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Halfway through my first year as your presidenton ‘a ticket’ to champion excellence in the practiceof ophthalmology and what are we doing?• We’ve responded with your views on
IS-TCs, ‘Good doctors, safer patients’,prescribing for optoms.
• We’ve alerted the PCT commissioners andNICE to the need for the new treatments forARMD to be available to our patients – andthe need for ophthalmologists to treat them.
• We have published some interim guidelineson the Management of ARMD and some indraft for Retinopathy of Prematurity.
• We’ve inaugurated a forum for staff andassociate specialist ophthalmologistmembers at the College with a view torepresentation on Council.
• We are well on the way to officialapproval for our continuous electronicrecord and audit systems for cataractsurgery, glaucoma management anddiabetic retinopathy treatment.
• We are running pilots for the newspecialist training scheme – one of veryfew colleges to do so – should make ‘takeoff’ more comfortable.
• We are the first college to receive approvalfrom PMETB for the new style curriculum– it is on our website. Have a look.http://curriculum.rcophth.ac.uk/
• We have a new exam structure to conformwith the PMETB rules.
• We spoke up in support of internationalmedical graduate ophthalmologists.
• We have recruited some excellent newmembers to our Lay Advisory Groupbringing a variety of expertise andexperience to inform and assist our work.
There is much more….Ophthalmologists are the ones to lead forophthalmic practice for the patients of ourcountry and we are doing it on your behalf.You have a great team of hard workingofficers and Council members and manyother college members are contributingconsiderable amounts of time and effort onyour behalf, ably supported by the 20 collegestaff. Thank you.
Make your views on these and any othersissues known through your regional rep orto me at the College: [email protected] there is lots more information on thewebsite www.rcophth.ac.uk about what weare doing.
Happy ChristmasBrenda Billington
President
QUARTERLY BULLETIN OF THE ROYAL COLLEGE OF OPHTHALMOLOGISTS
2Congress update
3Members news
5Focus
7Museum Piece
9International
11Educational andTraining
14HonoraryFellows
16Diary andAppointments
Winter2006
College NEWS
Articles and information tobe considered for publicationshould be sent [email protected] advertising queriesshould be directed to Robert Sloan 020 8882 [email protected]
Copy deadlinesSpring 5 February 07Summer 5 May 07Autumn 5 August 07Winter 5 November 07
Inaugural meeting of Staff and Associate Specialists Ophthalmologists Group
What is the College doing about…..?
In order for the ChildProtection system to functionproperly, experts within therelevant medical disciplines,including ophthalmology, needto engage with the civil andcriminal justice systems. Suchengagement, however, carrieswith it a risk to the expert’sreputation and career, whichhas led to a shortage of expertwitnesses for these cases.
These, and other difficultieswithin the Family Justicesystem, have led to theDepartment of ConstitutionalAffairs establishing the FamilyJustice Council (FJC). TheCouncil's primary role is topromote an inter-disciplinaryapproach to the needs of familyjustice, and throughconsultation and research, tomonitor the effectiveness of thesystem and advise on reformsnecessary for continuousimprovement. Local branches ofthe FJC have been established inmany areas, and it is hoped thatby a mutual exchange ofinformation between localcommittees and the council, best
practice can be disseminatedthroughout the family justicesystem. The FJC also providesguidance and direction toachieve consistency of practicethroughout the family justicesystem and submits proposalsfor new practice directionswhere appropriate.
The FJC advises Governmenton changes to legislation,practice and procedure toimprove the workings of thefamily justice system.
Issues currently beingconsidered by the FJC includethe promotion of strategies toimprove the supply and qualityof experts, e.g. training andaccreditation of expert witnesses.
The FJC meets four times ayear, in London, and is supportedby a dedicated secretariatbased in the Royal Courts ofJustice. More information isavailable at www.family-justice-council.org.uk/. I represent theCollege on the Experts’ Committeeof the FJC and would be happyto discuss its work further withinterested members.
Michael Clarke
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Congress News Child Protection and TheFamily Justice Council
The Honorary Secretary, Mr Larry Benjamin, will come to the endof his first term in May 2007 and has been nominated to stand again.The Honorary Treasurer, Mr John Talbot, has decided to stand downafter five years in the post.Both posts are open to any College member and anyone who wishesto nominate for either post should contact the Chief Executive by 8January 2007.
to Miss Michèle Beaconsfield, Consultant Ophthalmologist,Moorfields who has been elected as President of the OphthalmicSection of the Union Européenne des Médecins Spécialistes (UEMS).The four year term will begin in January 2007.
COLLEGE OFFICERS
Congress will be making a welcome return toThe ICC in Birmingham next year. Pleaseensure you have the dates in your diary:Tuesday 22nd to Thursday 24th May 2007.
