ICO News No10 Dec14 - Eye Doctors News10.pdf · debate whether tighter guidelines and ... McMahon believes legislation against ... Caroline Murphy, RTE, Conference Moderator

ICO NEWSLETTER | DECEMBER 2014 PAGE 1

NewsletterISSUE 10 DECEMBER 2014

With best wishes

Marie Hickey DWyer

On Wednesday 24th September,the Irish College of Ophthal -

mologists hosted a multi-stakeholderdiscussion to review the regulation ofdirect-to-patient advertising and todebate whether tighter guidelines andpossible legislation is required tosafeguard patients and their ability tomake fully informed decisions beforeundertaking a medical or surgicalprocedure.

Currently in Ireland, there are norequirements for advertisements or

marketing material to provideinformation on the health risks ofprocedures. The ICO, together withour colleagues from the specialities ofPlastic and Reconstructive Surgeryand Dermatology, has expressedconcern that this lack of regulatoryoversight impacts on patients’ accessto unbiased information.

In her opening address, Presidentof the ICO, Marie Hickey-Dwyer tolddelegates that the purpose of the

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]

Messagefrom the President

ICO Host Meeting to Debate Direct-to-Patient Advertising in Ireland

Continued on page 2 ➥

Dear Members,

Welcome to the latest edition of ournewsletter as we look back on what

has been a very busy final quarter for theCollege and look forward to upcomingevents to close the year.

I am honoured to be welcoming myfriend and our esteemed colleague,Professor David Wong as this year’sguest speaker for the MontgomeryLecture, which will be held on Friday 5thDecember in the RCSI. Currently theChair Professor in Ophthalmology at theUniversity of Hong Kong, David is wellknown to many of us and will talk about‘Physics in Everyday Ophthalmology andVitreoretinal Surgery’. I look forward toseeing you all at the lecture.

I was delighted to see so many of ourmembers at the Annual Retinal Meetingin Adare. The meeting was a fittingoccasion to present this year's Bursary toDr Meadbh Rhatigan and to acknow -ledge the significant research beingundertaken in the area of ophthalmologyin Ireland.

The newly designed ICO websiteeyedoctors.ie is now live. Much work hasgone into developing and enhancing thewebsite to ensure it responds to visitor’sneeds, both the public and for ourmembers. We would be delighted to hearyour feedback.

In a previous issue I wrote ofproposals on a new programme tosupport doctors health and wellbeingcalled Practitioner Health Matters. I amdelighted to say this new programme,under the guidance of Dr Ide Delargey,which provides support to doctors withmental health and addiction problems isnow up and running, you can read aboutthe service in this edition.

May I take this opportunity to wish avery happy Christmas and a prosperousNew Year to you and your families.

Patrick Ormond, Consultant Dermatologist, Billy Power, Marie Hickey-Dwyer, MargaretO'Donnell, President of the Irish Association of Plastic Surgeons and William Kennedy, IrishMedical Council

ICO NEWSLETTER | DECEMBER 2014PAGE 2

meeting was to exchange views withthose working in the specialtieswhose patients are most impacted bydirect-to-patient advertising,alongside the views of the regulatorsand the patient advocacy bodies.

The ICO was prompted to holdthese discussions following a decisionby the Advertising StandardsAuthority of Ireland (ASAI) not touphold a formal complaint we madein July 2012 in relation to an offer oflaser eye surgery as a competitionprize. This prompted furtherreflection on the issue and led to theSeptember debate.

As the expert and educationalbody for eye care in Ireland, theCollege is of the view that advertisingand marketing practices should nottrivialise the seriousness of surgicalprocedures and that questionableadvertising may be misleading orinaccurate, and / or may fail to revealimportant risks and potential complic -ations of treatment to a patient

This view is mirrored by thePresident of the Irish Association ofPlastic Surgeons, Ms MargaretO’Donnell, a key speaker at theSeptember meeting, who said that“the patient should have realisticexpectations of what can be achievedby cosmetic surgery and non-surgicalprocedures. Ms O’Donnell said this isnot helped by the use of photographsof models that have never hadcosmetic treatments, in cosmeticsurgery advertising and websites. Useof such models and/or airbrushedphoto graphs has been banned insome countries, including France andDenmark.”

Ms O’Donnell said that there isany number of misleading advertise -ments on websites and in beautysalons and pharmacies at the presenttime which claim to eradicatewrinkles, and use before and afterphotograph results of which cannotpossibly be achieved by the treatmentsuggested.

Presenting on the challenges inophthalmology, Billy Power, EyeSurgeon at the Blackrock Clinic toldthe delegates, “We want the patient in

a position to make the most informedchoice, without unrealistic advertisinginfluencing their decision.”

Mr Power highlighted that theincrease in the proportion of refractivesurgery legal cases is disproportionateto other areas of eye surgery and saidthe question must be asked whetherpatients were being given unrealisticexpectations. He questioned why ithas become acceptable to advertiseand trivialise laser eye surgery, whichhas the potential to have risks andcomplications as any surgery does,when this form of advertising andpromotion isn’t common practice withother forms of eye surgery such ascataract surgery. The answer, he said,is because there is huge commercialinterest in laser eye surgery.

Addressing delegates at themeeting, Frank Goodman, ChiefExecutive of the AdvertisingStandards Authority of Ireland(ASAI), said that “while a number ofcomplaints in this and related areashave been upheld, the existing code iscurrently under review anddiscussions at today’s meeting will beinstrumental in informing the self-regulatory body on the views of keystakeholders on this matter. Changesmay need to be implemented in theinterests of appropriate advertising ofmedical products and services.”

Also speaking from the regulatoryperspective was William Kennedy,Director of Regulation for the IrishMedical Council and John Elliot,

Registrar of Solicitors and Director ofRegulation for the Law Society.

