What first interested you in ophthalmology?
When I was at school, I remember seeing a black-and-white program on TV of a cornea transplant (it turns out this was performed by somebody who eventually became my mentor!). I had never considered being a doctor before, but after seeing the transplant I thought it was amazing that they could even do that.
Then later on, I was in medical school in Ireland and following the herd – all the macho guys wanted to do general surgery or orthopedics, and so I was falling into that line. But my classmate John Chang, now an ophthalmologist in Hong Kong, convinced me to join him to watch Professor Peter Eustace perform cataract surgery at the Mater Private Hospital in Dublin. It wasn't even a closed operating theater – it was in a library, but with vinyl on the floor and music playing in the background, and the surgeons were sitting down doing surgery using microscopes. I just couldn’t believe it… It all seemed very civilized, unlike the crazy stuff I had seen in neurosurgery and orthopedics and vascular surgery. Eustace used 8-0 silk to close up what we would now consider a huge corneal wound, and he also put an anterior chamber lens implant in the eye after intracapsular cataract extraction with a cryoprobe. I thought all of this was fantastic with so much technology. The rule was, if you saw surgery with Prof Eustace then you had to visit the patient the next day with him too. So the following morning we were back at the hospital. Professor Eustace took the patch off the patient's eyes, and just the look on the patient’s face was priceless… I was sold. I thought, “This is what I want to do with my life.”
Were there specific mentors that influenced your career?
Strangely enough, it turns out that the surgeon I had seen on my black-and-white television was David Paton, the founder of Orbis, and in a curious twist of fate he became like my dad in ophthalmology.
After Ireland I went to the US, but I couldn't get into ophthalmology at the time, and so I did internal medicine there instead. While doing that, at weekends I did research with the well-known glaucoma specialist Robert Ritch and an elective with Mark Kupersmith, a neuro-ophthalmologist at New York University. Then I applied to get into ophthalmology, and was interviewed at the Catholic Medical Center in Brooklyn & Queens where David Paton was. I couldn't believe he was in this derelict place, but he wanted to work in an impoverished area and set up systems for people who desperately needed care, and it turns out he wanted somebody like me, and I was very lucky and grateful to be accepted into the program.
The opportunity was fantastic, and I learned a lot working in Brooklyn & Queens under many mentors, including David Paton and Andrew Prince. With regards mentorship, David Paton actually coined the term “human templates of excellence” (HTEs) – which basically means you find mentors with behaviours and values you consider excellent, and learnt to develop and imprint them on yourself. As you progress through life and meet new individuals with qualities you admire, you grab them and move on, also ensuring you omit traits that are not good. In other words, take the best out of all the people that you meet. This is something I have consciously done throughout my life. There are many other mentors, including Edward J Holland and Richard L. Lindstrom, that have influenced me, however David Paton was probably the most impactful mentor I had both on me personally and my career.
Do you have any advice for ophthalmologists just starting out in their careers?
You will always succeed if you ensure you steer your life with a great set of values. Basically follow David Paton’s advice on HTEs! Find people who you admire, then see what they do, how they behave, and what their value system is. Figure out what you like about them and draw that into yourself. By the same token, find the things you don't like and try not to be like them in that regard, because there's always a balance. In that way you'll become a better person and you'll thrive. What kind of advances have you seen throughout your career? I feel quite privileged because I've seen the whole gamut of change. From extracapsular cataract surgery to phacoemulsification, foldable lenses and now advanced technology lenses. With regards refractive surgery, when I was a fellow in 1991 refractive surgery was mainly radial keratotomy (RK). We were doing some trials on the excimer laser, but back then the excimer laser was quite complicated with a bunch of boxes, which included a computer, a laser and tanks of gases all attached to a microscope. I learned how to do RK and performed this when I entered practice in New York City – lasers were not approved by the FDA at that stage! Coming back to the UK in 1994 was fantastic because there were lasers available, and as I had already had experience doing automated lamellar keratoplasty, I used the device and combined this with the Excimer laser and performed what was probably the first commercial LASIK operation in the UK.
From there, femtosecond lasers came along, and we now have better and better lasers. Excimer lasers are like little aircraft now – they've got black boxes in them, every pulse that's delivered is measured and readjusted for the next one, and you can trace where all the pulses go on a cornea. They’re much faster – they go at 10 to 20 times the speed of the original lasers – and it's a totally different ball game.
This also applies to diagnostics. When I was a fellow, to do a topography used to be such a chore because one eye would take half an hour. And now we can do this in seconds. That's down to computer processing power. There's so much that we can glean from diagnostics now. Before I even see a patient, if I just go through all their diagnostics I already know what's going on with them. All I have to do is verify it by sitting down with them and taking a look at their eyes and talking to them.
