Workforce, training and education
East of England

The Medical Ophthalmology service, which deals with infectious and autoimmune inflammatory diseases of eye and orbit, and ocular complications of systemic disorders, is run by Dr Paul Meyer. Rachna Murthy, Honorary Consultant Ophthalmologist, shares in the management of thyroid eye disease.

Clinical: A clinical database, which includes every patient seen since 1994, now contains more than 3400 records. It provides an evidence base that enables the accumulation of large case series and the assessment of new and established treatment modalities. Particularly interesting have been new strategies to control thyroid eye disease and inflammatory macular oedema, and to prevent corneal graft rejection and peri-operative exacerbations of inflammatory eye disease. A number of new physical signs have been developed and insights are also emerging regarding the relationship between abnormalities of the systemic circulation and ocular disease.

Thyroid eye disease: Immunomodulatory management of thyroid eye disease has been a major interest for many years, culminating in the development of a regime employing intravenous methylprednisolone and ciclosporin A. More recently, we have been studying remote drives in autoimmune disease and are conducting a trial to examine the effect that treatment of nasal Staph aureus may have on the progression of thyroid eye disease. We are interested in the mechanisms underlying the clinical spectrum of thyroid eye disease and, from this research, a new clinical scoring system is emerging. We are also developing new clinical and MRI methods for documenting and quantifying disease activity.

Imaging of microcirculations: Haemoglobin video imaging was developed here to describe the changes in microvascular rheology that accompany systemic and ocular diseases. It is now being honed into a quantitative technique for establishing the diagnosis, severity and prognosis in systemic inflammatory diseases. It is also being used to investigate mechanisms by which erythrocytes traverse microcirculations.
Optics: There is a special interest in the optics of ocular examination, resulting in the technique of mirror examination of the upper fornix and new methods of slit lamp examination. By developing an adjustable focus air lens, it has become possible to achieve presbyopic spectacles that have a variable focal plane.

Paul Meyer