ICO News No11 APR15 News No11...To resume driving, such patients can be classified as exceptional...

ICO NEWSLETTER | APRIL 2015 PAGE 1

NewsletterISSUE 11 APRIL 2015

With best wishesMArIe HIckey DWyer

In February 2015, the ICO

published new Guidelines for

Refractive Eye Surgery as a

reference for the public, patients

and healthcare

professionals and as

part of our mission to

advance developments

and improvements in

eye health and

patient safety.

Followingconsultation withstakeholders andfeedback receivedfrom interestedparties at the MedicalAdvertising in Ireland meetingorganised by the ICO lastSeptember, the College workedclosely with our members and theother relevant expert bodies,including the Medical Council,patient associations and theAdvertising Standards Authority,in ensuring this document sets theappropriate standard for refractiveeye surgery practice in Ireland.

Clear indications relating to thequalifications, facilities and clinicalgovernance of surgeons whoperform refractive eye surgery arecentral to the guidelines, which

recommend that surgeons must beregistered with the MedicalCouncil (Ireland) on the Divisionof Ophthalmic Surgery SpecialistRegister and must have undergone

sub specialist trainingfor refractive surgery.

The guidelines alsorecommend that

surgeons must keep theirknowledge and skills up

to date.The guidelines provide the

public with information onwhat to expect during the

process, from decisionmaking to post-operative care.

Standards Relating to Advertising

and Marketing

A dedicated section onStandards Relating to Advertisingand Marketing are contained in thenew Guidelines. The recommend -ations were devised following theMedical Advertising in IrelandMeeting in September 2014 whichfacilitated a debate by expertbodies on the impact direct-to-consumer advertising for a medicalor surgical procedure can have ona patient’s decision making.

Message fromthe President ICO Publish Guidelines for

Refractive Eye Surgery

Continued on page 2 ➥

Dear Colleagues

Soon we will all gatherin Westport for ourAnnual Conference. Thisyear's Mooney Lecturer is SimonHarding and we will also welcomeCarmel Noonan, Ian Marsh and FionaRowe from Liverpool. Carmel has been afantastic support to the College duringthe training programme inspections andI am delighted that we will have theopportunity to host her in Westport toshow our appreciation. I am also lookingforward to welcoming Carrie MacEwan,President of the Royal College ofOphthalmologists. Carrie will speak onocular trauma but the visit will also be anopportunity to grow the long standingrelationship with our UK colleagues.From this year all our juniors will besitting the first part of the Royal Collegemembership exam and this changecoupled with Carrie's visit will no doubtlead to a reinvigorating of links betweenour two Colleges.

Brain Murphy from the HSE willupdate us on the review of primary eyecare. I hope that the review will prove anopportunity to improve the resourcesavailable to our colleagues in theCommunity. Thank you to all those whohave contributed to the work of thegroup, particularly Alison Blake andLoretta Nolan.

As my own term as President of theCollege draws to a close I want to thankall of you who have contributed toCollege life and to encourage you tocontinue to do so. We may be small innumber in comparison to our sisterColleges, however our independenceallows us to focus on the issues ofparticular importance to our patients andour specialty. This is only possiblethrough the great generosity of time andeffort of so many of you, thank you andlong may it continue. It has been myhonour to serve you as President, everygood wish to my successor Billy Powerand to all of you.

Irish College ofOphthalmologists

GUIDELINES FOR REFRACTIVE SURGERY IN IRELAND

Published byIrish College of Ophthalmologists121 St Stephen’s Green, Dublin 2. Tel 01 402 2777 · [email protected] www.eyedoctors.ie · t: @eyedoctorsirl

If you would like to make anysuggestions for future issues of theCollege Newsleer please contact Siobhan on [email protected]

ICO NEWSLETTER | APRIL 2015PAGE 2

The guidelines state thatinforma tion on procedures must nottrivialise the seriousness of surgeryor minimise the potential risks andthat time limited deals, financialinduce ments and any advertisingwhich undermines surgery shouldnot be used. They include thatadvertising material must be legal,factual and not misleading andmust be designed to safeguardpatients from unrealisticexpectations.

This document is an importantstep in the College’s continuedefforts to safeguard patients andprovide accurate information to thepublic.

The Guidelines will be circulatedto all relevant stakeholders,including key political audiences,HSE lead officials, patient advocacyand lobby groups in tandem withour on-going engagement withhealth media to help raiseawareness of the publication.

A copy of the Refractive SurgeryGuidelines is available to view onthe ICO website.

➥ Continued from page 1

Visual field defects and driving

The Directive of 2009 was a game-changer, specifically laying downminimum and legally-bindingstandards for vision, diabetes andepilepsy. These were in turn based ona series of expert working groupssuch as the Eyesight Working Groupi,whose deliberations were transposedin a manner not always completely intune with their content.

Once the 2009 Directive wasenacted in Irish law, it was clear thatthere was a need for more detailedguidelines on medical fitness to drive.The Road Safety Authority and theRoyal College of Physicians in Irelandset up the National Programme Officefor Traffic Medicine, with over 30disciplines, including ophthalmology,optometrists and orthoptists, on itsworking group. The Programme isfortunate to have a good workingrelationship with the DVLA in theUK, and representatives of theProgramme sit as observers on the UKPanels: Ms Patricia Logan has beenour representative on the Visionpanel.

The resulting output has been theguideline Sláinte agus Tiomáintii, nowapproaching its third edition, and anassociated educational programme,including a newly developed

Certificate in Traffic Medicine. Theguidelines have been shown to haveutility and applicability in generalpracticeiii.

There are many ways in which thisguide differs from the excellent DVLAAt-A-Glance guidelines with whichmany readers who worked in the UKwill be familiar. In particular, there isan extensive introductory section,giving an overview of trafficmedicine, and clearly outlining theresponsibilities of drivers, health careprofessionals and the National DriverLicensing Service (see table).

A consideration of particular notefor ophthalmologists is that of Group1 drivers (cars and motor bikes) whohave adapted well to a significantfield defect which does not satisfy thestandard of a horizontal visual field isat least 120 degrees, with extension ofat least 50 degrees left and right and20 degrees up and down.

