DR PETER SCANLON PROFESSORSHIP
In November 2011, Dr Peter Scanlon was offered an appointment as a Visiting Chair in Medial Ophthalmology at the University of Bedfordshire to work with the Bedfordshire and Hertfordshire Postgraduate Medical School (BHPMS).
PASCAL Retinal Laser donated by the Eye Therapy Trust
Ophthalmologists have used laser to treat problems in the retina for the last 35 years. Retinal laser treatment is used in diabetic patients to prevent abnormal new blood vessels growth in the retina that can lead to bleeding and vision loss and to treat thickening of the central retina. The lasers are also used to treat patients with retinal tears preventing detachments and for some patients with macular degeneration, vein occlusions and other retinal conditions. Laser treatment is the second most common procedure after cataract surgery.
Early lasers took up a whole room, were cumbersome to use, and resulted in large retinal burns. Treatment was very uncomfortable and often needed local anaesthetics. Over the last 2 decades the lasers have become smaller, the type of laser used has changed, but there has been very little major change in the way we laser, until recently.
The Eye Therapy Trust has recently raised funds for a new type of retinal laser with major benefits for patients in Gloucestershire. Unlike the previous Argon laser, the PASCAL retinal laser, uses a special computer driven scanner allowing multiple almost simultaneous spots of laser. The actual laser shots have a much shorter duration (0.01 seconds compared to 0.1 seconds) so the treatment is much faster and more importantly much more comfortable. The more focused laser spots are also thought to result in less damage to the surrounding tissues so that more patients will maintain field of vision an important consideration to maintain driving independence.
In diabetics with new vessels a laser treatment previously involved 3 sessions of treatment each lasting 30 minutes with around 3000 burns to the retina in total. The treatments were often uncomfortable and some patients required an injection of local anaesthetic before the treatment.
The new PASCAL has been in use for 3 weeks. An average treatment takes me about 10 minutes, and most people only require 1-2 sessions of treatment. Patients have commented on how much more comfortable the new laser is and I have not had to use injection local anaesthesia on anyone since the change. The table of the PASCAL laser is also designed to enable easy positioning of larger patients and patients in wheelchairs. A patient which I struggled to position last month for her first laser session had a much more comfortable experience this week.
The laser also allows connection to camera and external monitor in the future to help with training future ophthalmologists.
In the current climate there is little chance that a laser whose main advantage is easier and much more comfortable treatment for the patient would be purchased. We are grateful for the continued support of the Eye Therapy Trust.
CATARACT SIMULATOR MACHINE DONATED BY THE EYE THERAPY TRUST
Through the generosity of the Gloucestershire Eye Therapy Trust a state of the art Cataract Surgery Simulator, the EYESi, has been purchased for the Gloucestershire Eye Unit. This is only the third such simulator in the UK.
Before the development of surgical simulators trainee eye surgeons practiced stitching techniques on plastic eyes or pig eyes, before operating on actual patients. Although this form of training teaches the trainee how to use the operating microscope and improves their manual dexterity, it does not come close to simulating the surgical manoeuvres carried out during modern cataract surgery. Trainees therefore still have to learn the individual steps of cataract surgery by watching their consultant and then practice these steps on patients. Once each step has been mastered the trainee can then combine a series of these steps, until finally the complete operation has been undertaken from start to finish.
What is the EYEsi Surgical Simulator
The EYEsi Surgical Simulator uses virtual reality technology to produce high-fidelity simulations of cataract surgery. The simulator is mounted on a stand complete with an operating microscope, a VDU and pedals to operate the cataract extraction equipment and the microscope.
From the trainees’ point of view the major technical challenges posed by modern cataract surgery are learning how to use the operating microscope and how to train both of their hands and both feet to do different things at the same time!
The EYESi cannot only help with teaching these skills it can also simulate each stage of cataract surgery. This means that trainees can practice each of these steps until they have perfected them, before they operate on patients. The EYESi also provides feedback to the trainee regarding how they are performing and gives them advice as to how they can improve their technique.
