants affected and continually go above and beyond their role to ensure that patients receive optimum care.

The future aim of the team is to increase the number of independent nurse screeners available so that ultimately a telemedicine service can be provided and infants requiring second opinions can be screened in their local hospital rather than be transferred to the Trust. This would avoid considerable expense and the risk associated with transferring patients.

“Being involved in the Bayer Ophthalmology Honours awards enabled our team to reflect on the quality of service we are providing. Being awarded a highly commended award only reinforced the value of the service we provide to patients and their families. The awards enabled us to highlight our service both within the Manchester Royal Eye Hospital and the Neonatal Department at St. Mary’s Hospital. We would recommend entering this competition to any outstanding team large or small.”

Miss Sarah Chamney, Paediatric Ophthalmology Fellow, Manchester Royal Eye Hospital


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For further information on this initiative, please contact Sister Julie Flanagan, Neonatal Intensive Care Unit, St. Mary’s Hospital at [email protected]

Best patient support or education initiative

It is a major life event for parents when they are told that their perfect baby or young child has a cataract which needs surgery and what that might involve.

Such considerations include:

• There may be an inherited cause for the cataract and may have implications for further children

• The presence of a cataract may indicate another underlying medical disorder

• The nature of the surgery and need for subsequent examinations under anaesthetic

• The risks both short term and long term of glaucoma and retinal detachment

• The use of contact lenses that they will have to insert and remove from their baby

• The need for occlusion therapy

• The likelihood that they will not have ‘normal’ vision

• The later development of strabismus

• The need for regular hospital appointments

• The impact on the whole family

• Long-term concerns about education and driving

The goal of this clinic was to create a pathway to ease the anxieties of parents and provide, as much as possible, a smooth and consistent experience. The team also wanted to ensure that patients and parents were seen at the same clinic and by the same team where possible.

The team aimed to alleviate fears around diagnosis, treatment and the use of contact lenses. They also wanted to ensure that parents had a consistent and regular multi-disciplinary team looking after them and their children and wanted to provide parents with the best available advice and information. It became apparent that it was important for paediatrics and education professionals to be involved from the early stages of the treatment pathway and genetics professionals were also required for parent and sibling examinations where appropriate.

It was evident to the team that parents were often distraught at the diagnosis of their child and there was a lot for them to take on board at the first consultation, with little information given in written form and little support. Once over the initial shock, it was clear that parents were often most worried about the idea of having to use contact lenses in their children.

Initially, children at the hospital were being seen in various clinics and often by differing doctors, orthoptic and optometric specialists. There was no clear pathway in place and information shared with parents was varied. As a result, the team set themselves the challenge of redesigning the service and the way that patients were seen.

The Paediatric Intraocular Clinic

WINNERAlder Hey Children’s Hospital NHS Foundation Trust


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Host Danny Crates, Paralympian and former world record holder and judge Clare Bailey, Consultant in Ophthalmology, Bristol Eye Hospital, present the award to the finalist

The following actions were taken to improve the care provided to patients and the support given to their parents:

• At the initial clinic when giving the diagnosis the team gave the parents time to take things on board;

– Parents were introduced to the orthoptist / optometrist and contact lens nurse

– Parents were sent an email with ‘hyperlinks’ to information on infantile cataracts and various online groups

• An appointment was offered within ten days, outside normal clinic hours, to talk through the diagnosis and treatment. It was suggested that the parents bring extended family, and 90 minutes was set aside for the consultation

• A referral was made to the community paediatrician (Neuro-disability) and clinical genetics

• At the time of surgery the contact lenses were inserted

• Post-surgery appointments were made for the contact lens changes and contact lens ‘teaching’ by the contact lens nurse, who had received appropriate training by an optometrist

• The children now attend a specific regular Friday morning clinic involving:

– A consultant, an orthoptist, two optometrists and a nurse (contact lens)

– Before the clinic a roundtable discussion is undertaken deciding which child needs to be seen by which clinician in which order

– The optometrists were taught to use the monocular indirect ophthalmoscope for funduscopy and use the rebound tonometer on the infants to measure the pressure

– Copies of all correspondence are sent to the parents

– In combination with the orthoptist the visual rehabilitation was managed with clinical input from the consultant where appropriate

– The parents benefitted from incidental regular meetings in the clinic waiting area with other parents of children with similar problems

• The infants would be discussed at the next multi-disciplinary ‘Vision Clinic’ co-chaired by the consultant and neurodisability consultant and attended by support groups and visual rehabilitation officers for the region

Through the changes adopted at this centre, the team has achieved a consistency in practice and by using the same clinical team they have greatly assisted in reducing the anxieties experienced by parents.