To resume driving, such patientscan be classified as exceptional casesby a medical eye-doctor competent

Up to 2009 there was little overt discussion on medical fitness

to drive within the medical profession in Ireland. However,

change was in the offing, largely prompted by a series of

European Union Directives on fitness to drive which in the first

iterations were rather generic.

Overview - Irish College ofOphthalmologistsRefractive SurgeryGuidelines:• The appropriate experience

and qualifications of surgeonsperforming refractive surgery

• Requirements of the facilitiesat which it takes place

• Information that should beprovided to patients – must beaccurate, fair and balanced

• The patient consent process• Relevant issues of clinical

governance• Advertising and marketing of

services• Specific issues related to the

post-operative management ofpatients.


medical authority, subject to thefollowing strict criteria: a) The defect must have been present

for at least 12 months. b) The defect must have been caused

by an isolated event or a non-progressive condition.

c) There must be no other conditionor pathology present which isregarded as progressive and likelyto be affecting the visual fields.

d) The applicant has sight in botheyes.

e) There is no uncontrolled diplopia. f) There is no other impairment of

visual function, including glaresensitivity, contrast sensitivity orimpairment of twilight vision.

g) Clinical assessment of fullsatisfactory functional adaptation.

In addition, the EU Directive mandatesthat there must be a satisfactorypractical driving assessment, carriedout by an appropriately qualifieddriving assessor. This is a new aspectto practice, and requires forging a linkwith a driving assessor. Currently theNPOTM is working on guidelines onon-road assessmentiv, but in theinterim there are a number of privateand voluntary organisations andindividuals who can carry out thisfunction, including and not confined tothe Irish Wheelchair Association, theDisabled Drivers Association ofIreland, Transport and MobilityConsultants-Ireland and SouthernMobility.

A critical aspect of the referralpathway is a referral letter from thetreating ophthalmologist to thedriving assessor confirming that a)the assessment is for an adapted fielddefect, and b) that in the opinion ofthe ophthalmologist the patient hasfulfilled the criteria a-g above. Thisletter is needed to suitably tailor theassessment, and to reassure thedriving assessor that theophthalmologist considers the patientto have made a full satisfactoryfunctional adaptation.

The adjudication of functionaladaptation is a clinical one, backed byappropriate multi-disciplinarysupport as required.

i New standards for the visual functions of drivers: report of the eyesight Working Group. Brussels,european commission (DG TreN), May 2005. http://ec.europa.eu/transport/road_safety/pdf/behavior/new_standards_final_version_en.pdf

ii road Safety Authority. Slainte agus Tiomaint: Medical Fitness to Drive Guidelines, 3rd edition. Ballina,road Safety Authority, 2014.http://www.rsa.ie/Documents/Licensed%20Drivers/Medical_Issues/Sl%c3%A1inte_agus_Tiom%c3%A1int_Medical_Fitness_to_Drive_Guidelines.pdf

iii kahvedžić, A., Mcfadden, r., cummins, G., carr, D., & O’Neill, D. (2014). Impact of new guidelines andeducational programme on awareness of medical fitness to drive among general practitioners in Ireland.Traffic injury prevention, (e-pub ahead of print).

iv http://www.rsa.ie/en/Utility/News/2015/The-National-Programme-Office-for-Traffic-Medicine-launches-a-public-consultation-process-for-Medical-Fitness-to-Drive-Assessments/

Roles and responsibilities of drivers, healthprofessionals and the NDLS

Driver • To report to the National Driver Licence Service (NDLS) and their

insurance provider any long-term or permanent injury or illness thatmay affect their ability to drive without elevated risk: if holding a licencefrom an EU country other than Ireland, or a recognised country forlicence exchange, and developing a condition which could elevate risk ofimpairment while driving, the driver must contact the NDLS to arrangefor an exchange of their licence.

• To respond truthfully to questions from the health professional regardingtheir health status and the likely impact on their driving ability.

• To adhere to prescribed medical treatment and monitor and managetheir condition(s) and any adaptations with ongoing consideration oftheir fitness to drive.

• To comply with requirements of their licence as appropriate, includingperiodic medical reviews.

Health professional • To assess the person’s medical fitness to drive based on the current

Sláinte agus Tiomáint medical guidelines. • To advise the person regarding the impact of their medical condition or

disability on their ability to drive and recommend restrictions andongoing monitoring as required.

• To advise the person of their responsibility to report their condition tothe NDLS if their long-term or permanent injury or illness may affecttheir ability to drive.

• To treat, monitor and manage the person’s condition with ongoingconsideration of their fitness to drive.

• To report to the NDLS regarding a person’s fitness to drive in theexceptional circumstances where there is a risk to the public and thedriver cannot or will not cease driving.

National Driver Licence Service (NDLS) • To make all decisions regarding the licensing of drivers. The NDLS will

consider reports provided by health professionals. • To inform the driving public of their responsibility to report any long-

term or permanent injury or illness to the NDLS if the condition mayaffect their ability to drive.

• Will act on reports of third parties, Gardaí, general public and healthcareworkers regarding concerns of public safety relating to medical fitness todrive.


Recruitment to VISICORT study commences in Ireland

Immunological rejection remains

the most important cause of

corneal graft failure with failure

rates of up to 60% at five years in

high risk situations, such as in

patients with prior graft failure or

herpes keratitis.

VISICORT is a multi-disciplinaryresearch project involving 12 partnersfrom across the EU with expertise incorneal transplantation, cell therapy,immunology, bio-sampling, systemsbiology/immune profiling andbioinformatics. The project willcomplete the first ever systematicimmune profiling of human cornealtransplant recipients. Clinical data

and bio-specimens from over 700corneal transplant recipients at fiveleading transplant centres, includingthe Royal Victoria Eye and EarHospital and RCSI, will be centrallycollated and distributed to cutting-edge laboratories for multi-platformprofiling and integrated bioinfor -matics analyses. Profiling data willgenerate a better under standing ofcorneal transplant rejection andfailure. This knowledge will be usedto develop novel biomarker-basedsurveillance strategies and, coupledwith SME-based expertise in cellproduct development, will alsoinform the design and initiation of an

optimised clinical trial strategy ofimmunomodulatory stromal stem celltherapy in high-risk human cornealtransplant recipients. The project isbeing coordinated by Prof MattGriffin, Professor of TransplantBiology at NUI, Galway.

