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ICO NEWSLETTER | SUMMER 2017 PAGE 1

NewsletterIssue 18 suMMeR 2017

With best wishesDr AlIson BlAke

Message from the PresidentDear Colleagues,

I hope you are allenjoying summer. I wasboth honoured andhumbled becoming your President at theAnnual Conference in Cavan in May. Iwould like first to publicly thank BillyPower for being such a wise and graciousPresident, and for also taking the role ofclinical lead at such a difficult time lastyear and I am grateful for his care of theCollege for the past two years.

I welcome the new members ofCouncil, John Dorris and Ian Dooley, andam appreciative of the wisdom of MarieHickey-Dwyer and Maureen Hillery whoreturn to Council.

Jeremy O'Connor and the ScientificCommittee put together an extraordinarymeeting with both international and localexperts contributing with junior Ophthalm -ologists to an exciting conference thateducated the mind and the spirit, endingwith an excellent joint psychologypresentation that drew the audience out oftheir seats and their comfort zone makingus healthier individuals.

Particular thanks to the Mooney LecturerProf Jonathon Crowston who gave hugelyof himself to all aspects of the meeting.

The Primary Care Eye Services ReviewGroup Report has just been published andwith it, we enter an exciting andchallenging phase in Irish Ophthalmology.The report draws national attention to ourspecialty. We must use this opportunity toadvocate for our patients and our specialty,while supporting each other during thistransition. I am determined to make everyeffort to secure the investment needed todevelop the service and I know that I cancount on all College members for help andsupport, thank you.

The College will announce details of itsnew training pathway for Medical andSurgical Ophthalmology at this year’sMedical Careers Day in Dublin Castle inSeptember and I would like toacknowledge and thank Yvonne Delaneyand the Training Committee for theirextensive work in preparing for theannouncement and transition in 2018.

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]

HSE Publish Primary Care Eye Services Report

The ICO published a statement towelcome the Report, and called on theMinister for Health Mr Simon Harristo ensure that the necessary funding ismade available to implement therecom mendations of the ReviewGroup.

Speaking to the Medical Independent

in response to the Report publication,ICO President Alison Blake high -lighted the importance of thatcommitment to funding from theMinister, as the HSE has already saidthat primary care is not funded wellenough in general but in terms of eyeservices particularly.

In respect of implementation,Alison also emphasised that it is veryimportant that the national nature ofthis is front-and-centre and high -lighted the crucial role of medicalophthalmologists to the plan, addingthat it is important that terms andcon ditions attached to this role areaddressed in the implementationpiece.

Brian Murphy, Head of Planning,Performance & ProgrammeManagement, Primary Care Division,

and Chairman of the Review Groupthanked the Review Group membersfor their work and to everyone whotook part in the consultation process.The ICO is now focused on meetingwith the Minister for Health todiscuss and secure his commitment tothe funding requirements and isliaising with Brian Murphy and theHSE in relation to the promptformation and activation of theimplementation steering group inorder to allow for the execution of keypriorities to get underway.

The HSE Primary Care Eye Services Review Group (PCESRG) Report was

published on Wednesday, 28th June. The national review of Primary Care

Eye Services sets out the current levels of service, models of service provision

and the consultation process undertaken with patients and advocates,

ophthalmic staff and representative bodies.

The ICO Annual Conference, with

over 200 delegates in attendance,

took place in The Slieve Russell

Hotel in Cavan from the 17th – 19th

May.

The College was delighted towelcome guest speakers from homeand abroad to an immensely engagingand educational three days of talksand symposia. The meeting goes fromstrength to strength each year and wethank all who participated andattended this year’s meeting andparticularly to Jeremy O’Connor andthe scientific committee for organisingan outstanding programme of talksand sessions.

The clinical symposia topicsincluded “New Developments inOcular Imaging” and “EvolvingConcepts in Glaucoma Management”,while a separate symposia on‘Adapting and Leading for Change’discussed matters relating to doctorshealth and wellbeing, and taking onand tackling the challenges and oppor -tunities in a changing environment.

It was a great honour for theCollege to welcome ProfessorJonathan Crowston, Head ofOphthalmology at the University ofMelbourne as the Mooney Lecturerfor 2017. His talk entitled ‘Climbingthe Glaucoma Mountain”, outlinedcurrent knowledge of the disease, andhighlighted some of the challengesand opportunities that exist inresearch and clinical practice.

Jonathan also participated in theglaucoma symposium, presenting alecture on the new evidence from anovel study relating to the impact oflifestyle on glaucoma risk. Thefindings of the recent mouse modelstudy at the Centre for Eye ResearchAustralia (CERA) shows that exercisecan modify the ability of retinalganglion cells to recover followinginjury. The studies found that exerciseprotected RGCs against dysfunctionand cell loss after an acute injuryinduced by elevation of intraocularpressure. This age-relatedvulnerability was almost completely

reversed by exercising mice for fiveweeks before and seven days afterinjury. Professor Crowston tolddelegates at the conference that thedata provides compelling evidencethat exercise can reverse negativeimpacts of ageing in RGCs andmodify their response to injury.

Jonathan was joined at theglaucoma symposium by fellow guestspeakers Leon Au, ConsultantOphthalmologist at the ManchesterRoyal Eye Hospital and AugustoAzuara-Blanco, Professor ofOphthalmology, Queens UniversityBelfast. Leon’s talk focused on thelatest surgical development inglaucoma, particularly surroundingminimally invasive glaucoma surgeryand examined the various options,clinical data, and patient selectionprocess and how they compare withour current standards.

Leon argued the importance ofperfecting existing surgical techniquesand increasing detection of glaucomaover the myriad of new “wondertreatments” and dependence ontechnology. He said this competitionhas highlighted the need to do betterand refine, shorten and make existingestablished surgery more patient-

friendly. He noted that while some ofthe latest technologies have assisted inmaking glaucoma surgery lessinvasive, and some new proceduresare quick with little risk, they are notas effective as traditional surgeriessuch as trabeculectomy and may notbe around in five years. He believesthe concept of minimally-invasive eyesurgery is to be embraced.

Professor Azuara Blanco reviewedthe evidence on different options tomanage chronic primary angle-closure glaucoma, and looked at theresults of the EAGLE trial, of whichhe is Chief Investigator, that reportedrecently of the superiority of clear-lens extraction in terms of patient,clinical and economic outcomescompared with laser iridotomy, andhow to use the results of the trial inclinical practice.

In her presentation on the optimaluse of OCT imaging in glaucoma atthe Imaging symposium, YvonneDelaney pointed out that glaucoma isunusual in that it has a long lead intime, and no single test to easilydiagnose it, so there is frequentlysignificant structural (i.e. retinalganglion cell) loss before noticeablefunctional (vision) loss occurs.

ICO NEWSLETTER | SUMMER 2017PAGE 2

(L-r) Leon Au, Consultant Ophthalmologist, Manchester Royal Eye Hospital, Colm O’Brien ,Professor of Ophthalmology, Mater Misericordiae University Hospital, Augusto Azuara-Blanco,Professor of Ophthalmology, Queens University Belfast and Jonathan Crowston, RinglandAnderson Professor of Ophthalmology, University of Melbourne, key speakers at the glaucomasymposium at the ICO Annual Conference 2017 in The Slieve Russell Hotel (17th-19th May).

ICO Annual Conference 2017


Yvonne highlighted that spectraldomain OCT offers improvedresolution and better segmentationalgorithms to image the retinal nervefiber layer and macular ganglion celllayer in glaucoma patients. HoweverOCT's modest sensitivity in pre-perimetric disease and only moderatecorrelation with visual field functionin more advanced disease representtwo significant challenges. For themoment OCT imaging remains auseful adjunctive tool but clinicalevaluation of the optic nerve headand VF testing still remain centrestage in glaucoma diagnosis andmanagement.

Guest speaker Alex Shortt, fromthe UCL Institute of Immunity andTransplantation, London discussedthe advances in corneal imagingwhich are relevant to generalophthalmologists in clinical practice.His talk gave specific focus to cornealshape analysis, corneal OCT and itsrole in the surgical setting, cornealconfocal microscopy and thediagnosis of atypical microbialkeratitis, and corneal ultrasoundbiomicroscopy and its role inrefractive surgery. The future ofcorneal imaging including preclinicaltechniques such as full field opticalcoherence microscopy and functionalOCT imaging were also discussed.

The ICO was delighted to alsowelcome past trainee Pearse Keane,Consultant Ophthalmic Surgeon atMoorfields Eye Hospital in London,who gave a fascinating talk on thelatest advances in artificial intelligenceand how they can apply to healthcare,in particular a technique called “deeplearning”.

