Eye care developments centre focus in Kilkenny

The 2022 Annual Conference of the Irish College of Ophthalmologists (ICO) took place from Monday 16 to Wednesday 18 May at the Kilkenny Convention Centre, Lyrath Estate. Approximately 220 clinicians and trainees attended the first in-person ICO Annual Conference since 2019, with a fantastic atmosphere and packed programme. 

Symposia included a clinical session on ocular surface disease; a service delivery session on ‘Planning for the Future’ examining medical retina and telemedicine/virtual review, IOP clinics and glaucoma diagnostic hubs; whilst a separate symposium focused on the integrated eye care teams, highlighting the model of eye care implementation at national, regional and community level. There was also a separate clinical session on recent clinical trials in glaucoma, myopia and retina. 

Prof Stanley Chang, K K Tse and Ku Teh Ying Professor of Ophthalmology, Columbia University, New York, US, presented this year’s Annual Mooney Lecture. A specialist in vitreoretinal disorders and surgery, Prof Chang has pioneered many of the surgical techniques currently used in this field. 

Addressing delegates at the conference, ICO President Mr Tim Fulcher, said: “Despite the challenges of the past two years, much progress has taken place in the specialty of ophthalmology with investment into the new integrated eye care teams at community and hospital level, and the establishment of dedicated cataract theatres. There is much more to be done to address the waiting lists in ophthalmology and our focus, alongside the work of the National Clinical Programme led by Prof William Power, remains on delivering a service equipped to manage the areas of greatest patient demand.” 

Integrated eye care teams 

Speaking to the Medical Independent, Prof Power said the integrated eye care teams have been successfully rolled out in the three Dublin area CHOs to date (CHO 6, 7, and 9), and are functioning well. For example, the full pre-operative assessment and follow-up care for cataract surgeries in the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin can now be carried out by Dr Margaret Morgan, Consultant Medical Ophthalmologist, RVEEH and CHO 7, and her integrated eye care team, which are able to share information and care seamlessly. “So it is fantastic. From the patients’ point of view, they only need one visit into town to the RVEEH, even though they would normally need three visits. They are now being seen in the community [for two visits]. So it is freeing up our patient slots. That is working very well.” 

Dr Morgan’s team is also seeing some of the RVEEH’s stable glaucoma patients, whose eye pressure needs to be assessed every six months, again leading to a better patient experience and freeing up in-demand slots at the RVEEH.

 In addition, the CHO 7 integrated eye care team is now beginning to do minor laser procedures (follow-up cataract and glaucoma laser surgery) following the delivery of a YAG laser and Selective Laser Trabeculoplasty (SLT), Prof Power said, adding that the plan for the coming year is to acquire a larger premises that will allow the team to offer the administration of anti-VEGF injections for age-related macular degeneration (AMD) patients, who currently need regular visits to hospital ophthalmology clinics but could be treated in the community. 

In relation to paediatric eye care and screening waiting lists, which had reached record numbers in Dublin in the last decade, the establishment of the integrated eye care team in CHO 9 has had a dramatic impact on reducing these lists, with the other CHO teams also following suit. 

Prof Power noted that the excessive paediatric waiting lists had been a key driver in getting the Model of Eye Care across the line and introducing new ways of doing things. “So it is very rewarding now that these three CHOs in Dublin are doing well in this area.” 

Outside of Dublin, there have also been a number of key appointments of consultant medical ophthalmologists in waiting list blackspots including Cork and Drogheda, with a number of posts now advertised in the west of Ireland. “So slowly things are improving. The blueprint is there now, which is great, and the eye care teams with the doctor, optometrist, nurses, and orthoptists, are coming on stream, and the clinical pathways we are refining so that patients get seen as efficiently as possible.” 

