ICO News No30 SPRING 18 - Eye Doctors

Messagefrom thePresident

Dear Members,

Spring is returning and it is time foranother newsletter. 2018 marks onehundred years since Irish Ophthalm -ologists started gathering as a nationalsociety, and we look forward tocelebrating this anniversary throughoutthe year. The ICO was formed from theIrish Ophthalmological Society and theyounger Faculty of Ophthalmologytwenty seven years ago but the IOS wasfounded in 1918 when the politicalindependence of our country was yet tobe established. Ophthalmology is anancient specialty that owes its roots toancient India and its name to classicalGreece. There have been many advancesin eye care since that time and IrishOphthalmologists have much to beproud of including progress made in theone hundred years that we nowcommemorate.

The highlight of the year will be ananniversary dinner in conjunction withthe Montgomery Lecture on the 16thNovember.

As part of our role to advocate forpatients, the ICO has well publicisedconcerns about the lack of regulation formedical advertising. A multi-stakeholdermeeting was held in 2014 and effortshave continued since to influence lawmakers and the Department of Health onintroducing appropriate regulatoryoversight in this area. The College isengaging with the National PatientSafety Office as the Licensing Bill goesthrough the legislative process.

The ICO Annual Conference takesplace in Kilkenny in May and I verymuch look forward to hearing from ouresteemed colleagues and internationalguest speakers on topics which are ofinterest to all.

DR ALISON BLAKE

ICO NEWSLETTER > SPRING 2018 PAGE 1

NewsletterISSUE 20 SPRING 2018

Published byIrish College of Ophthalmologists121 St Stephen’s Green, Dublin 2. Tel 01 402 2777 · e: [email protected] w: www.eyedoctors.ie t: @eyedoctorsirl

If you would like to make anysuggestions for future issuesof the College Newsletterplease contact Siobhan on [email protected]

The Irish College of Ophthalm -ologists Annual Conference 2018

will be held in the Lyrath Estate Hotel,Kilkenny from Wednesday 16th toFriday 18th May, 2018.

The programme will include asymposium looking at the changing faceand future of ophthalmology.

The Mooney Lecture will be deliveredby Dr Cynthia Bradford, former Presidentof the American Academy of Ophthal -mologists (AAO) and Professor of

Ophthalmology at the Dean McGee EyeInstitute/Department of Ophthalmologyof the University of Oklahoma HealthSciences Center in Oklahoma City. DrBradford’s lecture will be on Challengesof Cataracts highlighting the complexityof cataract surgery and the high successrate due to the skill and training ofsurgeons.

Mr Mike Burdon, President of theRoyal College of Ophthalmologists in

ICO Annual Conference

Annual Montgomery Lecture 2017

Continued on page 2 ➥

Prof. Michael O’Keeffe, Consultant Ophthalmic Surgeon and Newman Clinical Professor of PaediatricOphthalmology, UCD is pictured with Prof. Martina Hennessy, School of Medicine, Trinity College Dublin andAlison Blake, President of the Irish College of Ophthalmologists at the Annual Montgomery Lecture which washeld in the Trinity Biomedical Science Institute on November 24, 2017. Professor O’Keeffe’s lecture on “TheEvolution of Paediatric Cataract Surgery” discussed classification, surgical technique, complications and therecent advances to improve visual outcomes in paediatric cataract surgery. The ICO was honoured to inviteProf. O’Keeffe to deliver this year’s Montgomery Lecture in recognition of his significant contribution to thespecialty and paediatric ophthalmology in particular. Photos from event on Page 6/7.

ICO NEWSLETTER > SPRING 2018PAGE 2

London will speak on his sub specialty ofNeuro-ophthalmology together with MrPatrick Lavin, Professor of Neurology andOphthalmology at Vanderbilt Universityin Nashville. Dr Millicent Stone, Specialistin General Internal Medicine andRheumatology at Guy’s and St Thomas inLondon will also present.

We look forward to seeing everyone inKilkenny for what promises to be a mostinvigorating and stimulating programmeof talks and knowledge sharing. Furtherdetails on the Annual Conferenceprogramme are available on the ICOwebsite www.eyedoctors.ie

IOS CENTENARYCELEBRATIONSRequest for Photos

To mark the 100th Anniversary ofthe IOS, the College is currently

seeking to collate photos which may beavailable from down through the yearsin Irish Ophthalmology in order tocreate a slideshow of images for displaythroughout the CommemorativeProgramme of Events in 2018.

We would be delighted to hear frommembers who may have photos toshare from ophthalmology gatheringsover the past decades for inclusion inthis visual record.

Members can contact CommunicationManager Ciara [email protected] or call theICO office on 01 402 2777

Dr Cynthia Bradford, Professor ofOphthalmology, University ofOklahoma Health Sciences Center,Oklahoma City.

Mr Mike Burdon, President of theRoyal College of Ophthalmologists,London.

Dr Millicent Stone, ConsultantRheumatologist in the Division ofOphthalmology Guys and St ThomasHospital.

Mr Patrick Lavin, Professor ofNeurology and Ophthalmology atVanderbilt University, Nashville.