Benefitting from a €6 millionaward from the European Commis -sion, the project launched in May 2014and following a development phasewe are delighted to announce thatpatient recruitment has commenced.Having performed 111 corneal trans -plants at RVEEH in 2014, we expectthe Irish contribution to recruitmentto be strong and we look forward tobeing able to achieve better outcomesfor our patients in the future.

conor Murphy

First patient recruited to the VISICORT study.

PharmaceuticalGrants Awarded toDoctors or MedicalBodies to beDisclosed

From January 2016 information

will be published on all grants

given to individual doctors or

bodies by the pharmaceutical

industry.

The Irish PharmaceuticalHealthcare Association hasintroduced changes to their Codeof Practice that will oblige membercompanies to make public fromJanuary 2016 all payments toHealthcare Professionals andOrganisations. The informationwill be made public no later than1st July 2016 and will conveydetails about transfers of valuesuch as research and development,donations and grants (includingmedical education and unrestrictededucational grants), consultancyfees, conference registration fees ortravel costs to attend medicalcongresses.


The ICO Annual Conference 2015

will take place at the

Knockranny House Hotel & Spa in

Westport, Co Mayo from Wednesday

13th to Friday 15th May.

This year's overseas speakers willinclude Professor Simon Hardingfrom Liverpool University Hospitalwho will give the ICO AnnualMooney Lecture on DiabeticRetinopathy. Professor Hardingspecialises in the diagnosis andmanagement of retinal diseasesincluding diabetic retinopathy andage-related macular degeneration inwhich he leads a number of nationaland international researchprogrammes.

The programme this year willinclude a symposium on the OcularComplications of Acquired Braininjury with speakers Miss CarmelNoonan, Consultant Ophthalmologistand Mr Ian Marsh, ConsultantOphthalmic Surgeon from the RoyalHospital in Liverpool and orthoptistFiona Rowe from LiverpoolUniversity.

Professor Richard Collin,Consultant Ophthalmic Surgeon atMoorfields Eye Hospital, London, willcontribute to the Ocular Plasticssymposium which is being chaired byKate Coleman.

Paul Connell will present thehonorary SOE Lecture entitled‘Diabetic retinopathy andmaculopathy; Seeing beyond anti-VEGF therapy’.

We look forward to welcomingBrian Murphy, Head of PlanningPerformance and ProgrammeManagement and Assistant NationalDirector for HSE Primary Care whowill give a keynote talk on therecommendations of the Primary EyeCare Review Group. The ICO iscollaborating with the HSE PrimaryCare Division and various HSEdepartments including the PrimaryCare Reimburse ment Scheme, PublicHealth and the Directors of Nursingon the Review Group. The role of theGroup is to examine and documentthe primary care eye services

currently provided to children andadults nationwide including HSEdirectly provided services andcontracted primary care services andto determine the needs of thepopulation for these services. Thegroup is also tasked with reviewingthe current service in terms of quality,safety and consistency and to identifyissues for action.

The evaluation process aims toprovide a clear blueprint withrecommendations for the delivery ofprimary care eye services which willensure a high quality, safe andconsistent service for patients. Areport and recommendations on thefuture delivery of services will bepublished in mid-2015.

Patricia McGettrick who sits on theCollege’s Ethics Committee is organis -ing a very timely seminar on Ethicaland Legal aspects of Clinical Practice.Speakers will include Dr DiarmuidHegarty GP and Mr Asim Sheikh,Barrister-at-Law, both of whom are onthe faculty of the RCSI Masters inHealthcare Ethics and Law course.

A new edition to the programmethis year will be a discussion forumon Eye Care Practice and Policy. Theformat will be interactive Q & A andinput from members will be verywelcome.

This year’s conference will includea very special contribution from Guestspeaker – Mark Pollack. Mark hasovercome significant challenges, firstblindness at the age of 22 followed bya fall in 2010 which left himparalysed, to explore the frontiers ofhuman capability and courage. Histalk promises to be a highlight of themeeting.

ICO Annual Conference

This year's Mooney Lecture willbe given by Prof Simon

Harding. Prof Harding, from theUniversity of Liverpool’s Instituteof Ageing and Chronic Disease willpresent on Diabetic Retinopathy.Simon has carried out significantresearch through the IVAN trials(Alternative Treatments to InhibitVascular Endothelial GrowthFactor in Age-related ChoroidalNeovascularisation), whichinvestigated whether treatment-asneeded is as effective as monthlytreatment for AMD.

The Mooney lecture is named inhonour of the Mooney Family fortheir multi-generationalcontribution to ophthalmology inIreland.

Brian Murphy

2015 MooneyLecture

Professor Carrie

MacEwan,

President of theRoyal College ofOphthalmologistsin London willspeak at thisyear’s conference on theepidemiological aspects of oculartrauma. Carrie was elected to therole of President of the College fromMay 2014 to May 2017 and is aConsultant Ophthalmologist atNinewells Hospital, Dundee andHead of the Department ofOphthalmology at the University ofDundee.

ICO NEWSLETTER | APRIL 2015

The principle aim of the group isthe adoption of the aspirations ofVision 20/20 to eliminate preventableblindness and to develop a nationalvision strategy for implementation inthis country to support that initiative.

The Coalition also supports theadoption and implementation of theNational Care Plan for Ophthal mologywhich has been developed under thestewardship of Paul Moriarty(National Clinical Lead for Ophthalm -ology) and aims to use its advocacyvoice through the service users and thestrength of the coalition to promotepolitical and adminis trative awarenessof the needs of the vision impaired andblind community in Ireland.

The third goal of the Coalition is theintegration of all aspects of eye care inIreland under one umbrella; from thosewho need spectacles, to those whoaccess hospital eye services and rightthrough to mobility training with acane or a guide dog for individualswho suffer severe vision loss andblindness.