The parents and children now develop a close relationship with the whole clinical team and this is further assisted by provision of a contact email address where they can seek further advice, information, repeat prescriptions and order further contact lenses.

The evolution of this service means that the clinical team now see individual patients over the years as they progress, which enables staff to improve their skills and knowledge. Furthermore, they are now assisted by the integration of an educational service via a support group.

The clinic has expanded from a cataract clinic to an intraocular clinic, involving children who have any form of intraocular surgery including, glaucoma, anterior segment abnormality and penetrating trauma. It is evident from feedback that parents and specifically older children value this service and the way it is delivered.

“We never expected to attend the ceremony and win. To realise we had, and to have our dedicated work recognised by national leaders within the eye care profession, was a great honour for the team and made us very proud of our department, particularly in this time of financial stringency.”

Mr William D Newman, Consultant Ophthalmic Surgeon & Neuro-ophthalmologist, Alder Hey Children’s Hospital NHS Foundation Trust


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For further information on this initiative, please contact Mr William D Newman, Consultant Ophthalmic Surgeon & Neuro-ophthalmologist, Alder Hey Children’s Hospital NHS Foundation Trust at [email protected]

Four years ago this clinic introduced an Eye Clinic Liaison Officer (ECLO) service to provide patients with instant access to emotional support.

Several key points led to the development of the role including:

• A decrease in the number of referrals to the Kent Association for the Blind’s (KAB) services

• Patients being lost in the system

• Referrals / registrations getting lost in the notes due to staffing pressures

• Patients with dry AMD being discharged without a safety net

• A lack of emotional support and information provision in clinic

• Staff untrained in best practice for caring for sight impaired patients

• Patients not being referred on to other services, for example social services, falls clinics or occupational therapy

• Links not being made to other clinics, for example stroke or diabetes clinics

Having an ECLO in clinic means that there is instant access to emotional support for patients and further information about eye conditions. If this support is not provided in clinic then patients are referred.

Following the appointment of the ECLO at East Kent, the key aim was to increase the number of registrations for the service and ensure patients understood what this meant and what the benefits were. The team wanted to be able to liaise with and signpost patients to support agencies such as the Macular Society and International Glaucoma Association. Furthermore, the ECLO would reduce pressures on medical and secretarial staff by completing cortical visual impairment (CVI) / low vision referrals.

The centre also aimed to train staff not only in the eye clinics but throughout relevant departments to ensure all sight impaired patients received the best possible care, whichever clinic they attended within the hospital environment. Subsequently, the team wanted to raise awareness amongst staff and the public of the importance of eye health and attending optician appointments through highlighting National Eye Health Week, Deaf Blind Week and International Glaucoma Week.

During the time that the ECLO, Fran Smith, has been in service, she has initiated letters for all new patients explaining the ECLO service and set up well-structured referral pathways. Fran has regular training sessions with eye clinic staff, day surgery, junior doctors, student

Kent Association for the Blind ECLO Service


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HIGHLY COMMENDEDEast Kent Hospitals University NHS Foundation Trust


Host Danny Crates, Paralympian and former world record holder and judge Clare Bailey, Consultant in Ophthalmology, Bristol Eye Hospital, present the award to the finalist

nurses, occupational therapists on stroke wards and with external agencies including visual impairment clubs and the Macular Society. Furthermore she introduced the eye champion initiative with Lynne Hadley, Ophthalmology Matron, supports staff through the Take 5 challenge and has run the Eye Ball for two years. Fran has a good working relationship with all team members of the eye clinic from consultants to secretaries and has formed links with stroke wards, elderly care wards, screening and eye casualty. She ensures that clear, up-to-date and relevant information is displayed on clinic noticeboards and is always available by email, text or phone to suit patient need, not just in clinic but throughout their entire eye care journey.