Continued from page 1 100 Years of Irish Ophthalmological Society

ICO Annual Conference 2018 Guest Speakers

This year marks the Centenary of theformation of the Irish OphthalmologicalSociety in 1918, the forerunner to theICO. The College is delighted to use theoccasion of our Annual Conference tolaunch a special programme of commem -orative events to mark the Centenary.

We look forward to honouring theachievements of our forefathers in thespecialty, as well as the opportunity tolook forward in our goals for the futuregeneration of ophthalmologists inensuring the highest standards ofophthalmic care in Ireland are maintainedand protected.

The Centenary milestone alsofacilitates an opportunity to celebrate therelationships the ICO and the IOS andIrish Faculty of Ophthalmology before usachieved with our international colleaguesand ophthalmological societies, includingthe Royal College of Ophthalm ologists,the American Academy ofOphthalmologists, the UEMS and theSOE. It is this essential sense ofcollegiality and of a unified community inour common goals that has ensured theadvancement of our speciality over thepast 100 years and which continues toprosper.

Mr Barry Quill speaker, Ms Mairead Heffernan Pamex, Dr Alison Blake Chair, Mr Diarmuid Gavin Pamex.

East Coast Ophthalmology meetingThe 4th East Coast Medical Ophthalmology meeting was held in Dublin on the 20thFebruary. Chaired by Alison Blake, guest speaker Barry Quill, ConsultantOphthalmologist at the Royal Victoria Eye and Ear Hospital, spoke on the subjectof adult refraction through cataract and refractive surgery in 2018 “to Emmetropiaand Beyond”. Sponsored by Pamex, the meeting is now well established on thecalendar.


National Diabetic Retina Screening ReportHighlights Globally Unique Programme

Launching the report, the Ministerfor Health, Simon Harris TD, said thefree screening and treatmentprogramme is globally unique and hevery much welcomed the significantprogress being made. He added thatwhen fully implemented, it will halvethe rates of blindness and vision lossdue to diabetic retinopathy andencouraged all individuals with diabetesto avail of the service.

Mr. Charles O’Hanlon, Head of theNational Screening Service highlightedthat what makes the HSE NationalDiabetic Retinal Screening Programmein Ireland unique is having anintegrated treatment component andelectronic medical records systemwhich allows visibility of the patientsthrough the entirety of their carepathway.

David Keegan, who is Clinical

Director of the Programme, stated thatDiabetic RetinaScreen has alreadystarted to deliver positive results fordiabetic patients in Ireland, detectingpre-symptomatic disease and providing

sight saving treatments in at riskpatients. Uptake rates to the programmeare steadily rising.

David said Diabetic RetinaScreen issteadily becoming a world class modelwhich many other nations aspiretowards. The electronic health record isa major component which enables theprogramme to see patients’ screeningand treatment activity. This supportsclear and transparent reporting on allpatients’ pathways.

Ms. Colette Murphy, ProgrammeManager said that many internationalpeers at the recent World Sight DayDiabetic Eye Conference in Belfastcommended Diabetic RetinaScreen forits foresight to include screening andtreatment activity as part of theprogramme. Close links with inter -national diabetic retinal screeningprogrammes gives us access to newinnovations and technological changes,placing us in a fully researched positionto adapt to our needs.

The Diabetic RetinaScreen ProgrammeReport 2013-2015 can be viewed anddownloaded at www.diabeticretinascreen.ie

The HSE National Diabetic RetinalScreening Programme released

its inaugural programme reportproviding screening statistics for thefirst two screening rounds of theprogramme’s operation (2013–2015)on November 15th, coinciding withthe annual World Diabetes Week.

Billy Power, Marie Hickey Dwyer and David Keegan

Charles O’Hanlon, Head of the National Screening Service, Minister for Health, Simon Harris TD, ColetteMurphy, Programme Manager and David Keegan, Clinical Director of Diabetic RetinaScreen pictured at theDiabetic Retina Screen launch which took place on November 15th.


Congratulations to surgical traineeEmma Duignan who was awarded

the Ophthalmology Best PaperCategory for her paper entitled ‘Long-term visual acuity, retention andcomplications observed with the type-Iand type-II Boston keratoprostheses in anIrish population’ at the Royal Academyof Medicine in Ireland (RAMI) ResearchAwards on November 29th.

The project was a paper presenting theresults of Professor Billy Power'skeratoprosthesis patients, a techniquelearned in the Massachusetts Eye and EarHospital from the inventor of thekeratoprosthesis, Dr. Claes Dohlman. Dr.Dohlman continues to work at perfectingthese devices at the age of 96, anincredible achievement and contributionto our speciality.

The aim was to evaluate the outcomesof the type-I and type-II Bostonkeratoprostheses in a single Irish centre.A retrospective chart review ofkeratoprosthesis implantations carriedout from November 2002 to March 2014was performed. All procedures wereperformed by a single surgeon.

The cohort of thirty-four patientsachieved excellent vision. The procedureinvolves placing a plastic optic within acorneal graft for those patients where allother surgeries are doomed to fail. In themajority of these cases, the vision is verypoor prior to surgery. Eighty-five per cent

of the patients achieved an improvementin their vision and fifty per cent of thepatients achieved a best-ever vision of6/12.

