Archive for the ‘News’ Category

Artificial intelligence in eye care

Artificial Intelligence (AI) has attracted a huge amount of interest and excitement over the past 10 years. The most publicised application is in relation to language processing, for example as with ‘ChatGPT’, but other applications are almost infinite and include transportation and traffic management (including facilitating self-driving cars), increasing energy efficiency, aiding public safety, crime detection, facial recognition and object detection. AI also has widespread applications in the management of large datasets, analysis of data, identifying patterns, and data-driven diagnosis and decision-making.

It is in this latter context that AI is having a great impact in medicine and surgery – and especially in ophthalmology. Any medical specialty that uses digital imaging such as pathology, radiology and ophthalmology will be revolutionised by AI. In ophthalmology, as in other medical specialties, imaging has transformed diagnosis and patient management since the first X-Ray. Now, with CT and MRI scanning, ultrasonography, corneal imaging and retinal optical coherence tomography (OCT) to name just a few examples, being able to analyse very large datasets and utilise machine learning (ML) to improve diagnosis and management is a huge advantage for doctors and other health-care professionals. For example, with regard to corneal conditions such as keratoconus (see below scans), which can be difficult to diagnose in the early stages, AI can use information from very large databases with deep learning (DL) to improve diagnosis and predict which patient could be at risk of developing the condition in later life. A decision to treat the patient – or monitor closely can then be made.

These scans demonstrate keratoconus:

A scan which demonstrates keratoconus

 

A scan that demonstrates a patient with keratoconus

 

I have included 3 scientific review articles below (and in the reference section of this website) written by colleagues of mine at Moorfields Eye Hospital, London, in collaboration with scientists and physicians around the world, for those who might like to learn more about this exciting technology.

  1. Artificial Intelligence in Cornea, Refractive Surgery, and Cataract: Basic Principles, Clinical Applications, and Future Directions
    – Radhika Rampat, Rashmi Deshmuhk, Xin Chen, Daniel S W. Ting et al.
    – Asia-Pacific Journal of Ophthalmology; Volume 10: Number 3, May/June 2021, p268-281.
  2. Artificial intelligence and deep learning in ophthalmology
    – Daniel She Wei Ting, Louis R Pasquale, Lily Peng, John Peter Campbell et al
    – Br J Ophthalmol. 2019;103:167-175
  3. Deep learning in ophthalmology: The technical and clinical considerations
    – Daniel S W Ting, Lily Peng, Avinash V Varadarajan, Pearse A Keane et al.
    – Progress in Retinal and Eye Research;72: (2019) 1-24

The story of re-opening The Wimpole Eye Clinic after lockdown

After the first lockdown when doctors began to resume private practice I was asked by the business medical journal – The Independent Practitioner Today – to summarise the coronavirus precautions I had put in place when reopening my own clinic in June 2020 –– as well as telling the story of how The Wimpole Eye Clinic had come about.

A brief history of The Wimpole Eye Clinic

I was appointed consultant surgeon to Moorfields Eye Hospital NHS Foundation Trust in July 1995 and, having built up a private practice over the years both at Moorfields and at The London Clinic, it had been my long-term ambition to enjoy the independence – not to mention the legacy and the hoped-for investment value – of owning my own clinic.  My plan was to invite my closest sub-specialist colleagues to work with me – colleagues with whom I had worked closely for many years and whom I would happily refer all of my friends and family to (not just my mother-in-law!).  I had been looking unsuccessfully for premises in the Harley Street/Wimpole Street area for some time when one happy patient (I do actually have more than one!) asked if I had ever thought of owning my own clinic. Had I? I explained that, notwithstanding the expense, it seemed that all of the really suitable properties had already been bought up – mostly by someone called Howard de Walden!  Those still on the market, often after months or years, either needed major reconstructive surgery or had unworkable legal constraints. My ‘happy patient’ had been “in property” all of her career and reassured me that she was confident of finding something suitable for me. I reassured her in turn that I was confident that I would not be holding my breath!  Then, a few months later, she called with the news that a doctor who owned a clinic at 46 Wimpole Street, along with the freehold, was ‘thinking of selling’.  To this day she has not revealed to me how she had managed to read his mind! I went along the following day to take a look. It seemed perfect for developing into an eye clinic with plenty of space and a layout that permitted efficient patient flow – a valuable asset which was to become particularly useful for social distancing when the original lockdown was lifted.

After a six month period of refurbishment I opened The Wimpole Eye Clinic at 46 Wimpole Street, Marylebone, London W1, in October 2015 and proudly affixed my brass plate to the wall outside.  Of course, I then had to close on Monday the 23rd of March 2020 – the first day of the first lockdown – along with all private clinics. And to think that I had assumed that 2020, regarded as a very high standard of vision on the optician’s test chart (20/20 or 6/6), was certain to be a good year for eye specialists!