We are delighted that many esteemedophthalmologists have agreed to chairsessions and we have an excellentprogramme planned. Sessions include:
All in the Mind - Mr Richard HarradAllergic Eye Disease - Mr. Stuart CookArtificial Vision - Mr. Winfried Amoaku & Mr. Dinesh VermaBOPSS Highlights - Mr. Anthony TyersBowman's Club Highlights - Mr. Stephen Kaye,Mr. Francisco Figueiredo & Mr. Frank LarkinBritish & Eire Glaucoma Association Highlights -Mr. Ian CunliffeCataracts in Children - Mr. Arvind Chandna &Ms. Isabelle Russell-EggittCommon Vertical Deviations - Mr. ArvindChandna & Ms. Gill AdamsDiabetic Maculopathy - Mr. Jon GibsonDiabetic Retinopathy Screening - Mr. Peter Scanlon& Mr. John TalbotDuke Elder Lecture - Professor Andrew Dick Edridge Green Lecture - Mr. Richard Harrad Evolving Techniques in Corneal Surgery: Layer byLayer - Mr. Stephen Morgan & ProfessorHarminder DuaInfective Uveitis - Mr. Carlos PavesioIntracranial Aneurysms - Mr. Mike BurdonIOL Design, Wavefront Technology in CataractSurgery - Mr. Larry BenjaminLacrimal without Tears - Mr. Geoffrey RoseMedical Ethics - Mr. Graham KyleMyasthenia - Dr. Gordon PlantOcular pathology - Professor Phil LuthertOphthalmology Showcase - Professor David WongResearch Methodology - Mr. John SparrowRetinal Dystrophies - Professor Anthony MooreTeaching the Teachers - Mr. David Smerdon & Mr. Michael NelsonThe Great Debate - Mr. Larry BenjaminTo maken vertue of necessite: The Primary Care Tales- Mr. Nick AstburyWhat's New in Glaucoma? - Professor Peter Shah
Please visit the website for the latest newswww.rcophth.ac.uk/scientific
For the energetic among the membership,Bausch & Lomb will be holding a 5 a sidefootball tournament on the Wednesdayevening. Please contact Marcia Cotton on020 8781 2986 or [email protected]
Heidi Booth-AdamsHead of the Scientific Department
CONGRATULATIONS
THE NETTLESHIP MEDAL is awarded every 4 years for the best piece of original work by a Britishophthalmologist (even in training) published in anyjournal during the last three years. This year the awardgoes to Mr Michael Clarke, Consultant Ophthalmologist in Newcastle. His paper "randomised controlled trial oftreatment of unilateral visual impairment detected atpreschool vision screening" was described by the panel of judges as being a definitive study of considerableimportance with implications for clinical practice. Hejoins a distinguished list of ophthalmologists dating backto 1904 that includes, George Coats, Treacher Collins, Sir Stewart Duke Elder and Henry Stallard. David Wong
3
THE ACTON TRUST FOR THE BLIND (ATFB) has been funded to produce an 80 minute oral history on CDdocumenting the Second World War, which will go to libraries, schools and museums. It is looking for people who werevisually impaired during WW2 and lived, worked or went to school anywhere in London. Contact: 020 8563 2922 [email protected].
Collection of email addressesThe College would like to be able to email allmembers. As a first step, in July we wrote to all UKconsultants asking them to [email protected] with one contact emailaddress. The response so far has been good but wewould like all UK consultants to participate.In due course we hope to collect email addresses forthe entire membership.
Jackie Trevena, Head of Finance and Membership
FROM THE MEMBERSHIP DEPARTMENT
ObituariesMr Derek Ainslie (1919 – 2006), the pioneer of refractive surgery in the UK, trained at Cambridge and TheMiddlesex Hospital, graduating in 1944. He immediately joined the Royal Army Medical Corps and wasposted to Africa for several years before returning to London to resume his career. He trained inophthalmology at the Middlesex Hospital, and at Moorfields; being appointed Consultant first at theMiddlesex Hospital, and subsequently at Moorfields, City Road in 1960.
He was permitted by Moorfields to confine his own clinical and surgical endeavours to the field that reallyfascinated him - anterior segment surgery of the cornea, iris and lens - leaving the management of retinalproblems to his Senior Registrar.
In Bogotá, Colombia, he studied new techniques for the surgical improvement of the refractive state of thecornea. There were two basic techniques. The first involved lifting up the front surface of the eye by forming athin, hinged flap under which the shape of the cornea is changed. The second uses corneal tissue from adonor, which is frozen, reshaped and transplanted into the patient.
These techniques, devised by the Spanish surgeon, Professor José Barraquer, were the forerunners of manymethods for refractive surgery in current use today. Derek, however, was immensely cautious, mastering thedifficult techniques using Barraquer's microkeratome – a device with an oscillating blade designed forcreating a corneal flap of 100-200micrometres.
