Ophthalmology
Introduction
The department of at the Chelsea and Westminster provides eye care for a wide range of ophthalmic conditions. We have five consultants, each with different specialist interests, and we also provide a general ophthalmology service. As a teaching hospital, we give training for ophthalmologists from year 1 to year 7 (fellowship level) and we also have medical students from Imperial College whom we introduce to the specialty.
Consultants
- Mr Nigel Davies—Diabetes, Macular degeneration and General Ophthalmolgy
- Miss Suzanne Mitchell—Uveitis and HIV and General Ophthalmology
- Mr Naresh Joshi—Oculoplastics
- Ms Luna Dhir—Paediatric Ophthalmology
- Miss Marianne Shiew—Diabetes and General Ophthalmology
General clinics
The general clinics are run on Monday afternoon, Tuesday morning, Thursday afternoon and Friday afternoon and here we assess and treat patients with a large number of different conditions, including:
- Blepharitis
- Dry eyes
- Conjunctivitis
- Eyelid cysts, ‘lumps and bumps’
- Corneal problems
- Glaucoma
- Cataract
- Vitreous detachment
- Optic nerve abnormalities
- Ocular and periocular infections
- Ocular trauma
Emergency Ophthalmology
During the working week 9am – 5pm we receive referrals from local GPs, opticians and the main hospital A&E for patients with acute ophthalmic problems. We can be contacted via the hospital switchboard asking for the eye clinic, or via direct line:
- Eye clinic reception
T: 020 3315 8884 - Doctors rooms
T: 020 33155016/7/8 - Sisters Office
T: 020 3315 5042 - Fax for accompanying urgent referral letters
F: 020 3315 5040
Members of the medical team can be bleeped directly from switchboard. Because of our workload we are unfortunately not in a position to offer a walk-in eye service and patients who do walk in are asked either to see their GP for assessment and referral if needed, or to attend the main hospital A&E department.
Out-of-hours services
Out of working hours we are part of the on call service that is based at the Western Eye Hospital. There is a 24 hour walk in ophthalmic service run by the trainees with consultant cover and we participate in the on call rota.
Specialist services
We run several specialist services each week and the details of these are outlined below:
Medical Retina
Medical retina clinics are run by Mr Davies on Wednesday mornings. Patients seen in this clinic have diabetic eye disease, age-related macular degeneration, vein occlusions, artery occlusions and other retinal diseases. The clinic offers full retinal assessment with fluorescein angiography and 3d retinal scanning performed as necessary on the same day. We also perform retinal laser treatment during the clinic. The department is in the process of upgrading the fluorescein angiography system to a new high resolution system, which has been supported via the Trust capital bid programme.
Macular degeneration one-stop service
The new anti-VEGF treatments for wet macular degeneration (lucentis, macugen and avastin) are transforming the visual outcome of this otherwise devastating disease. The new AMD service at the Chelsea and Westminster is being run by Mr Davies and is a one-stop service. Patients referred with wet AMD are seen urgently and assessed with angiography and OCT scan. Patients with treatable disease can come to theatre the same afternoon for the required treatment, which is administered by intravitreal injection. Following the initial course of 3 lucentis injections over 3 months, patients are reviewed and assessed again in the clinic and retreatment can be given the same afternoon if necessary. This minimises the number of hospital visits. Continuous outcome audit data are kept.
Diabetic retinopathy
Patients with diabetic eye disease are seen either on a monday morning in Miss Shiew’s clinic or a Wednesday morning in Mr Davies’ clinic. There is a joint clinic held on the first calendar date of each month on wednesday morning, with Mr Davies and Dr Kevin Shotliff, where patients with problematic diabetes can be seen both by the ophthalmologists and the diabetologists at the same time. Angiography, OCT scan and retinal laser treatment are all performed same day.