As East Kent is a large region, with many hospitals, it was initially difficult to understand the correct areas to work in, with which staff as there are so many, where everyone was based and the timings of clinics. Essentially it was difficult to know where Fran would be best placed.

Initially, some staff were reluctant to change and refer their patients to Fran and used her as a last resort, rather than an ongoing support alongside their treatment. Similarly, some patients were reluctant to accept help as they wanted to be seen by a doctor. In addition, overbooked busy clinics sometimes lead to referral opportunities being missed.

Despite these challenges, Fran has had a substantial impact over the last four years and as a result, has been invited to speak at an international conference and nurse forum. The number of registrations has increased. Fran sees on average 60 patients per month in addition to anonymous patients and inpatients. Patients have a greater understanding of why they are being registered, what it means and what help may come from it, with emotional support for all patients available when they need it. In addition, a glaucoma support group has been set up.

CVls are no longer missed in notes and processed in a more timely manner. There has been a rise in referrals to low vision clinics, falls clinics, social services, benefits support etc. as required, and the centre has seen an improvement in multi-disciplinary working. Statistical information is also being reported monthly to KAB to feed into service planning.

Patient feedback:

“In a word – Brilliant. You gave me the confidence to navigate a dark place that I knew nothing about and helped me find my way. Having an ECLO means that the people who are nervously sat waiting, who are too shy to speak up and ask for help, have someone there on the front line who will go to them to check they are okay not left sitting in the dark.”

“Being a lone social care worker in a medical world can be quite daunting. It is a great privilege to have the role’s importance recognised by my medical colleagues. This can only lead to improved multi-disciplinary working and better support for the patient.”

Fran Smith, Eye Clinic Liaison Officer, East Kent Hospitals University NHS Foundation Trust


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For further information on this initiative, please contact Fran Smith, Eye Clinic Liaison Officer, East Kent Hospitals University NHS Foundation Trust at [email protected]

The clinical set up of care for intra-vitreal treatments (including for Wet AMD, DMO and RVOs) consists most commonly of one-stop, multi-step, complex patient pathways. Patients are required to attend appointments that involve a number of clinical and imaging tests as well as intraocular treatment in the same visit.

Inevitably these complex pathways are susceptible to bottleneck formation that adversely affects patient flow. They are labour and resource intensive and prone to disruption caused by fluctuations in staffing levels. The result for service users is long periods of time spent in waiting areas as well as confusion from the numerous steps of the pathway, adversely affecting patient experience of care.

In order to address issues around consistency in patient flow across different sessions, to minimise the time patients spend in waiting areas and to optimise patient experience of care, the team at Manchester Royal Eye Hospital developed a bespoke, electronic, patient tracking platform called MAP (Manchester real-time patient journey Assessment Platform).

MAP enabled the team to:

• Track patient flow and visualise the patient journey through multi-step injection clinics

• Draw real-time data on patient flow across multiple steps in the clinical set-up of care

• Get a real-time overview of clinical activity which was made available to the clinical co-ordinator and consultant in charge

• Offer real-time alerts on bottlenecks forming at any step of the pathway to allow prompt action to reinstate smooth patient flow

• Offer real-time information to service users relating to waiting times and position in the queue resulting in an improved experience of care

• Accrue data over time on clinical activity to provide information for business cases aimed at increasing available resources in terms of staff, space and equipment

• Achieve reduced patient time spent in waiting areas, maximise productive time spent actively on patient care and optimise utilisation of limited resources within macular services

Real-time Patient Journey Assessment Platform


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WINNER Manchester Royal Eye Hospital

Best ophthalmology care innovation

Host Danny Crates, Paralympian and former world record holder and judge Helen Devonport, Consultant in Ophthalmology, Bradford Royal Infirmary, present the award to the finalist

The initiative to introduce the innovative electronic platform for visualising the patient journey in macular clinics came as a result of evidence-based service reviews. This included a series of patient listening events where service users were invited to share their remarks and concerns around their experience within the service with health professionals. These events offered invaluable insight into the strengths and deficits of the service and informed a number of projects amalgamating into an ambitious ‘Outpatient Improvement Programme’.

