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Aloha from Hawaii!

Aloha!  I recently attended the ARVO meeting in Hawaii. This is an annual meeting of eye research, devoted to vision and ophthalmology and is one of the largest conferences in the world. Having been in Baltimore last year (less popular), the venue was in Honolulu, Hawaii this May. I was one of about 10,000 delegates. The meeting offered an exceptional opportunity to meet leading researchers and discuss some of the latest developments in Ophthalmology. The ARVO dress code is informal, so yes many of us wore Hawaiian shirts, whilst enjoying the balmy weather.

The results of a new glaucoma drop were presented – this drop is a new class of drug called Rho-Kinase inhibitors and is the first novel glaucoma drop for over 20 years. It has just been licensed in the US, and hopefully will be available in Europe soon, once approved by the European regulators. It offers useful pressure lowering, but is not a miracle agent, and has some side effects like red eye – but it will be a useful additional drug.

Interesting research was presented on a diverse range of topics, including Wet AMD, aspects of correcting astigmatism with cataract surgery using lens implants (so-called “TORIC IOLs”) and the results of glaucoma microstent surgery.  My colleagues and I were presenting some research on aspects of eye inflammation, including the use of an immunosuppressive drug called Tacrolimus, and the treatment of eye inflammation caused by a common infection: toxoplasmosis.

After the meeting finished, I was able to escape the slightly disappointing urban sprawl of Honolulu by spending a couple of days in Maui. This offers much more of the Hawaii experience – unspoilt beaches, surfers, and a mountainous interior topped with clouds. And thankfully it is not volcanically active – unlike its neighboring island which started to misbehave whilst I was there!

Exploring Hawaii’s interior


Hawaiian weather not quite living up to expectations!

As a keen astronomer, I had terrible telescope envy…

That’s more like it!


Happy New Year – and Mark’s book!


We’d like to wish all our patients and colleagues a happy and healthy New Year in 2018.

Some of you may know that Mark has been busy writing a book!  Not an action adventure blockbuster, alas, but a primer on uveitis aimed at ophthalmologists in training.  Mark runs uveitis clinics at Moorfields Eye Hospital in addition to his interests in glaucoma and cataract surgery. It’s available from good bookshops or on Amazon (click here) for those who are interested.

Those of you who have come to see us in the practice recently will have noticed a few changes: Sylwia, our practice secretary for the last 6 years, has moved on – she will be missed by patients and ourselves alike.  We wish her the very best in her new role.

Sandrine has now taken over as Practice Manager. She has been involved with the practice behind the scenes for many years, so is familiar with what we do and the way we work.  She also loves working with technology – we’re already fully computerised, but she will no doubt keep us moving onwards!

Avni, our optometrist, and Anabela, our practice secretary remain as familiar faces in the practice.


Argentine Uveitis Society

During the summer I was privileged to give a couple of lectures at the inaugural meeting of the Argentine Uveitis Society following a kind invitation from a colleague and fellow specialist, Professor Christobal Couto.  One of the lectures I gave was on a rare inflammatory disease of the eyes called Birdshot retinochoroiditis. I have a research interest in this potentially serious eye disease, as I manage a number of patients with this disorder at Moorfields Eye Hospital. This rare but serious disease occurs primarily in Northern Europeans, and results in chronic  inflammation within the retina and  the underlying nourishing blood supply, called the choroid. Thankfully treatment is available but it usually involves long term steroids and immunosuppressive drugs. Professor Couto and myself have a shared interest in this condition. There are a number of patients in Buenos Aires with birdshot, arising as a result of the European heritage of many of the Argentinians. I very much enjoyed the opportunity to meet with some Argentine colleagues, and we discussed treatment strategies for this condition. I also toured the ophthalmology department. The central hospital is in the medical district of Buenos Aires – many of these buildings were built in the 1940s, and have a distinctly fascist German inspired architecture, having been built in the Peron era. It wasn’t all work, though – I took some time to sample the wonderful Argentinian steaks and wine!


Minimally Invasive Glaucoma Surgery (MIGS) – The iStent


There is currently a lot of interest in newer surgical techniques for treating glaucoma. Until recently, if the intraocular pressure could not be controlled with drops, and in some cases laser treatment, glaucoma specialists resorted to glaucoma surgery, either trabeculectomy (where a trapdoor flap is created to relieve pressure), or a tube. Whilst successful, these operations are invasive, time consuming, and carry risks and significant side effects.

Minimally invasive glaucoma surgery is an alternative approach – whereby one or more very small stents (tubes) are inserted into the drainage part of the eye (the trabecular meshwork). These procedures are less invasive, and quick to perform. I have recently become one of the first group of surgeons in the UK to start using the “iStent” (there’s definitely a joke in there somewhere about being an iSurgeon…).

The iStent is a tiny hollow tube that is made out of titanium metal, and is only 1 mm long. It is thought to be the smallest medical device to be implanted in the human body. It is inserted into a specific part of the microscopic drainage canal structure of the eye (Schlemm’s canal – part of the trabecular meshwork). It’s inserted using a microscope, thereby improving the drainage of aqueous fluid and lowering the eye pressure.

The surgery time is quite quick, (5–10 minutes) and the iStent procedure is often combined with cataract surgery. An ideal candidate for use of the iStent would be a patient with mild glaucoma, who is taking one or two glaucoma drops, and who is embarking upon cataract surgery. Following surgery, we would hope that the patient might be able to stop a glaucoma drop.

