Manifesting a clear vision for eye care

Priscilla Lynch speaks to HSE National Clinical Lead for Ophthalmology, Ms Aoife Doyle, about her priorities for the specialty and the impact of HSE investment in eye care

Ms Aoife Doyle, Consultant Ophthalmic Surgeon at the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, was appointed as Clinical Lead for the National Clinical Programme for Ophthalmology last December, taking over from Prof Billy Power.

Ms Doyle is one of Ireland’s leading glaucoma experts, having been among the first glaucoma specialists to be appointed nationally. She led the development of the glaucoma service in the RVEEH and has also been significantly involved in training at European and Irish level.

She studied medicine and trained in ophthalmology in Ireland and spent 18 months at the Glaucoma Institute in Paris.

Ms Doyle also carried out research into novel delivery methods for anti-fibrotic agents in glaucoma surgery, as well as clinical research during the early stages of a new laser technology in glaucoma, which is now in widespread use.

During the Covid-19 pandemic, she launched a ‘virtual’ drive-through intraocular pressure monitoring service for stable glaucoma patients in Dublin. The learnings from this project led to a permanent virtual clinic in the RVEEH where stable glaucoma patients can be successfully monitored in a much less resource-intensive way, with fewer clinic visits required.

Changes in care

Over the past seven years, ophthalmology care in Ireland has seen significant advancements under the clinical programme, following the publication of the landmark Primary Care Eye Services Review Group Report by the HSE in June 2017. This long-awaited report laid the groundwork for a major overhaul of ophthalmology services, shifting many services from hospitals into the community. The introduction of multidisciplinary integrated eye care teams across the country has alleviated hospital workloads and reduced long waiting lists. Additionally, the role of the medical ophthalmologist has been redeveloped and enhanced to lead these teams, with ongoing investments in dedicated cataract theatres further improving care delivery.

“That’s been extraordinary,” Ms Doyle told the Medical Independent (MI).

“There’s been a huge reduction in waiting lists, particularly on the paediatric side in a really short time period. It’s very impressive. And obviously, also in the cataract waiting lists, [which is] the bread and butter of the hospital service.”

Ms Doyle’s priorities for the clinical programme include the continued expansion of integrated eye care teams and the implementation of a national electronic clinical management system. These initiatives aim to enhance coordination, streamline patient care, and improve overall service delivery across the country.

Integrated eye teams

“The main direction of the clinical lead role at the moment is to improve the care through the integrated eye care teams in the community,” she said.

“The main pathways are paediatric, cataract, medical retina, and glaucoma, which are the most important areas. I suppose [these are] the biggest bulk of necessity, if you like, for eye care and the ones that can start their journey in the community and with the integrated eye care teams.”

According to the HSE, integrated eye care teams have been established in six of the nine Community Healthcare Organisations (CHOs): CHO 1, 2, 4, 6, 7, and 9. While progress continues in setting up teams in the remaining areas, Ms Doyle noted that the HSE’s recruitment embargo, now gradually being lifted, has had a negative impact on this work.

During this year’s Irish College of Ophthalmologists Annual Conference, held in Westport in May, delegates received updates on how integrated eye care teams have dramatically reduced paediatric waiting lists and developed much more efficient and patient-friendly care pathways. A presentation on the Galway experience received rapturous applause at the meeting.

“It’s a really exciting time. We’re seeing these new consultant medical ophthalmologists being appointed all around the country,” Ms Doyle told MI.

“They’re running their units really efficiently. You’ve seen the example of Galway. They have orthoptists and optometrists working with them. It’s great seeing everybody working to the top of their licence and running their clinics, the paediatric waiting list reduction has been phenomenal. We don’t have a paediatric waiting list anymore in the areas where the teams are fully working. For example, CHO 6 and 7 have cleared their paediatric waiting list completely, which is another good news story, which doesn’t always get out there. So it’s phenomenal.”

However, Ms Doyle emphasised that while this level of efficiency is commendable, the HSE must recognise the need for appropriate support when demanding increased productivity from clinical staff. She noted that the current approach often overlooks the critical need for adequate recruitment and funding to sustain and further these improvements.

“If we really want to improve productivity and want our consultants working at the maximum of their licence and capacity, the only way to do that is to have the full team in place, for them to be able to delegate to [the other team members]… and also to have the proper infrastructure in place.”

Cataract theatres 

In regard to cataract care, the roll-out of dedicated theatres in Dublin and Nenagh, with new theatres also open in Waterford and in Cork, has driven huge improvements in waiting list times in many areas.

However, Ms Doyle added that the need for surgery is also increasing due to the rising and ageing population. 

“If you actually look at the activity levels, the activity levels are up. So even if the waiting lists are rising, I think it’s population-based, but the amount of work actually being done is very high.”

Under the new model of care, within fully functioning integrated eye care teams, cataract assessments can be conducted in the community, surgeries performed at dedicated cataract units, and post-operative follow-ups managed back in the community.

“Which is fantastic,” said Ms Doyle.

“I mean that’s a model for other parts of the healthcare service for other surgeries. It’s amazing. That’s what patients want and it frees up so much time in the hospitals as well.”

Integrated medical records

However, one key remaining challenge is the lack of integrated medical records and systems between the hospitals and the new community-based teams, Ms Doyle acknowledged.

She was heavily involved in the development of the integrated cataract and glaucoma service across the RVEEH and CHO 7 in Kilnamanagh/Tymon Primary Care Centre. The centre operates a paperless model with an electronic medical record and imaging platform shared with RVEEH to allow all clinical information to be accessible at the point of patient care.

Ms Doyle would like to see this type of fully integrated system rolled out in all the other CHOs and hospital units. She said this is a key focus for the clinical programme under her tenure.

She hopes that funding will shortly be secured to move to tendering for a national electronic ophthalmology system, following the success of the CHO 7 system and other pilots.

“This is one of the biggest projects I am working on,” she commented.

While Ms Doyle admits it is challenging, she points out where the integration of records between hospitals and community services has been piloted, it has enabled seamless sharing of care between settings, greatly improving coordination and efficiency.

“So all of the pre- and post-op care can be carried out and the patients arrive and everybody has access to exactly the same records, in real-time, which is great.

“It’s also a really important part of safe transfer of patients to the central hospital as needed, whether it’s for their surgery or for emergency care or for more complex care. And then, as soon as they’re ready to be managed closer to home, they can be sent back out to the community. I mean, it just allows true integration of the teams…. But there’s a lot of work to be done on that one, and that’s my focus for the next couple of years.”