In 2016, Pearse initiated a formalcollaboration between Moorfields andGoogle DeepMind, the world’s leadingAI company with the aim of applyingmachine learning to automateddiagnosis and assessment of OCTimages of retinal diseases. Pearseexplained that the project is workingon creating a general algorithm for thediagnosis of retinal disease and couldeventually reinvent the eye exam.

His project aims to investigate howmachine learning could help analyseOCT scans and make the diagnosis of

these conditions more efficiently andeffectively, leading to earlier detectionand intervention for patients. Pearsesaid that OCT imaging is very effect ivebut the images contain a huge amountof complex data, which takes consider -able time, training and experience toanalyse correctly, with very largevolumes of such scans taken daily inbusy ophthalmology clinics.

He explained that the idea of usingAI is that it is a technique that thealgorithm learns from experience so itcan look at a process of thousands, ormillions, of scans and become as goodas a retina specialist at diagnosingthese conditions.

Pearse said it is hoped researchfindings will be published sometimebefore the end of 2017 showing a‘proof of concept’ of the algorithm,though it will be a little bit further inthe future before it can be used inpractice.

In the closing session of the AnnualConference, Hadas Levy, Psychologistand Manager of the EducationDevelop ment team at the RoyalCollege of Physicians Ireland andStephen McIvor, Sports Psychologistand former Munster and Irelandrugby player gave a practical andmotivational presentation at the'Adapting and Leading for Change’symposium.

An expert on doctor’s health andwellbeing, Hadas spoke about doctors

developing resilience and dealingwith burnout in times of stress, alongwith negotiating skills and how toinfluence people, while StephenMcIvor discussed the skills requiredin taking on and embracing oppor -tunities for change in the aim forgreater progress. Stephen alsodiscussed the importance of medicalprofessionals finding balance in theirwork/life situations and taking careof their mental wellbeing in order tohave the resilience and required focusand energy to deal with the pressuredenvironment that medical practition -ers are exposed to.

A recent study of hospital doctorsin Ireland led by RCPI showed that1-in-3 doctors were found to haveexperienced burnout and up to 10 percent reported severe to extremelysevere levels of depression, anxietyand stress. This occurred despite thefinding that over 70 per cent ofdoctors were strongly motivated topractise medicine. The findings onophthalmology were mixed - mostdoctors in the specialty enjoyed theirwork, but it had the highestproportion of doctors who would notwant others to know if they had amental health problem.

Mental resilience along withemotional intelligence (self-awarenessand of others) were examined during

Keynote speakers at the ‘New Developments in Ocular Imaging’ symposium at the Irish College ofOphthalmologists Annual Conference were: Alex Shortt, Institute of Immunity andTransplantation, University College London, Yvonne Delaney, and Pearse Keane, Moorfields EyeHospital, London.

Continued on page 4 ➥

Anew purpose built Cataract Unit at the RoyalVictoria Eye and Ear Hospital was officially opened

by Minister for Health, Mr Simon Harris on Monday, 3rdJuly.

Capital funding for the unit was provided by theRVEEH Teaching and Development Foundation. The unitis a state of the art facility which was developed to increasetheatre capacity within the hospital and to provide a costeffective solution to increasing waiting lists for cataractprocedures. The development of a cataract unit was one ofthe main proposals detailed in the hospitals ophthalmology

strategy 2015-2020 published in 2015. The opening of the unit has been welcomed by stake -

holders and the hospital is actively engaged in obtainingoperational funding in 2017 and 2018. The hospital hopesto clear its own waiting list by the end of 2018. Waiting listsacross the other 11 hospitals in the Ireland East HospitalGroup are also hoped to be eliminated by the end of 2019.

Currently, there are 3,180 patients on the waiting lists inthe group, with an average wait time of eight and a halfmonths. Without the additional capacity, this was forecastto grow to 12,000 by 2021 due to increasing demand as thepopulation ages. The new unit provides a 36% increase incapacity within the hospital group.

Speaking at the launch, Mr Harris made reference to the

recently published Primary Eye Care Report, promising tomake resources available to implement the primary eye-care strategy. He said the opening of the new cataracttheatre at the Royal Victoria Eye and Ear Hospital "is a realdemonstration that our health service can respond to thechallenges that we face and deliver better outcomes forpatients."

The new cataract unit will be open four days a weekand will prioritise the longest-waiting patients.


the session as a means to creating anenvironment that is motivational inself-determination, and the reciprocalimpacts of behaviours within thatenvironment where explored andconsidered. It was highlighted thatalong with having the role clarity andagreed expectations within a team,that the interpersonal relations andindividual perspectives (‘balance’) arealso factors in reducing antecedents ofpsychological burnout.

Speaking in in his interview withthe Medical Independent ahead of theAnnual Conference, Billy Power saiddoctor burnout is something that isrightfully gaining more attention.College CEO Siobhan Kelly is currentlya member of a HSE working groupdevising a strategy on doctors' health.

Billy said, “A lot of these surveysare anonymised, and you are muchmore likely to get a more truthful typeof a response, whereas sometimes inthe hurly burly of work and so on,probably it is not something people

tend to talk about. It is only with thepublication of these types of surveysthat people realise you can havefeelings yourself [such as] you areworking very hard, the days are very

long, etc, and especially in a highpressure environment, perhapsparticularly in the hospital where theresources that you might hope youhave are not available.”

Billy Power is pictured with Hadas Levy, Psychologist, Royal College of Physicians of Ireland andStephen McIvor, Sports Psychologist and former Ireland and Munster Rugby Player at the‘Adapting and Leading for Change’ symposium, ICO Annual Conference 2017.

Continued from page 3

Minister for Health officially opens Royal VictoriaEye and Ear Hospital Dedicated Cataract Unit

Minister Simon Harris cutting the ribbon on the new Eye and EarCataract Unit.


Findings from a pilot study aimed

at facilitating and implementing

greater support services for patients

diagnosed with sight loss conditions

were presented at the ICO Annual

Conference in Cavan.

Kirk Stephenson presented hisabstract on the study, which is acollaboration between the NCBI andthe eye care team at the MaterHospital, which has facilitated arepresentative of the NCBI beingavailable to service users followingtheir consultation with the ophthalm -ologist. The pilot is examining thebenefit to patients of having an EyeClinic Liaison Officer (ECLO) servicefor the first time in Ireland. The studywas carried out during the weeklyinherited retinal dystrophy (IRD)clinic at the hospital in December 2016and January 2017.

After seeing the doctor, consentwas acquired for the patient to meetwith the ECLO. The role of the NCBIrepresentative is to educate patientsregarding available services andsupports as well as to coordinatetraining in specific supports ifrequired. During the pilot studyperiod, 26 patients were seen by theNCBI Liaison Officer.

Chris White, CEO of the NCBIspoke to delegates at the Conferenceabout the importance of earlyintervention of support services inimproving outcomes for people withimpaired vision.

Chris said, “There are currently51,718 people living with blindness orserious vision impairment in Ireland.NCBI receives approximately 1,700new referrals per year, which webelieve is less than a third of allpeople being diagnosed with seriouseye conditions on an annual basis.Research consistently finds that theprovision of early intervention andsupport at or immediately afterdiagnosis means that people requireless intensive support at a later date,and furthermore, better equips them

with the confidence and skills tomaintain independence.”

Chris added, “Following theoverwhelming positive feedback tothe availability of this service fromparticipants, the NCBI is focused onworking towards our goal ofproviding this service to patientsnationwide. One of the key findingsfrom the study was that 12 per cent ofthe patients who participated in thepilot had never been in contact withNCBI before and were unaware of theavailable supports. Some expressedthe view that they wished it had beenthere when they were first diagnosed;vocalising feelings of isolation, fearand loneliness when they firstpresented with vision problems”.

Evaluating the results of the study,Kirk said that from the ophthalm -ologist’s perspective, this direct linkwith support services is an idealopportunity to maximise visualfunction, independence and quality oflife for patients as part of their on-going treatment plan.

He concluded that the evidencefrom this brief pilot study of an ECLOin the Mater Hospital is positive andin keeping with expectations from UK

data, where eye clinic liaison officersare embedded in the eye clinic service.The aim is to expand this service fromIRD to all visual pathology within theMater and then to recommend theintroduction of ECLOs nationally.

Ireland’s First Eye Clinic Liaison Officer Piloted by NCBI at Mater Hospital

NCBI Chief Executive, Chris White pictured with Alison Blake and Kirk Stephenson at the ICOAnnual Conference 2017

ICO Medal Winners2017Congratulations to the winners

of the ICO Medals for 2017,Christine Goodchild (BeaumontHospital) who was awarded the SirWilliam Wilde Medal for her posteron “An Audit of the Quality ofInpatient Referrals Received byOphthalmology ConsultationService in a Tertiary Hospital andDavid Brinkman, BeaumontHospital, who was awarded theBarbara Knox Medal for his paperon “Comparing the Effectivenessand Tolerability of Preservative-Free Tafluprost Versus PreservedLatanoprost in the Management ofGlaucoma and OcularHypertension”.