He used donor eyes initially, and then carried out operations on the eyes of volunteers with denseamblyopia. A tiny piece of cornea had to be removed, quick frozen, reshaped on a miniature lathe and thenreplaced in the eye. A slip would have been calamitous. In order to minimise mistakes, he made a taperecording with step-by-step instructions to play in the operating theatre during the procedure. The resultswere technically superb but were not reliably followed by excellent visual results. He continued to work withmyopic patients and young patients without a natural lens, known as aphakes, for whom he would insert aground lens of donor corneal tissue within the patient's corneal stroma.
This work was sadly interrupted in 1975 with the onset of a severe illness compounded by visual loss fromglaucoma and he retired at the age of 55.
Derek was a man of immense charm, a delight to be with and a keen supporter of Arsenal, whose homegames he would attend, complete with hat, scarf and rattle! Lucky juniors who showed the slightest interestwould be invited along to lend their own support.
Derek's last years were spent with his loving family, especially with his adoring grandchildren.
Arthur Steele and othersWe also note with regret the death of:Percival Louis (Val) Allen Aldershot, Hampshire
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IntroductionRetinoblastoma is a malignant tumour of the retina, whichaffects between 35 and 45 children per year in the UnitedKingdom. The children typically present in the first two yearsof life and 30% - 40% of them will be bilaterally affected.
All bilaterally affected children, all children with apositive family history and 8%-10% of unilaterally affectedchildren will have a germ line mutation predisposing them toretinoblastoma and carrying implications for their future wellbeing and for the likelihood of family members being affected.1
PresentationMost children with retinoblastoma present with eitherleukocoria or strabismus. Buphthalmos, heterochromia,pseudohypopyon, severe inflammation and raisedintracranial pressure are all recognised but rare presentations.
There is considerable evidence that early detection offersthe best chance of successful treatment of retinoblastoma,and one of the major challenges facing all service providers isto identify affected children whilst the tumours are smallenough to allow effective conservative therapy.
In a UK setting, where relatively early presentation is thenorm, long-term survival can be anticipated in 95% or moreof the children. However, in other parts of the world wherediagnosis and/or treatment may be delayed until extra-ocular spread has occurred, 5 year cancer free survival isreduced to less than 20%. 2
DiagnosisDiagnosis of retinoblastoma is essentially clinical, andrequires a detailed fundus examination with indentation to
visualise the Ora Serrata. In children of this age there must,therefore, be rapid access to general anaesthesia to allow anadequate examination. The organisation of the UK serviceinto two national centres ensures that the diagnosis andmanagement is always in the hands of experienced cliniciansand greatly reduces the risk of false positive and falsenegative diagnoses.
Examination under anaesthetic is often combined withimaging – particularly ultrasonography to identifycalcification within the tumour mass and MRI, looking forevidence of optic nerve involvement.
There is no role for diagnostic biopsy and indeed,breaching the corneo-scleral envelope, either spontaneouslyor iatrogenically, is associated with a substantial increase inthe likelihood of orbital and distant dissemination, which inturn carries with it a much poorer prognosis. 3
A comprehensive differential diagnosis of leukocoria iswell known to all Ophthalmologists, but in reality the majordiagnostic dilemmas seen in a retinoblastoma service areCoat’s disease, persistent hyperplastic, primary vitreous andretinal dysplasia associated with Norrie’s disease. We alsosee occasional children with tuberous sclerosis or intraocularmetastases from other malignancies.
ManagementFor more than 50 years it has been recognised thatretinoblastomas are vulnerable to the effects of radiation and formost of that period plaque brachytherapy or external beamradiotherapy have been the mainstays of conservative treatment.
While plaque brachytherapy remains an invaluabletreatment modality, external beam radiotherapy has largely
Retinoblastoma
FocusWinter2006
THE ROYAL COLLEGE OF OPHTHALMOLOGISTS
5
Caption?
been replaced by chemotherapy as the first line conservativemanagement. Increasing recognition of the long-term adverseeffects of external beam radiotherapy on the facial skeleton,the neuro-endocrine system and, particularly, the substantialincrease in second tumour formation, has led to thisfundamental change in approach.
Children with germ line mutations have a relatively highrisk of second malignancy in early adulthood by virtue oftheir dysfunctional tumour suppressor gene. They have a 5fold increase in risk as compared to the general populationwith a particularly high relative risk of developing bony orsoft tissue sarcomata. That risk of a second malignancy,however, rises to between 18% and 35% by the age of 35 ifthe children are exposed to external beam irradiation.
The UK chemotherapy regimen employs a combination ofVincristine, Carboplatin and Etoposide given in 3 to 4 weekcycles, and most commonly employing 6 cycles. The regimensused elsewhere in the world occasionally employ fewer (rightdown to carboplatin monotherapy) or more agents. There isparticular interest in combining these three agents withCyclosporin in an attempt to eliminate the problem of tumourmulti-drug resistance. At the moment pre-treatment withcyclosporin is not widely used, but there are reports of impressiveeye salvage rates in some children with recurrent disease.