The first project undertaken by theCoalition was the development of aframework document for a NationalVision Strategy, which was publishedin November 2012. The documentoutlines the principles for a NationalStrategy and recommended that anyfuture strategy must include; 1) the full agenda of eye health for

children and adults2) maximising quality and assuring

safety for all the access services 3) all services and supports should be

provided on a person-centred basis 4) people with sight loss will have the

supports in place to enable them tolive fulfilled lives, exercising choiceand control in their lives

5) services will be provided usingseamless pathways to reversinghealthcare, and social care in thevoluntary sector

6) resource allocation and services willbe guided by evidence basedapproaches where quality of accessto treatment rehabilitation andsupport is prioritised

7) research will serve as a key enablerin our continuous commitment toimprove outcomes in the quality ofcare provided

8) the strategic development of eyehealth and support care in Irelandwill be aligned as appropriate withpublic health policy framework.

Following on from those principles thekey objects to be considered nationallyare; 1) co-ordination and integration of

services2) a core focus on prevention and

early intervention with respect tovision impairment and sight loss

3) knowledge and awareness of theconditions that cause visionimpairment and sight loss

4) to foster a research culture toprevent vision impairment andsight loss and indeed reverse sightloss

5) those affected by vision impairmentand sight loss will have fullinclusion and support to take partwholly in society.

Following on from the adoption of aframework for a National VisionStrategy the second aim was to gainpolitical support. The Coalition made apresentation to the Joint OireachtasCommittee for Health in June 2014.This was followed by a Seanad debatein July 2014 from which the Coalitionhas achieved cross party support forthe adoption of a National VisionStrategy. The motion to adopt thatstrategy was passed in the Seanadfollowing the debate. The Frameworkhas enjoyed the support of both theprevious Minister for Health, Dr. JamesReilly and the current Minister Dr. LeoVaradkar.

The Vision Coalition aims to ensurethat there is an adoption of theNational Vision Strategy via theDepartment of Health and the HealthService Executive and that there will bethe implementation of specific asksdetermined by the Coalition. These arecentred on the needs of the individualand the care plan as adopted by theclinical programme. We continue towork as a group to further these aimsin the best interests of our patients. Welook forward to providing furtherpositive updates in the coming year.

Report on National Vision Coalition

CEO Siobhan Kelly is pictured outside Leinster House with the National Vision Coalition

representatives ahead of the Seanad Debate on July 16th.

The National Vision Coalition is a coalition of stakeholders in eye care

delivery in Ireland and includes the charities; Fighting Blindness, National

Council for the Blind under the chairmanship of Ms. Avril Daly and Mr. Des

Kenny. Also represented are the Irish College of Ophthal mologists, clinicians,

Child Vision, Guide Dogs for the Blind, the Association of Optometrists in

Ireland and there is a service user represent ative. Coalition meetings have been

facilitated by Prospectus with funding for the project generously supported by

Novartis, by way of an unrestricted grant.


A40-foot container, which is

packed with donated medical

equipment, no longer required by

Irish hospitals, has arrived in Africa

as part of the EQUALS Initiative - a

joint initiative between the Health

Service Executive and the Royal

College of Physicians of Ireland. The

ICO is fully supportive of the

initiative and has provided financial

support on behalf of our members.

The first shipment includesultrasound machines, endoscopes,incubators, defibrillators, hospitalbeds and other minor equipment thathas either been replaced or is nolonger required by hospitals inIreland.

The EQUALS Initiative aims toprovide medical equipment andquality support through partnershipsin healthcare to less developedcounties and to address inequalities inglobal healthcare.

The equipment has been deliveredto the Monze District Hospital, theUniversity Teaching Hospital Lusaka,the Ndola Central Hospital, theLivingstone Hospital and theNORTEC Training Institute forBiomedical Engineers.

The EQUALS Initiative wasfounded by the HSE and the RoyalCollege of Physicians of Ireland in2013. It came about following a requestfrom Irish trained consultant DrMichael Breen, an obstetrician based inMonze, Zambia for a much-neededultrasound machine for his patients.

“This equipment will enable localstaff to provide essential and lifesaving care to their patients”, says DrDavid Weakliam, National Lead of theHSE Global Health Programme.

“The concept of ‘EQUALS’ isabout improving quality of care forpatients and the programme will

follow up with our colleagues inAfrica by supporting training of theirlocal engineers and clinical staff so theequipment can be maintained andused effectively in their ownenvironments.”

“There is a regular turnover ofmedical equipment in Irish hospitalsas items are replaced with newermodels. Often the existing equipmentis still good quality and functioningwell, but it will not be used again inIreland,” says Professor FrankMurray, RCPI President.

“We have worked with the HSE aspart of a multi-agency team to establisha system to donate equip ment thatwould be suitable for use in Africa andhave received huge good will and co-operation from many people.”

In August 2013, Prof Murray andDr Diarmuid O’Donovan, Director ofPublic Health, HSE West/NUIGalway, travelled to Zambia to meetofficials from the Ministry of Healthto assess the types of equipmentrequired and to develop links with

key hospitals and traininginstitutions.

“It was immediately evident whenwe visited, that the donation ofequipment alone would not be thedesired ‘game changer’ because oftenas much as 80 per cent of medicalequipment currently in developingcountries does not function orrequires maintenance. We recognisethat in addition to training inbiomedical maintenance we also needto offer our experience to support thedevelopment of post-graduatetraining programmes for doctors inZambia” said Prof Murray.

Dr Diarmuid O’ Donovan and DrDavid Weakliam will travel to Africain March 2015 to visit the sites thatwill benefit from the equipment.

The EQUALS Initiative iscompletely funded by donations andall support is welcome. If you havegood quality equipment available forthe initiative and you work in eitherpublic or private hospitals, pleasecontact Ger Flynn to discuss how youcan contribute to this fantasticinitiative.

Ger Flynn, National Clinical Headof Medical Devices HSE, co-ordinatedthe collection of equipment fromhospitals.

Anybody interested in donatingequipment can contact Ger [email protected] or for furtherinformation, contact Taimse Tracey,[email protected]

Equals Initiative RCPI Hospital Equipment gets new

lease of life in Africa

Professor Frank Murray, President Royal College of Physicians of Ireland pictured with Dr David

Weakliam, National Lead of the HSE Global Health Programme

ICO Supports EQUALS Initiative which ships vitallifesaving equipment to hospitals in Zambia


ANNUAL MONTG

Reinold Goetz & Claire Hartnett.