Can you share with us a highlight of your career?
There are two highlights: One is becoming the most recent European President of the American European Congress of Ophthalmic Surgery (AECOS). In June this year we had our biggest conference ever in London. It is an amazing organization that promotes innovation, education and advocacy, unashamedly working closely with the ophthalmic industry.
The other career highlight of which I am most proud – and is probably our most cited article as well – is our work on limbal stem cell transplantation. While at the Corneoplastic Unit, Queen Victoria Hospital in East Grinstead, UK, it was fortunate to have the Blond McIndoe Research Foundation housed within the organization, and they had special expertise in cell culture. I was interested in doing epithelial cell and stem cell culture, which they successfully accomplished. We managed to get ethics approval and demonstrated proof of concept that we could culture presumed stem cells, and took these cells manufactured in the lab and transplanted them into patients. In 1999, this was quite a dramatic event, in terms of what it did for patients’ eyes. The real breakthrough was finding the restored ocular surfaces had no donor DNA present after nine months. The ramifications of this finding were potentially huge.
When we published these findings, it was everywhere – it was on the front page of The Times, and I had CNN, Sky News and other international news agencies queuing up to interview me. So that was one of the biggest highlights for me – not in cataract or refractive, but in the ocular surface restoration of mainly bilaterally blind patients.
What are your main interests within ophthalmology right now?
Working to streamline what we do. This includes the IMVIS 3D visualisation device, developed by Prof Tom Williamson and myself, as well as artificial intelligence (AI). We need to find ways to assimilate knowledge and information, and get it all simplified so that we can get on with our jobs. I think that's where carefully used AI is going to help us tremendously.
In the UK and elsewhere we have a problem with doctor burnout – and that’s not just because electronic medical records and managers in the NHS are tormenting doctors! There's just a huge amount of work that needs to be done in a day to ensure compliance on so many fronts in addition to seeing and treating patients. This includes educating them and ensuring there is mutual trust in any decision making, as well as communicating with all stakeholders – much of this can be helped by AI. Furthermore, consider the sheer volume of information being accumulated in medicine - there’s bound to be gaps in knowledge, and all those gaps can be filled in using AI. This will enable us as doctors to concentrate on getting on with the job and accomplish what's absolutely best for our patients, hopefully without burnout.
When I was at school, I remember seeing a black-and-white program on TV of a cornea transplant (it turns out this was performed by somebody who eventually became my mentor!). I had never considered being a doctor before, but after seeing the transplant I thought it was amazing that they could even do that.
Then later on, I was in medical school in Ireland and following the herd – all the macho guys wanted to do general surgery or orthopedics, and so I was falling into that line. But my classmate John Chang, now an ophthalmologist in Hong Kong, convinced me to join him to watch Professor Peter Eustace perform cataract surgery at the Mater Private Hospital in Dublin. It wasn't even a closed operating theater – it was in a library, but with vinyl on the floor and music playing in the background, and the surgeons were sitting down doing surgery using microscopes. I just couldn’t believe it… It all seemed very civilized, unlike the crazy stuff I had seen in neurosurgery and orthopedics and vascular surgery. Eustace used 8-0 silk to close up what we would now consider a huge corneal wound, and he also put an anterior chamber lens implant in the eye after intracapsular cataract extraction with a cryoprobe. I thought all of this was fantastic with so much technology. The rule was, if you saw surgery with Prof Eustace then you had to visit the patient the next day with him too. So the following morning we were back at the hospital. Professor Eustace took the patch off the patient's eyes, and just the look on the patient’s face was priceless… I was sold. I thought, “This is what I want to do with my life.”
Were there specific mentors that influenced your career?
Strangely enough, it turns out that the surgeon I had seen on my black-and-white television was David Paton, the founder of Orbis, and in a curious twist of fate he became like my dad in ophthalmology.
After Ireland I went to the US, but I couldn't get into ophthalmology at the time, and so I did internal medicine there instead. While doing that, at weekends I did research with the well-known glaucoma specialist Robert Ritch and an elective with Mark Kupersmith, a neuro-ophthalmologist at New York University. Then I applied to get into ophthalmology, and was interviewed at the Catholic Medical Center in Brooklyn & Queens where David Paton was. I couldn't believe he was in this derelict place, but he wanted to work in an impoverished area and set up systems for people who desperately needed care, and it turns out he wanted somebody like me, and I was very lucky and grateful to be accepted into the program.