The aim of chemotherapy in retinoblastoma treatment isusually to reduce the size of the tumour (chemoreduction)and allow complete tumour control with adjunctive focaltherapy. Only rarely is complete tumour control, withchemotherapy alone, the objective.
The focal therapies employed include laser therapy(particularly trans pupillary thermotherapy) cryotherapy andplaque brachytherapy. For tumours situated at the macula,complete control with chemotherapy may be attempted to avoidthe effect of macula thermotherapy on the child’s long termvision. Once again, the results with this approach are variable.
For those children with tumours that cannot be controlledconservatively, or in children with unilateral disease wherethere is no possibility of preserving a seeing eye, it may wellbe deemed inappropriate to expose them to 6 cycles ofchemotherapy. In that case enucleation offers a, usually,curative treatment. Both families and clinicians, however, needto remember that approximately 1 in 3 enucleated eyes showadverse histological features (optic nerve or deep choroidalinvasion by tumour cells) which will necessitate 4 cycles ofchemotherapy to reduce the risk of metastatic dissemination. Itis also apparent that a proportion of children who haveundergone enucleation in childhood develop significantpsychological problems related to their enucleation andartificial eye as they grow older. A comprehensive service tothe families needs to take account of these later developments.
GeneticsTraditional genetic counselling for families with an affectedmember has been derived from a statistical analysis of risk.Review of 1600 UK families, for example, showed that if aparent had bilateral disease then the risk of the offspring
carrying the germline mutation is 50% and the risk to theoffspring of developing retinoblastoma is 45%. Theequivalent figures for the offspring of a unilaterally affectedparent is a 4% chance of developing retinoblastoma, which ifit occurs will almost always be bilateral.
Though this data is useful for guidance, in any individualit fails to provide absolute information. The identification ofthe retinoblastoma gene on the long arm of chromosome 13has facilitated much more precise guidance to families, hasintroduced the possibility of pre-natal diagnosis and has ledto a detailed, though as yet incomplete, understanding of thebasic mechanisms involved in retinoblastoma formation.
The retinoblastoma gene, located at the 13q14 site ofchromosome 13, is a large 27 exon 18 kbase gene responsible forthe production of retinoblastoma protein (pRb). The Rb gene isa ubiquitous oncogene, and both alleles must be lost from a cellfor it to undergo malignant transformation. In children with agerm line mutation one allele is missing from all cells and onlythe “second hit” causing loss of the homologous gene isnecessary for retinoblastoma to develop. Loss of thathomologue may be triggered by a number of agencies, butoncoviruses and radiation seem to be particularly important.
Gene sequencing enables mutation detection in the vastmajority of children with a germ line mutation. This in turnmeans that family members can be screened and eithereliminated from the need for repeated screening, or placedon an intensive screening programme to facilitate earlytumour detection and treatment. An assessment fromToronto has suggested that mutation analysis has allowed112 Ontario families to avoid 630 EUA’s and 1416 clinicappointments. It also provides the information which allowsprenatal diagnosis (using amnioscentesis or chorionic villussampling) and even embryo screening.
Basic MechanismsWhilst cells are in the G1 phase of the cell cycle they may entera quiescent stage, they may undergo senesence, apoptosis orthey may differentiate. Once the cell progresses to the S phasethen they proceed inevitably to cell division. The movementinto the S phase is enabled by a number of transcriptionfactors, of which E2F is pivotal. The role of retinoblastomaprotein is to bind E2F and prevent the uncontrolledprogression into S phase. Without its influence, cells showuncontrolled replication, which is the hallmark of malignancy.
This fundamental role of pRb in cell division explains notonly the 90% incidence of retinoblastoma in germ line mutationcarriers, but also the very significant increase in risk of othermalignancies (sarcoma, melanoma, epithelial cancers) amongstcarriers. In the future it may become possible to target thisbasic failure in the cell biology, in the hope of avoiding thegeneral systemic effects of chemotherapy. Targeted therapyaiming to manage the gene defect or modify the cellularresponse to the defect, may well represent the “golden bullet”of retinoblastoma treatment.
Harry WillshawConsultant Ophthalmologist, Birmingham Children's Hospital
6
References 1 Sanders BM, Draper GJ, Kingston JC “Retinoblastoma in Great Britain 1969-1980:Incidence, treatment and survival”
Br J Oph (1983) 72 ; 576-583
2 Antonelli C, Steinhorst F, Ribeiro K et al “Extraocular retinoblastoma: A 13 year experience” Cancer (2003) 98 ; 1292-1298
3 Stevenson KE, Hungeford JL, Garner A “Local extension of retinoblastoma following intraocular surgery”Br J Oph (1989) 73 ; 739-742
7
The Western Eye Hospital iscelebrating its 150th anniversarythis year. It was founded in 1856by Henry Obré FRCS and JohnWoolcott FRCS in a building at 1 St John’s Place off LissonGrove and was called the StMarylebone Eye and EarInstitution. Three years later itdropped “Ear” from the name.
