Since 2002, cataract surgeon Mark Westcott has split his time between several London locations – he is consultant ophthalmic surgeon at St Bartholomew’s and Royal London and Moorfields Eye Hospitals and he operates his own private practice from Harley Street and Moorfields. Criss-crossing London on a daily basis means Westcott sees patients from a wide variety of backgrounds.
‘Every Friday morning I have my cataracts list at Barts and Royal London. There are a high number of Bangladeshi patients on this list, and many of them arrive with very dense cataracts as they tend not to access the services until quite late,’ Westcott says. ‘For many of my elderly patients there is a significant language barrier. I’ve made an effort to learn some Bangladeshi phrases which I use in the operating theatre – like look up, look down and all is going well.’
The role, he says, is very rewarding, as the surgery can make a remarkable difference to a person’s life.
He recalls treating a former explosives expert, who had suffered a shrapnel injury to his eye 25 years earlier. The man’s hobby was competitive flying, but glare from the sun meant he sometimes struggled to see clearly, and eventually he stopped flying. ‘He needed perfect uncorrected vision if he was to get back to competitive flying,’ Westcott explains. ‘We were able to achieve that for him, and he was delighted. It made a big difference to his quality of life.’
Another patient, a theatre critic, only realised how bad her cataracts had been once the surgery had been completed. ‘She re-read some of her old reviews and found that her lack of perfect vision had caused her to be overly harsh on some performers. After the surgery she began writing much nicer reviews,’ he says. ‘I like to find out about my patients, particularly what they do, as that will tell me what their visual requirements are.’
Spending time with patients before the operation to explain the procedure and address any concerns or unrealistic expectations is an important part of the job. Understanding the operation and what exactly it entails and what happens after can go a long way in reassuring a patient and lowering their anxiety levels, Westcott says.
‘I spend time with my patients discussing the operation and letting them know they may experience dry eye or may be slightly more susceptible to ocular surface problems. They need to be aware of this,’ Westcott says. ‘I also make an effort to see all of my patients after their operation. I want to make sure that everything is healing correctly and everything is going well. However, I can usually tell just by the look on their faces that they are happy and the surgery has been a success.’
Improving technology
The technology, Westcott says, has progressed markedly since he first began. Incisions to the eye, made under the old procedures, required stitches and while the procedure was usually successful, the healing time was significant. The modern procedure – phacoemulsification – involves microscopic incisions to the eye, meaning stitches can be avoided altogether and the recovery period is only usually a matter of days. Each procedure takes between 15 and 25 minutes. Micro-cuts are made to the cornea and then, using a phaco-probe that emits ultrasound energy, the nucleus of the cataract is liquidised. A new silicone or acrylic lens is then implanted.
‘People will go home that day and even by the next day they will begin to notice a difference,’ he says. ‘The technology has improved so much and the visual outcomes are much better. There are definitely more people having the surgery these days. The threshold for qualifying for surgery is decreasing and we are now operating on patients with much milder symptoms that we were 15 years ago. It is a great tribute to how successful cataract surgery is.’
As part of his role, Westcott is also involved in training other ophthalmic surgeons to operate on cataracts. It is a gradual process, he says, and one that takes place in a ‘back-to-front’ manner.
‘It is a delicate operation and there is no room for error, so those that we are teaching are supervised all the time,’ he explains. ‘What happens is that I will do most of the operation, and then the ophthalmic surgeon in training – who is often a very senior doctor – will perform the last parts of the operation. Each time they will perform a little bit more. We work back to front in this process – it certainly isn’t a case of just letting a doctor start making incisions.
‘We also video all of the surgery and review it every time so that the person in training can see what they can improve. I am very keen on training – I feel we have a duty to train the next generation of surgeons.’
Westcott is hard pressed to find a downside to his work but says perhaps the hardest part is having to turn people away. ‘In cataract surgery there are very few hopeless cases,’ he notes. ‘But every now and then I see people with, for example, end-stage glaucoma with total optic nerve damage, and then there is nothing I can do to help. I think that is the worst part of the job – learning how and when to say no. You can’t put somebody through the operation if it will not help them. Sometimes these people have flown in from another country and I still have to say no.’
Overall, Westcott describes ophthamology as an ‘exciting field’, particularly due to the evolving technology, and says his work is ‘immensely satisfying’.