The opportunity was fantastic, and I learned a lot working in Brooklyn & Queens under many mentors, including David Paton and Andrew Prince. With regards mentorship, David Paton actually coined the term “human templates of excellence” (HTEs) – which basically means you find mentors with behaviours and values you consider excellent, and learnt to develop and imprint them on yourself. As you progress through life and meet new individuals with qualities you admire, you grab them and move on, also ensuring you omit traits that are not good. In other words, take the best out of all the people that you meet. This is something I have consciously done throughout my life. There are many other mentors, including Edward J Holland and Richard L. Lindstrom, that have influenced me, however David Paton was probably the most impactful mentor I had both on me personally and my career.
Do you have any advice for ophthalmologists just starting out in their careers?
You will always succeed if you ensure you steer your life with a great set of values. Basically follow David Paton’s advice on HTEs! Find people who you admire, then see what they do, how they behave, and what their value system is. Figure out what you like about them and draw that into yourself. By the same token, find the things you don't like and try not to be like them in that regard, because there's always a balance. In that way you'll become a better person and you'll thrive. What kind of advances have you seen throughout your career? I feel quite privileged because I've seen the whole gamut of change. From extracapsular cataract surgery to phacoemulsification, foldable lenses and now advanced technology lenses. With regards refractive surgery, when I was a fellow in 1991 refractive surgery was mainly radial keratotomy (RK). We were doing some trials on the excimer laser, but back then the excimer laser was quite complicated with a bunch of boxes, which included a computer, a laser and tanks of gases all attached to a microscope. I learned how to do RK and performed this when I entered practice in New York City – lasers were not approved by the FDA at that stage! Coming back to the UK in 1994 was fantastic because there were lasers available, and as I had already had experience doing automated lamellar keratoplasty, I used the device and combined this with the Excimer laser and performed what was probably the first commercial LASIK operation in the UK.
From there, femtosecond lasers came along, and we now have better and better lasers. Excimer lasers are like little aircraft now – they've got black boxes in them, every pulse that's delivered is measured and readjusted for the next one, and you can trace where all the pulses go on a cornea. They’re much faster – they go at 10 to 20 times the speed of the original lasers – and it's a totally different ball game.
This also applies to diagnostics. When I was a fellow, to do a topography used to be such a chore because one eye would take half an hour. And now we can do this in seconds. That's down to computer processing power. There's so much that we can glean from diagnostics now. Before I even see a patient, if I just go through all their diagnostics I already know what's going on with them. All I have to do is verify it by sitting down with them and taking a look at their eyes and talking to them.
Can you share with us a highlight of your career?
There are two highlights: One is becoming the most recent European President of the American European Congress of Ophthalmic Surgery (AECOS). In June this year we had our biggest conference ever in London. It is an amazing organization that promotes innovation, education and advocacy, unashamedly working closely with the ophthalmic industry.
The other career highlight of which I am most proud – and is probably our most cited article as well – is our work on limbal stem cell transplantation. While at the Corneoplastic Unit, Queen Victoria Hospital in East Grinstead, UK, it was fortunate to have the Blond McIndoe Research Foundation housed within the organization, and they had special expertise in cell culture. I was interested in doing epithelial cell and stem cell culture, which they successfully accomplished. We managed to get ethics approval and demonstrated proof of concept that we could culture presumed stem cells, and took these cells manufactured in the lab and transplanted them into patients. In 1999, this was quite a dramatic event, in terms of what it did for patients’ eyes. The real breakthrough was finding the restored ocular surfaces had no donor DNA present after nine months. The ramifications of this finding were potentially huge.
When we published these findings, it was everywhere – it was on the front page of The Times, and I had CNN, Sky News and other international news agencies queuing up to interview me. So that was one of the biggest highlights for me – not in cataract or refractive, but in the ocular surface restoration of mainly bilaterally blind patients.
What are your main interests within ophthalmology right now?
Working to streamline what we do. This includes the IMVIS 3D visualisation device, developed by Prof Tom Williamson and myself, as well as artificial intelligence (AI). We need to find ways to assimilate knowledge and information, and get it all simplified so that we can get on with our jobs. I think that's where carefully used AI is going to help us tremendously.
In the UK and elsewhere we have a problem with doctor burnout – and that’s not just because electronic medical records and managers in the NHS are tormenting doctors! There's just a huge amount of work that needs to be done in a day to ensure compliance on so many fronts in addition to seeing and treating patients. This includes educating them and ensuring there is mutual trust in any decision making, as well as communicating with all stakeholders – much of this can be helped by AI. Furthermore, consider the sheer volume of information being accumulated in medicine - there’s bound to be gaps in knowledge, and all those gaps can be filled in using AI. This will enable us as doctors to concentrate on getting on with the job and accomplish what's absolutely best for our patients, hopefully without burnout.