In 1860 a building was rentedat number 155 on MaryleboneRoad. Six years later theInstitution was renamed TheWestern Ophthalmic Hospitalwhich remained its name untilrecently when “Ophthalmic”was replaced by “Eye”.
The hospital expanded in1889 with the purchase ofadjoining buildings and its ownfreehold.
This building wasdemolished in 1930 and thepresent hospital built on thesame site.
In 1951 the ophthalmicoutpatient department of St Mary’s Hospital was movedto the Western Ophthalmic, andfour years later, all ophthalmicwork and post graduate training.
The only ophthalmologistwho served at both hospitals inthe 19th century was Sir WilliamWhite Cooper (1816 – 1886) whowas the first ophthalmologist atthe newly opened St Mary’sHospital in 1851.
He was consultantophthalmologist to the Westernin 1876. In 1859 he had beenmade oculist to Queen Victoriawho made him a knight in 1886.Two days after theannouncement he caughtpneumonia and died before hecould be dubbed.
Among an impressivenumber of publications he is bestknown for ‘Wounds and Injuriesof the Eye’, 1859, the first bookwritten exclusively on the subject.
Richard Keeler Museum Curator
Museum Piece150th Anniversary
Sir William White Cooper 1816 - 1886The Western Ophthalmic Hospital 1956
The Western Ophthalmic Hospital 1856
The Western Eye Hospital
9
‘For she's a jolly good Fellowand so say all of us’. This is theview of the Trustees of theBritish Council for Prevention ofBlindness (BCPB) of Dr WanjikuMathenge, whose PhD projectwill address the causes of somespecific forms of blindness inher homeland of Kenya.
She is the holder of theCharity's first Sir John WilsonFellowship, which honoursone of our founder Trustees.The aim of this Fellowship isto support, to the tune of£60,000 per annum for threeyears, carefully selectedindividuals who will returnhome to set up units that willteach their compatriots how todevelop and run blindnessprevention programmes.
The Trustees hope shortly tomake an appointment to acomplementary Fellowship, theeponym of which will recognisethe tremendous contributionthat a past member of Councilhas made to the prevention ofblindness worldwide. The BarrieJones Fellow will be someonewho aims to hold a seniorappointment in the UK butwhose research work willinvolve spending time in a lowincome country. Again, the
funding will be £60,000 a year(for two or three years,depending upon the appointee'scareer plans).
These recent developmentsresult from a logical evolutionof the BCPB's contribution tothe prevention of blindness overthe past thirty years.Importantly, they combineresearch and training, both ofwhich are cardinal features ofthe Charity's support in thisfield. One of the highlights ofresearch we funded led to theintroduction of Ivermectin,which has been so successful inthe treatment of those withonchocerciasis. (It was a currentBoard member, Lady Wilsonwho, when travelling with herlate husband in Africa, coinedthe readily rememberedcatchphrase 'River Blindness').As regards training, we havecontributed, over the pasttwenty five years, to the furthereducation of some fifty MScstudents (Boulter Fellows)studying at the InternationalCentre for Eye Health, thebrainchild of Professor BarrieJones.
The present Trustees fullyendorse the ambitious aims ofVISION 2020 and believe theCharity is well placed tocontinue making a significantcontribution to the prevention ofavoidable blindness throughoutthe World. For further information pleasevisit www.bcpb.org
Andrew Elkington
In Africa there is on average only oneophthalmologist per million peoplecompared with 15 per million in the UK. The VISION 2020 Links Programme, based atthe International Centre for Eye Health,works with eye training institutions overseasto identify their main needs and prioritiesand match them with a suitable UK trainingeye centre.
In July a letter went out to all UKconsultant ophthalmologists seekinginformation about involvement (past orpresent) with overseas institutions with theintention of establishing a database ofophthalmic staff that have worked abroador might be willing to be part of newinitiatives to help eliminate avoidableblindness overseas.
There has been a wonderful response withover 185 ophthalmologists returninginformation which shows that over half arealready associated with hospitals in 45countries around the world. Almost all haveindicated that they would like to be part ofdeveloping a link and 40% have beenencouraging about their trust’s potentialwillingness despite the present financialclimate in the NHS.
By gathering this information we hopeto be able to put people in touch with oneanother and match the needs of overseaspartners with appropriate UK ophthalmicstaff, eye departments or trusts. At presentwe have 17 links programmes either beingdeveloped or underway and in severalcases the trust CEOs or Chairs arepersonally involved.
There is much to be done at home, butan even greater challenge is for us to shareexpertise, teach and train in parts of theworld that are under-resourced and forwhom blindness is part of daily life.
