1.) During your career there have been a number of highlights, which moment are you most proud of?
I was most proud of the moment when I got my Higher Degree FRCS from all three Royal Colleges in UK, Royal College of Edinburgh, Glasgow and Royal college of Ophthalmologists in UK.
2.) What is the most complex surgical procedure that you have performed?
When I was a NHS consultant, I used to perform a lot of complex corneal grafts which included not only corneal transplantation but removal of cataracts and implantation of new intraocular lenses in the eye.
Recently we performed surgery on a keratoconic patient where an old iris clipped intraocular lens needed to be removed due to dislocation and then we had to perform a lens replacement with new intraocular lenses. This case took us 12 months to complete as the surgeon and patient needed to be patient for stabilisation of prescription. This complex procedure was very rewarding to both us and the patient and feel honoured and proud to have contributed to restoring the vision of this patient in this very complex and challenging clinical case.
3.) If you had a choice between laser eye surgery and implantable contact lenses, which would you choose?
I believe ICL is a better choice for my patients as it is reversible, doesn’t cause dry eyes and gives better high definition vision, especially for those who have moderate to high prescriptions. For lower prescriptions, laser is often more than adequate. For more information click here.
4.) Can you describe how laser eye surgery has evolved over the last 30 years?
One of the most important changes I’ve seen in laser eye surgery is the progression and improvement of the tools used to perform it. Laser surgery has progressed leaps and bounds over 30 years.
I am fortunate to have been involved in the advancement from the early days of laser eye surgery when a procedure called PRK was the one and only form of treatment and that involved pain and a delayed recovery for the patient. Then came LASIK, but with a very crude instrument to create the corneal flap, followed by a blade (microkeratome). Then came eye tracking and femtosecond lasers to create corneal flaps (blade free), which has quickly become the gold standard because it provides lower risk of complications and better vision. As a surgeon, I much prefer this technique, because it creates a cleaner, thinner and more predictable corneal flap.
The significant evolutionary aspect from a visual correction point of view is the Advanced Wavefront Technology which eliminates night vision problems like halos and glare around artificial lights and we can treat patients with larger pupils who used to be turned down for laser treatment in the past.
Then there are also advances in laser treatments available for treating presbyopia (the need for reading glasses after the age of 40 yeas) such as supracor and presbyond laser. These are innovative ways of reshaping the cornea so that there is a blended area to allow for extra near vision focus. Click here to find out more.
5.) Why should patients consider private cataract surgery when it is free on the NHS?
Unfortunately, due to complex financial constraints and a lack of resources, the waiting list for cataracts on the NHS can be up to a year long and even then, there is often quite a large time period in between the two eyes being treated. People’s lifestyles are changing, with more awareness placed on leading an active and healthy life, well into your 70s and beyond. Patients do not want to wait that long to have their cataract surgery. Cataracts cause temporary loss of vision which can lead to accidents, fractures and the lack of being able to carry out one’s day to day activities can even lead to depression. With private cataract surgery, there is no need to wait; patients can have surgery as quickly as they wish.
In terms of visual outcomes, the NHS provides only monofocal (single vision distance) intraocular lenses for patients, which means patients require reading glasses for near vision tasks, and often varifocal glasses. The NHS does not consider cataract surgery to be a refractive surgery (surgery to rid a patient of their glasses and/or contact lenses) and therefore focus solely on removing the cloudy lens and replacing it with a basic single focus lens only. 10-15% of NHS cataract patients are left with a residual prescription which requires correction using glasses. With private cataract surgery, any residual surgery can be enhanced with laser surgery. This does vary between practices, but here at my London clinic, I provide my self-funded patients with a free laser enhancement as part of their 1-year comprehensive aftercare package. This reassures them that any minute visual imperfections will be addressed if need be.
I also provide the newest generation Trifocal lenses for my patients, which can rid them of reading, distance and varifocal glasses for the rest of their lives. At AVC, we perform Trifocal lenses in 99% of our cataract cases, which is why our patients choose to have private cataract surgery. We have available to us the best quality lenses and the most advanced technology to ensure timely surgery, excellent clinical and visual outcomes and the best quality care; all leading to better quality of life for our patients. For more information click here.
6.) Why is AVC’s 1 year aftercare guarantee so important?