Saying the Right Thing…

Opening the session, PatriciaQuinlan outlined the ICO’s guidelineson the consent process which wereformally launched at the ICO WinterMeeting last December, Patriciaadvised that the purpose, potentialbenefits and pitfalls of any plannedprocedures should be fully explainedusing plain language with the patientand fully documented. Common[even if minor] side-effects should bedisclosed, as should rare but seriousadverse outcomes, Patricia toldparticipants, adding that all questionsshould be answered fully andhonestly and the patient should beasked if they fully understand whathas been discussed.

Doctors need to ensure all stagesof the consent process with theirpatients are fully recorded prior toany procedures taking place. It wasdiscussed that the consultant isultimately responsible for obtaininginformed consent, even when the taskis delegated, so the consent processmust be appropriate, thorough,patient-centred and scrupulouslydocumented.

The importance of giving patientsadequate time and privacy to considertheir options or to consult othersbefore signing consent forms wasdiscussed, with the exception ofemergency treatment situations.

The ICO has produced a newrange of patient information leafletson common eye conditions and

procedures and consent process inophthalmology which are available toview on the ICO website. Membersare encouraged to contact the Collegewith any suggestions on the issue.

Addressing the workshop, AngelaTysall, HSE Lead in Open Disclosure,urged transparency and openness asmuch as possible in all dealings withpatients. She stressed the importanceof expressing regret to patients whenthey experience negative outcomes inthe health system, keeping them fullyinformed and providing an explana -tion of what had happened andpotential remedies where possible, aswell as the steps taken to prevent arecurrence of the adverse event. Shestressed that open disclosure is formalHSE policy and is also supported bythe Medical Council. Protectivelegislation will appear in the CivilLiability Amendment Bill 2017.

Angela reiterated that an apologyis not an admission of guilt, is veryimportant to patients and helpspromote a more open culture andlearning from mistakes.

Patricia McGettrick outlined theAssisted Decision Making (Capacity)Act 2015 which is now law andstressed that doctors need tofamiliarise themselves with its contentand requirements. The law essentiallyprotects people who may lackcapacity and allows someone theytrust to help them make decisions inrelation to their care.

(l-r) Patricia McGettrick, Angela Tysall, Lead in Open Disclosure, Quality Improvement Division,HSE and Patricia Quinlan, speakers at the workshop on Open Disclosure, Consent Process andAssisted Decision Making, pictured at the Annual Conference 2017.

ICO Ethic’s Committee members Patricia Quinlan and Pat McGettrick co-

ordinated a workshop on informed consent, open disclosure and assisted

decision-making at the ICO conference in Cavan. Patricia and Pat were

joined by HSE Lead for Open Disclosure, Angela Tysall at the session.

Assisted Decision Patricia McGerick from theCollege’s Ethics Commieeoutlines the implications forDoctors of the AssistedDecision Making legislation.

The Assisted Decision-Making(Capacity) Act 2015 was signed

into law by President Higgins inDecember 2015 and has implicationsfor those of us who work in healthand social care. It replaces the LunacyRegulations (Ireland) Act 1871 andwill enable Ireland to finally ratify theUnited Nations Convention on theRights of Persons with Disabilities. Atthe root of the new legislation isrecognition that we all have equallegal Rights, but some of us may needhelp to exercise our Rights and makeinformed decisions.

About the Assisted Decision-Making (Capacity) Act 2015:The 2015 Act reforms Ireland’scapacity legislation. It recognises theright of those aged eighteen and olderto make their own decisions abouttheir general welfare and health. Itestablishes a framework to supportthe decision-making ability of adultswho lack capacity or may lackcapacity in the future, eithertemporarily or permanently, whetherbecause of mental illness, intellectualdisability, or cognitive impairmentdue to acquired brain injury ordementia. It sets out the statutorycriteria for assessing capacity and theguiding principles that must befollowed to ensure that a person canmake informed decisions and giveinformed consent.

It places an obligation on healthand social care professionals tofacilitate persons and support them tomake decisions on their own behalf. Itprovides a legal framework so that aperson who lacks capacity, or maylack it in the future, can have thesupport of a person of their choicewhen making a decision, so that thosedecisions are legally binding.

The Act covers decisions as farranging as day to day issues of whatto wear and eat to complex decisions


Making – what you need to know and whyabout residence, property, financesand consenting to medical investiga -tions and interventions. It alsoprotects a person’s right to makedecisions which may seem unwise toothers, such as refusal of medicaltreatment. The Act brings to an endthe Ward of Court structure. All Wardsof Court (currently 2700 in Ireland)will have their capacity reviewed overthe next three years and depending onthe outcome of the capacityassessment will be discharged fromward -ship completely or will besupported under the decision-makingsupport framework.

The Decision-Making SupportFramework:The 2015 Act allows a person whosedecision-making capacity may be inquestion to enter into a formalagreement with someone they trust tosupport them to make decisions. Thereare a range of agreements withdiffering levels of support dependingon the person’s needs, which in turndepends on their level of capacity. Theperson who requires decision-makingsupport is known, within the Act, asthe relevant person and their chosensupporter, who may be a familymember, or friend, is known as theintervenor. The relevant person canhave different agreements anddiffering levels of support for differentdecisions and from differentinterveners. There must be nopotential conflict of interest betweenthe intervener and the relevant person.

Governance:The role of Director of DecisionSupport Service (DSS) has beenestablished within the Mental

Commission in accordance with theAct. The Director will promote publicawareness of the 2015 Act andprovide guidance to relevant personsand interveners as well asorganisations that interact with themsuch as the HSE. The office of the DSSmust also establish, maintain andreview a Register of co-decision-making agreements and decision-making representative court orders aswell as Advanced HealthcareDirective (AHCD) and EnduringPower of Attorney (EPA).

What does Capacity mean?Capacity to make decisions is definedwithin the Act as “the ability tounderstand, at the time a decision isbeing made, the nature andconsequences of the decision in thecontext of the available choices”. TheAct sets out a functional test for theassessment of capacity. A functionalapproach recognises that a person’scapacity can fluctuate over time,depending on their state of health,either physical or mental. A person isconsidered to lack capacity if even oneof the following functions are lackingand the person does not have theability –1. To understand the information

relevant to the decision2. To retain that information long

enough to make a voluntarydecision

3. To use or weigh that informationas part of the process of makingthe decision, or

4. To communicate their decision.

Implications for DoctorsCapacity reflects the ability to giveinformed consent. Except where

emergency intervention is necessary, aperson must either have capacity todecide to consent to treatmentrecommended for them, or must havean appointed Co-Decision-Maker orDecision-Making Representativeacting with them or on their behalf.These are now legally bindingconditions, thus safeguarding aperson’s autonomy and right tochoose, even if the choice is to refusetreatment that may, in the opinion ofothers, improve their health or qualityand length of life. The assessment offunctional capacity is complex andcan be emotive for the person beingassessed and their family members.Any unnecessary capacityassessments or finding of lack ofcapacity contravenes the Act.Healthcare professionals have a dutyto help the relevant person to make,communicate and implement theirown decision and in most cases thiswill be successful without the need toconsider the formal range of optionslaid out here and embedded in theAct. Where clinical care is required forsomeone who does lack capacitydoctors will have to ensure theyidentify and communicate with therelevant person’s designated Co-Decision Maker or Decision-MakingRepresentative. Protocols for practicalimplementation of the Act have yet tobe developed and circulated.

Implementation of the ActThe HSE has produced comprehens -ive guidelines, currently in draft form.Within the HSE a Training andEducation Working Group andInformation and CommunicationWorking Group has also beenestablished and guidelines and Codesof Practice will be drawn up anddisseminated to all Health and SocialCare Professionals. It is expected thatthe Irish Medical Council and otherrelevant professional bodies willupdate their Capacity and InformedConsent guidelines in accordancewith the new legislation.