As a minimally invasive procedure, most specialists, myself included, believe that the iStent is a mild treatment that offers benefits to some patients. It is certainly not a “miracle”, but it has the advantage of minimal side effects. So far, my early results are encouraging, and I look forward to following up my early patients to establish its usefulness in the long term.

Finally, and worth mentioning, is that although the iStent is made of metal, it is non-magnetic titanium, so patients are safe to have future MRI scans!


The 11th Pan-Hellenic Vitreo-Retinal Meeting – and archeology…

I was invited to speak recently at the 11th Pan-Hellenic vitreo-retinal meeting, held in Athens. This was a welcome chance to catch-up with my many Greek friends and colleagues. Some I trained alongside and others I have helped train during their time spent at Moorfields. I was invited to oppose the motion of a debate “screening is mandatory in uveitis”. My brief was to argue that it is not necessary to perform endless blood tests to diagnose inflammatory eye disease (uveitis).This practice is usually not necessary, is wasteful of resources, and can cause patient anxiety.
Debates are quite popular in medical society meetings, as they are a way of summarising the science that might support both sides of an argument to the audience. Of course, the truth sometimes resides somewhere in the middle, but I think, on balance, that I helped to defeat the motion. After the meeting, I was invited to join colleagues on a 2 day guided tour of the archaeological sites of the Peloponnese. This was an excellent opportunity to meet ophthalmologists from across Europe and share experiences, whilst at the same time seeing some fascinating archaeological sites.
On the tour, we visited Olympia , the site of the ancient Olympic Games. We stayed overnight in a charming mountain retreat, and were surprised by the light dusting of snow the next morning. That morning we then visited Mycenae, which is the centre of the Bronze Age Mycenaean civilization, from 1600 BC to 1100 BC, that predates that of classical Greece. We visited a Mycenaean tomb, possibly of Agamemnon, and the impressive remains of the palace. Finally, we visited Epidaurus, which is the site of the best preserved amphitheatre in Greece. This is still used occasionally to stage plays, and can hold 16, 000 people. This theatre is famous for its remarkable acoustics – for example an actor’s whisper from the stage can be heard with perfect clarity by all audience members, even by those seated up in the “gods” in the highest and cheapest seats of amphitheatre. Also of interest to the group, as surgeons, was a small adjacent museum exhibiting some archaeological finds, including some fine surgical instruments, as this area was a centre for healing. I wonder if they had ophthalmologists?

I also did my best to help the Greek economy by stocking up on honey and olive oil…


Merry Christmas and a Happy New Year!

We would like to wish all our patients, clinic staff and our optometrist and GP colleagues a very happy Christmas and a healthy New Year! With best wishes from Mark, Sylwia, Avni, Anabela, Sandrine and Chris


Using lasers in cataract surgery….the femtosecond laser

Mark was invited to present at a conference at Moorfields Eye Hospital a couple of weeks ago, devoted to the use of femtosecond laser in cataract surgery. This allowed those initial surgeons who’ve spearheaded the use of femtosecond laser in cataract surgery in the UK to share their experiences. The audience were primarily surgeons interested in taking up the technique in the future (this surgery is well established but few surgeons have taken it up in the UK, in part due to lack of availability and high cost of the equipment). There’s a huge amount of interest in the surgical community in this technique – it’s the first major technological advance in cataract surgery for over 2 decades! Mark and his colleagues discussed future improvements in design with his colleagues and the manufacturers, most of whom were present and following the proceedings with great interest.


Merry Christmas and a Happy New Year!

We would like to wish all our patients, clinic staff and our optometrist and GP colleagues a very happy Christmas and a healthy New Year! With best wishes from Mark, Sylwia, Avni, Anabela, Sandrine and Chris


Euretina 2014

Mark attended and lectured at the “Euretina” 2014 meeting in London recently. Held at the ExCel Centre, this is one of the world’s largest congresses devoted to retinal disorders. The aim is to allow specialists with an interest in retinal disorders to share clinical experience, research ideas, and keep up to date with this rapidly expanding field. Over 5000 delegates attended.

As an invited speaker was Mark was able to meet with associates and colleagues as far flung as Australia and Canada, as well as Europe.
Mark says: “Enormous progress has been made in the treatment of retinal disorders in the last few years. Our treatments have been revolutionized by medicines injected into the eye. The principal treatments involve medicines that block a protein called Vascular Endothelial Growth Factor (VEGF) – this protein is one factor that causes abnormal blood vessels to grow under or within the retina and leak fluid. Injection therapy, which is painless, now allows successful treatment in many patients with wet macular degeneration, diabetic macular swelling (oedema) and retinal vein thrombosis. Early therapies required frequent injections (monthly) but newer anti-VEGF drugs have been developed to reduce the frequency of injections so it is much less burdensome for the patient.”

Mark also attended interesting presentations of other emerging therapies such as gene therapy and retinal implants. However these treatments, although promising, are still in their infancy.


Femtosecond laser assisted cataract surgery evening

Thank you to all the optmometrists and allied health professionals who came to Mark’s lecture at the Royal Society of Medicine.  The subject of the lecture was “Femtosecond laser assisted cataract surgery – Is it worth the hype?”.  This generated a huge amount of interest as it’s a relatively recent technological advance in cataract surgery (there are only 2 machines in the UK), and Mark is one of the few consultants using this new technique regularly in the UK.  The general agreement was that yes, it probably is worth the hype!

The lecture was followed by a wine tasting with Ray O’Connor, our wine expert, giving everyone a chance to mingle and discuss patients, practices…and wine.

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