MAP was a key project for this workstream and was conceptualised in collaboration between senior clinicians, allied health professionals and the business development manager. Some of the patient feedback that prompted this innovative solution included the concern around long waits in crowded waiting areas as well as confusion caused by a sense of ‘musical chairs’ as characteristically described by one of our patients. This related to the confusion caused by multiple movements back and forth between the waiting area and the various tests, assessments and treatments happening during each visit. The hospital became conscious of the need to prioritise policies that would ensure uninterrupted patient flow in all complex macular clinics to minimise waiting times but would also provide real-time information to patients concerning their expected journey within this particular service.

MAP was introduced in a pilot phase through a series of technical trials in the Macular Treatment Centre of the Manchester Royal Eye Hospital. This was critical to provide data on user-acceptability of the platform as well as feedback to refine the software and make it fit for purpose.

Following the technical trials, a series of full scale trials were conducted involving all staff members offering care in the Macular Treatment Centre (including clinical support workers, nurses, imaging technicians, optometrists and medical professionals) showing the platform to be user friendly and easily embedded in routine clinical practice. The trials offered a wealth of data on patient flow, space and staff-time utilisation, delays and waiting times showcasing the potential of this initiative to revolutionise care in macular services.

MAP has been implemented in a number of sessions in the Macular Treatment Centre. The platform has provided quantified data on patient flow and has offered an unparalleled level of real-time visualisation of clinical activity. The clinic co-ordinator has a real-time overview of all patients undergoing any assessment or treatment, as well as patients waiting to go through any step of the pathway. The platform allows the opportunity to observe the flow of patients from step-to-step in real time and can promptly highlight bottlenecks developing at any one step.

MAP also offers a unique opportunity to optimise patient experience and manage patient expectations in injection clinics. By linking the system to the main screen in the outpatient waiting area it is possible to offer information to service users on average waiting times between various steps of the pathway (e.g. how long they are expected to wait between having their scan and seeing their doctor). This fundamentally addresses issues around confusion in complex pathways and infuses a sense of involvement to patients ensuring a positive experience of care.

The system has provided graphs of clinical activity offering the possibility to highlight periods of slowing down of activity at any step of the pathway. By comparing graphs across different sessions, it is possible to deduce patterns of clinical activity. Such quantified data would be essential to inform business cases for building capacity in terms of staff, space and equipment in order to optimise clinical activity.

“Our team was immensely proud to receive the award for Best Ophthalmology Care Innovation for a second consecutive year. The proposed system for improving service performance and patient experience in macular clinics has great potential for wide implementation in hospital-based Eye Units. Our hope is that it will help address well-established problems relating to complex patient pathways. We were particularly encouraged by the wonderful, supportive comments made by the panel of judges who expressed admiration for the initiative and highlighted its potential to improve macular services across the board.”

Dr Konstantinos Balaskas, Consultant Ophthalmologist and Medical Retina Specialist, Manchester Royal Eye Hospital


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For further information on this initiative, please contact Dr Konstantinos Balaskas, Consultant Ophthalmologist and Medical Retina Specialist, Manchester Royal Eye Hospital at [email protected]

Judges’ special award

Retinal detachment is a common and potentially blinding condition. There is considerable evidence that genetic factors play a causative role but the exact mechanisms are poorly understood. Over the last 25 years, the Cambridge ophthalmology team has developed and led international research in Stickler Syndrome, an inherited connective tissue disorder that causes giant retinal tears (GRT) leading to retinal detachment, often in both eyes. It is the commonest cause of childhood retinal detachment.

Originally thought to be a single disease, there are now nine different known subtypes of Stickler Syndrome and due to the complexity of diagnosis and variety in clinical features, underdiagnosis / misdiagnosis can be common. In addition to retinal disease, patients may also have associated hearing loss, cleft palate, and premature arthropathy, depending on subtype.

In order to ensure correct diagnosis, the team identified that improvements to the clinical and molecular diagnostic approach were essential and that a multi-disciplinary team was needed to improve services. The team wanted to provide an accurate clinical and molecular genetic diagnosis and sub-classification for patients and families in England with suspected Stickler Syndrome. It was also important for the team to develop a central patient registry and repository of data for assessing longitudinal outcomes. In addition, they wanted to work with clinicians in other therapeutic areas to facilitate advancement not only in ophthalmic treatment but also in treatment of auditory, oro-facial and rheumatological complications of this disorder.