A lot of private eye surgeons discharge their patients after two post-operative visits and many clinics provide a total of 3-6 months’ aftercare. Patients are then charged for any additional follow ups to manage common side effects with laser enhancement surgery or YAG capsulotomy. But at AVC, we include a full 1 year comprehensive aftercare scheme so that our patients can have everything they require in that year without worrying about additional costs. This allows our patients to feel looked after, and filled them with peace of mind and reassurance. They appreciate our honest and transparent package price. I feel it is important to deliver excellent patient care and that differentiates AVC from our competitors.
7.) What would you say to patients who are considering eye surgery in another country, in order to save money?
I would strongly advise against having treatment abroad. The fact is refractive surgery is generally considered very safe and effective. However, it is still surgery, and therefore it does come with risks and complications, albeit minimal in this case. One of the most important things to look into when considering eye surgery (after surgeon expertise) is the type of aftercare that is provided. A lot of clinics offer comprehensive aftercare schemes, at my Harley Street clinic we provide 1 year of full comprehensive check-ups before discharge. The issue with treatment abroad is the logistical issue of accessing said aftercare if it’s required. I have had a fair amount of patients who have come to see me at my clinic looking for management of post-operative complications which are easily dealt with, but end up being quite costly to the patient. If the reason for choosing treatment abroad was to save money, this defeats the purpose. For those who cannot afford private post-operative care, waiting in long queues at NHS hospitals is the alternative. My advice to anyone considering surgery abroad is that you only have one pair of eyes; make sure you do not take any unnecessary risks with them.
8.) What does your role as the Medical Director of AVC actually involve?
As well as carrying out laser surgeries, it is my responsibility to ensure that our patients are dealt with in a professional, moral and safe manner. I am in charge of reviewing our clinical audits and ensuring that we are performing surgeries and running clinics in the best way possible and I constantly strive to improve our clinical outcomes. I chair our annual surgeon’s meeting where our surgeons and clinicians get together to discuss ongoing opportunities to improve our processes, as well as any complex clinical cases and their management. Our services are delivered by multi-disciplinary, multi-professional teams, and collaborative teamwork has had significant benefits in increasing efficiency, improving clinical outcomes, fostering innovation and delivering phenomenal academic and research opportunities.
9.) AVC regularly invests in new technologies. How do the latest lasers improve patient care?
Our latest laser, the TENEO TECHNOLAS 317 by Bausch & Lomb is the fastest treating laser available in the world. An average laser ablation takes only 3-4 seconds. This in itself allows for a safer procedure by reducing thermal effects on the cornea leading to a quicker recovery time.
Our latest laser comes with a Advanced Control Eye-tracking (ACE) system; this is a 6 dimensional eye tracker which will guide the laser during the treatment by tracking and mirroring the movement of the eye, and if there is too much movement the laser will shut off. It tracks all eye movements – 6 dimensions (XYZ, intraoperative rotations and static rotations using iris recognition technology), takes pictures of the eye at a sampling rate of 1,750 times per second (1750Hz), has a response time of 2ms so no laser pulses are ever misplaced and can follow the most sudden or subtle of eye movements.
10.) For those people seeking reassurance about laser eye surgery, what would you tell them?
Laser eye surgery has been around for more than 30 years now. It has shown to provide successful results with excellent visual results. It is important to understand that it is elective surgery, and ultimately it is the patient’s decision to proceed with said surgery. It is necessary to meet your surgeon before proceeding with any kind of treatment; they can discuss any risks and complications in person and can also reassure and explain any specific concerns. A good surgeon will make a recommendation based on the patient’s best interests. This includes declining surgery if they feel their patient is not an ideal candidate. If an experienced and respectable surgeon is chosen, their recommendation should be enough to allay any concerns.
11.) The implantable contact lens procedure is fully reversible. Have you had patients who chose to get it reversed?
At my London Clinic, I have not ever had any such patients. All our patients have been entirely satisfied with their visual outcome after having undergone ICL surgery. We had one patient who had had ICL treatment in Spain some 8 years prior, and we had to remove their ICLs because they had been inadequately selected for the procedure and the lenses were causing some complications. This is why selection criteria is key. I only ever recommend those patients who fall within our suitability criteria, and only after a thorough pre-operative assessment and analysis and consultation with the treating surgeon.
12.) In total, how many eye surgery procedures have you performed?
I have performed over 50,000 laser eye surgeries in my career.