Thanks for your replies so far. The letterand form are on the ICEH website at:http://www.iceh.org.uk/files/linksprogramme/Links_UKdatabase.doc
and if you would like more informationon links please contact:[email protected] [email protected]
Nick Astbury
INTERNATIONAL NEWSInternational Ophthalmology Links and the Vision 2020Links Programme
The BritishCouncil forPrevention ofBlindness (BCPB)
Courtyard of the Great Mosque Umayyed,Aleppo, Syria
ROYAL COLLEGE OF OPHTHALMOLOGISTS STUDY TOUR
SYRIA11th to 17th February 2007
For details please contact Christopher Liu on: [email protected]
11
NEWS FROM THE EDUCATIONAND TRAINING DEPARTMENT
Organised by: The RCOphth OphthalmicTrainee Group (OTG)
Topics to include: What being a consultant is really like,working with ORBIS, e-learning, how to be a good trainer.
Venue: Princess on Portland Hotel,Manchester
Cost: Course fee £155 (for dinner,accommodation and course fee)
Day rate: £60
The Programme details and application forms are availableon the college website www.rcophth.ac.uk/training/otg,please email other queries to: [email protected]
In August 2007 there will be a major change in UK specialist training as theunified ("run-through") training grade begins. The College’s Curriculum Sub-committee has devoted innumerable hours to developing a newCurriculum. It has also worked closely with the Training and ExaminationsCommittees to ensure that learning and assessment is fully integrated andcoordinated. The result is a curriculum written as a Learning Outcomesdocument based around 179 such outcomes. Widely lauded as an excellentpiece of work, it has been approved by the Postgraduate MedicalEducation and Training Board, (PMETB), subject to the outcome of thepilot project currently running in two deaneries.
Those entering Ophthalmic Specialist Training (OST) with a new TrainingNumber from August 2007 onwards must follow the new curriculum.Existing SpRs will normally continue on the old curriculum, although theymay be given a chance to swap at some stage.
The Curriculum has been produced as a web-based document and theCollege acknowledges the educational grant from Pfizer Ophthalmology. Please visit www.rcophth.ac.uk/education/new-curriculum
If you have any queries or concerns please contact: [email protected]
THE NEW CURRICULUM
ORYCLE 2007 29-30 March
Training the Trainers: These popular courses are offered in modular form and take place at the College.
Module Title Spring Autumn1 What to teach Tuesday 27 March Tuesday 25 September 2 How to Teach3 Improving Teaching Skills Tuesday 8 May Tuesday 2 October 4 Feedback and Appraisal 5 Assessment Tuesday 29 May Wednesday 14 November 6 Problem Solving
Please note that the course on modules 5 and 6 planned for Tuesday 21 November 2006 has been postponed until 23January 2007. Places are still available.The website reference is http://www.rcophth.ac.uk/education/traintrainers.
To Mrs Emily Beet,The Head of theExaminations Department, a daughter,Heather Louise Elizabeth, born 28 October. Congratulations to Emilyand Steve.
The European Board of OphthalmologyDiploma examination will be held inParis at the Palais des Congrès on the4th & 5th of May 2007.The examconsists of an MCQ and four 15 minutevivas; success confers the Diploma ofthe EBO, recognised as necessary forspecialist registration in several EUmember states. Details may be obtainedfrom the EBO website,www.ebo-online.org
EXAMINATIONSNEWS
12
Luer Lock Cannulae HazardThe danger of incorrectly mounted Luer lock intra-ocular cannulae as a potential risk in intraocular surgeryhas recently come again to the College’s attention.Following a case report submitted to EYE the NationalReporting and Learning (NRLS) database at theNational Patient Safety Agency (NPSA) was searchedfor potential similar patient safety incidents. On thisdatabase 3 more similar cases and 1 ‘near miss’ wereretrieved. These cases and one other that also came toattention from another source, share a common theme.This is of intraocular cannulae –such as Rycroft, hydro-dissection or wound hydration cannulae- ‘exploding’from syringes during cataract surgery and travellingharpoon like into the eye. Failure correctly to engageLuer lock cannula appears to be an issue, though faultydesign cannot be ruled out. It is prudent to highlightsuch incidents to the Medicines and Healthcare productsRegulatory Agency (MHRA) so that any deviceproducts concerned might be investigated further.Devices should be retained locally for further investigationif thought to be faulty. See www.mhra.gov.uk for moredetail and contact your hospital’s clinical risk manager.
Ophthalmic staff should be aware of this potentialrisk with intraocular cannulae despite Luer lockconnectors to syringes. The prudent ophthalmic surgeonchecks that the cannulae is firmly mounted on thesyringe and first squirts some fluid through the cannula-away from the eye- to ensure that all is workingcorrectly prior to intraocular use.