To achieve this, the team needed to:

• Improve the efficiency and turnaround time of laboratory diagnosis

• Communicate findings with GPs and work collaboratively with other healthcare professionals to provide a holistic healthcare approach

• Identify and evaluate a method for reducing the risk of retinal detachment in these patients

• Use the large repository of patients to conduct on-going research

• Engage and involve the patient-led Stickler Syndrome Support Group in the development of the service and other research projects

• Use the insights to help understand causative mechanisms in retinal detachment patients who do not have Stickler Syndrome

All patients referred to the Cambridge service are triaged by the Stickler specialist nurse and assessed by the provider lead (consultant ophthalmologist) or a nominated vitreoretinal consultant. Where indicated, blood samples are taken for DNA analysis. The laboratory testing has been streamlined to achieve the highest possible diagnostic yield. A small proportion of

Stickler Syndrome Diagnostic Service


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WINNER Cambridge University Hospitals NHS Foundation Trust

Host Danny Crates, Paralympian and former world record holder and judge Stevie Johnson, Clinical Lead, RNIB Evidence and Service Impact, present the award to the finalist


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For further information on this initiative, please contact Mr Martin Snead, Consultant Vitreoretinal Surgeon, Cambridge University Hospitals NHS Foundation Trust at [email protected]

patients (5–10%) require functional analysis, in the form of minigene / splicing analysis. This technique is used in research but this centre is the only laboratory in Europe utilising it for diagnostic purposes. With this technology the team achieves higher rates of diagnostic accuracy.

Treatment is shared between the team at Cambridge and the patient’s local hospital. For Stickler Syndrome patients at the highest risk of retinal detachment, the team developed a protocol for preventative surgery that substantially reduces the risk of childhood blindness. Their initial results showed that the prophylaxis protocol substantially reduced risk of retinal detachment.

According to the European protocol of analysing blood samples, results for Collagen Type II alpha 1 (COL2A1) genetic analysis, without prior specialist clinical assessment, resulted in a 41% positive mutation identification. The streamlined laboratory testing algorithm adopted by the team has resulted in >95% positive mutation identification, with a much faster turnaround time. The multi-disciplinary approach is therefore more effective and more efficient than the previous protocol for laboratory testing.

In addition, in the most recent analysis of the results of the prophylaxis protocol, patients receiving prophylactic treatment were compared with control patients matched for age and length of follow-up. The re-analysis showed that without prophylaxis the risk of retinal detachment is 5–8 times higher than in patients who have received prophylactic treatment.

Through collaboration with other healthcare professionals, the team formed good links with colleagues in further specialties, especially rheumatology, audiology, orthopaedics and radiology, who have in turn developed considerable experience and expertise in managing the non-ocular complications of Stickler Syndrome. This collaboration of medical specialties has provided holistic care for patients and has resulted not only in exemplary clinical care, but has also led to some remarkable insights into the clinical features of these patients.

As a result of the team’s research and multi-disciplinary service, in 2011 the Department of Health commissioned the team to provide the national diagnostic service for all patients in England with Stickler Syndrome. Health boards now access the service via their own commissioning arrangements so that all UK NHS patients have free access to a true multi-disciplinary team service unparalleled anywhere else in the world.

The team has also recently identified that a deep intronic variant in the COL2A1 gene in patients without Stickler Syndrome is associated with an inherited risk of retinal detachment. This has remarkable implications for the potential future care of patients with retinal detachment, and will help prevent this potentially blinding condition.

Patient feedback on the service:

“Always feel reassured after our visit to the Stickler Clinic that we can rely on the marvellous team.”

“Brilliant Stickler Syndrome team”

“The waiting time can be long but I feel this is completely understandable given the complexities of Sticklers and the sheer number of patients treated by the team. You always leave with answers, which is always worth the wait.”

“We were both delighted and very honoured to win this award in recognition of what can be achieved by close team collaboration between clinicians, scientists, and patients in the form of the national Stickler Syndrome Support Group. NHS England Specialised Services lead the way in providing and resourcing an MDT service unparalleled anywhere else in the world.”

