Virtually Anything Goes - a WebinarExperts Podcast
The "Virtually Anything Goes" podcast covers a wide range of topics centered around digital events, webinars, and livestreaming - as well as virtually anything else.
Lev Cribb talks to his guests about their passions in business and what drives them to achieve great results, while leaving plenty of space for their personal stories and achievements as well.
Listen in to hear, and learn, from subject matter experts and leaders in their field.
Virtually Anything Goes is a Webinarexperts.com podcast
Virtually Anything Goes - a WebinarExperts Podcast
Eye Surgery myths and how it works - with Eye Surgeon Andrew Davies
Eye Surgeon Mr Andrew Davies joins host Lev Cribb on the Virtually Anything Goes Podcast Expert Series to share his insights, stories, as well as humorously busting some myths about Eye Surgery. Andrew is an Ophthalmic Consultant, who is one of very few surgeons who specialise in Vitreoretinal Surgery, i.e. surgery at the back of the eye.
Ever wondered how advanced surgical techniques are pushing the boundaries of eye care? Discover the intricate world of vitreoretinal surgery with our esteemed guest, Mr. Andrew Davies, a leading consultant ophthalmologist and vitreoretinal surgeon. With extensive training from Moorfields Eye Hospital and Manchester Royal Eye Hospital, Andrew brings a wealth of experience and knowledge, offering a detailed look into the anatomy of the eye and the complexities of surgeries involving the vitreous and retina.
Join us as we break down the evolution of eye surgery, likening the human eye to a traditional camera to simplify the understanding of these complex procedures. Andrew shares his personal journey into the highly specialized field of vitreoretinal surgery, explaining why it attracts only a select few due to its unpredictable and often emergency nature. We discuss the remarkable advancements in surgical techniques and technologies over the past 100 years (and beyond), highlighting how modern innovations have significantly increased the safety and precision of eye surgeries.
This episode also light-heartedly addresses common myths and fears associated with eye surgery, providing clarity and reassurance to potential patients. Andrew recounts real-life cases, including a dramatic incident involving a jeweller, to illustrate the range and severity of conditions treated with vitreoretinal surgery. Furthermore, we explore the collaborative efforts of surgical teams, the future of robotic surgery in ophthalmology, and practical eye health tips to help you maintain optimal vision. Don’t miss our engaging "virtually anything goes" question segment to wrap up this enlightening conversation.
This episode is part of our Expert Series, where we speak to experts from a variety of different backgrounds, including Sleep & Insomnia, Addiction, Public Speaking, Eye Surgery, Crisis Communications, and even Magic! So be sure to subscribe and check out our other episodes on our Youtube Channel at @WebinarExperts
Find out more about Mr Andrew Davies at https://lancashireeyeclinic.co.uk/meet-the-team/
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Connect with Lev Cribb at https://www.linkedin.com/in/levcribb/
The initial assessment was that the eye is okay but there's just a tiny spot on the skin of the eye that suggested something had hit it and, being the nature of the item, ie a very high velocity drill bit, very high index of suspicion, and there was indeed a tiny fragment of drill sitting inside the vitreous jelly.
Speaker 2:Welcome to the Virtually Anything Goes podcast. This episode is part of our expert series, and each episode features a new expert from a range of interesting topics. Throughout the series, you'll hear about sleep and insomnia, addiction, mentoring, crisis communication, sales, eye surgery and even magic. You don't want to miss what the experts have to share, so subscribe and follow this podcast now, and then sit back and listen in.
Speaker 3:It's safe to say that today's expert guest is one of the only very few experts in his field. It has taken many years to develop the skill set he now possesses and uses every day to help people with their eyesight. Mr Andrew Davis is a consultant ophthalmologist and vitreoretinal surgeon, which means he specializes in surgery at the back of the eye. He specializes in all aspects of vitreoretinal surgery, cataract surgery, including both complex surgery and the complications of surgery and medical retina conditions. He completed his seven-year ophthalmology specialist training programme in the North West Deanery predominantly at Manchester Royal Eye Hospital. During his training he completed the fellowship at Moorfields Eye Hospital in London, followed by the Vitra Retinal Fellowship at Manchester Royal Eye Hospital. Andrew is also an honorary clinical lecturer at the University of Central Lancashire for the optometry degree and the college tutor for the Royal College of Ophthalmologists, and he regularly teaches locally and nationally and has published multiple journal articles, and he takes pride in training the next generation of ophthalmic surgeons. Mr Andrew Davis, very warm welcome. I'm delighted to have you on the show.
Speaker 1:Thank you, lev. An absolute honor to be here and thank you so much for inviting me. This is very exciting.
Speaker 3:Brilliant, it's great to have you and I look forward to this conversation. And now, for those of you who haven't listened to this podcast before, you should know that at the end of the podcast, I turn control over to Andrew for the Virtually Anything Goes question. This is where Andrew gets to ask me questions, or at least one question. It doesn't have to be related to today's topic and I will have to answer it, no matter what it is. I won't know what the question is before Andrew asks it, but the only caveat is that he will have to also answer the same question after I've given my answer. And, of course, if you like today's episode, please help us grow this podcast by liking and subscribing to it and sharing it with someone you think would like it too. So, Andrew, you told me I can call you Andy as well. Let me start with this question what is vitreoretinal surgery and how do you get into this specialised field?