These data demonstrate excellentvisual acuity and retention outcomes in acohort with a long follow-up period in asingle centre. Complications remain aconsiderable source of morbidity. Theseoutcomes provide further evidence for thelong-term stability of type-I and type-IIBoston keratoprostheses in themanagement of patients in whom atraditional graft is likely to fail.

The paper is published in the BritishJournal of Ophthalmology (2016 Aug;100(8):1093-7).

ProtectiveProvisions for OpenDisclosure includedin Civil Liability(Amendment) Act

The Civil Liability AmendmentBill, which includes protective

provisions for open disclosure, wassigned by the President Michael D.Higgins on the 22nd November last.This bill is now an act and is due tobe commenced this year.

A duty of candour (often referred toas open disclosure) is a respons ibility ona hospital, medical and nursing staff todisclose to patients and their families ifa mistake has been made that hasadversely affected the patient. The onusis on the healthcare staff to admit to thepatient or their family as soon as theyrealise their error.

Difficulty with this to date formedical practitioners has been the lackof protective legislation in place, whichcreated uncertainty in relation toadmitting an error, apologising orproviding information when an adverseevent happened as there were concernsthis could be used against them in civilproceedings.

The Government has tried tomitigate this through the Civil LiabilityBill, which has now passed all stages inthe Oireachtas and is due to be signedinto law this spring.

The Bill states that, whereinformation and an apology are given,it will not constitute an admission ofliability, fault or professional mis -conduct, and as such will not beadmissible in evidence. Nor will itinvalidate a contract of indemnity orinsurance.

Ireland originally planned to makeopen disclosure mandatory, as is thecase in other countries, but the Bill haspassed without the mandatory require -ment on medical and healthcare staff inIreland. It is widely accepted that fewerpatients will sue if errors and mistakesare acknowledged from the outset.

The HSE provides training on opendisclosure and following her present -ation to ICO members at our AnnualConference in Cavan in 2017, anymember of the College who would beinterest in attending this course cancontact Angela Tysall, HSE lead forOpen Disclosure at [email protected]

RAMI Research AwardsWinner of Ophthalmology Best PaperCategory 2017

Dr Emma Duignan, Prof Luke Clancy, Dr Patricia Kearney, Ms Annette Burns, Dr Dermot Power PresidentRAMI, Dr Joanne Kenney, Dr William Gallagher, Prof Kevin Barry

Dr Emma Duignan, Mr Declan Daly, Santen picturedat the Royal Academy of Medicine in Ireland (RAMI)Research Awards on November 29th.

The British Oculoplastic SurgerySociety Conference 2018 will

take place in Dublin from the 13th –15th June in The Printworksconference centre at Dublin Castle.

Tim Fulcher and Gerry Fahy are onthe organising committee and delightedto announce esteemed internationalcolleagues, Mr Timothy Sullivan,Brisbane, Australia and Mr PeterDolman from Vancouver, Canada willbe invited keynote speakers.

Timothy Sullivan completed hisOphthalmology training in 1988, andthen undertook further subspecialtyFellowship Training in Oculoplastics,Eyelid, Lacrimal and Orbital Disease atMoorfields Eye Hospital, London andPaediatric Ophthalmology in Toronto atThe Hospital for Sick Children. Hereturned to Brisbane in 1992 where hejoined the Terrace Eye Centre toprovide tertiary and quaternary levelsubspecialty care. Since then he has alsoworked in the public sector, conductingthe Orbital Clinic at the Royal Brisbaneand Women’s Hospital and Royal andLady Cilento Children’s Hospitals.Complementing his clinical andresearch efforts he is involved inmedical student, registrar and Fellowteaching as Professor of Ophthalmologyfor the University of Queensland. He isa former President of the Australian andNew Zealand Society of OphthalmicPlastic Surgery and the Asia-PacificSociety of Ophthalmic Plastic andReconstructive Surgery, and an active

Fellow of the American and EuropeanSocieties of Oculoplastic and Recon -structive Surgery. He is on the board ofthe International Thyroid Eye DiseaseSociety.

Peter Dolman is a Clinical Professorat The University of British Columbia(UBC), Vancouver, Canada and is onclinical staff at five hospitals. He is thedirector of ophthalmology fellowshipprograms at UBC, division head ofoculoplastics and orbit, and a pastPresident of the BC Society of EyePhysicians and the Canadian Society ofOculoplastics and ReconstructiveSurgeons. He is currently the president

of the InternationalThyroid Eye DiseaseSociety. Peter hassupervised over 45international oculo -plastics fellows, hasdelivered over 200invited lectures, andpublished 20 chaptersand over 70 journalarticles. He hasvolunteered as asurgeon or lecturer in20 developing nationsand has receivedseveral departmental

research and teaching awards, theASOPRS research award (2007) and theQueen Elizabeth Jubilee Gold Medal forcommunity service.

A welcome reception will take placeon the evening of Wednesday 13th Juneat the historical Dublin City Hall,followed by the Scientific Meeting onThursday 14th and Friday 15th June.

The deadline for abstract submissionis March 23rd (midnight) 2018.Notifica tion of acceptance of abstractfor presentation and posters will be onApril 16th 2018

For registration details and furtherinformation, ICO members can visitwww.bopss.co.uk. The end of earlyregistration is the 4th May 2018 andplease note that there are separatetickets for update day and scientificmeeting.