Further information:

www.assisteddecisionmaking.ie

[email protected]

Decision-Making Assistant ( DMA)

Assists in decision makingMakes sure relevant persons decisions are implemented

Co-Decision Maker ( CDM)

Makes decisions jointly with relevant person

Decision-Making Representative (DMR)Appointed by CourtScope depends on Court order

Relevant person has capacity but requires support togather information, personal records etc.Relevant Person makes decision

Relevant person lacks capacity to make decision withoutthe help of a CDM. A legal agreement is entered into withthe consent of the relevant person. Decision is made jointly with CDM

When relevant person lacks capacity to appoint a DMA orCDM and in the absence of Advanced Healthcare Directive(AHCD) or Enduring Power of Attorney (EPA).Decision is made by DMR

Prof Doug Veale, ConsultantRheumatologist, St Vincent’sUniversity Hospital, Dublin, gave apresentation on managing inflam -matory disease with biologics and therelevance for ophthalm ologists duringa breakfast symposium supported byAbbVie.

The link between uveitis andspondyloarthropathies (SpA) washighlighted and Prof Veale promotedthe usefulness of DUET (DublinUveitis Evaluation Tool), an algorithmdeveloped to assist the earlierdiagnosis of SpA by ophthalmologistsin acute anterior uveitis.

Prof Veale said DUET is verysimple and focuses on the presence orabsence of inflammatory back pain, soif patients have back pain that isworse in the morning time and getsbetter with exercise, that is the key.

Discussing the use of the variousbiologics, he concluded that mono -clonal antibodies seem to have ahigher level of efficacy than the fusionproteins in treating uveitis and SpA,with promising new agents in thepipeline. He said fusion proteins aresuitable for rheumatoid arthritis andseem to work very well but not sowell for anterior uveitis and theseronegative diseases.

Prof Richard Farrell, ConsultantGastroenterologist, ConnollyHospital, Dublin discussed thediagnosis and management of gutinflammation in ophthalmologypatients at the breakfast symposium,calling for greater collaborationbetween specialties and for doctors toask about symptoms outside theirown disease areas, i.e., do IBDpatients have eye symptoms or jointsymptoms and do eye patients havegut symptoms, etc.

Prof Farrell explained that suspectIBD symptoms in ophthalmologypatients can include chronic diarrhoea,abdominal cramps, rectal bleeding,weight loss, anaemia and raisedinflammatory markers (WBC, ESR,CRP), though the majority of thesepatients will have IBS, haemorrhoidsand gastroenteritis rather thanunderlying IBD.

He also explained that ocularmanifestations are more common infemales and those with colitis andpatients with other extraintestinalmanifestations. Episcleritis, scleritisand anterior uveitis are the mostcommon ocular manifestations ofunderlying IBD and treatment of theunderlying IBD can cure the eyepathology, he noted, adding thatsteroids and anti-TNF therapies areeffective for chronic scleritis anduveitis.

Prof Farrell highlighted that IBDtherapy can cause ocular pathology,including posterior subcapsularcataracts, glaucoma and opportunisticophthalmic infections induced bysystemic or topical steroids, opticneuropathy, nystagmus, ophthalm -oplegia caused by cyclosporine andanti-TNF therapies, while metho -trexate can build up in tears and causeconjunctival/corneal irritation.


Link between eye disease and rheumatoidand gastroenterology conditionsdiscussed at ICO Conference

Prof Doug Veale Prof Richard Farrell

Recurrent uveitis can be indicative that a patient has an underlying

autoimmune disease such as ankylosing spondylitis, so these patients

should be referred to a rheumatologist, while gut-related symptoms in eye

patients can be indicative of inflammatory bowel disease (IBD), delegates at

the ICO Annual Conference heard.

ProfessionalCompetence SchemeUpdateDoctors registered with the

Medical Council must enrol on aprofessional competence scheme andachieve a minimum of 50 points eachyear through educational andlearning activity. An annual audit ofan aspect of practice must also becarried out. The only exception is fordoctors who are on a structuredtraining scheme.

This year on the Medical Councilannual retention form, doctors wereasked to specify what scheme they areenrolled on and what date they paid theenrollment fee. The PCS year runs fromMay 1st to April 30th and retentionmust be completed by July 1st. Thewindow between May 1st and July 1stis the time during which doctors mustre-enrol and pay the PCS fee.

From now on, CME points forCollege organised meetings and eventswill be directly uploaded to membersPCS accounts. Please ensure that yousign the delegate list for any Collegeorganised meeting you attend andinclude your Medical Council number.You will need to continue to uploadpoints for any meeting you attend thathas not been directly organised by theCollege.

If you have any questions aboutPCS or need any assistance is using theonline portal please contact the ICOoffice.

MunsterOphthalmology –Vision for theFuture Study Day The Munster Ophthalmology – Visionfor the Future Study Day will takeplace at The Castletroy Hotel inLimerick on November 10th. Theprogramme will include six talkspresented by consultants from acrossthe public and private sectors and isopen to young ophthalm ologists,ophthalm ologists and ophthalmicnurses. The final part of the event willbe case studies and papers presentedby young ophthalmologists.


Stephen will undertake afellowship in PaediatricOphthalmology and Strabismus at theUniversity of British Columbia,Canada. The department of PaediatricOphthalmology in B.C. Children’sHospital manages the entire spectrumof paediatric ophthalmic conditions asthe only tertiary referral centre forBritish Columbia, serving apopulation of over 4.7 million.

Speaking about the opportunity,Stephen said, “The exposure iscomprehensive, working in a facultywhich manages the entire range ofpaediatric eye conditions includingcongenital anomalies, paediatriccataract, paediatric glaucoma,paediatric ocular malignancy andinherited retinal diseases.”

Teaching is an important elementof the academic mission in thedepartment. In addition to twoclinical fellows in paediatricophthalmology and strabismus,neurology and neuro-ophthalmologyfellows and ophthalmology residentsfrom the University of BritishColumbia are taught in theDepartment. There is one fundedfellowship position (McCormickFund) in Paediatric Ophthalmologyand Adult Strabismus per year, whichwas awarded to Stephen for 2017.

Dr. Christopher Lyons who iswidely recognized internationally inthe area of Paediatric Ophthalmologyand Strabismus supervises thefellowship.

Elizabeth McElnea has begun herfellowship this summer in MacclesfieldDistrict General Hospital in Cheshireto undertake comprehensive trainingin ophthalmic plastic, lacrimal, orbitaland reconstructive surgery.

Speaking about the opportunity,Elizabeth said, “This position offerswhat I hope will be unrivalledexposure to the clinical and surgicalmanagement of ophthalmic plastic,lacrimal and orbital disease, theopportunity to attend multi-disciplinary meetings and teachingsessions in three further centres in theUnited Kingdom – the RoyalLiverpool Hospitals NHS Trust, TheCentral Manchester Foundation NHSTrust and The Christie Hospital aswell as the chance to produce a bodyof research work that is of highquality and adds to the evidencebased practice of this ophthalmicsurgery subspecialty.”

We wish Stephen and Elizabethevery success on their Fellowshipprogrammes and look forward tohearing updates from both on theexperience.

ICO Trainees Awarded RichardSteeven’s Fellowship

Healthy DoctorsStrategy

College CEO Siobhan Kelly is

participating in a project

group tasked with making

recommenda tions to the HSE on

the development of standards for

the wellbeing of doctors in their

employment.

The group which is led by DrLinda Sisson, the National ClinicalLead in Workplace Health andWellbeing, has a wide representa -tion from across the health service,including NCHDs, Public andOccupational Health Specialists,Psychologists and others with abackground or interest in the area.

The project aims to propose aset of standards applicable to theIrish health service that willsupport the well-being of doctorsat all stage in their careers frommedical school, through training,specialist practice and intoretirement. The work of the groupaims to promote individualresponsibility for health and well -being, emphasising wellness andprevention as the starting point butwill reflect the very real challengesof the current workload in a systemwhere capacity does not meetdemands.

The group is drawing on arecent NICE publication onHealthy Workplaces which aims tomake health and well-being anorganisational priority.

Pictured at the induction day for trainees onthe International Medical Graduate TrainingProgramme which was held in the RoyalCollege of Physicians of Ireland on Monday4th July are (l-R) Muhammad Omar Ashraf,College of Physicians & Surgeons of Pakistan(CPSP), Siobhan Kelly ICO, Ayat Abu-Agla,Sudan Medical Specialisation Board, DrHafiz Syed Rehman, CPSP, Yvonne DelaneyICO, Zubair Idrees, University Hospital Corkand Niamh Coen ICO.

IMG Induction2017

Congratulations to Stephen Farrell and Elizabeth McElnea on being

awarded the HSE Dr Richard Steevens Fellowship for 2017.


ICO GALA

Tim Carpenter and Denise Curtin Alison Blake and Billy Power Barry Power and Claire Harnett

Sinead Connolly, Christine Goodchild, Gillian O’Mullane and Aoife MacCann

Loretta Nolan, Grace O’Malley, Maureen Hillary, Geraldine Comer andAnn McCarthy

Frank Phelan, Nafa Bader, Deborah Wallace and Dharm Pandeya

The 2017 Irish College of

Opththalmologists

Annual Conference was

held in the Slieve Russell

Hotel, Co. Cavan on 17th to

19th May.