Speaker 1:Great question, lev. So vitreoretinal surgery is, as the name would suggest, surgery to the vitreous and the retina. Now, obviously, to understand that does require some understanding of the anatomy of the eye and it's quite difficult to explain through a podcast. So we have got a photograph here to aid those that are watching, showing a cross section through the eye, and if you think of the eye as being like a sphere or a tennis ball, then the center of that is filled with the vitreous, which is a very thick, gloopy jelly, and then the retina is the lining of the back of the eye, the lining of the back of the eye, and we we operate essentially on any condition that can affect the, the retina or the vitreous that would benefit from surgery, and this photograph that also is here shows the how we get into that space through these very fine instruments, through the, through the wall of the eye.
Speaker 1:Um, the eye is often compared with being like a camera, and we look at the front of the eye, we have the lens, and when I say camera, I do mean cameras of people of our generation and older, of course, because I think the youth may not fully appreciate this. But the lens is at the front of the eye and we have a cornea and the actual crystalline lens, which both act in the same sort of way as a camera lens, and then the vitreous jelly, I suppose, is like the. The vacuum that separates the lens from the, the film and the retina is very much like a camera film, where light travels through the lens, hits the retina and and this turns into the images we see, because the retina is directly connected to the brain and it's considered to be part of the brain really. So that's the first part. And then you also asked me how do I get into this? And that's a, that's a.
Speaker 1:So, as you go through ophthalmology training, you try all these different specialties and I think, uh, you know the general public may not realize that, no, in in uk in 2024, there is not really any such thing as the ophthalmologist that does every type of eye surgery. We are all so subspecialized and you know, we go through all the different subspecialties and to me, I think, vitreoretinal surgery, as we'll probably come on to later. A lot of the work that we do is unplanned and emergency work, and that kind of probably fits in with my character, really, of just somebody that doesn't like to have too much planned in advance and you just deal with whatever's in front of you on that day or next week perhaps, but I don't like to plan too far ahead beyond that. Uh, you know, I find myself quite, quite calm in, uh, these environments of just not knowing what's going to happen that day and, uh, and I knew when I started doing it that, as a trainee, that this was what I wanted to do for the rest of my career Brilliant.
Speaker 3:And I mean just looking at that picture. I wouldn't be surprised if most people winced when they saw that and I would imagine and I think I sort of intimated it at the beginning there's not many vitreo-retinal surgeons in general in the UK. How many of you are there, and how does that compare to other areas of surgery in terms of the volume? Is it quite a small select group?
Speaker 1:It's probably less than 200, about 150 of us are consultant vitreoretinal surgeons in the UK. Precise numbers are very difficult to pin down. I can't say exactly what proportion of overall ophthalmic surgeons that is, but probably less than 10%. The vast majority of our surgeons will do cataract surgery. That's the bread and butter for all of us. But then beyond that we are subspecialized in a sort of niche area which VR surgery, as we abbreviate it to is, I think, the most exciting one.
Speaker 3:Okay, VR surgery I'll use that one because it's a bit of a tongue twister, for me at least.
Speaker 1:Yes, less of a mouthful, isn't it?
Speaker 3:Yeah, exactly so. I mean we saw that picture and, for those who are listening to the audio version of this, it basically showed the kind of effectively if I can paraphrase that the kind of the eyeball and very small fine instruments going into that for an operation. When was this first performed? Because I mean, clearly that wouldn't have been possible, probably even, I don't know, 100 years ago. When was it first performed and, excuse me, where?
Speaker 1:and how I mean this must be quite a recent thing, right? Yeah, so I mean eye surgery itself goes back thousands of years and I'm going to give you a little brief historical vignette because it's although it's not directly, vitreoretinal surgery. I suspect 2000 years ago there was a great need for vitreoretinal surgeons because the first, probably the first operation was cataract surgery. And you know, going back to, let's say, Roman times, or even before that, going back to, let's say, Roman times, or even before that, these days patients will have cataract surgery when they struggle perhaps to see their golf ball or they might be getting near to the legal driving standard, but it's pretty high visual standards that people in the UK would have these days. But if you don't do anything about a cataract, and especially with poor diet and no sunglasses and things like that, cataracts can progress to quite a severe level. So it can be blind from it if untreated. And so in the olden days, a long, long time ago, surgery to cataracts to get a very sharp stick and poke it straight through the cornea, through the front of the eye, and push the lens back into the vitreous cavity of the eye, which is where I now operate. So that's where eye surgery has come from. Thankfully things have moved forward a lot.