Mr Martin Snead, Consultant Vitreoretinal Surgeon, Cambridge University Hospitals NHS Foundation Trust

Macular disorders are the leading cause of blindness and a decade ago treatment options were limited. There continues to be a growing need for research to find better options for patients however locally, the opportunities to participate in clinical research has historically been virtually non-existent. In addition, there has been a growing demand to provide high quality clinical care for patients with macular diseases which need state of the art technology.

Having identified the unmet need for provision of services for macular diseases, the goal of the team at Bradford was to develop a centre of excellence by encouraging a culture of research and evidence-based practice. The team initiated clinical trials in the field of macular diseases with one consultant and one nurse to facilitate access to new treatment options for patients and develop local expertise.

The aims of the team were to:

• Develop infrastructure and expertise for clinical research

• Make modern medical interventions available to the local population where none were available before

• Promote research in routine clinical practice and integrate evidence-based clinical practice

• Complement clinical practice through investment in infrastructure and clinical expertise

• Develop local, national and international collaboration for enhancement of knowledge and clinical outcomes

• Develop, promote and incorporate innovative clinical care pathways, checklists and guidance for effective and efficient patient care

• Facilitate patient engagement through patient and public engagement

• Develop a centre of excellence for macular diseases by developing a culture of research and evidence-based practice

Bradford Ophthalmology Research Network: Enhancing patient care through research


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WINNER Bradford Teaching Hospitals NHS Foundation Trust

Judges’ special award

Host Danny Crates, Paralympian and former world record holder and judge Valerie Haylor, Associate Lecturer, Sheffield Hallam University, present the award to the finalist


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The initiation of photodynamic therapy (PDT) clinics in 2000 paved the way for the development of a research culture. Initially it was challenging to secure funding for PDT for wet AMD patients, however a multi-centre cohort study was developed to provide data for the Safety and Efficacy Register of New Interventional Procedures (SERNIP) to later inform the National Institute for Health and Care Excellence (NICE). This challenging task was undertaken by the lead medical retina consultant Faruque Ghanchi at Bradford supported by the eye clinic sister, and individual funding for patients was secured to cater for this area of unmet need.

An additional study, VPDT cohort, led onto the IVAN study conception meeting in Bradford in 2008 which stimulated further growth of research. As a result, a research sister joined the research team as the first dedicated research nurse. This ensured stability and allowed future growth of the research portfolio.

The Bradford ophthalmology research team has evolved from the original consultant and nurse to the current status of a collaborative ophthalmology research network working with researchers in clinics as well as universities. The team now includes a research optometrist, a research associate / data clerk, a research fellow and a research photographer. The team is now one of the strongest, most flexible and experienced research teams in the UK. The research associate has assisted in the development of electronic data capture for a multi-centre study, the team’s photographers are accredited to international standards by all major reading centres, and the aptitude, drive to succeed and dedication of the optometrists is noteworthy.

In addition to the human resources, the team has invested in physical infrastructure with a cash injection of research funds. They installed the first research optical coherence tomography (OCT) machine four years ago to support the NHS service and later upgraded that to high definition retinal angiography and OCT kit.

The team has participated in 20 studies in the last six years and has a growing portfolio, offering patients an opportunity to participate in a clinical trial. Despite being a new centre, the research team has outperformed its expectations. The team achieved first rest of world and first UK patient recruitment in three studies and fastest recruitment to target in another. The team has achieved the highest recruitment in the local research network over the past two years and 100% compliance to referral to treatment.

The evidence-based approach has resulted in excellent patient outcomes and the data for AMD and DMO patients have been presented at the Royal College of Ophthalmologists’ annual congress. The macular service has also been recommended for the Clinical Service of

the Year award of the Macular Society in 2014, 15 and 16. In addition, the researchers, Professor Ghanchi and Mrs Devonport, received national recognition individually for their contribution to industry studies in 2015.

The team shares research experience to enhance clinical care and implements innovative practice. They have embraced electronic patient records for almost a decade, developed eye injection checklists, implemented protocols for loading phase injections, introduced a care pathway for virtual assessment of retinopathy and conceptualised and introduced nurse injectors in clinics.

The team has built a robust research infrastructure with dedicated clinics and invested in a retinal imaging kit to support the NHS service. The research nurses are trained for retinal imaging, clinical assessments and injection procedures that complement the NHS service while offering clinical and research training to young ophthalmologists. The team has been instrumental in setting up the trainees’ research network to prepare for the next generation of research active ophthalmologists.