Gerry and Tim are hoping colleaguescan join them for what is expected to bea very educational and sociable few dayswith international colleagues in theOculoplastic subspecialty.


British Oculoplastics Surgery Society Conference 2018 – Dublin

Tim Fulcher and Gerry Fahy, members of the Organising Committee for the British Oculoplastics SurgerySociety Conference 2018 which will take place at The Printworks conference centre, Dublin Castle from the 13th- 15th June.

BRITISH OCULOPLASTIC SURGERY SOCIETY

Mr Timothy Sullivan, Professor ofOphthalmology, University ofQueensland.

Mr Peter Doman , ClinicalProfessor at The University ofBritish Columbia (UBC).


Annual Montgomery Lectu

Emma Duignan and Sarah Moran

David Keegan and Philip O’Reilly

Ann Marie Mongan, Reinold Goetz and Lisa McAnena

Claire Quigley and Geraldine Cunniffe

Ruth Ellard and Olya Scannell

Professor Michael O’Keeffe, Consultant OphthalmicSurgeon and Newman Clinical Professor of

Paediatric Ophthalmology, delivered the 2017Montgomery Lecture entitled ‘The Evolution ofPaediatric Cataract Surgery’ on November 24, 2017 atthe Trinity Biomedical Sciences Institute, Dublin.

ure, 2017

Marie Hickey Dwyer and Annie Nolan

Jim O’Reilly, Paddy Condon and Peter Tormey

‘Skin to Disc – Linking Dermatology, the Ocular Surface and Glaucoma’ clinicalsession at the ICO Winter Meeting 2017 were (l-r) Prof. Frank Powell,Consultant Dermatologist, Mater Misericordiae University Hospital and theCharles Institute of Dermatology, UCD, Aoife Doyle, Alison Blake, WilliamPower.

Tim Horgan, Sylvia Jungkim and Philip O’Reilly

‘I.T. Supporting Clinical Practice’ key speakers (l-r) Gregory Johnston, HSEProgramme Lead for E-Referrals, William Power, Alison Blake, Niall Sinnott,HSE Assistant National Director, IT Delivery Director for Primary Care andGerry Kelliher, Business Intelligence, National Clinical Programme in Surgery,RCSI.


ICO Winter Meeting

The ICO Winter Meeting took place on November 24th atthe Chartered Accountants House, Pearse Street, Dublin.

A Clinical Session on ‘Skin to Disc – linking Dermatology,the Ocular Surface and Glaucoma’ discussed rosacea andother skin conditions that have conjunctival and cornealeffect, and a talk on the management of glaucoma in thecontext of those challenges. Discussions at the ‘I.T.Supporting Clinical Practice’ highlighted the importance ofthe roll out of a robust IT system and electronic patientrecord (EPR) to the successful integration of community andhospital care, in line with HSE policy contained in thePrimary Care Eye Services Review Group Report.


The European Board of OphthalmologyDiploma (EBOD) Examination is a test ofexcellence in ophthalmology, designed toassess the knowledge and clinical skillsrequisite to the delivery of a high standardof ophthalmologic care both in hospitalsand in independent clinical practices. TheEBOD is the responsibility of theEducation Committee of the EBO. Theexam takes place in Paris every year andTrainees must have passed the MRCSI tobe eligible to take the examination. Thesuccessful candidate may add the titleFellow of the European Board ofOphthalmology (FEBO) after his or hername. Eligible candidates must be in theirfourth year of training. The exam has anMCQ and a Viva Voce. Success in the EBOis mandatory in Ireland to apply forSpecialist Registration as anOphthalmologist.

Consultants travel annually fromIreland to participate as examiners. TheICO wish to acknowledge and thank MarieHickey Dwyer, who has examined for theEBO nineteen times in Paris.The currentnational delegates are Deidre Townley andDenise Curtin who is chairperson of theCME Committee.

EBO Subspecialty ExaminationsEBO subspecialty examinations are

carried out in Glaucoma, Cataract and

Refractive Surgery, and Strabismus andPaediatric Ophthalmology.

Successful candidates of the EBOSubspecialty Examinations are awarded anEBO diploma: the Fellow of the EBOSubspecialty Diploma in formal recognitionof their advanced subspecialty training andexpertise in their chosen field.

The 2018 FEBOS GlaucomaSubspecialty Exam will be held in Vienna,Austria on Friday 21st September 2018(immediately preceding the ESCRSCongress).

The EBO, the European Strabis -mological Association (ESA) and theEuropean Paediatric OphthalmologicalSociety (EPOS) have established aSubspecialty Examination in Strabismusand Paediatric Ophthalmology. Theexamination is primarily intended forthose who have recently completed a one-year fellowship to ICO standards forFellowship Training in Strabismus andPaediatric Ophthalmology or equivalenttraining and are starting independentpractice.

The FEBOS – Strabismus and PaediatricOphthalmology exam is a yearly one-dayexam consisting of a written and oral part.The Exam is conducted in English.

The first Strabismus and PaediatricOphthalmology EBO Examination will beheld at the Palais de Congress, Paris on4th and 5th May 2018.

EBO offers 10 training grantsannually through its ResidencyExchange Programme.