Speaker 1:But retinal detachments, which is a significant part of my workload, they weren't really treatable until about 100 years ago. And then the first operations to treat that were not vitrectomies, it was more sort of external operations, pressing on the outside of the eye and trying to basically superheat the retina through the wall of the eye, which didn't have a great success rate but to give some patients the chance of seeing. But modern vitrectomy surgery and I think it's the first vitrectomy actually took place in 1971. So that's just over 50 years ago and really over the last 50 years there's just been such a dramatic increase in the safety of the surgery. The speeds, the outcomes are so much better, all because of the instrumentation, the technology that goes with that and also, I suppose, the learning, and every generation of surgeons will develop new techniques and then pass that on to the next generation. So the modern vitrectomy is, I suppose, 53 years old. I think it was first done in the USA by a surgeon called Macamer, but it's just developed since then.
Speaker 3:Right, and I mean you describe it and obviously you say there is a lot of advancement in that. But I would imagine I mean, if I came to you with an issue and it wasn't an immediate emergency where I had no choice, but I would imagine there'd be some common misconceptions around what people think has to happen or how much it will hurt, or kind of just overall, what are the common misconceptions that people come to you with, or how much it will hurt, or kind of just overall what? What are the the common misconceptions that people come to you with, and how do you, how do you address them? How do you, how do you put people's mind at rest?
Speaker 1:yeah, there's. There's quite a few things that people obviously people are extremely apprehensive about. Having eye surgery and also the majority of the operations we do, the vast majority we do under a local anesthetic, so patients awake for these, um, and and I think understandably people are often quite terrified about this. There's probably a couple of things that I can think of that really stand out and I can pretty much knock these on the head quite quickly for the patient and put their mind completely at ease. And the first is a misconception that we actually take out the eye to operate on it, like rest it on the cheek and then pop it back into place. And I can say categorically that that doesn't happen, partly because the eye is attached to the brain by the optic nerve, which does have a little bit of stretch in it, admittedly, you know it has a bit of give, but definitely not enough to put it onto the cheek. So that one's an absolute no-no. And then the other common one, when I tell patients that, tell patients that they're going to be awake for the surgery is they are petrified at the thought of me coming towards them with a blade, a knife that they can see coming straight into their eye and I don't know if you've seen the film Clockwork Orange, but some kind of torture scene like out of that. The eyes are pinned open and you have this knife coming straight towards you and that's just not the experience they have at all.
Speaker 1:During the surgery, the anesthetic around the eye will just completely change everything they see and and it's quite unpredictable what they will see Sometimes it just goes completely dark, Other times it'll go quite light, but there's this certain. There's one, one comment that amuses me because because it often demonstrates the patient's background, perhaps of they might see sort of kaleidoscope effect and bright lights, and they'll say I haven't experienced this since I was in Glastonbury in 1979 or something like that, and I don't sort of question what their experience was. So they'll see all sorts of things, but what they don't ever see is a horrible knife coming straight towards their eye well that that will be.
Speaker 3:Um, I mean, that was my thought as well when I thought about yeah, you know what would, what would the experience be? Um, you know this needle coming towards you, or a knife or whatever. So it's, yeah, I'd imagine they appreciate the fact that they won't see that.
Speaker 1:Um, yeah, so absolutely I.
Speaker 3:I mean the, the, the, I mean you spoke about a few things cataracts and so on, and, and, and, but typically for, especially for the VR surgery. What kind of diseases or injuries do you treat most most commonly? What you know. When is it needed?
Speaker 1:Yeah, so we treat a broad range of conditions, but probably the biggest bulk of our workload, especially in terms of planning for the unplannable, is retinal detachments, and so probably about 35, 40% of the operations I do are for retinal detachments, which often need to be done very quickly. So typically we aim to get certain categories of retinal detachments done within 24 hours. Others can wait a bit longer, but that's where this sort of unplannable aspect comes from. So that's the bulk of our sort of day-in, day-out work. Then there's all sorts of other things that can affect the retina as well. So that can be complications of diabetes, which can cause bleeding into the vitreous jelly, for example. Or people can develop membranes across their macula, which is the very central part of the retina and the bit of our eye that we use for very fine, detailed vision. So they can quickly develop quite significant symptoms from that, and so we are literally peeling off a membrane, often described as cellophane maculopathy, like by cling film off of the central part of the retina.
Speaker 1:You mentioned, uh, injury and um. This is the bit that always makes me wince, um, because we see lots of injuries. Now they're not, they're not the main cause of vitreoretinal surgery per se? Um, but there are some. You know. Sometimes we do have to do vitreoretinal surgery for patients with injuries, and I think I see danger everywhere, and when I say danger I just mean danger to the eye. I forget about the rest of the body, and my children will attest to this as well that in my mind, the most dangerous item imaginable is a pencil, right if, if it's held pointing upwards whilst running up some stairs, right? Um? So a pencil is a common cause of injury, not common, but you know, a very uh, unpleasant cause of injury. But perhaps the ones that can cause the most severe injuries in, certainly in the northwest of england, uh, not so much necessarily in other parts of the world, which might have more access to guns, for example, but the exploding drill bit?