One of the most difficult steps during cataract surgery is the removal of a circular piece of the capsule of the lens using delicate forceps, this is known as a capsulorhexis (see video). By using the EYESi simulator to practice their capsulorhexis technique trainees are able to complete this manoeuvre with confidence when they are operating on patients.
Simulator training will have a number of tangible benefits for our patients, trainees and the Eye Unit itself. The principle consideration when training any surgeon is patient safety and this has been the main driver behind the development of surgical simulators over the last decade. Although the complication rate during cataract surgery carried out by trainees is relatively low, there is good evidence to suggest that trainees that have had simulator training have an even lower complication rate.
Trainees will also be able to carry out surgery more quickly than they had done previously, which will be of obvious benefit to our patients. It will also enable more patients to be operated on per operating list, so improving the efficiency of our theatre lists. This is likely to reduce the waiting time for cataract surgery even more.
The EYESi is certain to have a hugely beneficial impact on surgical training in the Severn Deanery, as trainees from Bristol, Bath and Swindon will be able to join their colleagues in Cheltenham to make use of this new facility. I am immensely grateful to the Gloucestershire Eye Therapy Trust for their generous support that has enabled our unit to buy such a fabulous piece of equipment.
Finally, we envisage that he EYESi will be on view at future Eye Therapy Trust Open Mornings and that members of the public will, under supervision, be able to try their hand at cataract surgery! We also plan to have a stand at the Cheltenham Science Festival this summer, to showcase the EYESi and raise awareness of the wonderful work carried by the Gloucestershire Eye Therapy Trust.
Link to website for download of video of the EYESi in action
http://www.vrmagic.com/simulators/eyesi-surgical/
CHARITABLE DEEDS BY OPHTHALMOLOGY STAFF
On 27th March 2011 Howard Marshall, Lead Health Care Assistant in Ophthalmology Outpatients ran the Warsaw Half Marathon in Poland in aid of the Sue Ryder Hospice at Leckhampton Court. He raised £500 for the local hospice that provides palliative care for people with life shortening illnesses such as cancer and motor neurone disease.
Howard did the marathon in memory of his good friend Sister Tina Franklin who was a Sister in Eye Theatre at Cheltenham General Hospital for many years as she had received such excellent care at the local Sue Ryder Hospice.
He also previously ran the Tewkesbury Half Marathon in her memory raising £1000 on that occasion.
OPHTHALMOLOGY OPEN DAYS
As a Department, we try to open our doors to the public regularly so that they can experience how it feels to have an outpatient appointment or an operation with us. The last one was in 2010 and here is a little information on that:
OPHTHALMOLOGY OPEN DAY – SATURDAY 13th MARCH 2010
On 13th March 2010 the Ophthalmology Department opened its doors at Cheltenham General Hospital to welcome the public to have a look around at what goes on behind the scenes.
Both Outpatients and Theatre opened up their doors in order to provide the general public with first hand knowledge of how we run as a Department behind the scenes.
There were clinic rooms set up in which doctors gave short talks on various subjects such as Glaucoma, Laser Treatment, Casualty and Retinal photography. All grades of doctors were available for members of the public to speak to from Consultant to Junior Trust Doctors.
There was a good show of nursing staff on the day from Matron to Healthcare Assistants, all of whom gave their time voluntarily and tried to help keep things interesting by showing members of the public around and who also provided the Public with various eye tests during the morning.
People were also able to visit Eyford Ward where patients are cared for before and after operations and also through to the Eye Theatre to see where the operations take place.
The Mayor and Mayoress of Tewkesbury attended the day and found it very interesting, giving some very positive feedback to a member of staff following the day and we also had representatives from the Eye Therapy Trust in attendance. Martin Horwood, MP for Cheltenham also made a short visit early on during the morning.
The Spectralis Machine was donated to the Department on the Day by the Eye Therapy Trust and Quresh Mohamed, Consultant Ophthalmologist gave a short speech on the importance of this machine to the Department and thanked the ETT for their ongoing support in making our Department so well equipped in Gloucestershire.
Refreshments provided by staff within the Department were available on the day and were sold to raise further funds for the Eye Therapy Trust. In total the sum of approx £300 was made from refreshments and collections.
Date of the next Open Day - TBC