Over 200 delegates attended

the meeting and the college

welcomed speakers from the

UK and Australia, together

with local experts.


A DINNER

Aine Ni Mheoloid, Treasa Murphy and Ruth Ellard Patricia Quinlan, Aziz Rehman and Susan Kelly

Yvonne Delaney, Patricia Logan and Patricia McGettrick Elizabeth McElnea, Sarah Moran and Qistine Pilson

Dharm Pandeya, Michelle McNicholas, Marie Hickey Dwyer andKesavan Ravikumar

Richard Comer, John Doris and Tom Stumpf


Retina 2017 – Expert Pioneering Connected

This year, Retina 2017 will explorerecent research trends and clinicaladvancements in retinal health. Theconference has multiple elementsincluding a breakfast briefing onconnecting clinical practice withresearch as a clinician-scientist, keynotesessions, poster and oral presentationsand evening reception. Retina 2017therefore acts as a perfect platform toshare experience, facilitate networking

and hear from the many national andinternational speakers.

Prof Michel Michaelides is aConsultant Ophthalmologist atMoorfields Eye Hospital and a Professorof Ophthalmology in the Department ofGenetics at the UCL Institute ofOphthalmology. His clinical andresearch interests include diabetic eyedisease, age-related maculardegeneration and inherited eye disease

in adults and children.Dr Elise Héon is a clinician-scientist

in the field of ocular genetics at theHospital for Sick Children, Canada. Herclinical work focuses on themanagement of hereditary eye diseases,which include hereditary cancer(retinoblastoma) and other non-cancerous blinding conditions such asretinitis pigmentosa.

Prof Artur Cideciyan is from theDepartment of Ophthalmology at theUniversity of Pennsylvania and has aspecial interest in outcome measures inpatients with severe vision loss.

Retina 2017 takes place Friday,October 13, in the Radisson Blu RoyalHotel, Golden Lane, Dublin 8.Attendees will receive 7 external CPDpoints from the Irish College ofOphthalmologists.

The annual Retina Conference is organised by Irish patient led-charity

Fighting Blindness and brings together leading academic and clinical

researchers in the global effort to find treatments and cures for sight loss.

Funding is available through the ICOfor Trainees and NCHDs on theContinuing Professional DevelopmentSupport Scheme to attend themeeting.

Simply use the promo codeICO1983 when registering online atwww.Retina.ie. For more pleasecontact us on 01 6789 004 [email protected].

SOE Lecture 2017

Ian Dooley, European Society of Ophthalm ology Lecturer for 2017 on‘Retinal Detachment – Past, Present and Future’ at the ICO 2017 AnnualConference is pictured with SOE Board Member Pat Logan. In his lecture,Ian stressed the importance of rapid medical intervention for patientswho suffer a retinal detachment. The sooner the patient is treated, the lessinvasive treatment can be and the better the visual outcome. Patientslose about a line of vision for every three days a retinal detachmentremains untreated. For primary retinal detachments, the reattachmentsuccess rate is about 85-to-90 per cent and in secondary detachments,about 75 per cent. In the last 10 years, there have been noteworthyimprovements in treatment (small-gauge surgery, better tamponades,stains and viewing systems) and earlier detection of retinal detachment.

Scope Ophthalmics Education and Travel Bursary

Pictured at the announcement of the winner of the Scope OphthalmicsEducation and Travel Bursary Prize at the Irish College ofOphthalmologists Annual Conference which took place in The SlieveRussell Hotel, Cavan (17th-19th May) were, John Freyne, Director atScope Ophthalmics Ltd; winner of the prize, Margaret Morgan, StConal's Hospital Letterkenny; Fiona Kearns, and Alison Blake. ScopeOphthalmics sponsored an educational and travel fund as the prize forthe best case submitted for the Medical Ophthalmologists workshop atthe annual conference in Cavan.

Orbis helped establish Vietnam’sfirst national eye bank and funded thefirst wet lab in Vietnam, whereophthalmologists can developsurgical skills. Orbis initiated thedevelopment of the first workinggroup in Vietnam on VISION 2020 – aglobal effort to eliminate avoidableblindness by the year 2020. Orbis hasalso opened two Child Friendly EyeCare Units in rural Phu Tho and HaNam provinces in 2011 thusstrengthening Vietnam’s capacity toaddress childhood blindness bysetting up the first paediatric eye carenetworks of skilled health personnel.

In April 2017, I travelled with TonyMcAleer to Vietnam, where we werejoined by Dr Andrew Choyce(Anaesthetist) and Xia Ying Liu(Flying Eye Hospital nurse) toundertake a week-long hospital basedprogramme in Binh Dinh Hospital.

Binh Dinh is located in the southcentral coastal zone. The Orbispartnership with Binh Dinh EyeHospital commenced in 2015. One ofthe objectives was to establish a childfriendly facility and trained medicalteam to provide comprehens ive andquality paediatric ophthalmologyservices and act as a regionalpaediatric tertiary referral centre forBinh Dinh province and adjacent

regions (11 referring hospitals). BinhDinh Eye Hospital is a stand-aloneeye hospital with 100 beds locatedover three floors.

The goal of the programme was toundertake hands on training instrabismus surgery with two trainees,provide paediatric anaesthesiatraining and advise on theestablishment of a paediatricophthalmology department.

One trainee had undertaken a oneyear fellowship in paediatricophthalm ology in Indai and hadrecently returned to Binh Dinhhospital. The second trainee had

undertaken six months postresidency training in Ho Chi MinhCity. Interestingly in Vietnamtrainees do not receive hands onsurgical training during their fouryear residency training. Despite this,both trainees demonstrated goodsurgical skills.

The earlier part of the weekinvolved assessment of surgicalcases which had been pre-screenedvia the Orbis Cybesight website. Thetrainees uploaded clinical detailsand photos for review by the trainersto evaluate their suitability astraining cases during theprogramme. 12 strabismus caseswere selected and used to teachclinical assessment, examinationtechniques and surgical planning.The selected cases underwentsurgery in the course of the nextthree days. The cases includedstraightforward strabismus cases,paralytic strabismus and reoperationfor residual and consecutivestrabismus.

The latter half of the week wasspent developing the roles andresponsibilities of the various staffmembers within the paediatricdepartment. In addition the layout ofthe department was finalised andagreed with the medical director.

This was the first hospital basedprogramme in Binh Dinh EyeHospital and was followed by aFlying Eye Hospital programme inMay.

This was a very enjoyable andrewarding trip – both for us and thetrainees – in no small part because ofthe enthusiasm of all the staff weencountered, the generosity of ourhosts and the beauty of Vietnam. Wewould happily return.


Orbis Vietnam Trip

Vietnam has an estimated population of 92 million (2016) andapproximately half a million people are known to be blind. Poor eye

care, infrastructure, a shortage of trained ophthalmic professionals andlimited access to affordable quality eye care services encumber the nation’seye care situation.

Report by DOnAL BROSnAHAn

Donal Brosnahan pictured with Orbis colleagues in Viatman.

Orbis team pictured during surgical training at weeklong hospital based programme which tookplace in Binh Dinh Eye Hospital, Vietnam in April 2017

The ICO is delighted to confirmthe continuation of the

ICO/novartis Eye Research Bursaryfor 2017 and to announce the detailsfor this year’s application process.

Now in its 6th consecutive year,the annual bursary is an unrestrictededucational grant awarded to a doctorwho wishes to undertake a researchproject or specific training in the fieldof ophthalmology.

The College thank Novartis fortheir on-going support of thisfantastic opportunity which has beeninstrumental in facilitating eyedoctors in Ireland to undertakepioneering research into potential

cures and treatments for sight-threatening conditions.

At this year’s ICO AnnualConference in Cavan, the winners' ofthe awarded funding for theICO/Novartis Eye Research Bursaryin 2016, Sinead Connolly and ReinoldGoetz, presented an update on theirprojects.

Sinead Connolly's research focusedon developing new therapies for dryeye disease in Sjögren’s syndrome, anautoimmune condition characterisedby severe dry eye. Reinold Goetzexamined potential new areas fortherapeutic targeting in the treatmentof primary open angle glaucoma.


Irish College of Ophthalmologists announce detailsof ICO/Novartis Research Bursary 2017

Dr Reinold Goetz (left) and Dr Sinead Connolly (2nd right) are pictured with Miss Marie Hickey-Dwyer,Irish College of Ophthalmologists (2nd left) and Dr Jennifer Coppins, Medical Adviser, NovartisIreland (right) at the announcement of the winning projects for the ICO/Novartis Eye ResearchBursary 2016-17 which took place at the Annual Adare Retinal Meeting on the 29th September.