Speaker 1:Um of people, especially those that you know might work in that sort of environment of drilling into a wall and the drill bit might hit a bit of metal or something, and the drill bit will literally fly off at a very high velocity, so much so that it might cause very little external damage to the eye because it's super hot and traveling extremely high speed, so it can travel through the wall of the eye without really leaving much of a wound at all.
Speaker 1:But then it enters the eye and can sit on the retina and cause all sorts of problems. And I'll give you one example, actually of a jeweler, so somebody that was drilling um, making jewelry, and that the drill bit was it must be sort of half a millimeter wide, you know a really small drill bit, and they were doing something and they felt something just pop on the machine and then they felt something just felt like something's hit their eye, but they weren't sure if anything had hit their eye and they looked in the mirror and they couldn't see anything. And they went to the hospital and the initial assessment was that the eye is okay but the there's just a tiny spot on the skin of the eye that suggested something had hit it. And, being the nature of the item, ie a very high velocity drill bit, very high index of suspicion, and there was indeed a tiny fragment of drill sitting inside the vitreous jelly wow, wow um yeah, I mean glasses.
Speaker 3:Yes, that's the lesson here, I think, and, if you know, if you're listening to this podcast episode and you're wincing, but you're still listening. Thank you for sticking with us, because you know you can picture these things happening and you don't ever want it to happen to you. But just, you know, you mentioned a few things Is what you do mostly damage limitation then, and you kind of fix things, or is it? Is it typically related to actual complete healing of whatever it is that you're working on? What's the most common scenario and how effective is it?
Speaker 1:then? Well, the the answer to that is it depends, of course. So it really does vary a huge amount. So, actually, a lot of the time, what we do is damage limitation. So it does depend on how advanced the condition is.
Speaker 1:So, for example, retinal detachments, they will typically, you know, the retina obviously lines the hole at the back of the eye. I'm just going to show you this photograph of a retinal detachment. This is a photograph of the retina and I'll try and describe it, obviously for the listeners, those that aren't watching. But it should be a flat or rather concave surface and it's sometimes also compared with being like wallpaper. So it's sometimes a camera film. Other times it's sometimes also compared with being like wallpaper, not, so it's sometimes a camera film, at times it's wallpaper, and the, the top half of this retina that I'm showing you a picture of, is coming off like wallpaper, peeling off the wall, and we need to push it back into place again.
Speaker 1:Now, if the retinal detachment has started the periphery and is progressing towards the center but hasn't reached the center, then if we get that back in place, then that surgery carries about a 90 success rate, which means one operation fixes it 90 of the time, and that patient should have perfectly good vision afterwards.
Speaker 1:They may need a cataract operation afterwards, but they should have perfectly good vision. If, however, it's just progressed that little bit further and taken out the center of their vision, then unfortunately at that stage it's a much more what we say guarded prognosis, which means I can't guarantee what the level of vision is going to be like to the extent that all I can do is put the retina back into place and then how much vision they get back, because at this stage the patient's lost their vision. You know, they can see their hand moving, they might be able to count how many fingers I'm holding up, but they can't see much more than that. So we can put the retina back into place. We hope for improvement and it should improve, but how much, we just can't say. So that sort of thing is damage limitation Right.
Speaker 3:Absolutely so. I like the comparison to the wallpaper, because it's basically what you're saying is, you know, similar to the wallpaper.
Speaker 1:if the corner peels off, you can stick it back on, but once it goes past the sort of half of the wall, and it starts falling off right down to the bottom and you push it back up, you're going to get creases in it, right, right. And unfortunately the same sort of thing applies to the retina as well. And a crease through the retina even if it's microscopic, so we can't actually see it even when we're examining the patient is enough to cause really bad symptoms. Symptoms, and that can not just be blurred vision, but symptoms of just distortion, which can be so frustrating for the patient.
Speaker 1:They might be able to see quite small letters, but there's a huge kink going right through it, right. I really feel for the patients that have those symptoms because we can't do anything about it. Unfortunately, most cases right yeah, it's really.
Speaker 3:It's really fascinating and and I'd love to dig in a bit more into kind of a typical day in the operating room, um, what that looks like and perhaps the challenges you encounter there. I mean, first of all, you know what happens, you know how does it all work in terms of how do you get ready and operate and and how does that look. But what are the challenges then might come across?