Patient advocate, StephenMcMahon, CEO of the Irish PatientsAssociation said that the currentsystem of regulation isn’t robustenough to protect the patient and thatthis is a patient safety issue whichneeds urgent action. He reflected onthe example given by Mr PatrickOrmond, Consultant Dermatologist atSt James’ Hospital that it took 8 yearsof campaigning by the Irish Associ -ation of Dermatologists to achieve aban on the underage use of sunbedsin Ireland and that he was appalled atthe length of time it took to put thisprotection for the public in place. MrMcMahon believes legislation againstthese practices are necessary and thatthe Department of Health has a keyresponsibility, alongside otherstakeholders, to develop a publicawareness campaign to help informand empower people.

Catherine Reilly, Journalist withthe Medical Independent gave anoverview of an investigative seriesshe undertook earlier this year on theincreased commercialisation ofmedicine in Ireland, which includedan in-depth look into laser eyesurgery practices. She stated thatstronger sanctions in the realm ofmedical advertising, and potentially anew or adapted structure to monitorstandards associated with advertisingof medical treatments need to beconsidered, and that the Department

➥ Continued from page 1

Ms Margaret O'Donnell, President of the IrishAssociation of Plastic Surgeons.

Caroline Murphy, RTE, Conference Moderator.


of Health should have a role in thisarea.

Ms Reilly highlighted thatcurrently the self-regulating ASAIadjudicates on complaints associatedwith advertisements; however, incases where communications aredeemed by the Authority to havebroken rules, the usual remedy is thatthe advertisement be withdrawn oramended. In the case of medical-related advertisements, whichCatherine said may have alreadyinfluenced vulnerable consumers andpatients, this would appear to be ‘toolittle, too late’.

Discussions on the day acknow -ledged the fact that the decision tohave a medical or surgical procedurecan have a profound impact on thehealth and wellbeing of both thepatient and their families and whilethere is little doubt that a medical orcosmetic procedure can be positive forpatients when undertaken by trainedspecialists, it was unanimously agreedthat it is essential for patients to receivebalanced, unbiased informa tion inorder for them to be in a position tomake fully informed decisions.

The College has devisedGuidelines for Refractive Surgery,including a section on advertisingwhich are currently under finalreview following the feedback fromthe expert groups at the meeting.

A Full Report on the MedicalAdvertising in Ireland meeting can beexpected in the coming weeks.

Stephen McMahon, Chief Executive of the IrishPatients Association.

Primary Care Review GroupUpdate

The role of the Group is toexamine and document the primarycare eye services currently providedto children and adults nationwideincluding HSE directly providedservices and contracted primary careservices and to determine the needs ofthe population for these services.

The group is also tasked withreviewing the current service in termsof quality, safety and consistency andto identify issues for action.

The evaluation process aims toprovide a clear blueprint with recom -mendations for the delivery of primarycare eye services which will ensure ahigh quality, safe and consistentservice for patients. A priority is tofocus on an action plan to addressimmediate primary care paediatric eye

services issues in the Dublin area.There will be a consultation

process in December 2014 whichrepresentatives from the Irish Collegeof Ophthalmologists will attend.Other participants in this consultationgroup will include representativesfrom the allied health professionalorganisations, patient support andadvocacy groups and the regulatoryboards, including CORU and TULSA,the Child and Family Agency.

A detailed eye services survey hasbeen circulated to all ISA Managers tocollate data on WTEs and currentwaiting lists. It is aimed that datacollation will be completed byDecember 2014. Feedback fromservice users will be collatedthroughout December 2014.

Specialty Training Programme inOphthalmologyThe closing date for receipt of applications for the specialtyTraining Programme in Ophthalmology is Monday December 8th, 2014

Applications are invited for entry onto the ophthalmology trainingprogramme for July 2015. This is a common entry programme formedical ophthalmology and surgical ophthalmology.

Further information on the training programmes and the

application form is available on the ICO website

www.eyedoctors.ie

Electronic Applications only to [email protected]

In August 2014 the HSE Primary Care Division convened a Primary Care

Eye Services Review Group (PCESRG) to review all primary care eye

services. The group, chaired by Brian Murphy Assistant National Director for

Primary Care meets monthly and aims to have a draft report completed by

early 2015 with recommendations for implement ation throughout 2015-2016.

ICO representatives Siobhan Kelly, Alison Blake, Paul Moriarty and Loretta

Nolan sit on the Review Group, together with representatives from various

HSE departments including the Primary Care Reimburse ment Scheme,

Public Health, Directors of Nursing and oprthoptists.

The College is delighted to

announce that the recipient of the

ICO Eye Research Bursary is Dr

Maedbh Rhatigan, a medical graduate

of Trinity College who has just

completed her intern year at St. James

Hospital, Dublin.

Dr Rhatigan was announced as thewinner of the research award at the 6thAnnual Retinal Meeting in Adare,coordinated by Marie Hickey-Dwyer,President of the ICO and Eye Surgeon atUniversity Hospital Limerick, for herproject entitled ‘Negative Regulators ofInflammation and AMD in a cohort ofThe Irish Longitudinal Study onAgeing’.

The study is being carried out underthe supervision of Mark Cahill,Consultant Ophthalmologist andVitreoretinal Surgeon at the RoyalVictoria Eye and Ear Hospital and SarahDoyle, Assistant Professor in Immun -ology at the Department of ClinicalMedicine, Trinity College Dublin, and isbeing undertaken as part of an MSc byresearch in Clinical Medicine.

Explaining the project rationale, DrRhatigan said, “Age Related MacularDegeneration (AMD) is the leadingcause of central vision loss worldwide.The estimated prevalence of AMD inIreland is 7% with an annual cost over€130 million. The Irish LongitudinalStudy on Ageing (TILDA) is a uniquepopulation based study on the over 50sin Ireland with a focus on measures ofvision as one research theme.

Inflammation is known to play a role inthe development of AMD however theexact mechanisms remain unresolved.In collaboration with TILDA we plan tolook at levels of negative regulators or‘off switches” of three key inflammatorymediators, elevated in the blood ofpeople with AMD.”

Dr Rhatigan continued, “This studywill help to further understand the roleof inflammation in AMD. It is ourunderstanding these pathways may aidin identification of patients at increasedrisk of progression to more severe formsof AMD and may provide novel targetsfor therapeutic intervention”.