It is a continuous policy of theEuropean Board of Ophthalmology toencourage ophthalmologists to share theirknowledge within the countries of theEuropean Union in order to achieve thehighest standards of training.

Through its Residency Reviewprogramme, the EBO has established astrong network of training centers aroundEurope, which it has reviewed and certifiedas EBO accredited. Exchange of residentsamong these institutions has been takingplace since 2001.

Applicants must be residents fromEuropean University teaching centers,upon approval and recommendation by thelocal Chair/University Administration.Hosting centers must be EBO certified. Thechosen resident will receive from EBO anhonorarium of 1000 EUR.

The European Board of Ophthalmology (EBO) is a permanent working groupof the Ophthalmology Subspecialty Section of the European Union of Medical

Specialists (UEMS) and is tasked with overseeing the standards of education inophthalmology in Europe (UEMS Countries).

European Board of OphthalmologyReport by Denise Curtin

Khaldoon Al Tahs, Anne Marie Mongan and Fergus Doyle, presented with theirEuropean Board of Ophthalmology Diplomas (EBOD), are pictured with MarieHickey Dwyer and Barry O’Dwyer from Pamex at the ICO Winter Meeting,Chartered Accountants House, Dublin on November 24th 2017.

Paris 2017 successful candidates Kirk Stephenson and Sinead Connolly withexaminers Marie Hickey Dwyer and Denise Curtin

The Peter Eustace Medal wasestablished by unanimous decision ofGeneral Assembly of the EuropeanBoard of Ophthalmology (EBO) inTallinn on 20th June 2010 as a tokenof appreciation of the efforts of PeterEustace from Ireland who establishedthe first EBO diploma examination inMilan in 1995. Peter Eustace Medal isgiven to an ophthalmologist who hasdevoted long term and exceptionalefforts towards upgrading education inophthalmology in Europe.

Recipients included Marie JoseTassignon, Belgium; Roger Hitchings,UK; Jack Kanskii, Poland; and JoseLuis Menzo, Spain.


Training and Retaining Ophthalmologists in Ireland

To ensure that the guidance given topolicy makers is evidence based, the ICOcarried out research to examine whydoctors choose to specialise asOphthalmologists, what impact thoseconsiderations have on the currenttraining model and what issues inspecialty practice influence whetherdoctors stay working as ophthalmologiststhrough-out their medical careers.

A wide ranging survey was developedand distributed to ICO members. Anadditional survey with questions specificto the training experience was circulatedto ophthalmology trainees. The datagenerated by the survey and a series ofsemi-formal and informal interviewsinformed a number of recommendationsreflecting two broad themes; ‘Training theOphthalmologists of the Future’ and‘Retaining Irish Trained Ophthalmologistsin the Irish Health Service’

Reconfiguration of TrainingPathway To continue to attract high calibre traineesit is essential to continue to evolve thetraining pathways in the specialty. A 10-year retrospective review of trainees inophthalmology revealed a high degree ofattrition from those with the option ofcontinuing in medical ophthalmologytraining only. This can in part be explainedby the fact that the specialty has primarilyattracted those wishing to pursue asurgical career. To counteract this, thosewith a specific interest in medical practicemust be attracted into the programme andso from July 2018 the choice betweenmedical or surgical ophthalmology will bemade at the point of selection & entry notat the end of year three of common coretraining as has been the case.

Less than Full Time Training To support trainees who are challenged bythe realities of balancing family and workresponsibilities, alternatives to the fulltime five or eight-year training pathwaymust be considered and supported asappropriate. It is acknowledged that theacquisition of clinical and surgical skillsrequires a certain intensity and consist -ency of training. It is also recognised thatthere exists a perception that seeking out

less than full time opportunities may havea negative impact on training and futurecareer options. Options around ‘less thanfull time but more than half time training’may provide the right counter point toconcerns on both sides and should beconsidered further.

Additional Supports Duringthe Period of Transition fromTraining to Permanent Post A recurring theme reflected in the data isthe difficulties posed by the non-clinicalchallenges associated with deliveringhealth care. Many of those in the early partof their careers reported significantdifficulties in adjusting to independentpractice, in particular those who returnedto Ireland after a period of overseastraining. Support and guidance is neededduring the transitionary period, especiallyfor those taking up posts in the publichealth service. The ICO has introduced aseminar series for senior trainees and earlyyears Consultants aimed at providingsome of this support and guidance.

Retaining the Workforce A major challenge in attracting interestedcandidates to Community Ophthalm -ology Posts has been documented,

coupled with a growing challenge inretaining permanently appointed doctorsin those posts. The HSE’s Review ofPrimary Eye Care Service identified anumber of issues that have exacerbatedthis situation including cliniciansworking in isolation with very poorlystaffed and resourced clinics. Theevidence produced in this researchconfirms the significant challengecurrently being experienced incommunity practice. The model of caredeveloped by HSE Primary Care inconjunction with the Clinical Programmefor Ophthalmology includes a suite ofrecommendations that, if implemented,will address many of the challenges. Thisresearch has also confirmed that concernsover remuneration are having a significantdemotivating effect in CommunityOphthalmology. This must be addressedto both attract the future workforce andretain the existing one.

Further AnalysisThe data collection produced a wealth ofinformation that warrants furtheranalysis, including reviewing theresponses by a variety of the recordedcharacteristics e.g. age group, role, etc.and this is planned.