Speaker 1:um, and also what are the things that are most rewarding from the act of operating on on an eye so the operating uh, the operating room, I mean it's difficult to describe the whole environment and of course every place is different. I'm very lucky where I work we've got an excellent team that work with me. They they really understand the importance of what we're doing. There is a real team, team effort to get our patients through and we typically we operate, uh myself and my fantastic colleague Emma Linton. We operate five days a week between the two of us and we'll always plan to have some elective operations on there, so operations that have been planned a few weeks or months in advance. But there's always space. There's always space for those extras that come in and you can never predict exactly when they're going to be. So you can be, for example, on a monday. I typically operate, I do a clinic, in the morning and I will operate from about one o'clock till about 7 pm and I never like to start that operating list knowing that I'm going to be operating till 7 pm, because chances are something will come in in the afternoon, the need that afternoon that is probably best off being operated on the same day. So I always like to have some wriggle room so we might start off with the sort of more elective procedures and that might be the sort of epiretinal membrane that I talked about before. Okay, so that's something that the patient's been having symptoms for a while now that have been getting gradually worse, symptoms for a while now that have been getting gradually worse. And then you might find that basically half or two of the afternoon lists, somebody from one of my colleagues from downstairs in our emergency clinic will come upstairs and say I've got a macular on, I've got a mac on RD, which means a retinal detachment where the macular is still attached, and they just come to say I've got a mac on, and those two words are enough for me to know okay, we've got to find space, because that patient ideally should have surgery within 24 hours. That's the goal.
Speaker 1:Not all cases, but the majority will be aimed to get surgery done within 24 hours. And so I immediately think, okay, we need to get this patient done today. And it's great, because everybody else also understands the importance of that and everybody really wants to stay home, uh, stay, stay at work late. But and we try to avoid that because you know otherwise staff burnout's a real, a real risk but, um, they know this patient needs surgery to save their sight and it's. It's fantastic to see that sort of kick into place. And so the patient gets sent upstairs. They've and in between two cases I might pop out and see them and just explain what I'm going to do. They'll already be warned that they're going to have surgery with me and uh, and then we get them done and uh, that's that's. It's amazing to be able to provide that service yeah, yeah, brilliant.
Speaker 3:I mean those, those, those operations, and I suppose anything to do with the eye is obviously extremely delicate, and we we saw, you know, that image with the sort of small instruments at the beginning. Talk us through, kind of, what the tools are that you use, because you know it's clearly not a massive scalpel, is it? I mean, these are quite fine instruments, aren't they?
Speaker 1:Yeah, absolutely so. Yeah, if we go back to that first picture I showed you, but I'll describe it as well, of course. So it's microsurgery or keyhole surgery, and so when I have medical students with me, I tell them it's a bit like a laparoscopic surgery, which is what my wife does where they operate inside the abdomen with really quite big instruments. It's like laparoscopic surgery, but very, very small, teensy, tiny laparoscopic surgery. So the instruments we use we make holes through the wall of the eye, the sclera, which is the white of the eye, to an area that's just in front of the retina. So we avoid any critical structures. But these wounds are about a millimetre wide, and this is again where the technology has really transformed things just in the last 20, 30 years, because instruments need to be twice that size or maybe even bigger than that in diameter, not just in actual volume. So these instruments we need to illuminate inside the eye to see what we're doing, because it's a dark cave otherwise. So one of those instruments is a very fine pipe. It looks like a needle, I suppose, but it's got a light on the end of it and this is a fiber optic cable, essentially shining light. We use the vitrectomy cutter which, uh again, is the size of a needle, but it has a little guillotine on the end of it with the mouth and that opens and closes seven and a half thousand times a minute.
Speaker 1:Uh, to to suck the vitreous jelly out, but cutting it at the same time, because you can't just suck it out like an egg. Yeah, uh, it's. Uh, you know that'll start to pull on the retina. You need to cut it as well. And then there's all sorts of other things, including a laser. So I get to use a laser beam, which is that's kind of appeals to my slightly more immature side of things, you know, on. On an addition to that, I sometimes wear a laser in my head which really, really appeals to the inner child. So, laser beams to secure the retina back into place, microscopic forceps to pinch and peel those membranes off the macula and this is just incredible technology, material science that's led us to this stage, Amazing.
Speaker 3:I mean, we spoke briefly about it, Hearing all these things, things. I hope anybody listening to this will feel reassured that actually this is, this, is, you know, not some horrific experience and actually is, you know, very technologically advanced. But I would suspect some patients will still be quite reluctant to you know, as we said, to undergo this kind of surgery. What's the experience actually like for them? You touched on a few things, but you know, just in terms of coming into it, you know, getting the anesthetic, what, what would the experience be like typically for?
Speaker 1:yeah, so I'll I'll stick with the retinal attachment because it's such a important uh topic and for these patients it's I say I wouldn't think it's unflagging to say it's a life-changing experience, because normally they're people that have got no problems at all in their lives.
Speaker 1:It's most common in about age 60 to 65. So it's often working age people who have had healthy existence. There's no other, typically no association with any other illnesses. And then it may be that last night they noticed that their vision was a bit funny in the corner and they woke up this morning and now they're missing half of their vision and there's sort of realization that things are suddenly changing. And then they go to hospital and they see or they might see their optician in the first instance. Uh, who recognizes what the situation could be, refers to our emergency clinic and they see one of our doctors there and then they're referred to me upstairs in the operating theater, and all this will happen within the space of a few hours and they are by the time I see them. They're often a bit shell-shocked, petrified, because they can see themselves going blind and you know maybe that they've got a problem in their other eyes. This is their better seeing eye and all of a sudden their world is falling apart. So it's not uncommon to have patients in just really emotional situations and I think part of the biggest joy for me, and I think for the team that work with me as well, is just supporting the patient through that, reassuring them. And I'm told that I do have a reassuring voice when I see these patients in the operating theater environment.