Philip Cleary & Colm O’Brien.Marie Hickey-Dwyer, David Wong & John Hyland, Council member

RCSI

Ellen O’Sullivan (President College of Anesthetists) & Maureen Hillery.

Paul Moriarty & Sonia Manning.

On December 6th, 2014 Professor David Wong, Chair inOphthalmology at the University of Hong Kong

delivered the Annual Montgomery lecture. His talk was on'Physics in Everyday Ophthalmology and Vitreo retinalSurgery.' Professor Wong delivered the lecture withenthusiasm and style and ably conveyed the essence of avery complex topic by utilising many familiar everydayobjects.Prof John Hyland RCSI Council member and DrEllen O Sullivan, President of the College of Anaesthetistsjoined a large gathering of ICO members and trainees tohear the lecture.

The annual Montgomery Lecture was established byRobert Montgomery surgeon in the Royal Victoria Eye &ear Hospital in the early 20th Century. He named thelecture in honor of his mother Mary Louisa PrenticeMontgomery. Professor Wong joins a distinguished list ofinternational speakers who have honoured the College ingiving this annual talk.


OMERY LECTURE

Catherine Cleary & Robert Acheson. Sue Wong & Gerry Fahy.

Billy Power & Louis Collum. Patricia Logan & Mark Cahill.

Clare Quigley & Krishanth Vigneswaran & Louise Hendrick. Janice Brady & Jeremy O’Connor


Gerald Gleeson, David Wong, Marie Hickey-Dwyer & Alison Blake. Ian Flitcroft & Caroline Brady.

Fiona Kearns & Catherine McCrann. Malcolm Graham & Oonagh Hawe & Peter McManus.

Tahira Saad, Christine Goodchild & Niamh Wynne. Denise Curtin & Jeremy O’Connor.

ANNUAL MONTGOMERY LECTURE


Overview:Photoscreening is widely used inother European countries and inNorth America. This study,undertaken by Kathryn McCreery andPathma Ramasamay in CrumlinChildren’s Hospital, has shown thatthe utilisation of photoscreening inpreverbal children by a suitablytrained professional such as acommunity nurse/orthoptist in theprimary care setting would identifythose at higher risk of developingamblyopia or strabismus. At present,children are screened in preschool/school at age 4-6, and by this age, thechances of successful treatment ofamblyopia is limited.

Study:Currently screening our paediatricpopulation for visual defects frombirth to junior infants is by means ofparental history and examinationusing the red reflex test and motilityevaluation with the corneal light reflex.At age 5-6, screening is performed inthe school setting by a public healthnurse or doctor and children arereferred to an ophthalmologist if visualacuity is less than 6/9 in one eye, ifthere is more than 1 line of differencein visual acuity between eyes, thepresence of strabismus, family historyof strabismus or if there are anyparental concerns. As the efficacy ofamblyopia treatment in older childrenis less than that their youngercounterparts, a screening method thatenables earlier detection ofamblyogenic risk factors is desirable.

We conducted a study using aPlusoptiX S12 infrared portablehandheld autorefractor photo -screening camera which measures therefractive state, gaze asymmetry,pupil size/anisocoria, interpupillarydistance, ptosis, and media opacities.It is widely utilised in North Americaand continental Europe for visionscreening. All patients who presentedto our practice for specialist paediatricophthalmology evaluation in a 20-week period underwent photo -

screening; visual acuity testing,orthoptic evaluation and cycloplegicrefraction were included.Photoscreening resulted in either a“pass” or “fail” result based onpredetermined referral criteria. Theresults of cycloplegic refraction andmotility evaluation were compared tophotoscreening results. A total of 183patients were included in the study.The mean age of patients was 5.38years. Using the updated AAPOSvision screening referral criteria (table1), a sensitivity of 84.43% andspecificity of 85.25% in detectingamblyogenic risk factors was foundusing the device. False positives werelikely due to higher astigmatismidentified on Plusoptix thancycloplegic refraction while falsenegatives are often due toaccommodation in patients withsignificant hyperopia, and inintermittent exotropia1 it should benoted that this study was performed

in specialist referral paediatricophthalmology setting where mostchildren were at risk of developingamblyopia or undergoing treatment.

This study was presented byPathma Ramasamy at the Collegeconference in 2014 and highlightedthe ability of this device to be used asan adjunctive method to screen anddetect amblyogenic risk factors in thegeneral paediatric population. Withoptimisation of the referral criteria, ahigher sensitivity and specificity canbe reached thus minimising underand over referrals. It is quicklyaccomplished and may assist efficient,cost-effective and high-volumescreening. Combined with orthopticevaluation, photoscreening could beutilised for primary screening forvisual defects in the community.

reference1. Arthur BW, riyaz r, rodriguez S, Wong J. JAAPOS 2009;13:51-57

Study on Photoscreening of Children

Age (months)Anisometropia (D)Hyperopia (D) Myopia (D) Astigmatism (D)5-30 2.50 4.50 -3.50 2.00

31-48 2.00 4.00 -3.00 2.00

49-300 1.50 3.50 -1.50 1.50

Table 1: Updated AAPOS vision screening committee 2013 referral criteria. (Donahue SP, Arthur B,

Neely DE, Arnold RW, Silbert D, Ruben JB. AAPOS. 2013 Feb;17(1):4-8)

Website – directory reminderMembers will have received an

email notification at the end ofFebruary with a link allowing themto update their own profile page inthe eye doctor directory of the ICOwebsite.

Analytics has shown that one ofthe main reasons people visiteyedoctors.ie is to find a doctor.Completing this next phase ofdevelopment is an essential elementin ensuring we are responding to theneeds of visitors to the site.

We are encouraging members toinclude as much information as they

can in order to ensure the result isan informative and comprehensivedirectory.

We would also like to include aphoto of members and ask you toplease send a suitable portrait imageby email to our communicationsmanager at [email protected].

For those who may not have a phototo send, the College can select fromour archive of photography taken atICO events or indeed make sure tocatch you on film at this year’sconference!