Commenting on the how the bursarywill aid the continuation of the project,Dr Rhatigan said, “The Novartisbursary will allow us to screen these ‘offswitches’ in an unbiased manner usingcutting edge technology without whichwe would have been more restricted inour project design.”

Speaking with Dr Rhatigan at theAdare Retinal Meeting on Thursday, 2ndOctober, Loretto Callaghan, ManagingDirector, Novartis Ireland said, “NovartisIreland is pleased to support such animportant research bursary as part of ouron-going commitment to ophthalmology.Dr Rhatigan’s research is another


David Shahnazaryan, Dinah Minasynn and Pathma Ramasamy. Mark James, Sylvia Jungkim, Marie O'Connell and Philip O'Reily.

Winner of the ICO/Novartis Eye Research Research Aims to Investigate Role of Inflammation in AMD and Identify Patients at Increased Risk

President of the ICO, Marie Hickey-Dwyer is pictured with Dr Maedbh Rhatigan, winner of theICO/Novartis Research Bursary 2014 and Oliver McCrohan, Medical Advisor in Ophthalmology,Novartis Ireland Ltd.

excellent example of Irish doctors’dedication to finding solutions for theirpatients. At Novartis Ireland, our researchis driven by a clear scientific strategywhere we focus on unmet medical needs.We are dedicated to helping patients inIreland gain access to innovativetreatments to help their condition.”

Speaking on the significance of theaward, Marie Hickey-Dwyer said, “Weare delighted to present Dr Rhatiganwith this Eye Research Fellowship forher project on AMD. As always, thestandard of applica tions for this yearwere exceptionally high and the AnnualRetinal Meeting in Adare is a fittingoccasion to acknowledge and supportthe significant research being unde -rtaken in the area of Ophthalmology inIreland. On behalf of the ICO, I thankNovartis for their continued supportand recognition of the important

contribution this award makes infacilitating doctors to undertake aperiod of research or specific training inan eye care centre of excellence. “

Dr Rhatigan will present an updateon the research project at the IrishCollege of Ophthalmologists 2015Annual Conference.


Rob Acheson, Frank Kinsella, Deirdre Townley, Maire Hickey-Dwyer, Loretta O'Callaghan,Patricia Quinlan, Philip Cleary and Anthony Cullinane.

Alison Blake, Niamh Collins, Deirdre Townley, Yvonne Delaney & SoniaManning.

Richard O Regan, Tom Stumpf, Richard Comer & Tim Horgan.

Marie O'Connell, Sashin Thinagaran and Denise Curtin. Robert Acheson pictured with Eamon O'Donaghue.

Bursary 2014

Belfast,

June 17th-19th, 2015

The British Oculoplastic SurgerySociety will be holding its

annual meeting in Ireland for thefirst time next summer at theWaterfront Hall in Belfast fromWednesday 17th to Friday 18thJune. It is a friendly meeting whichwill touch on many aspects of lid,lacrimal and orbital disease andtreatment.

International speakers willinclude Michael Kazim from USA,Jack Rootman from Canada andWillem van den Bosch from theNetherlands. The first day of themeeting is a recent advances andteaching day aimed a little moretoward trainees. It will be followedby a drinks reception at the CityHall. The scientific programmewith lectures and short researchpresentations covers the Thursdayand Friday sessions.

The Gala Dinner will be held onThursday evening in the newTitanic Belfast building. A golfingtrip to Royal Portrush on Tuesday16th is also available to thoseinterested.

Full details, including registration fees

and a short video about the meeting,

are available on the BOPSS website

http://www.bopss.co.uk/meetings/

bopss-2015-belfast/

For booking before the end of

April, 2015,

• £125 for the recent advancesday and

• £300 [consultants]; • £210 [trainees] total for the

remaining two days; • After end April it rises to £155,

£350 and £255 respectively; • The gala dinner cost £80 for

anyone attending.

BritishOculoplastic

Surgery Society

PAGE 6 ICO NEWSLETTER | DECEMBER 2014

Professor Peter Eustace wasa Consultant OphthalmicSurgeon with a specialinterest in Neuro-ophthalmology.

He studied Medicine inUniversity College Galwaywhere he met his belovedwife Margaret.

His post graduate training wasundertaken in Birmingham in generalpractice initially and subsequently inOphthalmology.

He was appointed to the Materhospital and Richmond HospitalsDublin in 1975.

His energy was boundless and hisenthusiasm was infectious

He had great interest in-patientcare. He was readily available tocolleagues and trainees in particularhe enjoyed teaching and mentoringthe trainees. He took a keen interest intheir examinations and surgicaltraining. He developed many researchprojects and encouraged the traineesto present at national and inter -national meetings.

It is fitting that he was appointedas Professor of Ophthalmology toUniversity College Dublin and theMater Hospital Dublin in 1982.

He developed the Mater EyeDepartment with a number ofConsultant appointments each with asub-speciality interest. He forgedstrong links with Temple Street andthe Beaumont Hospitals.

He is co-author of Neuro-ophthal -mology which was published in 1998.

He established the first EBOdiploma examination in Milan in 1995to enable recognition of Europeantraining as he strongly supported the

European Board of Ophthal -mology and the harmonis -ation of training in Europe.

The Peter Eustace medalfor excellence in education isawarded annually since2011during the EBO exam inParis.

He was a co-founder ofthe British Isles neuro-ophthalmologyclub with Bruce Noble (BINOC)in1984. All attendees were required topresent a paper. Peter organised thethird meeting in Ireland which wasthe first of several meetings held inthis country. Peter was always at thecentre of the discussions and isremembered for his gentle wit andgreat scholarship. BINOC meetsannually and is attended bydistinguished neuro-ophthalmologistsfrom the US and Europe and hasbrought great fellowship and supportto all attendees.

He was President of the IrishCollege of Ophthalmology in 1993-95.He was a champion golfer and amember of Dun Laoghaire golf cluball his life, and he enjoyed sailing.

