Nurse the first in Wales to give sight-saving injections

A specialist nurse in Swansea has become the first non-medical practitioner in Wales to qualify to give a sight-saving injection.

People with certain ophthalmic conditions require steroid implant injections into their eye to avoid sight loss.

Melvin Cua is pictured above with Singleton Hospital consultant ophthalmologist Gwyn Williams and ophthalmology specialist doctor Mahmoud Awad

Previously, this could only be done by doctors. But now Singleton Hospital-based medical retina nurse practitioner Melvin Cua has completed a training module and has started providing the treatment to patients.

This will help free up doctors to do other work – vitally important at a time when eye departments across Wales are under huge pressure.

Medical retina is a sub-specialty of ophthalmology. It provides care to patients with age-related macular degeneration, diabetic eye disease and retinal vein occlusions.

One of the most important developments in the hospital eye service is the growing role of ophthalmic non-medical practitioners.

These are the nurses, orthoptists and optometrists who work under the guidance of consultant ophthalmologists to deliver vital procedures.

Treatments include delivering anti-VEGF injections and steroid implant eye injections, to avoid sight loss.

Non-medical practitioners have been delivering anti-VEGF injections for many years in Wales. But delivery of longer-lasting Ozurdex steroid eye implants could only be undertaken by doctors.

Now, with funding made available by Health Education and Improvement Wales (HEIW), Melvin has completed the medical retina module with the Wales Optometry Postgraduate Education Centre.

Left: Melvin Cua with patient Jackie Brock. It was the first time in Wales a nurse had given this injection

He carried out the first Ozurdex injection undertaken by non-medical staff in Wales on Jackie Brock, from Neath Abbey, who has cystoid macular oedema.

This is swelling of the retina, the thin, light-sensitive layer of tissue at the back of the eye.

It was Mrs Brock’s first injection and she said it was completely painless.

“Melvin did it very, very gently,” she added. “He was really good and put me at ease. I was very happy with the way it was done.”

Melvin said: “I am grateful for the opportunity given to me through the training I have received.

“I would encourage other nurses to be open to developing their skills in this manner.”

Suzanne Martin, Swansea Bay’s Head Orthoptist, said it was an exciting development for Melvin and for the department.

“It shows what can be done to develop our staff with appropriate support from within and outside the hospital,” Suzanne added.

“I am an orthoptic medical retina practitioner and hope to be the first orthoptist in Wales to administer an Ozurdex injection.”

Consultant ophthalmologist Gwyn Williams said non-medical practitioners were vital to the smooth running of the hospital eye service.

Melvin’s success, he said, showed what could be done.

He added: “I look forward very much to a future where non-medical practitioners all over Wales are trained to be the best they can be.

“The very future of hospital eye care nationally is entirely dependent on our ability to train whole armies of Melvin Cuas to save sight all over Wales. I am very proud of Melvin and all the medical retina team here.”

David O’Sullivan, Chief Optometric Advisor for Wales, said: “We hope Melvin will be the first of many nurses and allied health professionals to take on the exciting challenge of delivering treatments under the supervision of ophthalmologists, helping NHS Wales to continue to deliver a high-quality, forward-looking eye care service.

“More professional development of staff in non-medical practitioner roles ultimately means more people’s sight will be saved and preserved.”

Nik Sheen, HEIW’s Head of Optometry transformation, added: “It is essential to support the training of non-medical practitioners like Melvin.

“HEIW is committed to doing this through its advanced and extended practice education funding.

“We recognise the real and increasing pressures that hospital eye care is under and will continue to commission education for staff in those environments to remodel and transform services for patients.

“In the past year HEIW has sponsored Melvin, other nurses and orthoptists to do courses that advance their knowledge to enable them to undertake additional roles.”