Singleton Hospital eye care team scores another pioneering first

21/04/2022

A hospital team is saving people’s sight and cutting waiting times by training staff to undertake procedures previously only carried out by doctors.

The medical retina team in Singleton Hospital’s ophthalmology department has scored a second Welsh first in the space of a year.

Suzanne Martin has become the first orthoptist in Wales to train to inject a sight-saving steroid implant directly into a patient’s eye.

The steroid, Ozurdex, is used to treat diabetic macular oedema and retinal vein occlusion, both potentially sight-threatening conditions.

Last year, Singleton’s Melvin Cua became the first non-medical practitioner (a clinician who is not a doctor) in Wales to inject it.

Suzanne (right) with nurse Melanie Jones and patient Peter Dover-Wade.

Using non-medical practitioners frees up doctors to do other work, vitally important when eye departments across Wales are under huge pressure.

The fact that the injections can now be given in clean rooms in Singleton, instead of the more traditional operating theatres, also provides greater capacity for more eye surgery to take place.

Orthoptics, a separate profession from ophthalmology and optometry, diagnoses and treats eye movement disorders such as squints.

Unlike nurses, orthoptists do not traditionally give injections, so it has been a completely new experience for Suzanne.

Along with two colleagues, she initially trained to give anti-VEGF injections to treat age-related macular degeneration.

“They are easier to give so those are the ones we trained on to start with,” said Suzanne (pictured at the top of the page), Swansea Bay’s Head of Orthoptic Services.

“Ozurdex is technically more difficult but now I have trained to give it – the first orthoptist in Wales to do so.

“Giving injections did take me out of my comfort zone at the start because it was something I had never done before.”

Suzanne and her colleagues also learnt new techniques that are vital when working in sterile areas – from scrubbing up to infection control.

Next she will be training another orthoptist to give injections. It’s a part of her work that, she says, she really enjoys.

“It’s quite exciting to train someone else but nerve-wracking as well. But you nurture them and when they become qualified it’s a really nice feeling.

“It’s good for the department too, and helps with recruitment.

“We have had people come for interviews who say they have heard of our department because we are so progressive with our extended roles.

“They want to work for us because we have a really good reputation, which is great.”

One of Suzanne’s first patients is 91-year-old Peter Dover-Wade, from Swansea, who has been receiving injections for the last two years.

Mr Dover-Wade, who previously had only been given the injections by doctors, described Suzanne’s work as “perfect”.

The medical retina service deals with conditions at the back of the eye, which are treated medically using drugs, eye drops or lasers. It includes diabetic eye screening.

The development of non-medical practitioners to give injections is down to an investment in the service by Ophthalmology Clinical Service Manager, Cheryl Madeira-Cole.

She said: “It’s very rewarding to be a part of such an innovative and forward-thinking ophthalmology team.

“I am grateful to have the full support from our consultant ophthalmologist colleagues who share the vision to develop our non-medical practitioners into extended advanced practice roles.

“I am proud to be able to offer such attractive and rewarding career opportunities for our ophthalmic technicians, nurses, orthoptists and optometrists.”

Consultant ophthalmologist Gwyn Williams (right) said increasing the number of non-doctors giving this important injection increased capacity and saved more patients’ sight.

“We have a weekly clinic with around six or seven patients attending each week. So over a year it means a considerable amount of doctors’ time is saved.

“We are now also able to give the injections in specially-adapted clean rooms rather than in theatres.

“That means there are more operating slots in the theatres, and more doctors available to do the work only doctors can do.

“Obviously it means the non-medical practitioners doing it instead are then not doing the things they were employed to do initially. But we have got around that by employing more of them.

“With Cheryl’s support we are building a department in Swansea that is more innovative than any of its kind in Wales.”

His colleague Mahmoud Awad, specialist medical retina doctor, added: “Our medical retina team is maintaining its progressive and pioneering stand.

“We are always keen on improving the efficiency of the service and the training of our staff. What a wonderful place.”