Challenges in training and retaining the medical workforce are not unique to the specialty of ophthalmology or the IrishHealth Service. As both the Training and Professional body for Ophthalmologists, the College has an important remit

in actively engaging with all of the Institutions across the health service, to ensure that the best medical graduates continueto be attracted to the specialty and most importantly that the specialist skills of our trained ophthalmologists are retainedin Ireland and that a career in ophthalmology in this country is a rewarding experience.

ONE Network Reminder

The College wish to remind allmembers of the ICO, including

trainees, that you have access to theAmerican Academy of OphthalmologyOphthalmic News & Education(ONE®) Network by way of being anICO member.

The ONE Network is an onlineeducational resource that brings togetherthe most clinically relevant content, newsand tools from a variety of trusted sourcesand we encourage our members to availof this benefit.

Full text access to numerousophthalmology journals, includingOphthalmology, EyeNet, the AmericanJournal of Ophthalmology, the British

Journal of Ophthalmology, and theJournal of Clinical and AcademicOphthalmology, is also available to ONENetwork members.

Members will have received an emailfrom [email protected] with subject“AAO Access Instructions” with yourpersonal Access Key and the requiredfollow up steps in the last few weeks.

If you have any queries or needfurther assistance logging in, you cancontact the ICO office or [email protected]. Further details on thebenefits of subscribing to the AAO ONENetwork are available for members toreview on the ICO website.


No documents regarding the foundingof the society are extant, however, a verbalaccount provided by Ms Euphan Maxwell,a surgeon in the Royal Victoria Eye and EarHospital Dublin was recorded in 1951,where she recalled the establishment of thesociety in 1918 by the ophthalmologist,John Benjamin Story. While no details ofsociety’s early days are available, it ispossible to brief a sketch of the environmentin which the society was founded.

The population of the 32 counties in1911 was 3,139,688 with 10.5% of thepopulation over 65 years of age and while thenumber of people over the age of 65 has notmarkedly increased (11.7% in 2011), whatcould be regarded as significant was that776,594 people were documented as beingunable to read or write in 1911; evidence ofa society that had very different requirementsfrom the that of the modern era.

John Benjamin Story was one of foursenior surgeons the RVEEH in 1918, a timewhen the hospital had 102 inpatient beds.In common with contemporary VoluntaryHospitals, these surgeons provided theirskills to the hospital gratis. Two clinicalassistants and three house surgeonsattended to the patients, some combiningthe role of ophthalmic and aural surgery.Contemporary documents reveal that 1,610inpatients were admitted to the RoyalVictoria Eye & Ear in 1919, and a total of11,452 seen in Outpatient Department, withan average number of 140 patients attendingeach day. The average number of days spentin the hospital by each inpatient was 22.The doors to the Outpatient opened from9am to 10.30am each day. An analysis of theinpatients treated in the RVEEH in a singleyear, shows that 65 were treated forglaucoma, 78 for refraction, 186 for cornealproblems, 266 for lens problems , 198 forthe conjunctiva: 198, and 132 squintpatients were admitted.

A contemporary annual theatre list fromthe RVEEH document a total of 1060operations performed with cataractextractions: 281, squint: 106, glaucoma: 35,Enucleations: 62 of which 48 were fortrauma and 66 corneal ulcers werecauterised.

In attempting to analyse these figures,one must bear in mind that hospitals had atenuous existence in the early 20th century

as they did not receive any funding from thegovernment authorities. This was the era ofthe Voluntary Hospitals, where all treatmentand support provided for patients wasfunded by subscriptions, pensions,donations, and fund-raising events.Subscribers to the hospital funds wereallowed to recommend patients to thehospital for treatment and other than thosewho could pay, only those who wererecommended by a subscriber were

admitted to the hospital. The Poor lawUnions, the local authorities of the day, paidto have Poor Law recipients treated andlocal businesses subscribed to the hospitalto ensure that their staff could receivetreatment if required. Although there was acharge for outpatients, all accident caseswere always admitted on the basis of clinicalneed.

An annual income of the RVEEH in1919 was £7,515, and the combined feesfrom private patients, donations, Poor LawUnion patients (£1,647), annualsubscriptions (£842), donations (£237), andwar pension payments (£685), did not meetthe expenditure for the year of £8,128, ofwhich provisions and groceries (£2,267)and heating (£1,005) were the mainexpenditure. Medicine and leechesaccounted for £457.

The maintenance of the hospital was acommunity effort and in an era prior todisposable dressings, in 1918 the LordChancellor of Ireland, James Campbell,proposed the establishment of a Linen Guildin RVEEH, which he described as‘comparatively modern’. By 1919, the guildhad 280 members (each subscribing 10/-each) and the ladies of the Hospital LinenGuild made 6 dozen bandages and 539garments and provided much of themending of hospital sheets and clothingoften at work parties held every Mondayduring the winter months.

Louis Werner Snr, one of the surgeonsin the RVEEH also acted as a ConsultingSurgeon in the Mater Hospital in EcclesStreet. In 1917, the capacity of the EyeWards in the Mater Hospital was increasedto 24 beds now placed in adjoining wards to

Centenary of formation of first Irish Ophthalmological Society 1918-2018

War injuries: The famous picture entitled ‘Gassed’ by John Singer Sargent completed in March 1919demonstrates the appalling impact of eye injuries from mustard gas and illustrates what patients and staff had tocope with. Imperial War Museum, London.