A keen supporter of the arts whenhe retired he spent many months inConnemara painting and writingpoetry.

He is sadly missed by his wifeMargaret their children Ashling,Stephen, Nick, Joanne and Hilary hismany grandchildren, friends andcolleagues.

All who knew him benefited fromhis intelligence and his commitment;a leading figure in Ophthalmology heenriched countless lives with hisadvice and support. His dedication topatient care was exemplary.

Obituary Professor Peter Eustace FRCophth.

Professor Andrew ElkingtonFormer President of the RCOphth It was with sadness that the ICO learnt of the passing of Professor AndrewElkington, who died peacefully on 11 September. Many of our members willhave known him as a former President of the Royal College ofOphthalmologists (1994 – 1997), Honorary Fellow and a renowned teacher.The ICO express our sincere condolences to his family and friends.

The ICO is honoured to be

welcoming our esteemed

colleague, Professor David Wong

as this year’s guest speaker for the

Montgomery Lecture, which will

be held on Friday 5th December in

the RCSI. Currently Chair

Professor in Ophthalmology at the

University of Hong Kong,

Professor Wong will give a talk

entitled ‘Physics in Everyday

Ophthalmology and Vitreoretinal

Surgery’.

Professor Wong’s research in theretina field focuses on detachment,proliferative vitreoretinopathy andmacular degeneration, under -standing their pathogenesis andconducting clinical trials of surgerywith adjuvant therapy anddeveloping new surgical techniquesand tamponade agents.

David’s lecture on December 5thwill discuss how physics affects ourdaily living and how it is the basisto many applications in general

ophthalmology. A number ofexamples will be illustrated,focusing on those in David’s ownspecialty, namely vitreoretinalsurgery.

These will include:

1. Euclidian Geometry and ScleralBuckling Surgery.

2. Surface energy: do you need ahelping hand to stop youslipping?

3. From Newtonian to Non-Newtonian behaviour: how tomake fluids defy gravity.

4. The speed of light: how to maketransparent structures visible andvisible structures transparent.

5. From dressing salad topreventing glaucoma: issurfactant your best ingredient?

With such illustrations, a case ismade for blue sky research that canyield some amazing and unexpectedsolutions and benefits to many ofour problems.

David held the position ofPresident of the British and EireVitroretinal Society from 2010 – 2012and was Vice President of the RoyalCollege of Ophthalmologists from2003-2007.

He has authored 206 journalpublications and 22 chapters in 12books, over half of which have beenpublished in leading medicaljournals, including the BritishJournal of Ophthalmology and inOphthalmology, Retina and Graefe.


MONTGOMERy LECTUREFriday, 5th December, 2014, RCSI

Montgomery Lecture 2014 guestspeaker, Professor David Wong,Chair in Ophthalmology, Universityof Hong Kong

ESCRS –Áine Ní MhéalóidPresentationÁine Ní Mhéalóid is pictured at the Congressof the European Society of Cataract andRefractive Surgeons (ESCRS) in London,13–17 September, where she presented hertalk entitled “Anterior SurfaceOpacification of Intraocular Lenses afterDescemet Stripping EndothelialKeratoplasty”, a case series involving fourpatients. Two of the lenses have beenexplanted and are currently undergoinglaboratory analysis to determine whatexactly the opacification is. Áine proposed anumber of aetiologies for this opacificationincluding breakdown of the blood-aqueousbarrier and repeated intracameral injectionsof air.


Direct-to-Patient Medic

Frank Goodman, ASAI and Vivienne Ryan,Irish Competition Authority.

Avril Daly, Fighting Blindess, Una O'Rourke, Irish Medical Council and Caroline Murphy (RTE)Conference Moderator.

Garry Treacy and Fiona Kearns pictured at the Medical Advertising inIreland meeting.

Arron Mullaniff, NCBI and Rachel Rigley, Wellington Eye Clinic.

Matthew Graham pictured with Barbara Tynan and Kevin O Donnell ofthe Health Products Regulatory Board.

Alison Blake and Mark Cahill.

Pictured at the Direct-to-Patient Medical AdvertisingMeeting


cal Advertising Meeting

Catherine Reilly, Medical Independent and John Elliot, Law Society ofIreland.

Siobhan Kelly pictured with Frank Goodman, Chief Executive of theAdvertising Standards Authority of Ireland.

Paddy Condon and Yvonne Delaney pictured with William Donegan,Operations Manager, Irish Injuries Board .

Margaret O'Donnell, President of the Irish Association of PlasticSurgeons pictured with Billy Power.

Emer MacNeice and Kate Coleman. William Kennedy, Billy Power and John Elliot, Law Society of Ireland.


Spondyloarthritis (SpA) is aninflammatory arthritis that

predom inantly affects the lowerspine but may also cause anasymmetrical peripheral arthritis.SpA is an umbrella term thatencompasses ankylosing spondylitis(AS), psoriatic arthritis (PsA),inflammatory-bowel diseaseassociated arthritis (IBD-SpA),reactive arthritis (ReA) and undiffer -entiated (uSpA). The incidence isakin to that of rheumatoid arthritis at1% with AS being the most common.It usually has an insidious onset withcharacteristic symptoms of lowerback pain that improves with exercise.Back pain is a common complaintthat may have a multitude of causes.Frequently, if symptoms respond tosimple analgesia no investigationsare carried out to elucidate the cause.Furthermore, if the back stiffnessimproves with exercise or if the painresolves within an hour of wakening,the patient may not consider thesesymptoms significant. SpA isassociated with significant morbidity.Current available therapies such asnon-steroidal anti-inflammatorydrugs and biologics halt diseaseprogression but do not reverse theinflammatory changes in the joint.One of the major obstacles forrheumatologists treating SpA there -fore is the fact that patients with SpApresent so advanced in the diseasecourse. Early diagnosis is crucial asearlier recognition of SpA will lead toearlier intervention and treatment,improving patient quality of life.

