Eyes on the Prize

When did you decide ophthalmology was for you?
 

My interest in ophthalmology piqued as a third-year medical student at the University of Southampton. I attended an inspiring lecture titled “Tales of an Ophthalmologist,” which was delivered by a friendly and charismatic ophthalmologist called Steve Lash. I asked Steve if I could shadow him to learn more about the specialty, and he happily obliged. He would go on to become my supervisor for my intercalated BMedSc in ophthalmology. I led the undergraduate ophthalmology society at my university and organized ophthalmology seminars, skills sessions, and conferences. I also arranged an ophthalmology-themed elective abroad, another at Moorfields Eye Hospital, and I got involved in several exciting projects. All these experiences cemented my decision to pursue a career in ophthalmology.

What are your career highlights so far?
 

Publishing my first paper. Completing my first laser procedure, my first cataract operation, and my first subspecialist operations and – most importantly – hearing how relieved the patients felt afterwards and how these treatments improved their lives. Getting my first grant (NIHR). Completing my PhD thesis – a very long and hard journey, but one of the most rewarding things I’ve ever done. Learning to bounce back and overcome the many challenges of clinical academic training. And, of course, receiving the 2022 European Award in Medicine for Ophthalmology, in addition to other academic prizes – a wonderful way to recognize the hard work and contributions of our team, patients, and their families.

Who are – or were – your mentors?
 

As Sir Isaac Newton put it, “If I have seen further, it is by standing upon the shoulders of giants.”

I have had so many brilliant mentors – too many to list here, but I will do my best.

During my time in Southampton: Steve Lash, Andrew Lotery, Helena Lee, and Jay Self. These mentors helped me in the earliest days of my career, providing fantastic opportunities, patience, and guidance.

During my time in Leicester: Irene Gottlob, Frank Proudlock, and Mervyn Thomas all encouraged me to develop intellectual curiosity and critical thinking skills. They trusted me to lead high profile research projects and encouraged me to troubleshoot problems myself.

Whilst at GOSH/London: Richard Bowman, who supported me in setting up my research clinic in the GOSH Sight and Sound Centre, and gave me “free rein” to lead my research rather than micromanaging me. His approach demonstrated a great deal of trust and enabled me to fall in love with my research, rather than feeling restricted and demoralized. Also, Lola Solebo, Chris Lloyd, and Omar Mahroo all guided and mentored me through various career challenges and supported me by reviewing my second book, MCQs for FRCOphth Part 1 (Oxford University Press, 2022). Chris Lloyd also reviewed and wrote the foreword for my first book, A Practical Guide for Aspiring Ophthalmologists (World Scientific, 2021).

Most importantly, my dear parents – the greatest mentors I could ever ask for. They have patiently guided and supported me through all of life’s challenges, and worked tirelessly to provide me with education, opportunities, and a loving home. For this, I am forever grateful.

Please tell us about your research using handheld OCT…
 

Handheld OCT is a revolutionary technology that enables 3D imaging of the eye in amazingly minute detail, non-invasively, within seconds. This is a safe and child-friendly way to examine structures of the eye to guide clinical management. I was immensely fortunate to receive world-class training in handheld OCT image acquisition and analysis at Leicester, before applying this technique in high profile studies across Leicester, GOSH, and Oxford.

My first project with handheld OCT took place at Leicester – the first center in Europe to use handheld OCT technology. My project focused on foveal hypoplasia associated with infantile nystagmus. In 2012, Leicester began recruiting a cohort of infants with nystagmus imaged using handheld OCT. My objective was to reassess these children in our research clinic between 2016 and 2018, when they were old enough to do a formal chart vision test and repeat their handheld OCT scans.

Our study found that handheld OCT was the best predictor of future vision in these children, far better than the existing assessment called “preferential looking.” Hence, handheld OCT can guide the diagnosis, prognosis, and clinical management of infantile nystagmus. This work was published in Ophthalmology. I’ve also been invited to present the work internationally – and we’ve received several prizes, including the 2022 RCOphth Ulverscroft David Owen Prize for best pediatric research paper in the past three years.

In 2019, I secured an NIHR Doctoral Fellowship grant to lead the RIO Study: Recognition of Intracranial hypertension in children using handheld OCT. This study began at GOSH with handheld OCT expertise from Leicester, but I then established further collaboration with Oxford to boost the overall patient cohort and share expertise.

Intracranial hypertension in children can damage the brain and vision if unaddressed. Children with craniosynostosis – premature fusion of the skull bones – are particularly at risk. The gold standard method to measure intracranial pressure involves admitting the child to hospital, surgically inserting a pressure monitor into the brain under general anesthesia, then monitoring the child overnight. This is invasive and carries risk.

So far, the main findings of the RIO Study are that handheld OCT is feasible and repeatable in children with craniosynostosis. Additionally, we’ve found the optic nerve head is different in craniosynostosis and that handheld OCT can detect intracranial hypertension in children, which could protect children at risk of intracranial hypertension, speed up their treatment, and generally improve our understanding of the relevant disease processes.