Simon Kelly
The National DecontaminationProject “Where was your phacohand-piece last night?”Q.1 Concerned regarding cleaning of ophthalmicinstruments?
Q.2 Experiencing instruments tray turnaround timeproblems?
If you answered “yes” to either question above, youmight enquire what is happening to your local HospitalSterilisation and Decontamination Unit (HSDU) – orCSSD. If your local service hasn’t undergone a major
revamp recently, it is likely to in the next few years. The National Decontamination Project, run by the
Department of Health (DH), started in 2000 within NHS Estates. It followed a report by the National Audit Office (NAO) on management & control ofHospital Acquired Infection (HAI) in England. UKdecontamination practices gave rise to concern andadvice was sought from the Spongiform EncephalopathyAdvisory Committee (SEAC).
The Project aims to ensure all NHS hospitals haveaccess to decontamination services of agreed standards.Similar projects are underway in Scotland and Wales.The main difference for England is a trend towardscentralisation of services.
“Little Sister” bench-top autoclaves were quoted as example of variable, and impossible to verify,decontamination processes. These devices have nowbeen phased out over recent years.
MHRA guidelines apply not only to NHS establishments,but also to private facilities. All will be subject toscrutiny by the Healthcare Commission (England) orequivalent body.
It is expected that decontamination standards willrise, and the whole process monitored. It is planned thatinstruments are tracked throughout the decontaminationprocess by trays, if not individually. Instruments areexpected eventually to be etched with unique identifyingmachine-read codes.
The DH is supporting the Project with considerableinvestment in England, but several commercial “supercentres” with private investment are planned in“waves” over the next few years. With services coveringseveral trusts, many hospitals will decommission HSDUdepartments. This will entail instruments in some areasspending longer in transit. It is unknown whether thiswill pose problems or not.
Please let me know how the project has worked in your area:[email protected](include HSDU in the subject line).
Nick Hawksworth
Further reading:http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/EstatesAndFacilitiesManagement/EngineeringEnvironmentAndTechnology/EngineeringEnvironmentArticle/fs/en?CONTENT_ID=4118225&chk=QGWbyF
Professional standardsThe following topics have been brought before the Professional Standards Committee:
PARTICLES FOUND IN PATIENTS' EYES FOLLOWING PHACOEMULSIFICATIONMembers are reminded that the Medicines and Healthcare products Regulatory Agency (MRHA) should be informed if theabove situation should occur. www.mhra.gov.uk
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Below is the citation given forProfessor David Taylor at theAdmissions ceremony in June. It hasbeen edited for reasons of space.
Ladies and Gentlemen, MadamPresident, it gives me great pleasure todeliver this citation to David Taylor,Professor of Ophthalmology andHead of the Visual Sciences Unit atthe Institute of Child Health, London.He was born in Hobart in 1942 afterhis mother fled Singapore on one ofthe last ships to leave before theJapanese invasion. His father wasinterned in Burma and they did notmeet until David was 3 years old. David went on to study medicinein Liverpool and after commencingophthalmology training there,moved to London to join his futurewife Anna. He obtained a post inophthalmology at Great OrmandStreet Hospital (GOSH) which wasto determine the direction of hisfuture career. At GOSH he workedfor Kenneth Wybar, who becamehis mentor, and developed a lovefor paediatric ophthalmology andfor the institution of GOSH.Unusually for the times, he wasappointed to the house atMoorfields on his first attempt. In 1976 he was appointed to a jointconsultant post at the NationalHospital for Nervous Diseases andGOSH on the condition that heobtained further training inNeuroophthalmology which hegained in the US under Bill Hoyt. For a period of ten or more years,
David was one of the few specialistpaediatric ophthalmologist in theUK and was indefatigable inchampioning paediatricophthalmology as a specialty in itsown right. A generation ofophthalmologists, across the world,has been taught by David that inorder to be effective as a paediatricophthalmologist, it is not sufficientjust to have technicalophthalmological expertise; insteadthe effective paediatricophthalmologist must take intoaccount the general physical andpsychological health of the childand, sometimes, the parents – inshort he or she needs to be aphysician rather than a technician.That the worldwide medicalcommunity has valued thismessage, and his skills as acommunicator, is demonstrated byhis accumulation of 13 visitingprofessorships, 13 invitations togive named lectures, and 49 otheroverseas guest lectureships on everycontinent bar Antarctica.David has promulgated hisphilosophy of paediatricophthalmology not only throughthe annual paediatricophthalmology course he has runwith the Institute of Ophthalmologysince 1977, or via his home andoverseas British Council courses,but also through articles andtextbooks; an astonishing 57authored book chapters culminatedin the encyclopaedic prize winningPaediatric Ophthalmology, now inits third edition. While the currentedition is co-edited with his oldfriend and motor cycling buddyCreig Hoyt, he edited the first 2editions alone. The Sunday nightphone call from David enquiringhow the chapter was going becamea regular, and sometimes dreaded,event in the homes of paediatricophthalmologists up and down theland. It is a tribute to his skills as aleader and organiser, and to hisstanding in the paediatricophthalmic community, that hemarshalled his authors to produce
the most comprehensive and usefulbook ever written on the subject. David has also been a researcher,and the bare figures of 246publications and nearly £5 millionin research income demonstratesuccess in this arena too. Butsuccessful research is about morethan just such headline figures; it isabout determination and formingsuccessful working relationships.While David’s primary clinicalinterest has been in congenitalcataract, his most successfulcollaborators have been visualelectrophysiologists. He was alsoinstrumental in setting up a uniqueeye movement recording researchand study facility at the ICH.In 2003 David was promoted toProfessor and Head of the VisualSciences Unit at the Institute ofChild Health.There are now over 100 paediatricophthalmologists in the UK, manyof whom have trained with Davidand all of whom have beeninfluenced by his teachings. David,you truly deserve to be called thefather of paediatric ophthalmologyin the UK.