Speaker 1:And if you ask that patient the night before, so tomorrow, do you think you'd let somebody stick some needles into your eyes and fiddle around with the back of your eye for an hour? They'd think it's some kind of sick joke. But then by the time they are in this situation where they realize it's a choice of having an operation or losing their vision completely. Uh, they, you know, they accept, accept that it has to be done. And with that sort of situation there's no option certainly in most parts of the UK and many parts of the world to give a general anaesthetic. So it has to be awake and we have to just talk them through it, guide them, and sometimes we get one of our colleagues to hold the patient's hand through the surgery if that's what they want, and we all talk reassuringly. We give them the choice of music that they want. Or, if they don't care, we just put on heart dance and enjoy some dance music. The patient's choice comes first, though. Yeah, so it's a terrifying experience.
Speaker 1:Then they come in and we give the anaesthetic around the eye. That does cause a bit of pressure for a few seconds, but then, after that, pretty numb. And then they come in and we give the anaesthetic around the eye. That does cause a bit of pressure for a few seconds, but then after that, pretty numb. And then they're wheeled into the operating theatre.
Speaker 1:And this is a bit that can be tricky for some patients those with claustrophobia is we have to cover their cover, basically the top half of their body, with a, with a drape, sterile sheet, just exposing the eye itself. Everything else is completely covered up to keep our instruments sterile, and this is where it does get tricky. Sometimes. You know there's patients if they tell me that they can't get into a lift, um, because of claustrophobia, I immediately alarm bells ring that we need to do everything possible to get this patient through, be that sort of somebody actually holding the drape up as much as possible to let air go through. We do have a bar that supports the drape off their mouth, blowing oxygen into their face. So just trying to get them through it, right?
Speaker 3:I mean, it's clearly very specialist and you know, I think as UK residents, we're very lucky that this is available and surgeons like you are trained here and operate here. What's that like for other parts of the world? Is this? Are we in the UK? Are we ahead of this? Are we kind of similar for other parts of the world? Is is this? Are we, are we? Are we in the UK? Are we ahead of this? Are we kind of similar to other parts of the world? I assume there are some parts in the world that don't have this as an option. Um, are there movements towards bringing that more to more parts of the world as well?
Speaker 1:yeah. So I mean you know obviously that healthcare is a very hot topic in, certainly in the UK, and I think the the media in the UK Will give a very bad impression of our state of healthcare. So patients are often amazed when they do suddenly get this site saving treatment so quickly. They weren't expecting that, didn't think the NHS could provide that, so we are in a really good position. I think it does cost lots of money to provide this service and of course there's a lot of health inequality around the world. The western europe and antipodes do fantastically well.
Speaker 1:I actually did some training in l'hôpital jourgonin. So jourgonin was the first ever rational attachment surgeon in uh in lausanne in switzerland and you know switzerland, being an extremely wealthy country, has got incredible resources. But then you look at other parts of the world and you just see such mass inequality, even wealthy countries like the USA. Now I haven't worked there, but you are aware that there are challenges for some people to access health care because of financial constraints. And then of course we have the uh poverty stricken parts of the world and I've got a couple of friends and colleagues that work and live in sub-saharan africa.
Speaker 1:Um, a friend of mine from training was originally from ghana, did all of his training in the uk. He was a fantastic. He is a fantastic person and he could have got any job he wanted in the uk, but he went home and set up the first vitreo-retinal service in ghana and, uh, just, you know, hats off to him. Just an amazing guy, the work he does.
Speaker 1:But we know that in those parts of the world, patients will often present very late, um, because of not knowing what problem is difficulties reaching healthcare, just geography, not being able to travel. He works in the capital city, accra, but that's the only place you can go for VR surgery, so it's very difficult. And so he's clearly very experienced in complex surgery, because when pathology diseases present late, they are more difficult to treat. The outcomes are worse for the patients. What I would say is that any move to uh expand vr surgeries there are probably quite a few countries in sub-saharan africa that don't have any vr surgeons but it has to be fully invested, sustainable and not just popping in and making yourself feel good for a few weeks and fixing some eyes and then going home again. It has to be a full health infrastructure to deliver that care, and that's the real challenge.
Speaker 3:Yeah, I can imagine. We spoke briefly on the well, you mentioned also that there was continuous improvement of procedures and ways of doing it, techniques and, obviously, instruments. I would imagine as well If you were to look ahead for the next five, ten years. Um, what, what is you know what is going to happen? Can you kind of estimate what, how this area will advance? And I'm thinking also perhaps around the kind of robotic surgery that we see for other things, where you know the surgeon is in the uk and the patient is in the us or the other way around, or whatever it might be, where it's kind of operated like that. Is that something that would even be possible and where are we going with with the technology?