2018 marks the centenary of the establishment of the first ophthalmologysociety in Ireland, the Irish Ophthalmological Society. This later amalgamated

with the Faculty of Ophthalmologists to create the Irish College ofOphthalmologists in 1991.

Ophthalmologist John Benjamin Story, credited asFounder of the IOS in 1918. Dr Story served asPresident of the Royal College of Surgeons in Irelandfrom 1918-1920. Photo courtesy of the Royal Collegeof Surgeons in Ireland.

The General Scheme of the Patient Safety(Licensing) Bill was approved by Cabinet on12th December 2017 and is currently withthe Oireachtas Committee on Health for pre-legislation scrutiny. The ICO has beenadvised that a consultation exercise withvarious stakeholders engaged in this process,including the ICO will take place later thisyear to assist in identifying such activities.

The Bill is focused on ensuring thatappropriate governance arrangement arebeing applied by licensed entities, which willinclude hospitals but will also incorporatehigh risk designated activities that take placeoutside a hospital setting. HIQA will becomethe licensing authority and services will needto satisfy them that they meet minimumrequirements to provide safe care.

Statutory laws in relation to advertisingfor medical services in Ireland are currentlyabsent. The ASAI Code is a voluntary codeof practice for members. Following theirparticipation in the ‘Medical Advertising inIreland’ multi stakeholder meeting hosted bythe ICO in December 2014, the ASAIacknow ledged that discussions at thismeeting were instrumental in informing thereview group as they prepared the 7th editionof the Code, published in 2016. While theICO welcomed the amendments made to theHealth and Beauty sections of the new code,the position remains unchanged and distinctregulation of advertising of medical andsurgical procedures is required.

Key areas of concern to the ICO, IrishAssociation of Plastic Surgeons and the IrishAssociation of Dermatologists in relation tothe direct to consumer advertising formedical services include:

• Direct to consumer advertising ofmedical procedures is currentlyunregulated (ASAI code is voluntary)

• Advertising that only emphasises thebenefits of such procedures can lead tounrealistic expectations

• Unmet expectations can predisposepatients to take legal action

• Medical or surgical procedures must notbe regulated in the same manner asconsumer or lifestyle goods (currentstatus through ASAI code)

• Currently in Ireland there is noregulatory requirement for advertise -ments or marketing materials to provideany information on the health risks ofprocedures.

Examples of coercive and inappropriatedirect to consumer sales techniques formedical services include: • Financial inducements• Time limited deals • Celebrity Endorsements • Package deals (buy one, get one free /

refer a friend / reduced prices for 2person or procedure (2nd eye for laser)

• Surgery offered as a raffle prize

Procedure Specific PatientInformation Leaflets and ConsentGuidelines

The ICO would like to remind ourmembers of the Procedure Specific PatientInforma tion Leaflets and ConsentGuidelines developed by the College foryour use. The Patient Information Leafletson a range of ophthalmic procedures weredeveloped in order to provide patients withclear and accessible information in advanceof a proposed procedure.

Effective communication with a patientand ensuring the delivery of the necessarypoints in a way that is understood is centralto the consent process. Consent forms are notbinding contracts but do serve as evidencethat the process was undertaken by thedoctor with their patient. Discussion of risksis a crucial element of informed decisionmaking. Alternatives to and the potentialimplications of not having the procedureshould also be covered with a patient.

Procedure Specific Patient InformationLeaflets, developed by the ICO EthicsCommittee aim to provide; • Standardised information – all forms

state identical accurate risk information• Authoritative Information • Legible information (not handwritten)• More time to explain complications

The ICO has also developed ConsentGuidelines, Refractive Surgery Guidelinesand Advertising and Marketing Guidelinesfor ICO members in the interests of ensuringpatients receive clear and unbiasedinformation during the decision makingprocess and in supporting doctors.

All documents are available on the ICOwebsite or members can contact the office ifthey wish to receive further information.


which ensured that the same nursing staffcould care for all the ophthalmic inpatients.While a smaller number of inpatients weretreated in the Mater (138) the Materoutpatient clinics appear to have had agreater role in treating outpatients with32,490 outpatients seen in 1917.

The War effort took its toll at the Materwhere a general surgeon, Arthur Chance,complained to the hospital authorities aboutthe cramped conditions in the operatingtheatres and the lack of trained staff becauseso many had joined up to serve during thewar. World War One dominated all aspectsof life in the Great Britain and Ireland in1918, and particularly in the medicalsphere. Most hospitals attempted to providefor serving troops and war casualties, andthe Eye, Ear and Throat Hospital in Corktreated 5,523 soldiers, sailors and disabledservicemen from 1914-8 and at the outbreakof the war a special ward with 12 beds wasset aside in the hospital for the treatment ofthe military patients. The RVEEH also set

aside beds for military casualties, and in1916, 111 wounded soldiers were treatedthere. Ophthalm ologists in the later stageson the war were battling a new problem, theimpact of mustard gas which had the legacyof leaving many blind.

