‘The threat of sight loss makes us all anxious’

Mark Cahill is a consultant eye surgeon at the Royal Victoria Eye and Ear Hospital and the Beacon Hospital

I am an eye doctor and surgeon specialising in eye problems that involve the retina, the special layer at the back of the eye that turns light into electricity inside the eye. This electrical signal goes down the eye nerve to the brain, where it evokes memories at high speed that allow us to see.

The retina is affected by two of the most serious diseases causing sight loss: age-related macular degeneration and diabetic retinopathy. I also deal with general eye problems such as cataract and glaucoma, two other common eye diseases.

Until 2004 I worked in the US, starting at the Joslin Diabetes Center in Boston, a Harvard University hospital that treats only patients with diabetes. It is an important centre for research and treatment of diabetic eye disease.

I moved to Duke University Eye Center in North Carolina, which is renowned for developing many techniques for modern retinal surgery. I still keep in contact with colleagues from both Boston and North Carolina, and I travel to the US for meetings about twice a year.


Mentoring young doctors

Mondays start at 7.30am with either a research meeting with colleagues from Trinity College or interactive teaching with eye doctors in training. Mentoring young doctors is an important part of my work, helping them to learn about all aspects of eye disease and how to listen to and treat patients with eye problems. I then have a cataract surgery list followed by a post-operative outpatients clinic.

In the afternoons, I have an intra-ocular injection list. Injections of medicine into the eye have revolutionised the treatment of both age-related macular degeneration and diabetic eye disease.

It is so rewarding to prevent or reverse serious sight loss using injections of medicine into the eye. The idea of it is scary, but I work with a great team of nurses and ancillary staff who make the experience as easy as possible for patients.

We usually finish the injection list at about 7.30pm.

Reducing patient anxiety

On Tuesdays I see patients in clinic all day from 7.30am. Eye examinations are detailed, and in many cases require dilation of the pupil. It is a privilege to be able to help people regain their sight, but the threat of sight loss makes all of us very anxious, and eye medicine is different to other types of medicine.

In order to help reduce patients’ anxiety, I have modelled my clinical practice on my experience in the US. We have built a team of optometrists, nurses, technicians and secretaries who understand how worried people are when they come to the clinic and work very hard to help put them at their ease.

Tuesday evenings usually involve a meeting of the research foundation of the Eye and Ear Hospital or an executive meeting of the Irish College of Ophthalmologists. Young Irish doctors and scientists are smart and committed, and Irish eye medicine and science are contributing to the global understanding of eye disease.

Both the Irish College of Ophthalmologists and the research foundation are important supports of education and training of Irish eye doctors.

Improving quality of life

Wednesday is another early start at 7.15 am with a general eye surgery list. Cataract surgery makes a huge difference to the quality of people’s lives and it’s wonderful to help people improve their sight. The surgery list is followed by a management meeting of office staff in the clinic.

I am lucky to have excellent staff working with me in the clinic management team, who support myself and two other doctors. We use an electronic patient record, which enables us to answer patient questions easily and organise appointments and treatments efficiently.

Wednesday afternoons involve an outpatient clinic and in the early evening, I spend time following up on patients’ results and dealing with a variety of correspondence from patients and colleagues.

Diabetic eye disease

Thursdays often start with a management meeting of Global Vision, a company I help run which screens people with diabetes for diabetic eye disease (or diabetic retinopathy).

The screening programme, which is run by the National Screening Service, is one of the most important public health initiatives in Ireland and is preventing blindness and sight loss in people with diabetes.

When I came home from the US, I was part of the expert group that wrote the guidelines for screening for diabetic retinopathy in Ireland in 2008. The screening programme was set up by tender as a public-private partnership in 2012.

Our company has trained people with no previous experience to become expert technicians in taking and analysing photographs of the eyes. Through our contacts in the UK, we have also been able to get recognition for the training through the quality organisation overseeing the English national screening programme.

The rest of the day is taken up with outpatient clinics and finalising my retinal surgery list, which is on Friday.

Retinal surgery list

Fridays are busy and the main focus is my retinal surgery list. I am on call one week in three and while some of the cases I operate on are scheduled a few weeks in advance, most are emergencies. I am usually in the hospital early to ensure patients who have been seen the previous evening are ready for surgery.

Emergency retinal surgery is usually undertaken to fix spontaneous retinal detachments, which can occur without any underlying disease. However, retinal surgery is also used to treat a variety of serious problems including diabetic eye disease, age-related macular degeneration, eye accidents and eye infections.

The ward and surgical staff I work with in the Eye and Ear Hospital are very dedicated and hardworking, and it’s incredible how caring they are with patients who are facing potential blindness.

Despite the cutbacks in the hospital over the past few years, which have put huge pressure on them, they always look after patients with compassion and absolute professionalism. I try to finish the list by 6.30pm so I can be home by 7pm to see my family.

Out of hours

My week doesn’t really end on Friday as I am often in the hospital operating on emergencies on a Saturday and occasionally on a Sunday, but I am a third-generation doctor and I always knew what working as a doctor would be like. I frequently have research or other meetings at the weekends or I am reviewing research for junior colleagues.

However, I do miss my wife and three children during the week and my holidays with them are protected time that I love.

I am a keen rugby fan and I have been a Leinster season ticket-holder for many years. I bring one or more of my children to games with me as often as I can. Sunday mornings are my time alone with my children and we are usually out and about either at mini-rugby or horseriding.

On Sunday afternoons all five of us and our two dogs, Zippy and Lady Ru-Ru, go for a walk, usually in the Dublin Mountains and whatever the weather.

In the summer, now the children are older, we might play a game of tennis together. On Sunday evenings, we either go out for a meal together or call in to see their grandparents for tea.

Either way it is a nice end to the week and gets me ready for the busy week ahead.

AMD: The facts AMD Awareness Week aims to improve knowledge and understanding of age-related macular degeneration (AMD) and runs until September 20th.

Early detection can make a real difference and free eye tests will be available from participating eyecare providers and the Novartis mobile testing unit, which will be visiting Dublin, Galway, Limerick, Cork and Waterford this week.

The project is supported by the NCBI, Fighting Blindness, Association of Optometrists Ireland, Irish College of Ophthalmologists, Healthy Ireland and Novartis. See amd.ie