Critical to understanding the needfor change is the paradigm shiftwhich has taken place inpostgraduate medical education witha worldwide movement away fromtime-based to competency-basedprograms. The Medical Councilrequires that national trainingprograms remain in line withinternational best practice and theincorporation of competence-basedtraining into our NTP is not onlylong overdue, but is essential forcontinuing accreditation by theMedical Council. Competence-basedtraining also brings with it atransparency and clarity to thetraining pathway which is key toattracting and retaining high-qualitytrainees. The latter is a priority forthe HSE. They are eager to eliminateunnecessary ‘gap’ years andrationalise training programsnationally so as to maximise return oninvestment, improve graduateretention and more effectively aligntraining programs to futuremanpower demand and patientneed.

Within the ophthalmiccommunity and the ICO itself, thereis recognition of the need for change.The most recent ICO inspectionprocess in February 2014,benchmarked our NTP against othertraining programs in well respectedjurisdictions. In terms of length oftraining, our existing NTP is clearlyan outlier, with gap years extendingthe training journey from a nominal8 to 10-12 years. Such a prolonged

training journey, particularly in anenvironment where a third of allmedical graduates are now graduateentry, has been cited by trainees as asignificant issue in their willingnessto stay and train in Ireland.

From the curricular perspective itis also difficult to stand over atraining model which drives traineesinto ‘gap’ years, in order to becomecompetition-ready for HST. The gapyears are overtly dedicated to thepursuit of research, publications,MDs and surgical numbers. All ofthese are important but may bebetter purposefully embedded into acurricular structure rather thanpursued individually for the sake ofcompetition. The new program willring-fence a number of HST posts forthe academic arena but design themain competition to enter HSTaround surgical and clinical skillsthat can be acquired in BST.Publishing papers, understandingresearch methodologies, criticalappraisal of the literature, statisticsetc will in turn be redesigned into arevised HST curriculum andembedded into HST year 1 upwards.

Challenges ahead

The ICO is currently operating in acompetitive environment of HSE-MET driven change. The RCSI andRCPI, College of Anaesthetists andFaculty of Radiology are allrationalising their trainingprograms, removing incentives tostep out of training and shorteningthe total training journey. The ICO

must remain cognisant of thisenvironment. To stand still and failto engage with change will leave usvulnerable to losing the bestgraduates to other sister Collegeswith ‘well planned’ programs.

With the new program will comeadditional responsibilities. The keyfeature of the new training pathwayis that career progression and entryinto HST is linked to traineeperformance during the basiccommon core years of training.Therefore it has never been moreimportant to ensure equity of accessto training opportunities across alltraining units nationally. To do so inthe current climate of severe fiscalrestrictions with theatre and otherresource limitations, will bechallenging.

It is important that as we phase inthe new system that trainees in theexisting program, who have alreadyexpressed valid concerns regardingequity of access to enter HST, aretreated fairly. During 2018 to2020/21 a dual- intake process willfacilitate trainees entering HST viaboth the current and new system.Adjustments will be made to theHST numbers in order toaccommodate the dual-intakeprogram and to ensure fairness toboth the ‘current’ as well as the ‘new’trainees. However it is important toemphasise that of each trainee cohortwho enter common core training, beit in the current system or in the newprogram, only a minority areexpected to successfully enter highersurgical training.

Many challenges lie ahead as weengage with the new Program inJuly. Despite some uncertainties theophthalmic community – trainers,trainees and the College - will worktogether to ensure the continueddelivery of high-quality ophthalmictraining in the College and at alltraining sites nationally.

yvonne Delaney

Redesign of the new Surgical Training Pathway

Many of you will already be aware that new changes are being

introduced to the National Training Program (NTP) for Ophthalmic

Surgery in July 2015. There are multiple reasons from within the specialty

to implement these changes but there are also external drivers from both

the HSE and Medical Council to introduce certain design changes to the

existing NTP in Ophthalmic Surgery. A convergence of external and

internal factors create a compelling argument for a more rationalised

approach to the training pathway, with the aim of eliminating the gap

years and shortening the total training time, whilst retaining competitive

entry into HST.


New NCBI Online Referral Processand Referral Advice for Doctors

Alcohol AllianceThe RCPI, in association with

Alcohol Action Ireland, has

established the Alcohol Health

Alliance. The primary aim of the

Alliance will be to support the

Government’s Public Health

(Alcohol) Bill to be published in

coming months and enacted by the

end of the year.

The group, chaired by Prof FrankMurray, President of the RCPI, willinitially articulate support for themeasures included in the Bill, suchas Minimum Unit Pricing, which areevidence-based solutions toreducing the harm caused byalcohol.

Further to Professor Murray’sinvitation to medical training bodies,health professionals and NGO’s tojoin the Alliance, the ICO is veryhappy to lend our support to theaction group as the legislation makesits way through the Oireachtais.

Mary Mitchell O’Connor, FineGael TD for Dún Laoghaire-Rathdown, spoke at the recent pressconference in RCPI on the 5th Marchannouncing the formation of theAlliance and highlighted the keypoints of the submissions to theOireachtais.

The ICO has recently beeninvolved with a similar alliance insupport of tobacco plain packaginglegislation, which has nowsuccessfully passed Dail Committeestage. Ireland has led the way withthe smoking ban and we believesimilar strides can be made throughthe introduction of Minimum UnitPrice and other measures to curbmisuse of alcohol in our society.There is very strong researchevidence available to show thatminimum unit pricing reduces theamount of alcohol consumed byyoung people, a key target group forthis legislation.

It is to be expected that theresistance to some of the elements inthe proposed Alcohol bill will beeven greater than that faced by thetobacco legislation and therefore thesupport of expert medical bodieswill play an important role instrengthening the ‘for’ argument.

The National Council for the

Blind has developed a new

online referral process which makes

referring patients a quicker and

simpler process for doctors. There is

a form specifically for Eye Doctors

which asks for the relevant details of

your patient. When the form is

submitted, the NCBI will make

contact with the patient to discuss

any difficulties they may be having

and how NCBI can help.