Speaker 1:so, uh, I'll start with the robots perhaps. Um, I mean, that's it's always a fascinating topic robots uh, there are some very clever academic vr surgeons around the world who are using robots. It's for a very specific indication at the moment, I think. So what we do is VR surgeons have typically got pretty good outcomes, and you know what I do day in, day out. I can't see at the moment how a robot can improve on that and I think that that's unlikely within my lifetime, within my career at least.
Speaker 1:But the robots are being used to inject gene therapy blebs of fluid under the retina, and this is a volume of liquid of about 0.05 mils. That has an approximate cost of about 300 000 pounds for that drop of fluid. So with that you can see how it's really important to get that drop in the right place. And that's where I think that's where robots are being used. My understanding of the the I think, handful really of true academic experts in this field globally, that's the primary sort of target. They are using it for other things. It's an experimental stage.
Speaker 1:So I feel safe in my career for now that I'm not going to be taken over by the robots, but who knows where it will lead to. You know it's impossible to say. As for the question about being operated in a different country, I mean, if you think about what I was saying earlier about the patient's anxiety, and part of the success of the surgery is that personal interaction with the patient, because it's teamwork really they have to be fully on board with getting their eye fixed and letting you do it and trusting you to do it, and I don't think a robot's quite as reassuring. I don't think. Maybe it is more reassuring, but I wouldn't find a robot as reassuring. Sometimes even just the surgeon, a gentle hand on the shoulder or on the forehead where I'm operating, there's enough to get through the surgery.
Speaker 3:Yeah, yeah, I know it's fascinating and you know it's such a specialized field that I think that hopefully we've been able to answer lots of questions, but we're not quite done yet and I do want to talk a little bit about general eye health and any recommendations you might have for all of us to say.
Speaker 1:Well, actually, you know, do this in order for us not to have to come and see you. We don't want to put you out of a job. But general eye health any advice you can give us on that one? So, general eye health. There is the saying that the eye is the window to the soul, I think, and the eye is a reflection of the. That means really that the eye is a reflection of your overall bodily health. Okay, so I do. It's not an uncommon question to be asked, and really, the better you look after yourself, the better your eyes are going to be, and so my standard advice to any patient asking that question is just look after yourself, do exercise so your cardiovascular system is working well. Eat a good diet, and we know that lots of green leafy vegetables, for example, can protect you from macular degeneration, which, which is a condition that has a significant cause of vision loss, and smoking actually I'm not one to go on about smoking, but smoking specifically does make macular degeneration worse, for example. So that's sort of general ophthalmology.
Speaker 1:In terms of retinal detachments and vitreoretinal surgery, I would say actually there's not a huge amount that can be done to prevent the majority of situations. Trauma plays a small part in the vitreo-VR surgery, so safety goggles for those that work in dangerous environments, safety goggles for all children that carry pencils, but that might be stretching it a bit too far. Um, the the two biggest injuries I think we see in the um, the sort of general ophthalmic a and e, the eye a and e I can think of um not necessarily requiring surgery but certainly that bring their eyes at risk are, depending on the age of the patient, nerve gun injuries. So to all parents don't let your children find nerve guns in each other's faces. Okay, nerve guns can be fun, but only if done sensibly.
Speaker 1:And then the other one is champagne corks. So shaking the bottle of champagne and looking down at it as the cork flies up is a nasty cause of injury, similar to squash balls as well. They fit very well inside the eye socket and can cause significant compression injury. And then perhaps the final group is patients with diabetes, and that's a condition I see a lot of, where diabetes is a silent condition. It doesn't cause any symptoms at all, so it can often be ignored, but it is causing gradual damage to the eye and eventually can cause severe vision loss. So that's a very specific cohort, of course. But it all fits in with looking after yourself, looking after your body.
Speaker 3:Yeah, thank you for that, and I think probably some that aren't particularly obvious, like squash balls, and I mean Nerf guns, you can see exactly what would happen. Um, whether that's considered is another question, and um, I've probably fallen foul of that at times as well, but, um, this has been really insightful and and really interesting, and thanks for joining. We're not quite done yet, though, because I did ask you to prepare the virtually anything goes question um for our new listeners.
Speaker 3:This is where andy gets to ask me a question. I've asked plenty of questions today. Um, I don't know what the question is, but it can be anything, any question on any topic, and and I have to answer it, no matter what. Uh, the only caveat is that once I've given my answer, andy then has to also answer the same question. So, um, the control is in your hands, andy. Um.
Speaker 1:Yeah, okay, so I get a little bit of background. My wife is reading a book by Professor Steve Peters called the Chimp Paradox. Right, it's about all of us controlling our inner chimp, which is the kind of bit of our personality that we struggle to control. Now, lev, of course, we are also not just podcast friends, but actually know each other in real life as well. Yeah, and you are perhaps one of the calmest, most measured people that I know. My question to you is when was the last time, or can you think of a time when you've been angry at something? But as a caveat, I'm afraid you're not allowed to use your children as an example. Okay, so what were you? When were you angry, and what were you angry about? How about that? Oh, good question? Um, because I can't imagine you being angry well, uh, I I do get angry.
