Dilen Marian

The Royal College of Ophthalmologists annual congress is often a window into the speciality’s collective mind and direction. The city hosting this year’s conference was Manchester, where on and off rain and sun, and rich history of industry and innovation set in red brick mirrored some of the congress’s key themes.

Providing perspective is perhaps the key takeaway form attending congress, especially for resident doctors and early trainees. In normal clinical work, the learning taking place is usually more immediate or practical, but at congress, the learning widens, and broader directions are showcased. Measured in microns, margins and millimetres Ophthalmology isn’t a field that is short of detail, and annual congress this year was a reminder that precision alone is not the future of the speciality.

For juniors, congress is a motivator. Learning can be arduous at times, and congress is a moment that widens the lens. Below are reflections and learning points from some sessions. They include presidential handover, an important moment for the Royal college’s identity, high volume care, the impact of systemic medicines entering ophthalmic conversations and reflective, interactive vitreoretinal surgeon sessions.

Leadership and Continuity

A particularly disarming moment took place in the congress’s opening ceremony. In the words of the outgoing RCOpth president, it was the time to hand over of the ‘necklace thingy’ to the colleges’ next president.  This remark brought humour and a certain lightness to what would otherwise be a standard ceremony. What this was though, was an important moment of continuity and what followed was the new president’s ambition over the next three years.

Specifically, of honesty, integrity, and the royal college being an organisation where direction is determined by the members, for the members. This is particularly important for those pre or early into training, especially in the context of workforce pressures and high demand. Having leadership keen to tackle problems as they come keep teams motivated and keen to learn and grow as clinicians. Being for the members, by the members reframes the college as more than just an institution, but as a community, whatever the grade. The ambitions demonstrated alongside humour was grounding and made the college feel more human, while remaining clear about its direction.

High Volume Care

Included in the opening keynote was the work around high volume cataract pathways and the shift in culture that enabled it. This culture flipped the pyramid where a surgeon would be the top and replaced it with the culture and team. The focus on colleagues and the culture cultivated by a Scottish team translated to 30-40 cases being performed routinely by consultants or higher trainees. Every stage of the pathway had been maximised, from the booking software to patient selection and relied on a backbone of clear two-way communication between clinicians or between clinician and patient.

This talk shifted the focus slightly away from the exact choices of the surgeons, away from individuals practicing, and being more integrated into a wider, uniform system which remains balanced between patient care and culture of the multidisciplinary team. 

This session was a useful reframing of what surgical excellence can look like. Shifting the focus to the system, who makes up the system, culture and trust demonstrated how high volume doesn’t necessarily need to mean impersonal, and that robust systems can ensure excellent care is given to a high volume of patients.  The take home message seemed to be the solution to high demand isn’t to work faster, but building teams that are willing and keen to work better and perhaps more sustainably.

Ozempic and Ophthalmology

Last year’s congress seemed to be dominated in large parts by Artificial Intelligence. Although, still popular as ever, some of the appetite for conversation has shifted towards GLP-1 agonists. Given the rapid adoption and widespread use of Ozempic and similar compounds, congress overviewed these medication’s mechanisms of action, and looked further, asking broader questions including how should Ophthalmologists respond?

The necessity to increase the channels of communication between Ophthalmologist and colleagues in endocrinology was a clear answer. Ophthalmology is a field that lies at the intersection between surgery and medicine, and new systemic conditions will surely emerge and require Ophthalmologists to adjust their practice.

A developing theme is the way in which Ophthalmology is becoming increasingly interconnected with other fields of medicine; the future may not be exclusively derived by innovations within the eye and may be influenced by the decisions and pathways of other specialities. The value of this lesson, especially for more junior colleagues is especially high, it will encourage wider history taking and deepening the relationships with other specialities. This review of Ozempic and similar medications demonstrates the way field is willing to discuss and integrate new developments outside of Ophthalmology before they become a routine source of clinical uncertainty.

Learning from complications

The young Vitreoretinal (VR) surgeon’s interactive session was another session of high interest at congress. Many conference presentations understandably highlight the absolute peak of polished, stand out work. This session took another approach. These sessions centred on learning from mistakes, and especially for someone still learning, this was refreshing.

Surgery is predominantly presented through the lens of success, of elegance and high technical ability, but this session was a clear presentation of surgical maturity, whereby senior colleagues discussed cases and offered what they would do next through a poll system.  This framed complications as not simply an unfortunate technical event but something more educational whilst acknowledging the burdens faced by patients and the operating surgeon. It seems a culture which prioritises learning is being cultivated and seeing real cases and their recordings as well as the walk through of the operating surgeons’ thoughts then and there made this session particularly relevant to trainees.

This session became memorable because it confronted some ‘hard truths’ and offered honest accounts from highly proficient surgeons. This is the kind of learning that matters at all stages because it demonstrated that true master is most definitely not having a 0% complications rate, but the ability to reflect and willingness to examine difficult cases without defensiveness. This will almost certainly extend past VR surgery, and could mean juniors will develop wider habits, of asking for help earlier, learning from feedback and being honest about their uncertainties, all to keep our patient’s safety at the centre of practice.

Conclusion

Taken together, the congress this year provided perspective and a snapshot of Ophthalmology’s direction. It highlighted that Ophthalmology is a speciality facing pressure, but very willing to step up to the challenge, not by simply working quicker, but by incorporating new technologies, working closer with other specialities, and towards training, to become more open and offer further opportunities to reflect and learn. Manchester’s red brick and robust reinvention felt an apt backdrop to that message. Congress overall, felt more than a series of updates and demonstration of excellence, it demonstrated that Ophthalmology is living, breathing and exciting, regardless of stage of training. I would highly recommend attending and getting involved!