The link between SpA and

AAUAnterior uveitis (AU) is the most

common extra-articularmanifestation of SpA. Although thereis clear evidence that HLA-B27 iscommon to both SpA and AAU, the

exact mechanism linking joint andocular inflammation remains largelyunknown. Both conditions sharesimilar demographics affecting 20-40year olds with a slight malepredominance.

Project RationaleAU patients present within a few

days of onset either directly to anophthalmologist or indirectlythrough the GP or optician due tointolerability of symptoms ofredness, pain, photophobia andmildly reduced vision. Back pain ofinsidious onset, which improveswith exercise may go unnoticed formany years. Most cases of AU arenot managed by a uveitis sub-specialist but instead attend theophthalmology emergency room orthe general ophthalmology clinic.Therefore, all ophthalmologists havea role in identifying patientsattending with AU who may have aconcurrent SpA with the aim ofearlier diagnosis. Referral to arheumatologist for suspect cases willimprove patient outcome in thesepatients. The question thereforearises, which patients presentingwith AU should be referred?

In our collaborative study

between Royal Victoria Eye and EarHospital (RVEEH) and St Vincent’sUniversity Hospital (SVUH) werecruited 104 patients presenting tothe emergency department at theRVEEH with non-infectious AU withno known systemic association.Subsequently, these patients werescreened by our rheumatologycolleagues at SVUH for the presenceof SpA. Based on the most statistic -ally significant features of thesepatients an algorithm of referral wasgenerated which was then validatedin a further 74 patients.

ResultsAfter rheumatological examina -

tion, 42% of patients were diagnosedas having an SpA. Following step-wise statistical analysis, thealgorithm in figure 1 was generated.This stated that patients less than 45years old attending theophthalmologist with non-infectiousAU should be asked about thepresence of back pain. Specifically,patients with back pain of any natureand present for greater than 3months duration should have ablood test to check for HLA-B27. Inaddition, any patient who hasattended their GP for back painshould also have HLA B27 checked.If HLA-B27 is positive in thesepatients, they should be referred totheir local rheumatologist forassessment. If HLA-B27 is negativein these patients, they should beasked specifically about a history ofpsoriasis. If the patient has psoriasis,they should also be referred. This isbecause patients with psoriaticarthritis are less likely to be HLA-B27positive. The sensitivity andspecificity of this algorithm is 95%and 98% respectively.1

ConclusionThe effective recognition of SpA

amount patients with AU is anachievable goal using this simple buthighly effective algorithm. This willresult in appropriate and timelyreferrals from ophthalmologists torheumatologists to the benefit ofpatients with spondyloarthropathies.

1. Haroon M, O'rourke M, ramasamy P,

Murphy cc, FitzGerald O.

a novel evidence-based detection of

undiagnosed spondyloarthritis in patients

presenting with acute anterior uveitis: the

DUeT (Dublin Uveitis evaluation Tool).

annals of the rheumatic diseases 2014.

The Dublin Uveitis Evaluation Tool (DUET)A novel-evidence based method for detecting undiagnosedspondyloarthritis in patients presenting with acute anterior uveitis


The 15th annual RetinaConference was hosted

in early November by Irishpatient-led organisation,Fighting Blindness. Over thecourse of the three dayevent, more than 350attendees participated in theconfer ence, which includeda clinical trials roundtablediscussion, a scientificmeeting for researchers and eyedoctors, as well as a highly successfulpublic engagement day, designed tobring patients and families togetherwith experts in the field.

The event saw leading Irish andinternational experts share insightsinto curing and preventing blindnessand heard how gene therapy andinnovative technologies are alreadyrestoring eye sight in patients.Fighting Blindness was pleased towelcome Minister Leo Varadkar TD toopen the conference and called onhim for further funding and supportfor clinical trials in Ireland. Thecharity highlighted their dedicatedregistry development project, Target5000, as a method for paving the waytowards targeted gene therapytreatment in Ireland.

Speaking during his openingaddress, Minister Varadkar said, “Thisis an exciting time for the vision

health community, especiallypatients and families who areaffected by sight loss. Theinnovative and pioneeringwork presented today isincredibly important andgives hope to the 224,000people affected by sight lossin Ireland, and to futuregenerations affected bygenetic eye disease. It’s really

encouraging to hear about the hugeprogress being made in treatingblindness, thanks to the dedication ofthose working in research and visionhealth, and the commitment of organ -is ations like Fighting Blindness.”

ICO member and board member ofFighting Blindness, David Keegangave a presentation on Target 5000,which aims to provide genetic testingfor the estimated 5,000 people inIreland who have a genetic retinalcondition. Through genetic screeningof the person affected and their familymembers, Target 5000 will providemore detailed information about thenature and inheritance pattern of theireye condition. The overall aim is thatpatients will be able to accesstherapies targeted to specific genesand mutations as they becomeavailable. They will also be added to anational patient registry so thatpatients who are eligible for future

clinical trials can be easily identified.To date, almost 600 people have beenrecruited into the programme betweenthe three sites in Dublin and Belfast.

A full conference report will beavailable at the end of November.

Retina 2014 – Fighting Blindness

Minister for Health, Mr Leo Varadkar is pictured with Avril Daly, CEO Fighting Blindness and ICOMember David Keegan

Fighting BlindnessLaunches ‘A Guide toConditions of theRetina’Fighting

Blindnesswill unveil anew patientguide tosupport peoplediagnosedwith a rangeof retinalconditions onTuesday,December 2 at 6pm.The publication, A Guide To Conditionsof the Retina, supported by BayerHealthcare and proudly endorsed bythe ICO, will be launched at an eveningreception attended by ophthalmologists,scientists and patients in the RoyalCollege of Surgeons in Ireland (RCSI)Atrium, Dublin.

The guide sets out information abouta range of rare inherited retinalconditions including retinitispigmentosa, Usher syndrome, Stargardtdisease and many more, as well asinformation about more commonconditions such as age-related maculardegeneration and diabetes related sightloss. It provides information about thecauses, symptoms, any availabletreatments and research into theseconditions. It details how the eyes workand defines the technical terms used todetail the parts of the eye, as well ashighlighting the roles of the various eyehealth professionals that people comeinto contact with and what tests may becarried out at an at an appointment.