ICO/Novartis EyeResearch Bursary2017 – ApplicationProcess The ICO is inviting interestedmedical practitioners to submittheir applications to the College byMonday 4th September, 2017. Thewinner will be announced at theAnnual Adare Retina Meeting onThursday, 28th September 2017.

The applicant should

include the following in

their entry submission:• A detailed outline of your

research project or specifictraining, including how this willimpact patient care andoutcomes in Ireland

• Evidence of support from asenior ophthalmologist assponsor

• Breakdown of costs

The prize is not restricted to eyedoctors in training and those inpractice are encouraged to considermaking a suitable application.Further details are available onwww.eyedoctors.ie.

Your TrainingCounts Survey2017The Medical Council’sannual national traineeexperience Your TrainingCounts survey, has beencirculated to over 2,500trainees in the past coupleof weeks. The survey willbe open for a period of 12weeks. This is the fourthyear of the survey.

For a number of years theOphthalmology Department of theRoyal Victoria Eye and Ear Hospital,Adelaide Road, Dublin 2 operated a24 hour on-site on-call serviceprovided by our Senior House OfficerBasic Specialist Trainees. Following aperiod of 24 hours on-site on-call,SHOs would receive the requiredcompensatory rest period and weretherefore absent for the followingday’s training activities. This system,while allowing the Hospital to main -tain a 24/7 emergency ophthalmicservice and achieve EWTDcompliance had two significantunsatisfactory side-effects; it wasdetrimentally affecting trainingopportunities for both BSTs andHigher Surgical Trainees and itreduced patient throughput.

The Ophthalmology Departmentand RVEEH Hospital Managementwere acutely aware of this negativeimpact on training and the associatedadverse effect on patient throughputduring core hours. The hospital wasdetermined to find a solution whichwould allow the hospital to continueto provide 24/7 ophthalmicemergency care while ensuring thattrainees maximised their exposure tohigh quality training. A system had tobe identified which would protectpatient throughput withoutnegatively impacting NCHDcompliance with the EWTD require -ment that medical staff do not work inexcess of 24 hours while also receivingappropriate compensatory restfollowing periods of work.

In January 2017, the RVEEHintroduced a new system of on-callwhich relies on overnight on-site on-call services being provided byResident Medical Officers (RMOs).The RMOS are all fully registered with

the Medical Council of Ireland and aregenerally undertaking research. TheRVEEH BSTs provide on-call cover on-site until 10pm after which a RMOprovides in-house cover. The RMOshift commences at 9pm allowing for aone hour handover period. The SHOis off-site from 10pm – 9am andrecommences duties the followingmorning. Currently the RVEEH hasengaged a number of RMOs, somewith previous ophthalmologyexperience and some without. Onnights where the RMO has previousophthalmic experience the BST is off-call, however when a RMO who doesnot have the requisite ophthalmologyexperience is rostered, the BST is off-site on-call and available to return on-site should an ophthalmic emergencyarise. In the event the BST has toreturn to the hospital they areprovided with the requisitecompensatory rest the following day.

Benefits of the current system

include the following:

1) BSTs are routinely available fornormal duties each day and aretherefore maximising their trainingopportunities.

2) BSTs are available to work withtheir assigned team. Under theprevious system BSTs werecontinually rotating betweenteams which made continuoustraining difficult as trainees wereunable to fully develop a trainingrelationship with a dedicated teameach six months.

3) HSTs are better supported byhaving the BST assigned to theirteam working with them every day.

4) Consultant staff are better able toprovide training opportunities dueto the regular availability of theirBST.

To date there is a high level ofsatisfaction with the positive impactthis change in practice in the RoyalVictoria Eye & Ear Hospital hasbrought about. This new approachcontinues to be audited and reviewedto ensure that it is meeting the needsof both trainees and the hospital. Thepriorities in this process continue tobe maintaining patient safety,maximising training activities for alltrainees while also maintainingcompliance with EWTD legislation.The RVEEH intends to continue toactively review service provision inorder to achieve the best results for allstakeholders.


The Royal Victoria Eye & Ear Hospital –A New Approach to European Working Time Directive Compliance

Niamh Coen

We are delighted to welcome NiamhCoen as a new member of theCollege’s Administration team.Niamh has over three yearsexperience in training adminis tra -tion, having previously worked inthe Dept of Surgical Affairs in RCSI.Niamh was part of the teaminvolved in the implementation ofthe run through surgical trainingpathway in RCSI. Niamh is currentlyreviewing HST assessment processesand documentation, and will provideadministrative support to thetraining programmes.

Compliance with European Working Time Directive legislation has

proven to be complex for all hospital units in Ireland but the difficulties

with creating a workable roster are particularly acute in standalone specialist

units where cross-cover between specialties is unsuitable.


In 2010, the President of the HighCourt established A Working Group onMedical Negligence Litigation andPeriodic Payments. Its remit includedthe examination of the system withinthe courts for the management ofclinical negligence claims; theidentification of shortcomings and themaking of recommendations to remedyany such shortcomings. The WorkingGroup’s findings and recommendationsare contained in its second report,submitted to the President of the HighCourt, in March 2012 (Working Groupon Medical Negligence and PeriodicPayments Report (Module 2) 2012).

In December 2015, the Legal ServicesRegulation Act 2015 (Section 219, LegalServices Regulation Act 2015)introduced provisions to govern clinicalnegligence claims. In her article, MsColeman confirmed that while therelevant part of the Act has yet to comein to force, when it does it willsignificantly change the way clinicalnegligence claims are managed.

Pre-action ProtocolThe Act provides for the intro -

duction of a pre-action protocol forclinical negligence claims. It will includerequirements which MUST be compliedwith BEFORE such claims are filed incourt. The purpose of the pre-actionprotocol is to:• encourage early resolution of

allegations relating to possibleclinical negligence,

• promote prompt communicationbetween potential parties to litigation,

• facilitate early identification of theissues in dispute,

• reduce the number of claims filed incourt, and

• encourage early settlement ofclinical negligence claims.

How will this be achieved?Regulations will be introduced to

compel early and prompt disclosure ofdocuments and information necessaryto facilitate assessment of a potentialclaim. Specific time limits will be

introduced. The pre-action protocol willprovide for:• disclosure of medical and other

records• notification of allegations of clinical

negligence• responses to such allegations• disclosure of material relevant to

allegations and responses• agreement to submit issues for

resolution other than by a court e.g.mediation.

Regulations will be introduced to compelearly and prompt disclosure of docu -ments and information necessary tofacilitate assessment of a potential claim.

Time LimitsTime limits will be introduced for

completion of the stages of the pre-action protocol. They have the potentialto put significant pressure on availableresources within healthcare facilitiessuch as hospitals.

A similar protocol in England andWales provides that medical and otherrecords must be disclosed within 40days. Once a detailed letter of claim isserved, a potential defendant has 4months within which to provide adetailed letter of response.

Beforehand, there is an obligation towrite a letter of notification detailing thenature of the claim in contemplationand provide identific ation informationwith regard to the relevant patient andhealthcare provider. A potentialdefendant is then in a position tocommence its investigation and notifyindemnifiers and/or the NHS LitigationAuthority.

Powers of Court In this jurisdiction, the court will

have the power to direct that a claimmay not proceed further until the stepsrequired by the pre-action protocol havebeen taken. In addition, failure tocomply with a requirement of the pre-action protocol may attract penalties inrespect of costs and, in the event a claimis successful, interest on compensationawarded.

Ms Coleman highlights, that to beeffective, realistic time limits forcompliance with the various stages ofthe pre-action protocol will have to beintroduced and enforced by the courts.She identifies that England and Waleshave achieved very significantreductions in the number of casesproceeding to court. Those that do areresolved more quickly as the pre-actionprotocol facilitates early identification ofthe issues in dispute between theparties.

Pre Action Protocol’s outlined by States ClaimsAgency Head of Clinical Litigation

Arecent article in the State Claims Agency’s newsletter by Head of

Clinical Litigation, Siobhán Coleman, outlined the pre-action protocols

and provisions contained in the Legal Services Regulation Act 2015, aimed at

improving the management and governance of clinical negligence actions.

Pinar Aydin O’Dwyer, Professor of Ophthalmology and Neuro-ophthalmologist, Ankara, Turkey,guest speaker at the ICO Annual Conference is pictured with Patricia McGettrick.

