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Apr
17

For our professional colleagues: Examining the optic disc

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Dear all,

We hope that you and yours are all safe and well.

As promised, we have posted another of Mark’s lectures on an educational topic. This lecture is a refresher on how to examine the optic disc in order to detect glaucoma and other conditions.

We hope you find it of interest, and we welcome any feedback.

https://www.dropbox.com/s/ey6jkxx5os7gghu/Optic%20disc%202020.pdf?dl=0

(Note: Some browsers seem to only show the first slide. If so, try another browser or download the pdf file using the arrow button next to the ‘Sign in’ button at the top.)

We have quite a broad collection of lectures on many topics, and if there’s any subject area you’d particularly like a refresher on, we will do our best.

Our practice is currently partially open – we’re available by phone and email as usual, but for the moment we’re only seeing sight-threatening conditions at the London Clinic (fairly rare in Mark’s specialities of cataracts and glaucoma). All elective surgery has been cancelled as the London Clinic and Moorfields have offered their theatres for urgent NHS surgery, freeing up space in NHS hospitals for Covid-19 patients.

Mark is reviewing every patient we have booked in April/May to see just how far we can postpone their appointments. He also held his first video consultations this week with patients who needed to be seen more urgently – this worked surprisingly well, although if anyone can tell us how to measure pressures over the internet, we’d be grateful…..

We wish you all the very best – stay safe!

Mark, Sandrine, Anabela and Avni

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Mar
31

For our professional colleagues: Online lesson on the interpretation of visual fields

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Firstly, we hope that you and yours are all safe and well. These are quite extraordinary times we’re going through.

We would normally be contacting you now to invite you to one of our regular lectures + wine tasting at the Royal Society of Medicine. Sadly, we’re going to have to put that off for the time being.

We recognise that much regular work is not taking place at the moment and many of you are facing uncertainties over your businesses, staff, etc. However, this ‘down time’ can at least be useful for brushing up on your clinical knowledge – so we thought we would put one of Mark’s lectures online every 2 weeks or so. This week’s lecture is on visual fields and Mark hopes that it’s a useful refresher for you:

https://www.dropbox.com/s/f3wei9u0e5zjy6f/Automated%20visual%20field_Marks%202020.pdf?dl=0
(Note: Some browsers seem to only show the first slide. If so, try another browser or download the pdf file using the arrow button next to the ‘Sign in’ button at the top.)

Please let us know what you think, or if there’s a subject area you would find particularly interesting.

Our practice is currently partially open – we’re available by phone and email as usual, but for the moment we’re only seeing sight-threatening conditions at the London Clinic (fairly rare in Mark’s specialities of cataracts and glaucoma). All elective surgery has been cancelled as the London Clinic and Moorfields have offered their theatres for urgent NHS surgery, freeing up space in NHS hospitals for Covid-19 patients. Mark is reviewing every patient we have booked in April/May to see just how far we can postpone their appointments. We are also looking at telephone and video consultations.

We’ve heard of several optometrists forming local networks to manage emergency cases across their practices. If we can help facilitate this at all, please get in touch.

We wish you all the very best – stay safe!

Mark, Sandrine, Anabela and Avni

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Mar
23

Coronavirus update 23rd March

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As a result of the global Coronavirus pandemic, and in line with NHS and worldwide best practice in affected areas, we have decided to partially close the practice from today until after Easter.  All patients who were due to come in have been informed – Mark is reviewing their notes and we are contacting them individually in order to reschedule.  Fortunately the specialties of cataracts and glaucoma don’t tend to require urgent care, so most patients can safely postpone their appointments for 2 months or more.

The practice is only partially closed as we’re still available by phone Monday-Friday and via email on secretary@mark-westcott.com.  The practice is fully electronic so we have access to all our patients’ files.  Mark will be able to answer queries, usually on the same day.  We are also planning to manage patients by video consultation and telephone consultation after Easter.