“I am delighted to learn of our team’s selection for

the prestigious Ophthalmology Honours Judges’

Special Award. Thank you Ophthalmology Honours

as each member of our team has been thrilled with

this national recognition - a real boost for us to

continue to deliver in future! I would like to thank

our colleagues, hospital management and our

patients for supporting our work.”

Professor Faruque Ghanchi, Head of Bradford Ophthalmology Research Network (BORN), Bradford Teaching Hospitals NHS Foundation Trust

For further information on this initiative, please contact Professor Faruque Ghanchi, Head of Bradford Ophthalmology Research Network (BORN), Bradford Teaching Hospitals NHS Foundation Trust [email protected]

UKEYL06160038ah Date of preparation: January 2017

Congratulations to the winners and those who have been highly commended and commended in the 2016 Ophthalmology Honours

The 2016 awards programme received a significant number of high quality entries. After much deliberation, the judges identified the finalists listed below for their exceptional initiatives and hard work.

Best ophthalmology team Winner: Making a Difference for Glaucoma Patients: A ‘Can Do’ Approach, Epsom and St. Helier University Hospitals NHS Trust

Highly commended: Central Manchester Foundation Trust Retinopathy of Prematurity Team, Manchester Royal Eye Hospital

Commended: Stickler Syndrome Service, Cambridge University Hospitals NHS Foundation Trust


Winner: The Paediatric Intraocular Clinic, Alder Hey Children’s Hospital NHS Foundation Trust

Highly commended: Kent Association for the Blind ECLO Service, East Kent Hospitals University NHS Foundation Trust

Commended: Making it easier to access charitable services for patients with sight loss, Aintree University Hospital NHS Foundation Trust with Blind Veterans UK

Commended: A support and education day for patients with Idiopathic Intracranial Hypertension, University Hospitals Birmingham

Best ophthalmology care innovation

Winner: Real-time Patient Journey Assessment Platform, Manchester Royal Eye Hospital

Judges’ special awardWinner: Stickler Syndrome Diagnostic Service, Cambridge University Hospitals NHS Foundation Trust

Winner: Bradford Ophthalmology Research Network: Enhancing patient care through research, Bradford Teaching Hospitals NHS Foundation Trust

Outstanding ophthalmology nurse or allied health professionalWinner: Anne-Marie Lacey, Nurse Practitioner, Royal Bournemouth Hospital

Highly commended: Clare Hall, Staff Nurse VR Theatre, Colchester Hospital University Foundation Trust

Highly commended: Sue Walker, Specialist Ophthalmic Science Practitioner, East Kent Hospitals University NHS Foundation Trust

Commended: James Bayley, Clinical Specialist Nurse Practitioner, Oxford Eye Hospital

Commended: Nicola Hopkins, Retinal Nurse Specialist, Colchester Hospital University Foundation Trust

Commended: Josna Patel, Diabetic Specialist Nurse, Hillingdon Hospital NHS Foundation Trust

Unsung heroWinner: Cara Mitchell, Macular Service Coordinator, Bradford Teaching Hospitals NHS Foundation Trust

Highly commended: Christopher Ellis, Ophthalmic Imaging Technician, Colchester Hospital University Foundation Trust

Commended: June Crosby, Senior Eye Clinic Liaison Officer, Eye Hospital, Hull Royal Infirmary

Bayer is committed to delivering the Ophthalmology Honours programme in order to continue to recognise the outstanding work being carried out by multi-disciplinary teams in ophthalmology throughout the UK.

Don’t miss out on your chance to be part of next year’s awards programme. The 2017 awards programme will be open for entry on Monday 24th April 2017.

For more details please visit: www.ophthalmologyhonours.bayer.co.uk

The 2017 entry deadline will be Friday 18th August 2017.

We look forward to receiving your entry! For further information on the Ophthalmology Honours please visit our website www.ophthalmologyhonours.bayer.co.uk or contact Liberation Unlimited who is facilitating the awards on behalf of Bayer on [email protected].

Documents

2016 - Bayer Ophthalmology Honours - Home · the 2016 Ophthalmology Honours. The results were announced at the awards ceremony on the 1st December 2016. The Ophthalmology Honours