Speaker 3:I'm trying to think when the last time was and what it would have been. Um, I might have to edit out the long pause here. That's a great question. This can be edited right. Yes, it can be and probably should be, it might take a little while.
Speaker 1:Do you want to go and make yourself a cup of tea?
Speaker 3:last time. I don't really get sort of apoplectically angry where you know it's just loss of of all senses and control.
Speaker 1:Uh no, I know, but I can't imagine that I was.
Speaker 3:I was incredibly angry, to the point that I felt like writing a, a letter which I rarely do, um to a local mp. Because, um, the other day I was driving around in the car and I had felt the car just being a bit swaying, it felt like it was on water and I thought something clearly is wrong with it. So I took it to the garage and in fact, what MOT was doing they called me, saying it had failed, and I thought it was the windscreen wiper that had come off slightly. And they said, no, is, um, the, the front suspension is completely shot. And I said, oh my gosh, okay, so they had to change it. And they said they showed me the, the kind of the suspension which wouldn't move at all, and then the, the kind of roll bar which was completely bent. And they said it must have been a pretty high impact. And I thought, well, no, I can't remember any high impact. And I checked with my wife just in case and she said she hadn't driven a car in a while. So it clearly was something to do with me.
Speaker 3:And I just couldn't think back what it was because I'd only felt it for the last two, three weeks. But the only thing I can remember is a ginormous pothole at the back roads where we live which was, during the winter, covered in, um, just a sort of you know, looked like a small puddle, um, and I went through that and I heard a huge, tremendous bang. So potholes make me very angry, and just generally the state of repair of our roads in the uk, um, and whenever I drive on a road that's been freshly palmacked, it just stands out. I think this is what it should be like and you know, but but 99.9 of roads aren't like this, so that that makes me angry to the point that I have considered writing a letter to the local mp.
Speaker 3:Um, probably, that's probably how you know the most angry angry I get if I think of anything else we'll edit this in afterwards that's a great, great example what about? What about you? I have to put this question back to you now yeah.
Speaker 1:So I think I like to think of myself as also being, you know, try to stay zen, um, and not get too angry about stuff, because you know most things don't matter that much.
Speaker 1:And but, um, again, it's talking to my wife that I realized that you, some things are just out of your control. And driving to work, it comes back to cars. Right, this is where cars, I think, are the problem here. Driving to work, you know, you set off for a good time to be at work, plenty of time, and yet there might be a bit of bad weather and all of a sudden things slow down and then the traffic stops on the motorway and then there's some cars that have been spun out to control.
Speaker 1:But before I get to that stage, I get angry and then I realize, you know, I have to talk to myself, you can't be angry about this, because this is just life, it's not. Life's not fair. And also, I'm only going to be late for work for 20 minutes or half an hour, and somebody else might be having something really awful happening in their lives. So it's just a note to myself to um, to stay zen and remember that, as long as you know, the outcome for me is really not that bad. I might be a bit stressed at work for an hour or so, which is okay. I can handle that, uh, whereas somebody else might be having the worst day of their lives, yeah. So just keeping things in perspective, yeah, and that helps to control that inner chimp and put it back in the box yeah, no, it's.
Speaker 3:It's a great question and and yeah, as you say, I think there's a lot of things that will make us angry. But actually observe from from space. You know, it's probably pretty minimal, isn't? It probably just doesn't matter? These things don't matter no be more chill, be more zen, um, and, and exactly yeah, live life fantastic look, uh andy this has been a really, really interesting conversation.
Speaker 3:Really, um enjoyed listening to you, know the insights you gave and I hope the audience will agree as well. Um, it's not something that we typically come across and, and you know, for the first um five, ten minutes of you explaining the kind of the stuff that you do, I was clenched sort of all over and wincing internally, but actually it is fascinating and it is reassuring that this is available and it's something that can be done quite quickly. As you mentioned, we don't have to wait a long time for this kind of thing when it's an emergency or for any time for that matter. But I appreciate you being on and sharing this insight with us, and it's a view into an area that we don't often get. So thank you for your time and thank you for talking to me well, I'm really grateful for you inviting me on the podcast there.
Speaker 1:As I said to you before, I was a little bit anxious about this, but it's been great fun and also your questions have been really insightful and show, I think, just just great questions, really probing this whole field, which I love. So thank you so much for having me.
Speaker 3:No, you're welcome, and I can't see how you could be anxious about this when you operate for nine hours a day on eyes with small instruments. But no, it's been brilliant.
Speaker 2:That's easy.
Speaker 3:And thank you to all of you for listening as well. If you like this episode there's plenty more Like and subscribe this one and share it with others. Spread the word and spread the insights and interesting conversations. So thanks for listening and we'll see you in the next episode.
Speaker 1:Thank you.
Speaker 2:Bye. Thank you for joining us on this podcast. We hope you enjoyed it as much as we did For other interesting topics. Go to your favourite podcast platform or watch the video versions on YouTube. Just search for the Virtually Anything Goes podcast. See you next time.