If you have an appointment/procedure after Easter: We are monitoring the situation and will be in touch in the next week or two to confirm or reschedule.

If you have a concern or query: Please contact us on 020 7402 0724 or secretary@mark-westcott.com

If you need a prescription: Please contact your GP in the first instance – they will have your last clinic letter and can prescribe without requiring you to attend their practice.  If you need your last clinic letter, please let us know.  If it’s really not possible for you to get a prescription via this route, Mark will be sending out prescriptions twice a week, but obviously under the circumstances this is not his highest priority.

If you require urgent care: Please go to Moorfields Eye Hospital A&E.  As this is a specialist eye hospital, they are not currently treating patients with acute cases of Coronavirus.  If you are unable to get to Moorfields, we would recommend your nearest private or NHS A&E.

Please ensure you follow Government advice and stay safe!  We look forward to seeing you again soon.

Mark, Sandrine, Anabela and Avni

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Mar
15

Coronavirus update 15th March

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Many of our patients are concerned about the coronavirus. Obviously for the moment the number of confirmed cases in the UK is relatively low. We all hope that it will stay that way, but realistically it is likely to get worse before it gets better.

So what do we recommend to our patients?

Firstly, please follow the government’s advice.

If you have EITHER a new, continuous cough OR a high temperature then you should self-isolate.  There is no need to call 111 unless you need medical help.

The government advice can be found here:

https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

For those not at immediate risk the best thing you can do is WASH YOUR HANDS!! Simple and effective.

What about my appointment/surgery?

For the moment the risk is low. The London Clinic Eye Centre is a self-contained specialist ophthalmic centre with no other specialists consulting in the building (e.g. GPs or respiratory specialists). All staff and consultants work solely in ophthalmology. Patient turnover is relatively low and we have 10 waiting areas spread over 6 floors.

Everyone arriving in the building is being asked to wash their hands, and in addition there are hand sanitisers on the walls throughout the building.  We are wiping down all equipment (medical and administrative, e.g. credit card machines) between patients with disinfectant wipes.  The examining equipment is being fitted with clear guards for your protection.

Surgery, by definition, takes place within a highly regulated and sterile environment. Both Moorfields and The London Clinic have issued strict protocols around this virus, with similar actions to those detailed above. We are also planning to hold video and telephone consultations for those patients who are self-isolating (or if/when high risk groups are advised not to attend in person) – please call us if you’d like to find out more.

We hope that you find this information helpful in your decision-making and we will update this blog as needed. As ever, please don’t hesitate to contact us if you need any further information.

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Mar
03

Coronavirus update 3rd March

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Many of our patients are concerned about the coronavirus. Obviously for the moment the number of confirmed cases in the UK is low. We all hope that it will stay that way, but realistically it may well get worse before it gets better.

So what do we recommend to our patients?

Firstly, please follow the government’s advice. At the time of writing, anyone coming from areas with a known high incidence of the virus should self-isolate and call 111: certain parts of China and South Korea, Iran and named cities in Northern Italy.

If you have a cough, high temperature or shortness of breath and have recently returned from: other parts of mainland China or South Korea, Hong Kong, Japan, Macau, Malaysia, Singapore, Taiwan, Thailand, other parts of northern Italy (anywhere north of Pisa, Florence and Rimini), Cambodia, Laos, Myanmar or Vietnam – then you should also self-isolate and call 111.

The government advice can be found here:

https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

For those not at immediate risk the best thing you can do is WASH YOUR HANDS!! Simple and effective.

What about my appointment/surgery?

For the moment the risk is low. The London Clinic Eye Centre is a self-contained specialist ophthalmic centre with no other specialists consulting in the building (e.g. GPs or respiratory specialists). All staff and consultants work solely in ophthalmology. Patient turnover is relatively low and we have 10 waiting areas spread over 6 floors.

Everyone arriving in the building is being asked to wash their hands, and in addition there are hand sanitisers on the walls throughout the building. Within the consulting rooms and office, we are wiping down equipment between patients with disinfectant wipes.