Ophthalmology in Art


Special PrismGoogles help IrishJockey Robbie PowerWin CheltenhamGold Cup

Following care received by Ian

Flitcroft and Dublin

Orthoptist, Clare Sheehan, Irish

jockey Robbie Power raced to gold

cup victory at Cheltenham 2017

despite having suffered a serious

eye injury last summer which left

his future career in horse racing

uncertain.

Robbie was injured at theGalway Festival in July 2017 whenhe was kicked in the left eye as ahorse passed above him. He broke acheekbone and received a complexfracture of his left eye-socket, withadditional damage to the muscle onthe floor of his eye-bed. He haddiplopia in upgaze which wasparticularly troublesome due to thecrouched position required whenracing.

The solution was to fit a Fresnelprism on his riding gogglesspecially calibrated to be used inthe riding position.

Speaking to the Guardiannewspaper following theCheltenham race, Robbie said, “Iwear specially treated goggles tocorrect the double vision. It doesn’taffect me in everyday life. I can stilldrive and everything else is fine.It’s only a problem when you’re ona horse, looking out of the top ofyour eyeball.”

He added, “It was an unbeliev -able feeling. I’d say I appreciated itmore than winning the Nationalbecause I’m 35 now, not 25. Butthey’re the two biggest races injump racing. I’m very lucky to havewon both.”

Robbie has been told thatsurgery could be an option for himbut given how well the correctiveprism goggles have worked for himrecently he has said that he is nottempted to undergo surgery at thecurrent time.

The ICO has become a member ofthe Healthy Ireland network, an

initiative involving numerousorganisations from across the countrywhich aims to boost the nationalmovement for health and wellbeing.

The Healthy Ireland Network waslaunched by An Taoiseach Enda Kennyand Healthy Ireland Council ChairKeith Woods in Dublin Castle onThursday, 18th May.

The first phase of the new HealthyIreland Network has been establishedby the Council to get all types oforganisations across the country to sign-up to combined efforts to improvehealth and wellbeing of the Irishpopulation. The ICO pledged oursupport to the initiative in line with ouron-going engagement with theDepartment of Health and HealthyIreland Council members on eye healthrelated priorities and our overarchinggoal of achieving a national eye healthawareness initiation to form part of theoverall health and wellbeing plan.

The purpose of the Healthy IrelandNetwork is to establish and grow anempowering national movement thattreats health and wellbeing as anindividual and collective respons ibility,to support and advocate for the goalsand vision of Healthy Ireland and toensure the Healthy Ireland message isspread, understood, and acted onthroughout Ireland.

The Taoiseach was joined by Ministerfor Health Simon Harris and Minister ofState Marcella Corcoran Kennedy at theevent in Dublin Castle.

Acknowledging the good workalready underway in implementing theHealthy Ireland Framework, theTaoiseach said: “The health andwellbeing of our people is our mostvaluable resource which is why theimplementation of Healthy Irelandcontinues to be a priority for thisGovernment. We all have a role increating a healthier Ireland, a placewhere health and wellbeing is top ofeveryone’s mind and where no-one isleft behind. This new Network will beimportant in ensuring the HealthyIreland message is spread, understoodand acted on throughout all sectors inour society and all parts of the country.”

Minister for Health Simon Harris

said, “The Healthy Ireland Frame worksets out a blueprint for how we go aboutaddressing the many public healthchallenges we have such as the rise inchronic diseases. These are challengesnot just for the health services but for thegovernment and country as a whole. Wehave made a good start in implementingHealthy Ireland and I wish to publiclyacknowledge the commitment andcontribution of other Ministers and theirDepartments to this agenda. Howeverall parts of society need to be involvedfor health and wellbeing policies to havemaximum impact and to reduce healthinequalities. The Healthy IrelandCouncil and Network are so importantto this. This new Network will helpcreate a critical mass to generate afundamental shift in how we think andact on health and wellbeing, and themany factors that can impact onpeople’s quality of life.”

The new Network provides aplatform for the supportingorganisations to connect with eachother, communicate about what they aredoing and contribute to activelybringing Healthy Ireland to life acrossthe country. I encourage people andorganisations to avail of the resourcesand supports available under HealthyIreland, to help them do that.”

The ICO was invited to participateduring the initial membership of theHealthy Ireland Network, nominated bythe Healthy Ireland Council. TheNetwork includes a wide range oforganisations including those repres ent -ing Local Authorities, GovernmentDepartments, sports bodies, voluntary,community and charity sector organis -ations, cancer support organisations,Traveller support organisations,advocacy groups for older people,healthcare professional bodies, unionsand professional representative bodies,business groups, educational institu -tions and private sector companies.

To find out more about HealthyIreland, members can visitwww.healthyireland.ie. The Collegewelcome any feedback or ideas inrelation to activities or events that thewe can support or contribute to whichpromotes the Healthy Ireland visionand focus on eye health as part ofoverall health and wellbeing.

ICO joins Healthy Ireland Network inon-going commitment of HI Agenda


From July 2018, the pathway formedical and surgical ophthalmologywill be distinct from Day 1 oftraining rather than at the end ofYear 3 as it currently is. Applicationsfor the two programmes will beopened in November for July 2018start.

Training in medicalophthalmology has undergone anumber of changes in recent years.The most recent change occurred in2014 and with a significantrestructuring of post-BST training.The aim of the modification was tobring clarity to the training pathway,embed a robust assessment processwith a well-defined performancestandard and to equip the finalpractitioner with greater expertise inthe areas of paediatrics, glaucomaand medical retina.

Despite this new structure,trainees are still not entering themedical ophthalmology program inthe numbers necessary to producean adequate workforce of medicalophthalmologists to meet currentand future eye-care need. Carefulanalysis revealed that the currentcommon core entry processprimarily attracts trainees wishing topursue a surgical career.

The College has a responsibilityto respond to the changing demandfor eye care and to ensure thatmedical graduates choose to train asophthalmologists and must reactaccordingly. In order to aligntraining to meet future eye careneed, the ICO recognises thattraining program must produce apredictable and sustainable

workforce of ophthalmologists withhigh quality, evidence-based clinicalexpertise targeted to the three mainspecialties of paediatricophthalmology, glaucoma andmedical retina.

In July 2018, the ICO willcommence a stand-alone MedicalOphthalmology Training Program tospecifically highlight the demand formedical ophthalmology services andto promote it as an expanding andinteresting clinical specialty withvaried career options. By structuringa separate entry point the selectionprocess can target those interested inmedical ophthalmology from theoutset. The communication drivethat will accompany the launch ofthe new program will target thosewith an interest in the specialty ofophthalmology and highlightmedical ophthalmology as analternative viable option for thoseinterested in the specialty. Havingmedical ophthalmology as astandalone training program andextending the higher trainingcomponent to 2 years highlights itsexpanding clinical sphere andreflects its growing prominence ineye care delivery in Ireland today.The spectrum of career options andspecialty interests that the finalpractitioner, on graduating from theprogram, can choose will beemphasised.

The new Program

The common core stem will bediscontinued and trainees will entera dedicated medical ophthalmologytraining program from day 1, year 1

specifically designed to address thetraining needs of our future medicalophthalmologists. The framework isthree years of basic ophthalmology,MT1, MT2 & MT3 followed bycompetitive entry into two years ofhigher training MT4 & MT5. Theprogram will have at its core theteaching and assessment ofcompetencies necessary to deliver ahigh quality practitioner whilsthighlighting the increasing role ofmedical ophthalmology in thedelivery of eye care in Ireland and asoutlined in the Primary Eye careReview.

The dedicated medical programwill embed a high standard in thesubspecialties most relevant tofuture practice and future proof it asa valued career choice. The medicalretina module in MT4/5 has beenextended to 12 months in order toencompass all the recentadvancements in the subspecialty.Robust assessments processes areattached to each module of trainingin the higher program and willensure acquisition of subspecialtyknowledge to a high standard.

New Ophthalmology Training Pathway to beLaunched at Medical Careers Fair 2017

The ICO will announce details of its new training pathway for

Medical and Surgical Ophthalmology at the Annual Medical

Careers Day, organised by the Forum of Irish Postgraduate Medical

Training Bodies, which takes place in Dublin Castle on Saturday, 23rd

September.

Changes to TrainingPathway from July 2018Entry into both medical andsurgical ophthalmology has beenby a common route through 3 yearsof core training with the pathsdiverging at the end of year 3.From July 2018 common coretraining will be replaced by twoseparate programmes – one forsurgical ophthalmology and onefor medical ophthalmology. Thedecision on which career to pursuewill now be made before coretraining rather than during.


Nobel Prize

Joanne Kearney is pictured with ProfessorWilliam C Campbell, Nobel Laureate PrizeWinner in 2015 for his research on RiverBlindness, during a visit home to his nativeRamelton in Donegal in September 2016.