The European Awards in Medicine are a big deal – tell us more!
 

They were established to recognize exceptional work of medical professionals across Europe and to provide a platform for networking and knowledge exchange. They run alongside the European Legal Awards and European Technology Awards.

I was nominated along with 50 other candidates across Europe for the Ophthalmology award category. In September, I received an email from the European Awards Coordinator, Andres Lopes, asking whether I was available for a telephone call regarding the upcoming ceremony. I provided my telephone number and didn’t know what to expect, as I wasn’t aware I had been nominated or shortlisted at that point. Andres called me and revealed that I had been shortlisted for the Ophthalmology category, and the judging panel had selected me for the award. I was blown away to even be shortlisted, let alone win the award. This moment was made even more special because I answered the call sitting next to my wife, who heard everything – we could barely contain our excitement!

Andres explained that I was invited to attend the European Awards ceremony with a companion at the Ritz Paris, with a drinks reception, photoshoot, ceremony, speeches, press interview, then a four-course meal with entertainment. Wow. For a moment, I wondered if it was real – but a quick internet search gave me the answer; yes, this was truly the programme for the European Awards ceremony. 
I am extremely grateful to the European Awards team for selecting me for this prestigious award and for hosting me and my wife at the ceremony.

You won the award immediately after Harminder Dua – a well-known UK ophthalmologist. What does that say about the state of the field in the UK?
 

First of all, Harminder Dua is a huge source of inspiration to me and countless other ophthalmologists worldwide. He’s truly a superstar and veteran within the field of ophthalmology – and four decades senior to me. On the few occasions I’ve met him, he has provided me with excellent advice and encouraged me to pursue a career in academic ophthalmology. Therefore, I cannot find the words to fully express how honored and grateful I am to also receive the European Award in Medicine for Ophthalmology. Quite clearly, they have taken into account my position as an early career researcher within the new generation of young ophthalmologists. I am just fortunate to have had opportunities to lead exciting research, educational projects, and I followed guidance from giants of the field such as Prof Dua.

I think the UK has particular strengths in ophthalmic research. We are extremely well connected through the National Health Service (NHS), which makes it relatively straightforward to share powerful datasets and establish ethically approved, multi-centre research collaborations. Our NHS teaching hospitals are attached to research-intensive universities. We have numerous funding bodies – mine being the NIHR – promoting world-class research.

At the same time, I think it’s so important to learn from other people around the world who are doing truly incredible work with huge benefits to patient care. And that’s why I was especially pleased to have the opportunity to meet and learn from passionate medical professionals across Europe at the Awards ceremony in Paris. I exchanged contact details with colleagues from Spain, France, Austria and Italy, learning from the pioneering work they are doing across different medical specialties. By working together and learning from one another, we can provide the best possible care for all our patients.

What areas of ophthalmic research are most exciting right now?
 

Ophthalmology is such an incredible speciality for research. I think a huge part of this is because the eye is the only organ whose internal structures can be examined without breaching its integrity. The idea that the eye represents “the window of the soul” has been applied in the field of oculomics – using the eye to understand systemic disease. Other exciting areas of ophthalmic research include advanced ocular imaging, artificial intelligence, electrodiagnostics, gene therapy, novel treatments, novel surgical techniques – all of these are advancing at a rapid pace. As long as the patient is always kept at the heart of all our research efforts, the future of ophthalmology is exciting and bright.

And what are the biggest challenges facing ophthalmology – particularly pediatric ophthalmology – in the UK?
 

I think the biggest challenge facing ophthalmology in the UK – and elsewhere – is supply and demand. We have a growing demand from an aging population with complex health needs. This challenge has been further exacerbated by the pandemic, where a huge volume of appointments and operations have been delayed. We have a growing number of patients requiring highly specialized ophthalmic care. We need to provide an enormous volume of procedures, including cataract surgery, intravitreal injections, laser treatments, and more. We have to train more ophthalmologists to even hope to meet this demand. We also need to work effectively with our wider team members including ophthalmic nurses, optometrists, orthoptists, opticians, clinical scientists, and imaging specialists.

Pediatric ophthalmology is a rewarding subspecialist branch of ophthalmology – again, we need to train more pediatric ophthalmologists to meet the needs of the pediatric population, which requires ophthalmic specialist training posts followed by fellowship posts with adequate clinical and surgical exposure. We have also made good progress in applying similar levels of advanced technology in children as for adults, such as advanced ocular imaging techniques – but there is more work to be done to fully bridge the gap.

One main challenge is that funding and resources are limited. However, if we invest time, energy and funding into high quality ophthalmic research, we can improve diagnostic tests and treatments, which could help alleviate the huge demand in ophthalmology, improve the lives of our patients, keep people working (or enjoying retirement), and living their lives to the fullest.

If you weren’t working in ophthalmology, what would you be doing instead?
 

Realistically, I would probably have pursued a purely scientific career… But I would have also quite liked to be a writer and voiceover artist for children’s storybooks.

For further information, photos and videos, please visit theEuropean Awards website.