Meanwhile, in relation to cataract surgery waiting lists, which have been a particular issue in some parts of the country, there is a pilot ongoing of a detailed new national referral form for opticians, which will allow appropriate categorising and referral of these patients, while there are also more dedicated surgical eye theatres in development, with funding for a new theatre recently granted in Waterford, “while in the South Infirmary in Cork they are also in the process of getting a second eye theatre, while a second eye theatre has also been commissioned in the Mater… which should really help with the cataract waiting lists, while the NTPF is still taking long waiters,” Prof Power concluded. 

Training update 

Miss Yvonne Delaney, Dean of Postgraduate Education, ICO, gave delegates at the ICO Annual Conference an overview of the significant milestones and recent developments of the ICO National Training Programmes, and in particular the dedicated medical ophthalmology specialty training programme. 

Launched in 2017, the standalone medical ophthalmology programme was developed in response to the demand for ophthalmic specialists to treat patients in the areas of greatest eyecare demand, namely medical retina, glaucoma, and paediatric ophthalmology, coupled with an increasing ageing demographic and the huge expansion of new medical treatments for sight-threatening conditions – across all three areas, but particularly in medical retina. 

“This has led to a big change in how we practice and deliver medical ophthalmology and the reconfigured national training programme (NTP) has been designed to address workforce and service demands, with the curriculum mapped to the National Clinical Programme for Ophthalmology Model of Care,” she said. 

Miss Delaney noted that there has been significant investment in the specialty in recent years with the roll-out of the integrated eye care team model and appointment of new consultant medical ophthalmologist posts nationally. 

At the time of the launch of the dedicated medical ophthalmology programme, the integrated eye care team did not yet exist, but now the ICO is looking to expand the number of training posts for the medical programme year-on-year to align a specialised medical workforce with patient demand. 

“Now, in 2022, we have teams recruited and in operation across Dublin in CHOs 6, 7, and 9, making significant impact on waiting lists in their areas, in Cork CHO 4 and in development throughout the country, improving access to specialist care for patients closer to home in their communities,” she said, highlighting collaboration between the key stakeholders as key to this success. 

Ocular Surface Disease Symposium 

During this session, Prof Conor Murphy, Professor of Ophthalmology, RCSI, and Consultant Ophthalmic Surgeon, RVEEH, Dublin, presented on complex inflammatory disorders of the anterior segment that lead to progressive and often sight-threatening and painful conjunctival fibrosis. The key message was that early recognition and appropriate immunosuppressive and supportive therapies lead to a far better prognosis and quality-of-life in the long-term for affected patients. 

Mr David Sullivan, Chairman, Board of Directors, Tear Film and Ocular Surface Society (TFOS), Boston, US and former Associate Professor, Department of Ophthalmology, Harvard Medical School, gave a fascinating talk entitled ‘Ménage à trois: Sex, sex steroids, and dry eye disease’. He said that one of the most compelling epidemiologic features of dry eye disease (DED) is that it occurs predominantly in females. Many sex-related differences in the eye have been attributed to the effects of sex hormones “steroids” (eg, androgens and oestrogens). Sex steroids act on the meibomian gland, lacrimal gland, conjunctiva and cornea, and impact multiple structural and functional aspects of the ocular surface and adnexa. 

Sex steroids have also been linked to the development or treatment of meibomian gland dysfunction (eg, ageing), lacrimal gland inflammation (eg, Sjögren’s syndrome), corneal glycocalyx deficiency (eg, androgen insufficiency), and the pathogenesis of aqueous-deficient and evaporative DED. 

A foremost consideration is that a number of these hormonal effects may be sex-specific (ie, unique to males or females), thus recognition of these sex-related differences and the determination of their underlying basis (eg, sex steroid action) are extremely important. Such understanding may be translated into new insights into the physiological control of ocular tissues, as well as the generation of novel therapeutic strategies to treat DED. 

For more information on the ICO 2022 Annual Conference, go to www.eyedoctors. ie. 

Irish College of Ophthalmologists, Annual Conference, Kilkenny Convention Centre, Lyrath Estate, 16-18 May 2022.