The first president of the IOS was ArthurWellesley Sandford who was influential inestablishing the new Eye, Ear and ThroatHospital in Cork which opened in 1897. Hewas Vice-President of the OphthalmicSociety of the UK in 1902-05 and Professorof Ophthalmology and Otolaryngology inUCC. Mr A.M. Killen from Belfast followedSandford as president of the IOS in 1919,demon strating that the countrywide remitof the new society.

While John Story is credited withfounding the IOS, other responsibilitiesoccupied him in 1918 as he served asPresident of Royal College of Surgeons ofIreland from 1918-20, and at the same time,he was secretary of the Ophthalmic Societyof the UK. While another ophthalmologist,

Sir Henry Swanzy, had also been presidentof RCSI in 1906-8, it is interesting to notethat the ophthalm ologist, Charles EdwardFitzgerald was President of Royal College ofPhysicians in Ireland in 1916-18. In someways, the early 20th century could beregarded as a golden era for Irishophthalmologists giving them a confidencein their own ability to establish a society tofurther ophthalmology in Ireland. This,combined with the dangers from German U-boats when travelling by sea during the warprobably stimulated John Story to initiatethe events that led to the founding of theIOS in 1918.

Susan Mullaney

Acknowledgement: The ICO would like to acknowledge

Ms Helen Madden, Archivist in MaterHospital, and Ms Vivienne McGovern inthe Royal Victoria Eye and Ear Hospital fortheir assistance in researching this article.

ICO Advocates for Medical AdvertisingProvisions in new Patient Safety Legislation

The College is continuing to impress upon the National Patient Safety Officeon the importance of the inclusion of provisions on marketing and advertising

standards in forthcoming patient safety legislation.


Progressing the Management of Dry Eye Diseaseafter the TFOS DEWS II ReportProf. James Wolffsohn, Tear Film and Ocular Surface Society Board outlines the progress with Dry Eye Diseasemanagement following the TFOS DEWS II Report and highlights the aims of the next steps in advancing themanagement of the disease.

Mr Peter Barry Memorial LectureMrs. Carmel Barry is pictured with Professor Oliver Findl,Head and Founder of the Vienna Institute for Research inOcular Surgery (VIROS) at a Memorial Lecture in honour ofMr Peter Barry which took place on the 14th December at theRoyal Victoria Eye and Ear Hospital. Professor Findl’s lecturewas on the topic of ‘Lens Surgery and Retinal Detachment: Risksand Prophylaxis’.

Until the TFOS Dry Eye 2ndWorkshop (DEWS II), every clinicianseemed to have different criteria fordiagnosing dry eye disease. The newcriteria developed by my diagnosticmethodology committee and ratified bythe over 150 members of the consensusprocess narrowed the screening elementto just two questionnaires, the OcularSurface Disease Index (OSDI ≥13 cut-off)or the Dry Eye Questionnaire (DEQ-5 ≥ 6cut-off). In addition to symptomology, adiagnosis of dry eye disease requires atleast one of the following three signs to bepresent to indicate a loss of homeostasisof the tear film: a reduced (ideally) non-invasive break up time (<10s cut off forsubjective observation, but typically lowerfor automated devices); hyperosmolarity(≥308 mOsm/L in either eye or an inter-eye difference of >8 mOsm/L with thecurrently validated clinical device); or

ocular surface staining of the cornea (cutoff >5 punctate spots), conjunctiva (>9punctate spots) or lid margin (positive ifstained area ≥2mm length & ≥25%width).

There is now an evidence-basedconsensus opinion of diagnosis whichshould unify global diagnosis of dry eyedisease. A challenge to conducting thisdiagnostic criteria in practice is the lack ofavailability of some of the diagnostic signequipment, although technique selectioncriteria was ability to be conducted inclinical practice as well as non-invasiveand objective instrument ation with a highsensitivity and specificity.

Challenges remain on the treatment ofdry eye disease also, with a general lackof randomised control trials comparingbetween treatments (compared to acontrol) and identifying with whatseverity and sub-classification spectrum

(from evaporative to aqueous deficient) ofdry eye disease they are the best choicefor.

Hence the next step to advance themanagement of this chronic, debilitatingdisease is conducting a survey of howpractitioners currently diagnose andmanage dry eye disease and it would beso much appreciated if you wouldcomplete this to benchmark your practiceagainst others in Ireland and beyond andto inform future research.

The link is http://bit.ly/2zmZUIK andhas been circulated to ICO members viaemail by Siobhan Kelly. It is totallyanonymous and takes about 10 minutesto complete (quite a few clicks tocomplete the table, but it is relativelysimple). Thank you so much in advancefor giving up your valuable time to be partof this global initiative.

Prof. James Wolffsohn

Save the Date:VISION BALL, April 21, 2018

Fighting Blindness and National Maternity HospitalFoundation have joined forces to fund a new Retina

Camera for the neonatal unit at Holles St. This Ret Cam willscreen 500 premature babies at risk of blindness fromretinopathy of prematurity each year. Please join us at theupcoming VisionBall to help purchasethis vital equipmentand create a futurewe all can see forgenera tions to come.

For more information please visitwww.FightingBlindness.ie/events or please [email protected] or 01 6789 004.

Documents

ICO News No30 SPRING 18 - Eye Doctors