When did eye health become an area of special interest?
Alex Shortt When I was seven years old. My great aunt had type 2 diabetes, very advanced cataracts and was visually quite disabled. I experienced her admission to hospital for cataract surgery and the experience of seeing the bandages removed from her eye and the impact cataract surgery had on her life and our family made me want to help people in this way for a living.
What was your path to becoming an ophthalmologist?
AS I grew up in Dublin, Ireland and studied medicine at University College Dublin between 1993 and 1999 graduating top of my class. I was already committed to becoming an ophthalmologist and this led me to study for an MSc in physiology investigating the response of the retina to hypoxia at UCD (2000-2001). I then spent two years training as an ophthalmologist in Dublin followed by 11 years training at Moorfields Eye Hospital.
During my time at Moorfields, I undertook a three-year PhD in stem cell therapy for corneal disease, a three-year NIHR clinical lectureship and three fellowships in cornea and external disease. I was appointed as a consultant at Moorfields in 2014. I specialise in cataract, cornea and refractive surgery and also run active research programmes in these areas.
What are your research interests?
AS What motivates me to undertake research is seeing patients with visual loss for whom there is currently no treatment and who have been given up on. These patients feel abandoned and research into their condition gives them hope. Research really is 99% failure and 1% success but the successes make such a huge impact that the failures are soon forgotten. In the past my research has led to a greater understanding of the niche, or environment, in which corneal limbal stem cells are located and which provides them with the protection, support and instructions required for them to generate a continually migrating, shedding and regenerating corneal epithelium.
This work contributed to the establishment of a clinical transplantation programme at Moorfields and the UCL Institute of Ophthalmology where patients with severe ocular burns could be treated with limbal stem cell transplants prepared in a dedicated stem cell facility. Currently I run an active research programme which is focused on improving the outcomes of corneal stem cell therapy by optimising the three key steps of the process: stem cell graft preparation, recipient cornea preparation and transplantation and engraftment procedures.
Can you give a brief preview of your upcoming BCLA lecture?
AS My lecture will give an overview of the progress made in the field of corneal stem cell therapy with an emphasis on reconstruction of the severely damaged ocular surface.
Tell us about your research investigating the response of the recipient’s immune system to engrafted stem cells.
AS We now have excellent stem cell therapies for repairing the surface of the eye in patients with damage to one of their eyes. This is because we can use the healthy unaffected eye as a reservoir from which to obtain corneal stem cells for treatment. The problem arises in patients in whom both eyes are severely damaged and from whom corneal stem cells cannot be harvested. Stem cells from unrelated donors are rapidly rejected if transplanted. My four-year Wellcome Trust Clinician Scientist Award has allowed me to research this rejection process and to identify alternatives to donor cells as well as ways to prevent donor cells being rejected in the first place.
How do you assess the possibilities for patients with chronic or severe ocular surface disease through cellular therapies?
AS I have immense confidence that stem cell therapy will become a clinical reality within my professional lifespan. In fact this process has already started with successful clinical trials for limbal stem cell deficiency having been completed in several countries and trials in related macular degeneration well under way. Stem cell therapy will not be a panacea and will not be suitable for all conditions. At present we can use stem cells to regenerate or replace individual layers of the cells such as corneal epithelial cells or retinal pigment epithelium. The next step up in complexity and step forward in therapy will be to use stem cells to engineer more complex tissues with several layers such as whole corneas and whole retinae.
How do you divide your time between research and patient work? Are the two complementary?
AS Balancing NHS, private practice and research workloads is challenging. Having dedicated time to spend with patients at my Harley Street clinic has enabled me to collect and document a host of interesting dry eye/ocular surface disease, complex refractive surgery cases and corneal transplantation cases which I use to teach and lecture on throughout Europe.
Having performed over 150 corneal transplants and 1,000 cataract operations, do you have any clinical advice to optometrists in practice?
AS My advice to optometrists in practice is to be aware of the newer corneal transplant techniques because patients who previously may have been unsuitable for full thickness penetrating keratoplasty may nowadays be good candidates for a partial thickness corneal transplant. My advice in relation to cataract is that there are many ways to give a patient an extended depth of focus following cataract surgery. Mini-monovision (dominant eye target of plano and near eye target of -1.25) is a very popular alternative to multifocal intraocular lenses. In patients who have previously had cataract surgery, simulating mono vision in their glasses by giving a +1.25D in their non-dominant eye can have huge benefits but it is important to test for tolerance prior to dispensing.
BCLA Evening Meeting, Thursday, March 23
Lecture
Cell therapy for corneal disease (1 CET point, pending approval)
Venue
The Royal College of Surgeons, London.
This is an exclusive BCLA member-only event.