Who should you refer?NCBI assesses a person’s

functional vision, looking at theimpact of their vision loss and whatthey can no longer do as a result. Twopeople with the same level of sightloss may cope with it in very differentways so please refer anyone for whomsight loss is impacting on their dailylives to the point where they can no

longer drive, read and are finding itdifficult to get out and aboutindependently. NCBI works withchildren and adults.

Resources for Eye DoctorsNCBI’s leaflet and poster ‘Vision

Loss – Next Steps’ will help youexplain to patients why you aresuggesting that they contact NCBIand how we can help them. The NCBIhas eight regional centres nationwideand their services include advice andinformation, emotional support andcounselling, Low vision solutions,assistive technology advice andtraining, rehabilitation training, alibrary – large print, audio and Braillebook and employment advice.

For further information, the NCBIcan be contacted on 01 830 7033 /[email protected]

Following discussion at a

recent Council meeting, it

was agreed to support the

Practitioner Health Matters

Programme and to fund the

programme at the suggested

contribution per member.

The services providedthrough the Programme arenow available to members and theCollege would like to remind doctors ofwhat support the service can offer.Formally called the ‘Sick DoctorScheme’, the ‘Practitioner Health MattersProgramme’ (PHMP) is the new title ofthe scheme which provides confidentialcare and support for health professionalswho may have substance misuseproblem and other mental health issues.

Led by Dr Íde Delargy, a GP with aspecial interest in Addiction andSubstance Misuse problems, the‘Practitioner Health Matters Programme’(PHMP) is a new service which willprovide support and medical advice forany doctor or health care professionalwho has a concern about their mentalhealth or have a substance misuse

problem. which may beinterfering with their ability topractice safely. The service isstrictly confidential and Doctorswill receive help from expertswho will provide appropriateinterventions which will rangefrom simple and reassuranceadvice only to specialist

referrals. Specialist services which willinclude psychiatry, psychology,occupational health, career mentoring,life coaching, addiction counselling,financial planning and drug and alcoholtesting will be offered depending on theneeds of the individual.

More information on the service isavailable at www.practitionerhealth.ie

The ICO is financially supporting thePractitioner Health Matters pro grammeon behalf of members who can accesstheir services if required:

Q. What exactly is the Practitioner

Health Matters Programme?

A. The Practitioner Health MattersProgramme (PHMP) providesappropriate care and support for

health professionals who havesubstance misuse problem and/ormental health issues.

Q. How will medical care and

treatments be paid for?

A. Access to PHMP will be free ofcharge at the point of care to allpractitioners. Where referral toanother service or ongoingmonitoring is required, patients whohave health insurance would beexpected to avail of such cover tomeet the costs. Others will havetreatment provided through thepublic healthcare system. Incircumstances of financial hardshipspecial arrangements may berequired using our charitable funds.

Q. Where will patients be treated?

A. Care will be provided from a singlelocation in the Dean Clinic,Sandyford Dublin which is just offthe M50 and therefore providesconvenient access for patients.Suitably confidential rooms s areavailable for face-to-face assessments,limited therapeutic interventions,physical examination and sampletaking (for example, blood, urine).


Novartis is calling for submissions

for the 2015 eXcellence in

Ophthalmology Vision Award

(XOVA), which pro vides grants to

support innovative, sustainable, not-

for-profit eye care projects worldwide

that typically address the vision

needs of under served populations.

Launched in 2010 and co-sponsor edby Novartis Pharmaceuticals andAlcon, XOVA has awarded more thanEUR 650,000 for 21 grants in 16countries. XOVA welcomes entries upuntil April 30, 2015 from all eye carespecialists, including trainees andspecialist nurses, with the support oftheir responsible institutions.

The 2014 XOVA winners comprisedfive programs: door-to-door screeningfor glaucoma, diabetes and hyper -tension in India; surgery, postoperative

care and low vision devices for childrenand training of a vision professional ineastern Uganda; a hospital operatingtheater in Myanmar; training anddeployment of ophthalmic personnelto support an eye care service inEthiopia; and clinical and managerialtraining to enable affordable treatmentfor diabetic retinopathy patients inNigeria. In 2011, “Right to Sight”, theIrish non-profit organisation wasselected from over 80 applicationsthroughout Europe, and awardedfunding towards a state of the artsustainable cataract surgeon trainingcentre in Rift Valley, Kenya.

Application process and

eligibility

The 2015 XOVA applications areopen to ophthalmologists, optometrists

and allied eye healthcare professionals,including those in training.Applications must be endorsed by alegitimate academic institution ororganisation. The XOVA grants areawarded to the employing institutionsof the winning applicants. Winnerswill receive their grants as part of aXOVA ceremony at a medical congressin the autumn of 2015.

• The XOVA is awarded to eye careprofessionals and institutions whohave devised not-for-profiteducational or innovativeinitiatives;

• These not-for-profit educational orinnovative initiatives are expectedto have a significant impact onunmet needs in the field of eye care;

• Proposals must indicate how theinitiative can be run in the localcountry using local resources afterthe funds have been used;

• Proposals must demonstrate withclear plans and examples long-termviability, impact and benefit in thelocal area.

eXcellence in OphthalmologyVision Awards (XOVA) 2015

Practitioner Health Maers Programme


The dates for the 2015 meetings ofthe Retinal Imaging Society will be

April 24th and November 6th. Themeetings aim to showcase the retinalexpertise in Ireland by presentation ofcases by retinal specialists in an informalsetting and to provide an importantteaching opportunity for all ophthalm -ol ogists in practice and in training.

The two meetings held last yearwere a great success with ourinaugural meeting held in June 2014 atthe Royal College of Surgeons andguest chaired by Dr LawrenceYannuzzi, a leading expert in theworld of medical retina. It was a veryentertaining evening and manyexcellent cases were presented. DrYannuzzi himself presented six casesfrom his files. A range of Irish caseswere also presented and such was theinterest in the quality of the cases thatDr Yannuzzi asked to include three of

the cases presented in the next volumeor addition of his Retina Atlas. TheNovember meeting was held inconjunction with the FightingBlindness Retina 2014 meeting atCroke Park, and again was guestchaired by Professor Alan Bird fromMoorfield’s Eye Hospital.