Fighting Blindness are delighted toinvite all members of the ICO to attendthe launch event.

For more information please contactAnna Moran on 01 6789 004 [email protected]

David Keegan


According to the Centre, the mainaim of the research project was to gaina more accurate picture of the numberof people who experience a combina -tion of serious vision and hearingimpairments in Ireland. In addition, aNational Registry of people who areDeafblind in Ireland was established.

Anyone with a combined visionand hearing loss which causesdifficulty with communication, accessto information and mobility wasinvited to participate.

A question contained in the 2011census which asked people to indicatewhether they were blind or had aserious vision impairment or deaf orhad a serious hearing impairmentmade providing an estimate figure ofthe number of people affectedachievable. The CSO cross-tabulatedthe data on the Anne Sullivan Centreand Deafblind Ireland’s behalf for theresearch purposes and revealed that1,749 people have a combination ofboth impairments (699 under the ageof 65, 1050 over the age of 65).

Laura English, the Anne SullivanCentre’s Research Coordinator,contacted vision support servicesincluding NCBI, DeafHear, FightingBlindness, the Irish Deaf Society andother disability organis ations,requesting they distribute a shortsurvey to any of their service userswho had a combination of seriousvision and hearing impair ment. In thefour months that followed, 103 peoplereturned surveys and agreed to addtheir details to the new NationalRegistry.

The main findings of theresearch were: • At least one third of the Deafblind

population in Ireland are over theage of 65, representing the largest

diagnostic group within theDeafblind population

• Age Related Deafblindness, UsherSyndrome, CHARGE Syndromeand Congenital Rubella Syndromeare the leading causes ofDeafblindness in Ireland.

• Almost 20% of the Deafblindpopulation have a diagnosis ofUsher Syndrome. Of this less thanone quarter are engaged with aservice provider.

• 90% of Deafblind children andyoung adults have one or moreadditional disabilities.

• Almost two-thirds of people whoare Deafblind live with family.Fewer than 15% live alone andalmost 20% live in a residentialcare facility.

• 55% of people who are Deafblindare not in receipt of any services.

Laura English told the ICO, “Sincethe publication of the research, anumber of people who are Deafblindhave expressed an interest in forminga peer support and advocacy group asnone currently exists. The fact thatpeople are geographically spreadthroughout the country, in addition tothe communication difficulties facedby the population, makes thisextremely challenging.”

She added, “Currently, if a Deafsign language user is diagnosed withUsher Syndrome it can be extremelydifficult for them to obtain inform -ation about their RP or access supportfor adapting their communicationskills as their sight deteriorates to apoint that makes it impossible forthem to see people sign to them. Weare very anxious to campaign forsupport to be provided to this group

and others who, for a myriad ofreasons, end up with very little usablevision and hearing and becomeisolated from society. “

According to the Centre, to ensurethat Deafblind specific services areavailable in the future, there is asignificant case to be made formobilising the group along with theirfamilies, friends and the services theyengage with, into action.

In 2004, the European Parliamentpassed a Written Declaration recog -nising Deafblindness as a separateand unique disability. Eight EUmember states including the UK haveadopted this but nobody to date, hasmade a noise about the declarationhere in Ireland.

Having exhausted the option ofreaching people who are Deafblindthrough the voluntary andcommunity sector, the Centre hasexpressed that they feel it would behugely beneficial to make health carepractitioners – particularlyaudiologists and ophthalmologists –aware of the campaign. They believethat if people were given informationon Deafblindness at the point ofdiagnosis it would be a huge leaptoward having the disabilityrecognised and developing thenecessary services associated withdual sensory loss.

The research shows that the mostcommon complaint from people whoare Deafblind is that they fall betweenthe cracks of vision services andhearing services. This research is animportant reminder to medical andhealth care professionals of the impactof dual sensory loss can have on apatient and their family.

The ICO is currently liaising withthe Anne Sullivan Foundation onways to encourage greatercooperation between people who aredeafblind, their families and theservices providers.

Research into Dealindness in Ireland Reveals Extra SupportServices Desperately Needed for Dual Sensory Loss Patients

Research funded by the Anne Sullivan Centre and Deafblind

Ireland has shown that patients who are deafblind are at risk of

falling between the cracks of vision and hearing services.


The Programme is a not-for profitcharitable company. It is independentand separate from the regulatorybodies and has been endorsed by theMedical Council, representativeorganisations and training bodies.

The programme is lead by Dr IdeDelargy, a GP with a special interest inAddiction and Substance Misuseproblems. As well as being Chairpersonof the former Sick Doctor Scheme since2007, Dr Delargy’s other roles includeNational GP Co-ordinator for the HSEAddiction Service and Director of theSubstance Misuse Progamme at theICGP. She runs her own GP practice inBlackrock, Co Dublin.

The service is there to support anydoctor who has a concern about theirmental health or substance misuse.

They will receive confidential helpfrom experts who will provideappropriate interventions, includingadvice, support, mentoring andappropriate specialist referrals, fordoctors and dentists (includingundergraduate medical students) whohave a health problem which isinterfering with their ability to practicesafely.

Services may include access to arange of specialists who have aparticular interest and experience intreating doctors. These specialtiesinclude psychiatry, psychology,occupational health, career mentoring,life coaching, addiction counselling andfinancial planning, drug and alcoholtesting. Other services will be accesseddepending on the individual’s needs.

Access to PHMP will be free of chargeto all practitioners. Where referral toanother service or ongoing monitoringis required, patients who have healthinsurance can use this to cover thecosts. Others may need to havetreatment provided through the publichealthcare system. In circum stances offinancial hardship special arrange -ments may be required using ourcharitable funds. For patients treatedprivately, they will not be charged forcare and treatments but we willwelcome any contributions they offer.

