I have always wanted to be a doctor. My house jobs were in general medicine and oncology and paediatric surgery, including neonates. Prior to starting my training in ophthalmology I was advised to obtain the Primary FRCS and the MRCP. I therefore spent a year as an SHO in histopathology and then eighteen months in general medicine, emergency medicine and neurology.
My registrar training in ophthalmology was at the Tennent Institute in Glasgow. I worked for Professor Foulds and Dr. Damato in ocular oncology, Dr. Jay in anterior segment disease and glaucoma, Dr. Dudgeon in strabismus and retinal disease and Drs. Cant and Dutton in general and paediatric ophthalmology.
The post rotated to the Department of Pathology to examine specimens with Professor Lee, to the Royal Hospital for Sick Children, Yorkhill, to the Institute of Neurological Sciences at the Southern General Hospital for neuro-ophthalmology training, to the Maxillofacial Unit at Canniesburn Hospital, and to the Glasgow Eye Infirmary for casualty experience. While working with Professor Kirkness in corneal disease, I assisted in the oculoplastic service with Dr. Kemp, and this stimulated my interest in this sub-speciality.
While I was a registrar in Glasgow, I was asked to take up an overseas placement in the University of the West Indies, Barbados, and was appointed as a senior registrar. The Queen Elizabeth Hospital is the major hospital in Barbados and a regional referral centre for the Eastern Caribbean. Due to the high prevalence of cataract, glaucoma, external eye disease, ocular trauma and diabetes, the ophthalmology department is the busiest in the hospital. I was responsible for supervising my own outpatient clinics and one full-day operating list. On my arrival in Barbados, the waiting time to consult an ophthalmologist was in excess of one year. I managed to reduce this to six weeks by seeing twelve new patients at each of the three clinics per week. The receiving rota was one-in-three, affording considerable experience in operating on cases involving major lid and facial trauma. I was involved with my colleagues in commissioning the first Argon/YAG laser in the hospital. I have stayed in touch with the staff of the Queen Elizabeth Hospital and still regularly visit to provide care for patients with oculoplastic, lacrimal and orbital disease.
My senior registrar training proper started in the Queen’s Medical Centre, Nottingham, which at that time was a 1272 bed teaching hospital. There was a strong emphasis on "hands on" experience in ophthalmic plastics, orbital surgery, vitreo-retinal surgery and electro-diagnostics. Due to a major restructuring of the unit (two of the then six consultants left the unit), I decided to continue my higher surgical training in another post and was appointed to Moorfields Eye Hospital.
At Moorfields I worked in the anterior segment, medical retinal, vitreo-retinal and adnexal services. While in the medical retinal service I rotated to the HIV clinic at the Chelsea and Westminster Hospital, and to the Neonatal Unit at University College Hospital for experience in ROP screening. In the adnexal service I worked in the lacrimal and orbital clinics prior to my fellowship in lid disease with Mr JRO Collin.
The oculoplastic fellowship provided training in all aspects of lid disease including eyelid malpositions, ptosis, socket surgery and repair of cosmetic defects in the peri-orbital region. Four sessions per week were spent in clinic, including the blepharospasm clinic and the orbital clinic. Three sessions were spent in theatre, two in casualty theatre and one assisting in private cases. I gained experience in eyelid reconstruction and tumour management, including the use of grafts from auricular cartilage, the nasal septum, hard palate, and buccal mucosa. The harvesting of fascia lata and gluteal or abdominal fat was routine practice. I augmented my oculoplastic experience by taking part in general plastic and cosmetic surgical sessions. I exchanged with the oculoplastic fellow in Amsterdam, spending two weeks with the late Professor Leo Koornneef in the orbita centrum, gaining valuable experience in the management of thyroid orbitopathy.
When my fellowship was completed, I continued the senior registrar rotation in the ocular motility service, leaving Moorfields in June 1995. I was appointed to Forest Healthcare, and with their encouragement spent a year visiting oculoplastic centres of excellence in the UK, USA and Australia, including Dr. Alan McNab in Melbourne, Dr. Thomas Naugle in New Orleans and Dr. Robert Goldberg in UCLA. I funded this independently by working as a consultant in Brunei for six months, which was an extremely busy general ophthalmology job, and returned to the UK and a substantive consultant post in October 1996.
I did not find much support for my subspecialty work or for multi-disciplinary team working in my substantive post, and resigned in 1999. Since then I have been busy in private surgical practice, in teaching and operating in Barbados, in occupational ophthalmology with the Civil Aviation Authority, and in occasional locum work while setting up my own private healthcare company. I recently augmented my orbital skills by working with Professor Jack Rootman at the UBC Orbital Clinic at Vancouver General Hospital.
Previous appointments
1. Junior House Officer - General Medicine. August 1983 - January 1984. Gartnaval General Hospital and Western Infirmary, Glasgow. Dr G. Watkinson, Dr J. Hunter, Professor K. Calman.
2. Junior House Officer - Surgical Paediatrics. February 1984 - July 1984. Royal Hospital for Sick Children, Yorkhill, Glasgow. Mr. D. Young.
3. Senior House Officer – Pathology. August 1984 - July 1985. Victoria Infirmary, Glasgow. Dr. G. Roberts and Dr. W. Spilg.
4. Senior House Officer - Geriatric Medicine. August 1985 - January 1986. Victoria Geriatric Unit, Glasgow. Dr. J. Dall.
5. Senior House Officer - Neurology, Clinical Electrophysiology and Acute Medicine. February 1986 - January 1987. Dundee Royal Infirmary and Ninewells Hospital, Dundee. Dr. D.L.W. Davidson and Dr. R. Roberts.
6. Registrar – Ophthalmology. February 1987 - February 1990 & March 1991 - October 1991. Tennent Institute of Ophthalmology, Western Infirmary, Glasgow. Professor W. S. Foulds, Professor C. M. Kirkness, Professor W. R. Lee, Dr. J.S. Cant, Dr. J. Dudgeon, Dr. J.L. Jay, Dr. B.E. Damato, Dr. G. N. Dutton.
7. Senior Registrar and Honorary Lecturer, University of the West Indies – Ophthalmology. March 1990 - February 1991. Queen Elizabeth Hospital, Barbados, West Indies. Mr. D.C. Gibbons, Mr. E.H. St.John, Dr. C. Reifer.
8. Senior Registrar – Ophthalmology. November 1991 - January 1993. University Hospital, Queens Medical Centre, Nottingham. Mr. N.R. Galloway, Mr. S.M. Haworth, Mr. P.M. Jacobs, Mr. D. Knight-Jones, Mr. S.N.M. Rizk, Mr. S.A. Vernon.
9. Senior Registrar – Ophthalmology February 1993 – June 1995. Moorfields Eye Hospital, London. Miss L. Ficker, Mr. A.D.McG. Steele, Professor A.C. Bird, Mr. A.M.P. Hamilton, Mr. T.J. ffytche, Mr. Z.J. Gregor, Mr. G.E. Rose, Mr. J. Wright., Mr. J Lee
10. Senior Fellow - Oculoplastic Surgery. March 1994 – February 1995. Moorfields Eye Hospital, London. Mr. J.R.O. Collin
11. Consultant Ophthalmic Surgeon. Whipps Cross and Havering Hospitals, Barts and the London NHS Trust. June 1996 – February 2003. My work included lists for oculoplastics, phacoemulsification and lacrimal and orbital surgery. I ran general and specialist ophthalmology outpatient clinics, and supervised the management of emergency cases at these times.
