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Show Neuro-Ophthalmology in the United Kingdom Neuro-ophthalmology in the United Kingdom has a rich and longstanding history with a long list of luminaries that include John Hughlings Jackson (1835-1911), Douglas Argyll Robertson (1837-1909), Harry Moss Traquair (1875-1954), Sir Gordon Morgan Holmes (1876-1965), and William John Adie (1886-1935), to name but a few. These historical figures set the founda-tion for modern neuro-ophthalmology with their seminal work on fundamental concepts ranging from the topo-graphical organization of the visual cortex to the physio-logical basis of the pupillary light reflex and to the island of vision. More recent notable figures include William Ian McDonald (1933-2006) for his pioneering work on optic neuritis and multiple sclerosis and Anita Harding (1952- 1995) who in a short, but stellar, academic career pub-lished some of the defining articles on Leber hereditary optic neuropathy and the inherited neuromuscular diseases. The development of neuro-ophthalmology as a distinct subspecialty in the United Kingdom owes a large part to Michael Sanders who spent his fellowship year with William Hot at University of California, San Francisco, CA in 1967 before returning to practice at Queen Square in London (Fig. 1). This important transatlantic link has since flourished with a significant proportion of the current crop of British neuro-ophthalmologists having trained directly under Sanders' wings. Training Structure The majority of neuro-ophthalmologists in the United King-dom are Fellows of the Royal College of Ophthalmologists (FRCOphth), having initially trained as general ophthal-mologists before gaining additional subspecialty experience in neuro-ophthalmology. The minimum period of ophthalmology training is 7 years and, after being awarded a Certificate of Completion of Training, a trainee is eligible to apply for an attending position (known as a Consultant in the United Kingdom). However, an increasing number of neuro-ophthalmologists also come from a neurology background, which further adds to the diversity of skills and expertise. There are a number of FIG. 1. William Hoyt (center) with Michael Sanders (right) and Robert Daroff (left) during their fellowship year, 1967 (with permission from Kline LB. An interview with William F. Hoyt, MD. J Neuroophthalmol 2002;22:40-50). Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom; and NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom Yu-Wai-Man: J Neuro-Ophthalmol 2015; 35: e17-e19 e17 Worldwide Neuro-Ophthalmology Section Editor: Kathleen B. Digre, MD Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. well-regarded neuro-ophthalmology fellowships, for exam-ple, in Birmingham and in London, which attract both local and overseas trainees. Prospective candidates should keep an eye on the careers section of the British Medical Journal where openings are regularly advertised (http:// careers.bmj.com/). Neuro-Ophthalmology Services The National Health Service (NHS) in the United Kingdom is a publicly funded system of care that was founded in 1948 at the end of the Second World War. It is the world's largest healthcare system and despite mounting economic pressures, the NHS remains free at the point of use for UK residents. Although neuro-ophthalmology services are usually concentrated in larger ophthalmol-ogy departments based in major cities, many neuro-ophthalmologists will also provide outreach clinics, especially in parts of the country with catchment popula-tions spread over large geographical areas. Patients are referred by a number of sources, but the majority of those are from primary care physicians, casualty departments, and secondary referrals from ophthalmology, and other hospital specialties. Most neuro-ophthalmologists who come from an ophthalmology background will also provide a surgical service, for example, cataract and strabismus surgery, depending on their fellowship training and personal interests. Botulinum toxin injections also are frequently provided by neuro-ophthalmologists for the treatment of a wide range of neurological disorders, in particular facial dystonias, and in the management of more complex strabismus cases. Clinical and Research Meetings Neuro-ophthalmology is a relatively small subspecialty, but our members are heavily involved in the training of junior trainees at both local and national levels. Through the Royal College of Ophthalmologists, a number of dedicated neuro-ophthalmology teaching days are organized each year, which are always oversubscribed and highly valued by the attendees (http://www.rcophth.ac.uk/). As a result of popular demand, neuro-ophthalmology sessions have also become a permanent fixture of the main ophthalmology meetings