The Practitioner Health MattersProgramme operates on a not-for-profitbasis and depends heavily on financialsupport they receive from professionalrepresentative and training bodies andcontributions from health careprofessionals. Donations of any size aregratefully received. More informationon the service or how to make acontribution is available atwww.practitionerhealth.ie.

Practitioner Health Maers Programme

We are delighted to informmembers that the newly

designed ICO website eyedoctors.ie

is now live. Much work has gone intodeveloping and enhancing the site toensure it responds to visitor’s needs,for both the public and our members.Our aim was to create a compre -hensive website which is easy tonavigate and home to reliable and up-to-date eye health information.

The updates are in response to themain findings of web traffic analyticswhich showed the most visitedsections of the site to be informationon eye conditions, the training pages,the press section and the eye doctordirectory. The new layout has beendesigned so that visitors can moreeasily identify the relevant section orinformation to their search but also toenhance the overall access to eyehealth news and information in orderto promote greater interest andnavigation of the site by visitors.

The new trainee section containsupdated information on the differenttraining programmes and an insightinto ‘A Career as an Eye Doctor’. Wehope members will find the updated

section ‘For Doctors’ more inform -ative and in tune with their require -ments. The College plans to put agreater emphasis on our work withGP’s and a new dedicated section willkeep our colleagues in generalpractice updated on our ongoingefforts in this regard.

The College also contacted patientsupport groups NCBI, FightingBlindness, ChildVision and IrishGuide Dogs and asked them toinform the ICO of their guidelines forreferral pathways of patients to theirservices by eye doctors, which iscontained in the members section ofthe new site.

The new home page clearlyhighlights upcoming ICO and externalmeetings and events of interest. It alsodisplays a live report on our socialmedia activity on Twitter.

Phase two of the website develop -ment will be to enhance the eyedoctor directory and the College willbe in contact with our members toupdate individual biography andcontact details to ensure we areresponding to the search require -ments for visitors to the site.

We would be delighted to hearany feedback or further ideas for thewebsite that members may have aswe continue to update.

Formally called the ‘Sick Doctor Scheme’, the ‘Practitioner Health Matters

Programme’ (PHMP) is the new title of the scheme which provides

appropriate care and support for health professionals who may have a

substance misuse problem and other mental health issues.

Re designed eyedoctors.ie is unveiled


Cataract surgery is one of the mostcommonly performed day caseprocedure in public hospitals in Irelandsince 2005. It has been shown to be ahighly cost-effective procedure, both inthe developed and developing countries.The cost estimate of a cataract surgerycan vary substantially worldwide. Acase of cataract surgery was estimatedto be €318 in Hungary, €1087 in Italy,€1261 in Finland, €760 in Sweden andUSD2525 in the United States. Based on2010 data in Ireland, a day case cataractsurgery was estimated to be €1510.

With the increasing awareness onthe growing cost of healthcare, there isnow a shift towards a more cost-conscious surgeon. The aim of thesurvey is to evaluate the awareness ofthe surgeon on the cost of consumablesfor cataract surgery.

Methods

The questions in the survey werefocused on the following items:1. Instruments and medications that

are commonly used for providinganaesthesia

2. Peri-operative ocular medications(antibiotics, mydriatics, steroids etc.)

3. Ophthalmic viscoelastic device4. Intraocular lens implant5. Other devices for cataract surgery

A list of cataract surgery consumablesprices was obtained from a single eyeunit in Ireland. We designed the surveyusing the SurveyMonkey online service.A total of 37 questions were generated.The survey was circulated by email toall members of the Irish College ofOphthalmologist. Only one entry perperson was accepted and the datacollection period was over 1 month, fromthe 1st of October to 31st October 2014.Data collected were analysed usingMicrosoft Excel and SPSS (Version 22).

Findings

A total of 26 individuals responded tothe survey. Fifteen (57.7%) respondentsare currently working in the publicsector only, 5 (19.2%) only work in theprivate sector and the remaining 6(23.1%) work in both public and privatesectors. Twelve (46.2%) of therespondents are Consultants while theremaining are NCHDs (Figure 1). Halfof all respondents have carried outgreater than 500 cases of cataractextraction and lens implant surgery.

1. Instruments and medications usedfor providing anaesthesia - 9 itemsOne third of the respondents correctlyidentified the cost for a single usesubtenon anaesthesia pack andperibulbar needle respectively. Themajority of respondents perceived ahigher cost for anaesthetic medicationsused in cataract surgery.

2. Eye medications - 11 itemsOverall, this survey revealed that theunderstanding of the cost of eye medic -ations used in cataract surgery waspoor. Majority of respondents assumedthat the cost was higher than usual.

Cost of Consumables for Cataract SurgeryWe Fong Siah and Paul O’Brien

ICO members, Paul O’Brien and We Fong Siah have developed a

survey to find out what ophthalmologists know about the costs of

the consumables for cataract surgery.

Figure 1. Grade of respondents

Figure 2. Graph showing the overall correctresponses for each group of consumables. OVD= Ophthalmic viscoelastic device; IOL =Intraocular lens

Figure 3. Table shows the estimate price for cataract surgery consumables.OVD = Ophthalmic viscoelastic device; IOL = Intraocular lens


3. Ophthalmic viscoelastic device - 5 itemsTen (40.0%) respondents correctlyidentified the cost for Amvisc®. The costfor Visthesia® and Viscoat® wereaccurately determined by 14 (53.9%) and 7(28.0%) respondents respectively. Thequestion on the cost for Healon® andHealon GV® were answered incorrectly byall respondents; all of them over-estimated the cost.

4. Intraocular lens (IOL) – 4 itemsOnly 8 (30.8%) individuals correctlyidentified the cost for Akreous Adapt AoIOL. Less than 20.0% of respondentscorrectly determined the cost for CT-Asphina IOL, Acrysof IQ IOL or TecnisAcrylic IOL.