Uveitis, ocular infections and ocular inflammatory disease
The uveitis service at the Chelsea and Westminster hospital is run on Thursday mornings by Miss Suzanne Mitchell. Patients with ocular inflammatory disease are assessed in detail in this clinic, also on a one stop basis. Patients with ocular inflammatory disease often require immunosuppressive and immunomodulatory treatment and regular monitoring. Patients requiring intravenous therapy are admitted to the Medical Day Unit at the Chelsea and Westminster.
HIV-related eye disease
A specialist clinic for patients with HIV-related eye disease is run by Miss Mitchell on Tuesday afternoons.
Oculoplastic service
The oculoplastic service is run by Mr Naresh Joshi and the main clinic for patients with oculoplastic problems is on a wednessday afternoon. Here patients with problems such as lid malposition, lid tumours, thyroid eye disease, other orbital disease and craniofacial abnormalities are seen. There is frequent liaison with the plastic surgeons and the craniofacial surgeons. Once a month the team work at St Thomas' Hospital with the dermatologists using the Moh's micrographic surgery technique.
Paediatric Ophthalmology
Paediatric Ophthalmology is led by Ms Luna Dhir and supported by orthoptists and junior ophthalmologists. We specialise in the management of squint and amblyopia and assess children presenting to us with any eye conditions, but refer on to regional subspecialists those children with glaucoma, retinal detachment or retinoblastoma. Ms Dhir carries out surgery at Chelsea and Westminster hospital for patients from her clinics.
We provide an orthoptic led service for assessment of children referred by a school nurse or health visitor, and consultant led clinics for children referred by their GP. We also screen premature babies in the neonatal unit for retinopathy of prematurity and provide assessments for paediatric inpatients who develop eye problems.
Ophthalmic surgery at Chelsea and Westminster
Cataract surgery
We have 3 operating lists a week dedicated to cataract surgery. We perform small incision phacoemulsification cataract surgery on all patients and the preoperative assessment includes discussion with the patient about their preferred refractive outcome and biometric ocular measurements are made accordingly. We have a new state-of-the-art phacoemulsification machine which minimises surgical time and shortens the post operative recovery period. We also keep a continuous outcome audit. Annually we perform in the region of 800 cataract operations each year.
Intravitreal treatments
The new treatments for medical retinal diseases, including age-related macular degeneration, severe diabetic eye disease not responsive to laser treatment, recalcitrant macular oedema from vascular occlusions and inflammation are all adminstered directly into the vitreous cavity.
We adminster these treatments either during the cataract surgery lists, or in a new dedicated list on wednesday afternoons.
Laser retinal surgery
Laser treatment of the retina is the main treatment for proliferative retinopathy and for some causes of macular oedema. Most laser treatment is performed in outpatients and we have a dedicated session for this on a monday afternoon, run by our extremely experienced associate specialist Dr Lesley Burnett. Occasionally patients require general anaesthesia for this and the treatment is given in theatre.
Oculoplastic surgery
Oculoplastic problems often require a surgical approach and Mr Joshi operates twice a week in both the Treatment Centre and in the Main Theatres. Complex cases with more extensive disease problems are operated on jointly with both the oculoplastic team and the craniofacial teams.
Paediatric Ophthalmic Surgery
Children who require surgery, for strabismus or other problems such as eyelid cysts or congenital nasolacrimal duct obstruction are seen at Chelsea and Westminster under the care of Ms Luna Dhir, and any surgery required is performed by Ms Dhir in our paediatric theatres at the Chelsea and Westminster.
Referrals
We accept referrals via the NHS Choose and Book process, by letter, and emergency referrals via telephone accompanied by faxed referral letters. All routine referrals are triaged by the consultants to ensure that the patients are booked in to the most appropriate clinic.
We have worked hard over the past year and have run extra clinics to attain the 18 week wait target set nationally by the NHS. Our time to outpatient appointment is now around 4–6 weeks and over 95% of patients are now seen and treated within the 18 week time period.
With continued work and a sustained increase in our clinic activity we hope to maintain these waiting times in the long term.
