Annual Montgomery Lecture 2024

Professor Robert Scott (right), Consultant Ophthalmologist at St John and St Elizabeth Hospital, London, who delivered the Annual Montgomery Lecture 2024 at the Irish College of Ophthalmologists Winter Meeting on Friday, November 15th, is pictured with Mr John Doris, ICO President and Consultant Ophthalmic Surgeon, University Hospital Waterford, at the Albert Theatre in the Royal College of Surgeons in Ireland, Dublin, Friday, 15 November 2024.

Prof Scott is a former Royal Air Force Lead Military Consultant Ophthalmologist at the Birmingham and Midland Eye Centre (BMEC) and Royal Centre for Defence Medicine (RCDM) at Queen Elizabeth Hospital in Birmingham, sub-specialising in eye trauma, advanced cataract and vitreoretinal surgery.  His lecture, titled “Traumateyesed: Coping with Major Ocular Injuries”, offered a unique and invaluable clinical learning perspective on the management of severe ocular trauma, as well as practical guidance for ophthalmologists dealing with similar eye trauma cases in civilian healthcare settings.

During his lecture, Professor Scott told the audience of ICO members and trainees,

“All ophthalmologists, like myself, will be expected to deal with severe eye trauma. If you are not managing such patients day to day, it can be difficult to find a framework to work from. Eye injury is a disaster with life-changing functional, social and cosmetic effects. The role of the eye surgeon is to manage the patient, their family and the injury. Management should be staged with the aim of doing as little as is effective at any stage, initially aiming to stabilise the eye and then offering secondary management of longer-term complications. Eye protection prevents the worst effects of ocular injury and should be encouraged at a personal and legislative level. Eye injury patients require life-long monitoring and patients must know this.

For ease of memory, I organised the initial management of eye trauma cases into the acronym CLASSIC as follows. Perform a lateral Canthotomy and cantholysis for retrobulbar haemorrhage immediately if required. Take a detailed Log of history and examination with timings for any insurance or legal reports that will be required in the future. Make sure that systemic Antibiotics are prescribed if there is an open globe injury. Ensure that an appropriate Scan is performed, s-ray, CT scan or ultrasound ‘B’ scan. Perform a primary closure of the globe often with a Suture. Do not neglect communication with the patient’s family, and sort any general Issues that they might have, that is what the hospital welfare department is for. Ensure your patient is in a Comfortable and quiet environment to minimise stress and reduce potential Charles Bonnet syndrome. Follow these guidelines and you can handle the worst eye trauma that presents to you.”

Professor Scott also participated in the ICO Winter Meeting session earlier that day on the topic, “What Might the Future of Practice Look Like?” where he shared further expertise on ophthalmology healthcare delivery and discussed evolving management models for the specialty in light of his experience of the evolution of the UK healthcare system.