Michael Clarke
HONORARY FELLOWS – 2006
THE WILLIAM FARR MEDAL -awarded to a medical practitioner
who has made a significantcontribution to the management of
elderly people as part of originalclinical or research work in the UK.
Please contact:[email protected] for
more details by 15 January 2007
The President with Professor Taylor
We apologise that Mr Danny Morrison's appointment at Guy's and St Thomas's, London in September 2005 has not been previously noted.Miss Tina Dukes is a Consultant at the Royal Gwent Hospital and notLlanfrecha Grange Hospital as previously reported.
Miss Jane Ashworth Manchester Royal Eye HospitalMr Craig Burnett Hull and East Yorkshire HospitalMr Sean Chen Alderhey, LiverpoolMr José Gonzalez-Martin Southport and Ormskirk District GeneralMr Tim Jackson Kings College Hospital, LondonMr Jonathan Edward Moore Mater Hospital, BelfastDr Peter Scanlon Gloucestershire Royal Hospital,
Cheltenham
New appointments
College SeminarProgramme 2007Intravitreal Therapies 20 MarchThe Royal College ofOphthalmologistsCHAIRED BY: Professor UshaChakravarthy
Writing Research Proposals28 MarchThe Royal College ofOphthalmologistsCHAIRED BY: Professor Harminder Duaand Professor Alan Stitt
Intravitreal Therapies14 SeptemberThe Royal College ofOphthalmologistsCHAIRED BY: Professor Sue Lightman
Oculoplastics10 OctoberLocation TBACHAIRED BY: Mr Tony Tyers
Regional Study DaysVIIth State of the Art Refractive andCataract Symposium 200722 JuneHull and East Riding MedicalEducation CentreCHAIRED BY: Mr Milind Pande
College EventsAnnual Congress22 – 24 May The ICC, Broad Street, BirminghamPlease visit www.rcophth.ac.uk/scientific/congress2007 for more details.
Seniors Day14 JuneThe Royal College of OphthalmologistsDetails to be announced in futureeditions.
Royal College of OphthalmologistsStudy Tour to Syria11th to 17th February For details please contact Christopher Liu on: [email protected]
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Other events200712 – 14 JanuaryARCUSFour Pillars Hotel, near [email protected]
1 – 4 FebruaryThe 65th Annual Meeting of the All IndiaOphthalmological SocietyHyderabad, India [email protected]
9 – 10 FebruaryA Glaucoma Symposium to mark theachievements of Professor Roger HitchingsMermaid Conference Centre, [email protected]
28 FebruarySecond Newcastle Peri-ocular Tumour [email protected]
23 – 24 March Brighton Cornea CourseFor SHOs SpRs and Fellows. Lecturesand videos on management of cornealand external eye [email protected]
28 - 31 March 6th International Glaucoma SymposiumAthens, GreeceDeadline for abstracts - 2 November 2006www.kenes.com/[email protected]
5 – 9 May Annual Congress of the Société Françaised'OphtalmologiePalais des Congrès, Place de la PorteMaillot, [email protected] –for information on joining SFO.
9 – 12 JuneSOE/AAO 2007: a Joint Congress of theEuropean Society of Ophthalmology (SOE)and the American Academy of Ophthalmology(AAO), in association with the AustrianOphthalmological Society (ÖOG)Vienna, [email protected] submission deadline: 11 January 2007.
15 JuneAnnual Scottish Glaucoma SymposiumThe Royal College of Surgeons,[email protected]
5 - 7 September 200737th Cambridge OphthalmologicalSymposiumThe VitreousSt John’s College CambridgeCHAIRED BY: Mr Martin [email protected]
The Royal College of Ophthalmologists, 17 Cornwall Terrace, London NW1 4QWTel. 020 7935 0702; Fax 020 7935 9838 www.rcophth.ac.uk Co
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