And so to lockdown.
My colleagues and I at Moorfields Eye Hospital had a great deal of NHS administration to carry out at the beginning of the lockdown, cancelling routine appointments for those patients who could be safely moved from outpatient clinic and operating theatre lists and then stratifying them for rebooking at a later date according to their level of risk.  We all took part in an “emergency or semi-emergency” rota, which made us feel that at least we were helping in some small way – that is to say ‘less guilty’ – while others were at risk on the frontline.  I convinced myself that, as it had been 35 years since I had been a casualty officer at University College Hospital, London, I would most certainly have been more of a hindrance than a help to those who were up to date in emergency medicine and actually knew what they were doing.  As I readily admit to friends and family: “I used to be a real doctor!”  I therefore kept my head below the Moorfields parapet and stuck to the hospital’s emergency rota!  But it must be said that, at best, our work at Moorfields Eye Hospital during the first lockdown was certainly very part-time. I only carried out one emergency corneal transplant (for trauma) in the three month period from March to June 2020.  We were, and are, acutely aware of course that it will take some time to clear the backlog of missed clinic appointments and operation dates caused by the lack of activity during all 3 lockdowns.

On the private side, a number of clinics reopened in or around June 2020, respecting the Government guidelines on social distancing and personal protective equipment (PPE) and seeing limited numbers of patients as clinical need versus risk, speciality, and premises allowed.

Essential step
I took the opportunity to ask the adviser who had helped with my original Care Quality Commission (CQC) application for The Wimpole Eye Clinic in 2015 to provide an on-site risk assessment with regard to Covid-19 precautions. This was an essential step and one which I strongly recommended (in my article in The Independent Practitioner Today) to any colleagues who were opening up their clinics at the same time. Although I had been familiar with the very strict guidelines adopted by Moorfields Eye Hospital during the lockdown, and I was familiar with the numerous precautions in place, there were several other very constructive suggestions made at the on-site inspection specific to my own clinic. The adviser also provided a comprehensive 30 page COVID-19 protocol and the key points are set out in the box below:

There was certainly a great deal of work to do to prepare The Wimpole Eye Clinic for reopening in June 2020 but the rigorous measures that we put in place at the time meant that we were confident that we could safely reopen. We were all very pleased to be able to open up our doors once again in the confidence that all possible safety measures had been put in place.  It was good to be back.

I hope to see you soon,

David Gartry and team at the Wimpole Eye Clinic

A Coronavirus update from The Wimpole Eye Clinic – we have opened again

After just over 2 months of lockdown, during which the Wimpole Eye Clinic has only been open occasionally for important post-operative appointments, we are pleased to say that as of Monday the 1st of June, staff have returned and we are re-commencing ‘normal’ clinics.

In preparation for our return, we have recently undergone an official and extremely detailed 2-hour risk-management inspection in order to make absolutely sure that we are well within (and indeed exceed) CQC and Government guidelines on minimising the risk of coronavirus transmission. This has given us the absolute confidence to open up again and everything we have put in place should keep a focus on protecting everyone’s safety.

What can you expect as a patient? 

Combining all of the above we are protecting our patients (and ourselves) as much as is physically possible. Although it might seem rather dramatic, the same PPE measures will be adopted for our staff at The Wimpole Eye Clinic as at Moorfields Eye Hospital itself (where I have been taking part in emergency-only clinics and operating theatre sessions throughout the lockdown period).

If you would like to book an appointment, you can give us a call on 0207 490 7222 and we can chat through any questions you may have. Or if you prefer, you can get in touch via our booking form.

We very much look forward to seeing you.

Thank you from all of us at The Wimpole Eye Clinic,

David Gartry

David Gartry is featured in the Mail on Sunday

The Mail on Sunday’s Thea Jordan just published an article exploring why patients in their 40s and 50s are losing their sight to cataracts. She asked our very own David Gartry to provide some insights. He has performed about 15,000 cataract surgeries over his 30-year career and he certainly was able to shine some light on Thea’s question.

You can read the full piece here:

Why patients in their 40s and 50s are losing their sight to cataract

David Gartry voted one of the top UK cataract surgeons by his peers.

The Daily Mail asked 40 leading eye surgeons nationwide who they felt were the best in their field and those with the most votes made it into the ‘Good Doctors Guide’.

They were simply asked ‘If your own nearest and dearest were to need treatment in your field, to whom would you refer them — and why?’. This is what they said about David Gartry: ‘Dependable, approachable and gifted, he would be high on my list,’ says one of his peers. ‘He is someone who can always be relied upon to do the best for his patients.’

Daily Mail – 3rd October 2017

 

David Gartry was recently quoted in the Daily Mail in an article about the link between Rheumatoid arthritis and dry eyes.  We often see patients enquiring about refractive laser surgery (LASIK/LASEK) and although dry eye symptoms can be difficult to interpret, depending on the spectacle prescription, refractive lens exchange can sometimes be the better option.  Having rheumatoid arthritis does not automatically rule you out for surgery but careful consideration to dry eye must be taken into account.

The Oxford Ophthalmological Congress 2017

The Oxford Ophthalmological Congress was founded in 1909 by Robert Doyne, who had also founded the Oxford Eye Hospital in 1886.  The Congress quickly became established as a major UK national ophthalmic meeting and also had an international flavour, with guest speakers from Europe, the USA and “the old colonies”.  The present Congress organisers have maintained this policy of inviting distinguished overseas speakers to contribute to symposia.  Robert Doyne, if he was alive today, would recognise that the scientific programme of the 101st Oxford Ophthalmological Congress, which is just about to take place, is based on the original blueprint of his 1909 meeting.