in the United Kingdom such as the Annual RCOphth Congress, the Oxford Ophthalmological Con-gress (http://www.oxford-ophthalmological-congress.org.uk/), and the Annual Meeting of the Association of British Neu-rologists (ABN; http://www.theabn.org/). Gordon Plant laid the foundation for a Special Interest Group allied to both the ABN and to the Royal College of Ophthalmologists in 2006. This effort culminated in the creation of the United Kingdom Neuro-Ophthalmology Special Interest Group (UKNOSIG), and the sixth annual meeting took place on March 12, 2014 (Governors' Hall, St Thomas' Hospital, London, United Kingdom) with Andrew Lee (Houston, TX) as the keynote speaker (http://www.uknosig.com/). Another important date in the calendar is the annual TABLE 1. Some examples of neuro-ophthalmological research in the United Kingdom Region City Investigator Research Interests England Birmingham Mr Michael Burdon Idiopathic intracranial hypertension Miss Susan Mollan Idiopathic intracranial hypertension and giant cell arteritis Cambridge Miss Brinda Muthusamy Pediatric neuro-ophthalmology Leicester Prof. Irene Gottlob Eye movement disorders, nystagmus, and ocular imaging London Mr James Acheson Rehabilitation of neuro-visual deficits and vigabatrin toxicity Mr Nadeem Ali Neuro-motility and functional disorders Mr Fion Bremner Pupil abnormalities Dr Elizabeth Graham Uveitis, inflammatory and infectious diseases Dr Gordon Plant Optic neuropathies and demyelinating disorders Newcastle Mr Patrick Yu-Wai-Man Mitochondrial disorders, neurogenetics, and clinical trials Oxford Mr John Elston Pediatric neuro-ophthalmology Prof. Christopher Kennard Oculomotor control and neurodegenerative diseases Sheffield Dr Simon Hickman Optic neuritis, idiopathic intracranial hypertension, and clinical trials Northern Ireland Belfast Miss Jayne Best Idiopathic intracranial hypertension Scotland Edinburgh Dr Stephen Madill Adult strabismus Wales Bangor Dr Martyn Bracewell Higher order visual dysfunction and visuomotor control For those of you who are somewhat confused by the use of titles such as Mr and Miss in the above table, the explanation is relatively simple. In the United Kingdom, historically, surgical trainees who have successfully completed their Royal College examinations are referred to as Mr or Miss. This rather peculiar British tradition is a throwback to the early 18th century when surgeons (compared with physicians) did not possess a university medical degree (MD) but instead belonged to the "Company of Barber-Surgeons." However, to confuse matters even further, surgeons in Scotland frequently use the title Dr, and not Mr or Miss, in their clinical practice. e18 Yu-Wai-Man: J Neuro-Ophthalmol 2015; 35: e17-e19 Worldwide Neuro-Ophthalmology Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. gathering of the British Isles Neuro-ophthalmology Club (BINOC), which brings together a focused group of consultants with a subspecialty interest in neuro-ophthalmology. The BINOC meeting takes place over 2 days, and it provides the ideal forum for colleagues to discuss complex and unusual cases with a neuroradiologist in attendance. Research Networks The close personal links between neuro-ophthalmologists in the United Kingdom and the comprehensive clinical network provided by the NHS are valuable assets that have contributed to both the breadth and depth of neuro-ophthalmology research in this country. Our members are heavily involved at the cutting edge of both basic and translational research with active collaborations across several specialties (Table 1). The UK neuro-ophthalmology community has also been well represented within major international organizations over the years, such the North-American Neuro-Ophthalmology Society and the European Neuro-Ophthalmology Society (EUNOS). Christopher Kennard is the current President of EUNOS and the 11th EUNOS meeting (April 10-13, 2013) that took place in the beautiful and historic setting of Oxford was a great success. The future of neuro-ophthalmology is certainly very bright in the United Kingdom, but as a group, we are not resting on our laurels. A central element of our mission statement is the need to foster the next generation of neuro-ophthalmologists, not only to deliver a first class clinical service, but also to lead the way as the teachers, researchers, and leaders of tomorrow. Patrick Yu-Wai-Man, BMedSci (Hons), MBBS (Hons), PhD, FRCOphth Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom ACKNOWLEDGMENTS I am grateful to Simon Hickman (Sheffield) for his very useful comments on the historical development of neuro-ophthalmology in the United Kingdom. Yu-Wai-Man: J Neuro-Ophthalmol 2015; 35: e17-e19 e19 Worldwide Neuro-Ophthalmology Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