Surgery, by definition, takes place within a highly regulated and sterile environment. Both Moorfields and The London Clinic have issued strict protocols around this virus, with similar actions to those detailed above.

We hope that you find this information helpful in your decision-making and we will update this blog as needed. As ever, please don’t hesitate to contact us if you need any further information.

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Feb
17

Meditation and Glaucoma

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I attended the Moorfields International Glaucoma Symposium recently in London. Many interesting talks were delivered on a number of glaucoma topics at this two day conference.

Although there was much that was interesting, the most original and novel lecture was on the benefits of meditation on glaucoma – this attracted a lot of interest. A team from India looked at the benefits of mindfulness meditation in a group of glaucoma patients. In this well designed, scientific study, the researchers studied 90 glaucoma patients who were taking glaucoma drops. They were randomly divided into half – one group received a 3 week course of meditation instruction by a yoga instructor for one hour every morning. The second group did not meditate. Both groups continued their glaucoma drops. After 3 weeks, 75% of the meditation group demonstrated a 25% drop in their eye pressure. Those who did not meditate showed no difference in their pressures. Interestingly, the meditation group also had lower levels of markers of stress and inflammation in their blood after three weeks (cortisol). Meditation also increased the levels of “good” or beneficial markers involved in regeneration and repair (brain derived neurotrophic factor). No changes were observed in the non- meditating group.

This landmark study suggests that one can use meditation in order to lower stress hormones in glaucoma patients, with a measurable benefit on the eye pressure. There are likely to be other longer term benefits on the progress of the disease, but these need to be studied further. As one might expect, the researchers also found that meditation also improved the patient’s sense of general well-being. As a glaucoma specialist I also see one other attraction of meditation which is this: I spend a lot of my time counselling and managing the side effects of our glaucoma treatments – namely the side effects of drops, and the admittedly rare risks of interventions such as laser and surgery. Meditation really has no side effects or drawbacks as far as I can envisage, other than perhaps the time commitment required to do it. But this may not be so onerous, as it is suggested that you can get a useful effect with as little as 15 minutes, three times per week. You can also get mindfulness apps on your phone that can help (Calm and Headspace are two of the most well known, although I haven’t tried them!).

I am happy to recommend meditation to my patients and I think we will see further research interest in this area over the next few years. I would be very interested to hear from any of my patients who have tried this.

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Jan
13

2019 in numbers

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New year and time to look at our private practice stats again. These are only for the private practice and don’t include Mark’s NHS work at Moorfields Eye Hospital and The Royal London Hospital – otherwise the totals for surgery and consultations would be much higher!

Number of consultations (new patient and follow up): 2100

New patients: Over 370

Cataract surgery: 180

Laser procedures: Over 80

Intravitreal injections: 25

Number of combined lecture/wine tasting evenings we’ve run at the Royal Society of Medicine for London’s leading optometrists and opticians: 3

Number of houseplants Mark has managed to kill in his consulting rooms: 1 (he maintains it’s because he’s focusing on his patients…..!)

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Jun
03

New research from ARVO – The world’s largest eye research meeting

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The ARVO Annual Meeting is the largest gathering of eye and vision researchers in the world, attracting over 11,000 attendees from more than 75 countries. I went to ARVO in Vancouver in May to present some of my own research and to sit on the panel for one of the sessions.