5. Other devices for cataract surgery –5 itemsA quarter of the respondents were awareof the cost for Miochol-E (20mg) andVision Blue (0.06% Trypan blue). Four(15.4%) respondents correctly determinedthe cost for the Morcher capsular tensionring and the iris hooks respectively. Only3 (11.5%) respondents accurately identi -fied the cost for 10-0 nylon sutures while astriking majority under-estimated it.

Figure 2 shows the overall correctresponses for the above grouping ofconsumables. Figure 3 shows the estimateprice for the cataract surgeryconsumables.

Discussion

This survey revealed that the majority ofthe respondents were not familiar withthe cost of consumables for cataractsurgery. With the increasing ageingpopulation, there will be a rise in thedemand for cataract surgery and this hassignificant implications on the overall costof healthcare. It is therefore fundamentalthat surgeons who are performing cataractsurgery be willing to consider the costimplications of consumables used.

However, there are limitations to thissurvey. Firstly, the number of respond entswas small and therefore does notrepresent the majority of the surgeonswho perform cataract surgery in Ireland.Secondly, the cost of the cataract surgeryconsumables were based on the pricingobtained from one single eye unit inIreland. It is likely that the pricing ofconsumables may vary from one eye unitto another i.e. bulk discount.

Nevertheless, we hope that this surveywill influence cataract surgeons to bemore cost-conscious and to encourage apositive attitude towards healthcare costconsiderations.

The 68th Plenary Session of theUEMS Section of Ophthalmology

was held in Floriana, Malta 14th-15thJune 2014.

The Union of European MedicalSpecialists is an EU wide represent -ative body liaising with the EUCommission divided into sections byspecialty. UEMS represents over 1.6million medical specialists in all thedifferent specialties. It also has stronglinks and relations with EuropeanInstitutions (Commission andParliament), the other independentEuropean Medical Organisations andthe European Medical/ScientificSocieties.

The UEMS has 39 SpecialistSections, which represent independ -ently recognised specialties. Theyeach created a European Board as asubgroup, in conjunction with therelevant European Society, with aview to defining European standardsof medical education and training.They also contribute to the work ofMultidisciplinary Joint Committees(MJC) which address fields of amultidisciplinary nature. The Sectionof Ophthalmology encompasses theEuropean Board of Ophthalmologywhich awards the EBO Diploma.

The current President (4 yearterm) is Constantino Bianchi fromItaly, General Secretary Guy Aflalo(France) and Treasurer Eija Vesti fromFinland.

Elections were held at the meetingfor Treasurer and Vice Presidents (5)Eija Vesti was returned unopposed asTreasurer. The five Vice Presidents areWagih Aclimandos(UK), IvanHaefliger (Switzerland), PavelRozsival(Czech Rep), Renata Ivekovic(Croatia), Toomas Sepp. (Estonia)

President Bianchi finishes his termof office at the end of the year andHank Bonnemaijer (Netherlands)assumes the role of President inJanuary 2015.

Accounts are held in Brussels andthe annual accounts were acceptedby the Section.

EACCME (EuropeanAccreditation Council for CME)plays a major part in setting thestandards for CME/CPD throughoutEurope. This leading role is beingincreasingly recognised by politicalorganisations (European Commis -sion and Parliament), provider andfunding organisations, and doctors.It has mutual recognition with theAMA.

Symposium on the future of

Surgery in EuropeAttended by Hank BONNEMAIJER,

the two main topics were - the needto harmonize the training in Europeand the advent of robots in surgerytraining.

EFAB (European Forum

Against Blindness) and IAPB

(International Agency for the

Prevention of Blindness)

Advocacy CoalitionPresident BIANCHI was asked to

participate in the creation of a“European Coalition for Eye Health”on behalf of the Section of Ophthalm -ology, and was invited by the CEO ofIAPB (International Agency for thePrevention of Blindness) toparticipate in a meeting held on thissubject in October 2012 under theEuropean Parliament in Brussels.

Clearly this coalition, althoughinitiated by the associations with theaim of safeguarding the vision,consists mainly of representatives ofthe medical industry, optical,opticians and optometrists, with itscosts borne by the pharmaceuticalindustry. The stated goals of thecoalition are generous and ambitious,but do not specify what is the exactposition played in it byophthalmologists, and concerns mayarise about the ethical aspect of itssponsoring.

The Bureau is very reluctant togive its backing for such venture, butagrees to participate as an observer.

Report on UEMS Section ofOphthalmology Plenary SessionFloriana, Malta June 2014

UEMS Irish Representatives: Dr Alison Blake and Dr Denise Curtin


Lyndsay Sullivan, Bayer, Aideen Hogan, Hermitage Clinic and CatherineCleary.

Sarah Kwan and George Vartsakis

Professor Alan Bird, Professor of Medical Ophthalmology, HonoraryConsultant Moorfields Eye Hospital, UK and Mr David Keegan,Consultant Ophthalmic Surgeon, Mater Hospital Dublin

Paddy Condon, Waterford, Mark Pennesi, Casey Eye Institute, OregonHealth and Science University, USA and Max Tracey, Royal Victoria Eyeand Ear Hospital.

Daragh McCabe, Bayer and Mr. James Morgan, Louth County Hospital.

Retinal Imaging Society of Ireland. Chaired by Prof.

Alan Bird, Emeritus Professor of Medical

Ophthalmology, Honorary Consultant Moorfields Eye

Hospital Hospital and Mr. David Keegan, Ophthalmic

Surgeon, Mater Misericordiae Hospital Dublin.

Trainee and consultant grade ophthalmoloigsts fromthroughout Ireland attended the meeting held at the CrokePark Conference centre.

The meeting comprised case presentations by severalophthalmologists from Ireland and internationally ofclinically challenging retinal conditions. The cases werepresented to allow discussion of clinical management andfurther investigations that may be warranted. Thisfollowed an open exchange of clinical experience betweenthe ophthalmologists which is the aim of RISI events.

Retinal Imaging Society of Ireland meeting

Documents

ICO News No10 Dec14 - Eye Doctors News10.pdf · debate whether tighter guidelines and ... McMahon believes legislation against ... Caroline Murphy, RTE, Conference Moderator