Professor Campbell, a graduate ofTrinity College, became the second

Irish man to win the nobel Prize andshared his nobel Prize in Physiology orMedicine with two other scientists whohave also changed the lives of millionsof people around the world, byproviding powerful treatments forsevere medical conditions caused byparasites.

He was awarded alongside theJapanese microbiologist scientist SatoshiOmura, an emeritus professor atKitasato University, in discoveringavernmectins, which kill infection-causing parasitic roundworms. ProfCampbell, an emeritus research fellowat Drew University, in New Jersey,acquired Omura’s cultures and foundthat a substance from one of them wasremarkably effective against parasitesoccurring in farm animals. The bioactiveagent was purified and namedavermectin, then later modified andcalled ivermectin. The drug knockedout parasites in animals; when tested onhumans it had the same powerful effecton the parasite larvae linked to riverblindness and to elephantiasis.

Prof Campbell has spoken of themany positive influencers throughouthis life and career, including hisprofessor at Trinity College, DesmondSmith who he credited as changing hislife by developing his interest in thisparticular field, parasitic worms,through his mentoring and encouraginghim to purse his graduate work inAmerica which he commenced in 1952.

Challenges in training and retainingthe medical workforce are not unique tothe Irish Health Service and the tools ofevidence based workforce planning areincreasingly applied to safeguard theprovision of a skilled, innovative andflexible health workforce. The Model ofCare, disease prevalence, doctors’productivity and available technologyare all some of the things that have animpact on workforce planning. As boththe Training and Professional body forOphthalmologists, the College has animportant remit in actively engagingwith all of the Institutions across thehealth service, to ensure that the bestmedical graduates continue to beattracted to the specialty and mostimportantly that the specialist skills ofour trained ophthalmologists areretained in Ireland and that a career inophthalmology in this country is arewarding experience.

The College is undertaking a researchproject, with the support of HSENational Doctors Training & Planning, tolook at what drives the decision tochoose ophthalmology, what impactthese considerations have on the currentmodel of training and to understandwhy trained ophthalmologists are nottaking up consultant posts or communityposts or in some cases not staying inthose posts throughout their careers. Theproject will result in a set ofrecommendations which the College willmake to the HSE.

The Medical Council’s ‘MedicalWorkforce Intelligence Report 2016’reveals a gender pattern in specializationwith some of the surgical specialtieshaving less than 10% female while otherssuch as public health are over 70%female. Research increasingly revealsthat many of the reasons that were onceconsidered to have a most impact on thespecialty choice of female doctors arenow less gender specific and influencethe choice of both male and femalegraduates, particularly as work lifebalance concerns have greater influenceon decisions than was once the case.Female doctors have historically beenmore influenced by caring responsibil -ities when making career and specialtychoices, however this influence is nowevidenced in the specialty choices of bothmale and female doctors. Over the past

15 years work life balance has become astronger influencing factor for bothmales and females reflecting widersocietal trends and perhaps indicatingthat the influence of work life balance isa generational issue not a gender one.

The gender imbalance betweenspecialties is mirrored by an imbalancebetween senior and junior roles. Femaleshave been in the majority in IrishMedical Schools since 1990 but this hasyet to translate into similar numbers inthe most senior grades. Inophthalmology during the training yearsthe numbers of men and women havebeen equally matched for a considerablenumber of years now yet the pattern isnot repeated at Consultant level where75% of posts are filled by men. This isreflected across the health service as themajority of NCHDs are female while thenumber is reversed at Consultant level.Research has shown that female medicalstudents tend to underestimate theirtechnical abilities and the psychologyliterature demonstrates that an inabilityto see oneself as competent will have animpact on career choice

A healthy return on investment inmedical education is essential and whilethere is significant demand forophthalmology services with longwaiting lists, many posts, particularlythose in the community are currentlyunfilled. A greater understanding of thelived experience of doctors in thespecialty of ophthalmology both duringtraining and in practice, will enable theCollege to advise the HSE on the impactof the issues identified on the work forceand the implications for future planning.

Over the coming months ICOmembers and trainees will be invited tocontribute to the research to develop theevidence base in order to makerecommendations on the mostappropriate model for flexible trainingand retention of trained doctors in theworkforce. A review of publishedmaterial is currently underway. Aquestionnaire is being developed whichwill be circulated to all College membersand NCHDs to generate data that willthen be analyzed and inform therecommendations. The research is beingcarried out directly by the College andyour input is very welcome, pleasecontact Siobhan with your suggestions.

Training & Retaining theOphthalmology Workforce

The College is carrying out research to examine why Doctors choose tospecialise as Ophthalmologists, what impact those considerations have on the

current training model and what issues in specialty practice influence whetherDoctors stay working as ophthalmologists through-out their medical careers.

AMD Awareness Week 2017 will

take place from the 25th-30th

September. This year marks the 10th

anniversary of the public awareness

initiative which aims to create greater

public awareness and understanding

of the condition, and encourage those

aged 50 and over to get their eyes

tested regularly.

The concept of the 2017 campaigntheme ‘See the Whole Picture’ is tocreate a narrative about life with AMDthat has real people at its centre, tellingtheir story. Over the past 10 years, theAMD awareness campaign has beentelling Ireland what it is like to live withAMD, but this year the hope is to createan even greater impact with the public,by actually showing people what it islike to have AMD.

Renowned Irish photographer BarryMcCall has been recruited to captureportraits of people with AMD who wishto share their stories. An everydaymoment encapsulating a passion will becaptured and that same picture willthen be photo-shopped to show how aperson with AMD see’s that image.

The launch event for AMDAwareness Week 2017 will take place inthe newly refurbished National Galleryof Ireland with the portrait exhibition.The photographs will be placed side byside juxtaposing the image of how ‘we’see the images and the image as the

person with AMD sees it, with anemotive testimonial which describes theimpact of living with their condition.

The ICO would like to thank MarkCahill, Marie Hickey Dwyer and thenumerous ICO members throughout thecountry who offer their support andtime during the week to be availablewhen media requests to speak with eyedoctors arise and in helping us sourcepatient case studies. If any memberswould like to be further involved in thisyear’s campaign, please contact the ICOCommunications Manager, CiaraKeenan at [email protected]

In the past 10 years, over 5,000people have benefited from free testingduring AMD Awareness Week. Lastyear, the Novartis Mobile Testing Unittested 518 people across the country. Italso created more than 5 millionopportunities to hear and read thecampaign key messages via the multi-media approach of print, broadcast andonline media relations and interaction.

Further details on the 2017 campaign

are available on www.amd.ie website and on

the ICo website. our thanks to members

who have offered their services in previous

years to see referrals. The College will be in

touch in due course with further details of

this year’s schedule, which will also be

posted on our website and we ask members

to please email the College if you wish to be

involved.


ICO Medical Ophthalmology subspecialty Day –follow up OCT workshopFriday 15th SeptemberRoyal Victoria Eye and Ear Hospital, Dublin

AMD Awareness WeekLAUNCH: 25th September25th – 30th September 2017www.amd.ie

Adare Retina MeetingThursday 28th SeptemberAdare

Fighting Blindness Retina 201712-14th October Radisson Blu Hotel, Dublinwww.fightingblindness.ie A special discount will be available to ICOTrainees who register for Retina 2017. Pleaseemail [email protected] to requestthe code for submission during registration.

16th International PaediatricOphthalmology Meeting 201718th – 19th October Croke Park, Dublin

Mater Ophthalmology Meeting Living with sight loss and conqueringblindness: innovations in low vision assistancein IrelandFriday 27th OctoberMater, Dublin

Munster Ophthalmology MeetingA Vision for the Future Study DayFriday 10th November,Castletroy Hotel, Limerick

ICO Winter Meeting Friday November 24th, Dublin (venue tbc)

RAMI Winter Meeting Friday November 24th, Dublin (venue tbc)

2017 Montgomery Lecture, Prof Michael O’KeeffeFriday November 24thTrinity College Dublin

RCsI Charter DayFriday 9th February, 2018Royal College of Surgeons of Ireland, Dublin

ICO 2018 Annual ConferencePROV 16th-18th May

Further details for all events areavailable on the ICO website

www.eyedoctors.ie

Dates foryour Diary

2017 marks 10th Anniversary ofAMD Awareness Week

Pictured at the 2016 launch event for AMD Awareness Week were ambassadors and supporters ofthe campaign, RTE presenter Mary Kennedy, Minister Mary Mitchell O'Conner and RTE WeatherCorrespondent Evelyn Cusack.

ico news no18 sum17 - irish college of ophtalmologists · irish college of ophthalmologists 121 st...

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