ARVO is an excellent meeting for highlighting forthcoming trends and new developments. And it is always
a pleasure to catch up with colleagues from all over the world. This year there was great interest in “big data” and artificial intelligence. These algorithms can analyse large data sets to look for patterns and associations that the human observer cannot easily identity.
For all my glaucoma patients who detest the visual field test, and there are many of you, there is hope in the form of an interesting study from California. The researchers took data from glaucoma patients using scans of the retina (OCT) and used a ‘deep learning’ program to see how the measurements of retinal anatomy correlated with the visual field. They trained up an algorithm to predict the visual field based upon the retinal scans. After training the program, the researchers used it predict the visual fields of another group of patients using only the retinal scan measurements. They found that the program could predict the visual field with surprisingly good accuracy.
Obviously these results have to be validated but perhaps in the future you won’t have to do visual fields, as they could be predicted from your retinal and optic nerve scans.
One of my research interests is Tuberculosis (TB) in the eye – this is a potentially sight threatening condition of eye inflammation associated with TB infection in the eye. Unfortunately this condition is still very common worldwide- particularly in Asia. We have also treated a large number of cases at Moorfields in London – most cases are seen in members of the Asian community, particularly those from East London where TB infection rates are high. The meeting was organised by colleagues in Singapore and India, and was attended by representatives worldwide. The aim of the meeting was to standardise our descriptions of the different manifestations of TB infection in the eye. Standardisation is important as it allows researchers to compare outcomes following treatment across different regions.
Overall a good meeting in a very picturesque setting – the conference centre overlooks a bay that is surrounded by snow-capped mountains. Although tempted, I did not ski , although some colleagues did. My excursions were limited to a afternoon bike ride with some colleagues around Stanley park, admiring some impressive Totem Poles in a forest, surrounded by views of the ocean.

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Mar
04

2018 in numbers….

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We’ve been crunching some of our private practice numbers and thought we’d share them with you, to give an idea of our practice size and specialties. Obviously bear in mind that Mark carries out many of these procedures and operations in his NHS practice, too, so his actual total is much higher!

Number of consultations (new patients and follow-ups): 2000

Number of cataract operations: 160

Number of laser procedures (iridotomies/capsulotomies/SLT): 61

Intravitreal injections: 22

Number of combined lectures/wine tasting evenings held for professional colleagues at the Royal Society of Medicine: 2

Number of letters posted: Approx 7,500 (we’re planning to email more in 2019…)

Number of Valentines/Easter/Halloween/Christmas chocolates eaten by patients: 20+ packets! Although funnily enough we still have quite a few of the Christmas brussels sprout ones left…..

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Jun
11

Aloha from Hawaii!

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Aloha!  I recently attended the ARVO meeting in Hawaii. This is an annual meeting of eye research, devoted to vision and ophthalmology and is one of the largest conferences in the world. Having been in Baltimore last year (less popular), the venue was in Honolulu, Hawaii this May. I was one of about 10,000 delegates. The meeting offered an exceptional opportunity to meet leading researchers and discuss some of the latest developments in Ophthalmology. The ARVO dress code is informal, so yes many of us wore Hawaiian shirts, whilst enjoying the balmy weather.

The results of a new glaucoma drop were presented – this drop is a new class of drug called Rho-Kinase inhibitors and is the first novel glaucoma drop for over 20 years. It has just been licensed in the US, and hopefully will be available in Europe soon, once approved by the European regulators. It offers useful pressure lowering, but is not a miracle agent, and has some side effects like red eye – but it will be a useful additional drug.

Interesting research was presented on a diverse range of topics, including Wet AMD, aspects of correcting astigmatism with cataract surgery using lens implants (so-called “TORIC IOLs”) and the results of glaucoma microstent surgery.  My colleagues and I were presenting some research on aspects of eye inflammation, including the use of an immunosuppressive drug called Tacrolimus, and the treatment of eye inflammation caused by a common infection: toxoplasmosis.

After the meeting finished, I was able to escape the slightly disappointing urban sprawl of Honolulu by spending a couple of days in Maui. This offers much more of the Hawaii experience – unspoilt beaches, surfers, and a mountainous interior topped with clouds. And thankfully it is not volcanically active – unlike its neighboring island which started to misbehave whilst I was there!

Exploring Hawaii’s interior

 

Hawaiian weather not quite living up to expectations!

As a keen astronomer, I had terrible telescope envy…

That’s more like it!

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