Barnaby Carr
Conferences are often valued for the evidence they present, but their more lasting contribution may be the perspective they offer. This year’s Nordic Congress of Ophthalmology (NOK) brought clinicians from five countries to Gothenburg, home of Volvo and its freely shared seatbelt design, a fitting backdrop for a meeting so concerned with safety as a shared responsibility.
Attending as a British SHO, I arrived with the NHS as my frame of reference. Seeing familiar problems approached within different systems led me to question assumptions I had not recognised as such. The reflections below draw on five themes: inherited retinal disease, glaucoma, artificial intelligence, central serous chorioretinopathy and communication after complications.
Genes, Founders and Gene Therapy
The inherited retinal degenerations session illustrated that a genetic diagnosis is frequently the beginning, rather than the end, of clinical uncertainty. Sara Mikkonen presented genome sequencing in Finnish patients, a population descended from a small founder group and therefore particularly informative for the study of rare disease. Her cases demonstrated the limitations of standard gene panels, with many Stargardt patients carrying only a single identified ABCA4 variant. She also highlighted that certain genes, including the opsin genes, remain difficult to sequence with sufficient accuracy to establish a reliable genotype–phenotype correlation.
Margarita Sarri followed with five years of real-world experience of Luxturna in Copenhagen. Patients had maintained a meaningful functional benefit, although she gave a transparent account of the chorioretinal atrophy that may develop around the injection site and acknowledged that its causes are not yet fully understood.
Genomic testing is now well established in the UK through the NHS Genomic Medicine Service. What distinguished the Nordic experience was the long-term follow-up of small, well-characterised populations. The session reinforced for me that a negative panel should be regarded as a result to revisit as knowledge advances, rather than a definitive conclusion.
Beyond the Pressure Reading
It was notable that one of the principal keynotes at a Nordic meeting was delivered by a UK clinician. Professor Gus Gazzard of Moorfields opened by challenging the conventional view of glaucoma as a disease defined by pressure. Intraocular pressure remains the principal modifiable risk factor, yet despite treatment, a substantial proportion of patient’s disease continues to progress.
A considerable part of the lecture addressed protection of the optic nerve itself, whether through stiffening the lamina cribrosa, which is subject to mechanical strain with every cardiac cycle, or through strategies to preserve retinal ganglion cell health. Nicotinamide was among the most promising candidates, with trial evidence supporting a beneficial effect on ganglion cell function. The question I found most thought-provoking was whether, if the optic nerve could be made more resilient, a target of 15 mmHg might achieve what currently requires 10mmHg.
For the present, he concluded, management remains predominantly focused on lowering pressure. Discussion of the UK-led LiGHT trial alongside a Nordic session on laser-first treatment highlighted how closely glaucoma practice in both regions draws on a shared evidence base.
AI in Everyday Practice
The Young Ophthalmologists’ session on artificial intelligence was notably practical, with each presentation addressing a defined clinical problem. Nathalie Eriksen from Copenhagen began with a challenge familiar to any NHS clinician: communicating important information to patients who do not share a common language. Her group had used AI to translate patient information videos while preserving the original speaker’s voice and lip movements. Having worked in clinics where arranging an interpreter can take several days, I found the potential benefit for patient understanding and consent particularly relevant.
There was detailed descriptions of diabetic retinopathy screening in Malmö, where physicians grade the photographs of approximately 8,000 patients each year despite the majority showing no retinopathy, and where automated grading could release several hundred hours of clinical time. In the UK, this work is largely undertaken by trained non-medical graders, so the challenge differs in character, yet both systems are moving towards greater use of AI. The session concluded with a reflection on the future role of the ophthalmologist, who will likely remain responsible for the uncertain and complex cases.
Central Serous Chorioretinopathy
Dr. Jay Chhablani’s keynote prompted me to reconsider a condition I had largely regarded as self-limiting. Although central serous chorioretinopathy frequently resolves within a few months, close to half of patients experience recurrence or progression to chronic disease. He described four patterns of subretinal hyperreflective material and the mid-phase hyperfluorescent plaques seen on ICG angiography, which appear to reflect disease activity and reduced following half-fluence PDT but not with eplerenone. This is consistent with the findings of the UK VICI trial, and it was valuable to see independent bodies of evidence reaching the same conclusion.
His appraisal of the existing trials was candid. Most had classified patients by disease duration rather than imaging findings and had relied on visual acuity as the sole outcome measure. He therefore advocated a classification based on multimodal imaging, together with greater consistency in treatment protocols and trial endpoints. As a junior doctor developing skills in critical appraisal, I found this a useful illustration that a negative trial may reflect how a condition was defined as much as the efficacy of the intervention.
After the Complication
The sessions on cataract complications were less visually documented but left a lasting impression. Their emphasis was on communication rather than surgical technique: how to speak with a patient in theatre so that they remain calm and appropriately informed, how to counsel them honestly afterwards, and how surgeons can recover from a difficult case without carrying its burden alone.
This discussion aligned closely with the Swedish Cataract Register, in which complications are treated as shared data for learning rather than individual failings. The UK has comparable frameworks in the National Ophthalmology Database and the statutory duty of candour, so the principles were familiar. The difference lay in the tone, with complications discussed as an anticipated aspect of surgery for which a well-designed system prepares. For a doctor hoping to begin surgical training, it was reassuring to hear communication in theatre framed as a skill to be practiced and refined, in the same way as a capsulorhexis.
Conclusion
Taken together, the congress encouraged a more critical view of familiar clinical markers, whether a negative gene panel, a “normal” intraocular pressure or an apparently resolving case of CSCR. The Nordic context gave this added depth, with five countries sharing registry data, discussing their differences openly and treating outcomes as a collective resource. From the perspective of NHS practice, I recognised many of the same pressures but encountered different responses to them, and this comparison proved more instructive than any individual presentation. Gothenburg, a city associated with safety innovation shared for the common good, was a fitting host. I would strongly encourage UK trainees and applicants to attend a congress outside their own health system.