Robert Doyne (1857-1916)

RCOphth Annual Congress 2017

The Royal College of Ophthalmologists (originally known as the ‘Ophthalmological Society of the United Kingdom) was formed in 1880 by Sir William Bowman and is the voice of the profession. Every year a scientific meeting has been held bar some exceptions during the Second World War. The College has various roles including setting the curriculum and examinations for trainee ophthalmologists, providing training and maintaining standards in ophthalmology as well as promoting research and development.

The Royal College of Ophthalmologists is an independent charity and works closely with government health departments, organisations and eye health professionals to form patient care policies and further advances in this area. With over 4,000 members the work of the College extends to education and training, promoting standards, research and of course seminars and the annual scientific Congress.

David Gartry is an examiner for the College and also developed the Certificate in Laser Refractive Surgery. It was with great pleasure that he attended the 2017 Congress in Liverpool this month where he witnessed first hand new developments, keynote lectures and met with colleagues. The president’s symposium was chaired by Professor Caroline MacEwen (President of the Royal College of Ophthalmologists). Key guests included Professor Sir Peng Khaw, Professor of Ophthalmology, Moorfields Eye Hospital, London and UCL Institute of Ophthalmology; Dr Neil Miller, Professor of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, USA and Professor Rachel Williams, Professor of Ophthalmic Bioengineering, University of Liverpool.

Liverpool Metropolitan Cathedral

Fab Four

Arena & Convention Centre (AAC), Liverpool

Liverpool

Visit to Jerusalem

David Gartry visited Jerusalem in April as a guest of St. John Eye Hospital in Jerusalem. The charity has been instrumental in providing eye care in the West Bank, Gaza and East Jerusalem for over 130 years. Consisting of various hospitals in the area the charity treats people regardless of their ethnicity, religion or ability to pay. In addition to offering specialist corneal, retinal and paediatric facilities St. John of Jerusalem provides specialist ophthalmic nursing training and employs over 200 people.

David delivered a lecture to the St. John Ophthalmic Association on Femtosecond Cataract Surgery. Since being introduced several years ago laser-assisted cataract surgery has offered patients a more accurate outcome and better results. David Gartry has performed over 2000 laser-assisted cataract surgery procedures.

Whilst in Jerusalem David had the opportunity to visit some sites and meet colleagues – it was a fantastic and very rewarding trip.

Left to right: Mr Tony Tyers, Consultant Oculoplastic Surgeon, Salisbury; Professor Michael Michaelides, Consultant Retinal specialist, Moorfields Eye Hospital; Professor Chiara Maria Eandi (Italy); Professor Harminder Dua, Nottingham; Mr Gerry Clare, Medical Director St John’s; yours truly; Ms Alison Davies, Consultant Paediatric Ophthalmologist, Moorfields Eye Hospital; Dr Shirin Hamed Azzam (Israel); Mr David Verity, Consultant Oculoplastic Surgeon, Moorfields Eye Hospital and The Order Of St John.

 

David Gartry visit Jerusalem

 

A memorial in Jerusalem

 

Remembering Ferdinand Monoyer

Around 75% of the UK population depend on glasses, contact lenses or laser eye surgery to correct their vision. As such many of us will be familiar with the eye chart used at our initial consultation.

Today Google released another thematic doodle celebrating the life of renowned French ophthalmologist Ferdinand Monoyer. Monoyer would be 181 years old today and left an important legacy within the field of ophthalmology. It was in fact Monoyer who invented the eye test chart over 100 years ago.

Ferdinand Monoyer Google Doodle

 

It was Ferdinand Monoyer’s chart of shrinking letters that first showed each row as representing a different diopter. If Monoyer’s eye chart does not seem immediately familiar then that is because most clinics now use the more popular ‘Snellen’ eye chart which was developed around the same time by Herman Snellen in 1862. Used to test visual acuity, the Monoyer chart is unique in that it hides the name of it’s creator within the lettering. ‘Monoyer’ can be read on the left hand side of the chart reading upwards ignoring the last line and ‘Ferdinand’ on the right hand side. It seems the famous ophthalmologist had a sense of humour!

 

Monoyer Eye Chart

Monoyer Eye Chart, invented by Ferdinand Monoyer and featuring his name hidden within the letters.

One of Monoyer’s greatest achievements was inventing the dioptre in 1872, the unit of measurement of the optical power of a lens, which is still used today. (We often hear people refer to their refractive error as ‘-2’ for example. What they mean to say is that their refractive error is -2.0D or dioptres.).

 

Ferdinand Monoyer

Ferdinand Monoyer

Ferdinand Monoyer was born in Lyon, France and moved to the University of Strasbourg in 1871 where he was Associate Professor of Medical Physics at the Faculty of Medicine. He later on taught at the University of Lyon and the University of Nancy. Monoyer passed away on July 11th, 1912 aged 76 but his incredible legacy lives on and was honoured by Google worldwide today.