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Last Updated: Saturday, 16 February 2008, 00:47 GMT
Inside Medicine: The ophthalmologist
Alex Ionides
Cataracts are Mr Ionides' most common operation

In a series focusing on medical specialisms, the BBC News website meets Alex Ionides, a consultant ophthalmologist.

Ophthalmology is the branch of medicine which specialises in dealing with the diseases and surgery of the eyes and the areas affecting them.

WHAT IS YOUR JOB?

I am a consultant ophthalmologist (eye surgeon) at Moorfields Eye Hospital in London.

I specialise in cataract (clouding in the eye) and refractive surgery - used to improve the state of the eye and decrease dependency on glasses or contact lenses.

I hold clinics in general opthalmological and Accident and Emergency (both at Moorfields Eye Hospital).

Moorfields also now has a large number of 'out-reach' sites, where they work together with the local hospital to deliver eye care, so as well as working at the main Moorfields, in City Road, I also work at the Moorfields eye unit at St George's hospital in Tooting, London.

WHAT IS THE MOST COMMON CONDITION?

Cataract is the commonest eye operation I carry out and it is said to be the commonest operation performed in the NHS.

CATARACTS
The Romans, Greeks and Ancient Chinese and Indians used to carry out cataract surgery
The yellow tone of Turner's paintings has been attributed by some people to the onset of cataracts
Composer Handel went blind as a result of rudimentary cataract surgery

We now use vastly superior techniques and generally have excellent visual outcomes, although no surgery is without some risk.

A cataract is a clouding of the lens, which loses its transparency and becomes misty and foggy and white, like the 'white-water' of a turbulent waterfall - hence the name cataract.

The lens is held in place within the eye by multiple radial 'strings' called zonules, that radiate out like the rays of the sun on a child's drawing. These become weaker with age and with cataract formation.

In olden times these weakened strings used to be broken so that the lens was no longer suspended in the correct position and falls away from the pupil, dropping into the back of the eye, allowing light into the eye once more. The pupil is the central black circle of the eye and is the 'window' that lets the light in.

Today we take out the lens leaving behind the lens capsule and zonules and inject a new lens into the eye.

In the general opthalmology clinics the commonest condition I treat is blepharitis, a non-sight-threatening irritation of the eyes with recurrent redness and discomfort.

WHAT IS THE MOST COMMON PROCEDURE?

The most common procedure is cataract surgery.

This is mostly performed under local anaesthetic, often just anaesthetic drops.

When all goes well the operation can take less than 20 minutes and patients are seeing well the following day.

Owing to changes in the development of cataract surgery as well as changing attitudes to surgery, it is now common to perform seven to eight operations per list, and the waiting times have been reduced to under three months in almost all hospitals.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

Having enough time to see the numbers of patients that come through.

Even though it's a relatively small specialty, we have over 200 patients attending the casualty every day and many more coming for clinic appointments and surgery.

It is very busy and with the admin, meetings and trying to get research projects under way, it all makes for long days with few breaks.

It would be good to take more time over things.

WHAT IS YOUR MOST SATISFYING CASE?

Ophthalmology must be one of the most satisfying specialties as the results are immediate.

After routine cataract surgery about 20% of people get an 'after cataract' which is a thickening of a membrane behind the implant put in at the time of cataract surgery.

This makes the vision blurry but can be cured by a laser that takes five minutes to do and restores the clear vision again. Very satisfying!

Refractive surgery is also very satisfying, as people can see without glasses or contact lenses and are thrilled by the change in lifestyle this gives them.

If I had to pick one of my most satisfying cases, it would be a quadriplegic patient in his 30s who recently underwent bilateral cataract surgery and can now see to use his computer as well as read again.

WHY DID YOU CHOOSE THIS SPECIALITY?

I had a great ophthalmology teacher at medical school. I enjoyed most specialties but he was a particularly inspiring teacher.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

No.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

I would have gone into hospital-based general medicine.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

Cataract surgery continues to develop, with new technology in intra-ocular lenses offering better visual outcomes, whilst refractive surgery must be one of the fastest developing sub-specialties in ophthalmology.

In the last five years there have been considerable developments in intra-ocular lenses (implanted in the eye), which have all opened up new possibilities for patients undergoing cataract surgery.

The world of refractive surgery continues to become more refined.

Vision 2020, an initiative by the World Health Organisation, is aiming to reduce blindness around the world (there are currently approximately 50 million people blind in the world at the moment and this is increasing) as a result of cataract and the infectious eye disease trachoma.

CV - Mr Alex Ionides
1981: Gave up my English and Philosophy degree to take science A-levels and get into medical school
1989: Qualified at UCH/Middlesex hospital
1992: Started as an Ophthalmology SHO at Moorfields Eye Hospital
2001: Appointed consultant surgeon at Moorfields Eye Hospital




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