The November meeting included aguest presentation from Dr MarkPennesi of the Casey Eye Institute inOregon who presented a series ofinherited macular degeneration cases.The programmes for the 2015 meetingsare being finalised and promise to bean excellent addition to last yearcontributions. Bayer will continue tosupport the 2015 programme and havekindly sponsored a medal for theGuest Chairs and there will be a prizefor the best contribution from the floorfor an answer or query raised on footof the presented cases.

Retinal Imaging Society of Ireland

Practice TrendsSurvey: Practice trends in the routineadministration of intravitrealanti-VEGF injections

Led by Dr Helen Fogarty, a BSTtrainee in Ophthalmology and

under the supervision of Mr ZubairIdrees, Consultant OphthalmicSurgeon at the Dept ofOphthalmology in UniversityCollege Hospital Galway, a surveyentitled: “Practice trends in theroutine administration ofintravitreal anti-VEGF injections” iscurrently being undertaken.

The aim of the survey is toidentify inter-hospital practicedifferences in the administration ofanti-VEGF injections. The Collegehas circulated a link to ourmembers and ask you to please takea few moments from your busyschedules to complete the briefquestionnaire. All results will beanonymous.

The questionnaire is available inword document should you preferto complete it via this method,please contact [email protected] orthe ICO office.

You may also share this surveywith your NCHD colleagues forcompletion either on your behalf orin addition to your own.

Dr Fogarty would be delightedto receive as many responses aspossible in order to help advance theresearch.

15th International PaediatricOphthalmology ConferenceThe 15th International Paediatric

Ophthalmology Conference willbe held on the 15th and 16th October2015 at the Gibson Hotel, Dublin.

Topics for discussion will includeRetina, Stabismus, Amblyopia,Retinoblastoma, Uveitis and Neuro-ophthalmology.

The meeting is being coordinated

by Prof Michael O’Keeffe. ICOmembers David Keegan, John Stokesand Donal Brosnahan are among thefaculty speakers at the meeting.

For further details, contact Helen Murphy, secretary to MichaelO’keeffe at [email protected] orcall 01 885 8626.

This year’s conference willinclude a talk from Mark

Pollack – who despite thesignificant challenges life hasgiven him, has managed toinspire and motivate peoplefrom all walks of life throughhis enduring resilience andpersonal courage. Mark lost hissight at 22 and despite this took onextreme challenges, competing in ultra-endurance races across deserts,mountains, and the polar ice caps andan epic 2 month expedition race to theSouth Pole, which inspired many. Hewon silver and bronze rowing medals inthe Commonwealth Games.

His sight loss was tragicallyfollowed by a serious fall in2010 which left him paralysed.While the journey to get towhere he is today is anincomprehensibly difficult onefor most of us to imagine, Markcontinues to show incrediblestrength and has taken on the

new life challenge as a pioneer exploringthe frontiers of spinal cord injuryrecovery. His fascinating journey,pushing the boundaries on both apersonal and medical scientific level,will no doubt provide for a mostengaging and motivational talk at thisyear’s meeting.

End of PCS YearApproachingThe current PCS year concludes onApril 30th. Please ensure that youhave logged the minimum requiredpoints (50 CME points) on theePortal before that date.

Further information on the differentpoints categories is available on theIcO website www.eyedoctors.ie

Mark Pollack – Unbreakable

Looking for a book to inspire your

children, nieces, nephews or

patients about science? Well the wait

may well be over. Ian Flitcroft of

Temple Street Hospital has teamed

up with American artist Britt

Spencer to create a graphical novel

called A Time Traveller’s Guide to

Life, the Universe and Everything.

Albert Einstein is the tour guide onthis magical mystery tour throughtime and space. Along the way,Einstein explains the science behindeverything from the origins of theuniverse to the meaning of life,relativity, black holes, quantummechanics (for beginners), climatechange, evolution vs. intelligentdesign, and how the brain works: alldelivered in fun, easy-to-understand,bite-sized chunks.

This innovative graphic novel

pairs the narrative with fantastic,whimsical artwork to make difficultconcepts clear - and explain life, theuniverse and (almost) everything! Bewarned once the kids in your life haveread this book, you’ll have to read ittoo. Otherwise you’ll be left lightyears behind.

First published in the USA, it hasalready been translatedinto Chinese,Japanese andTurkish. Nowthis book hasfinally arrived inIreland where it isbeing published byO’Brien Press,Ireland’s largestindependentpublishing company,and should be inbookshops by April 1st.


A Time Traveller’s Guide to Life,the Universe and EverythingIan Flitcroft (author) and Britt Spencer (illustrator)

O’Brien Press, 1st April 2015.

Retired Doctors’and ProfessionalCompetenceRequirementsRetired medical practitioners are

subject to the same professional

competence requirements as all other

practising doctors.

This means that any retired doctorwishing to retain registration for thepurpose of practising medicine will beobliged to fulfil their statutory duty tomaintain professional competence,getting the annual minimum 50 CMEpoints. The College has compiled aninformation booklet for doctors in thiscategory with suggestions as to howthe points can be achieved

The guidance booklet is availablefor members to download on the ICOwebsite.

One of the current Clinical

Programmes is one for rare

diseases, covering all medical

specialities. Ian Flitcroft is the

representative for ophthalmology

on the programme working group.

There is no specific additionalfunding at a hospital level but oneof the aims of the programme is toensure that patients with rarediseases have access to the doctorswho are best able and willing tomanage them.

As part of a pan-Europeaninitiative a list of rare ophthalmicdiseases has been proposed fromEuropean figures, however the listdoes not seem fully representativeof the Irish population.

With family clustering of raregenetic diseases there may well beunits around the country that havegarnered expertise in a particulardisease that could benefit patientsfrom further afield.

If you or your unit manages acluster of what is otherwise a raredisease, it would very helpful toshare details with the Rare Diseasesprogramme through Ian Flitcroftemail [email protected]. Pleaseshare information on theuncommon condition and thenumber of patients with thatcondition under your care. The aimof this exercise is to find out wherepatients and the matching expertiseare to be found.

National Clinical programme forRare Diseases

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