Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Okay, one more minute, and then we can start. Yeah. Mhm. Okay. Whenever you want to make a start, Um uh, Welcome, everyone. Thank you for coming. Um, I think we'll just get started now. Um, so first with introductions. My name Zona. I'm part of the Ophthalmology Society at the University of Manchester. And the phase two rep. My name is Astrid. I'm also part of the autumn. A logical society. And I'm the Duke Elder Rep. Hi. My name is Saleh. I'm the integrate student, and I'm the president's of eight months. Um, so before I hand over to Alan Mirza, who's gonna be talking about his career today? Um, just a couple things to note. Um, feel free to turn your cameras on it. Be nice to see your face is, um and then we'll do a Q and A at the end. And for that, you can either a new it yourselves or put questions in the chat. Um, so I'll hand over to you now. Thanks, Sona. So, uh, how many? Thanks for the invite. It's a pleasure to be here today. I'm talking to you about my career in ophthalmology, hoping to inspire the next generation with my story. So, uh, let's go. So, basically what I'm gonna This is the outlines I'm gonna start off with how it all started and y eyes going to a little bit about my training, uh, s h o and registrar and a little about subspecialty training. And then life is a consultant. What? What that looks like give you some examples of setting up a service, uh, director role. I did as well as a little bit of insight into private practice and how we set up OOCL vision and then, obviously, throughout our pepper it with career highlights, they try and give you a flavor of what you're getting into. So background. I was born in Baghdad. That's me there. That's my mom and dad. I was born there, um, and then came over to the UK at the age of one. I wasn't born in school from 11. Um, Mom wanted to me to be a doctor. As a classical Middle Eastern thing. I want to be a doctor. Um, if you love me, that's what you need to do. Um, So I was good at the scientists. Okay, I'll give it a go That was my sort of motivation. I didn't really know what I wanted to do. Says okay, I'll, you know, try to get into medical school. So I managed to get into medical school. That's me. As a medical student, I went to try and cross the West minister now known as Imperial. So back then you didn't have to do a interrelated BSC you could get away with just doing five years. I think now, mostly it's six years. So I did that. Then I did house jobs. So I did six months in respiratory medicine, six months in general surgery. Neurology. Uh, back in those days, it was like 100 and 20 hours a week, uh, long hours punishing on calls. And actually, I was a bit demoralized, to be honest with where I was. Um, just because you think you do all this study and then you get to a point where you think is this really going to be my life? Am I really happy with this? So it was a bit of a dilemma at the time. I did enjoy watching. There's a program called ER or emergency room. Uh, I used to watch that quite a bit. It was an American sitcom. A series about emergency medicine. Um, a fact that launched George Clooney's career there. There he is there, so that, you know, that looks pretty exciting. Let me give casualty ago. So that was my sort of decision. I did an any job at Charing Cross and the Hammersmith. I was pretty good. It was quite interesting. The trauma was amazing, but after a while, the shift took its toll. So you'd be you'd be doing weeks potential of, like, 10 till 10 at nine. To eight in the morning. A week of that. Or it could be 12 midday to 12 midnight, that kind of thing. And I just thought I just looked at myself. Do I really want to be doing this? In my forties and fifties, that one was the kind of thinking I had. Um And then, as during that point, I took an interest in eyes. I like the fact that it was quite visual. You can see the problem. So, in casualty, you often see things like this. This is a subcontract. Have a hemorrhage from some trauma. This is like a metal foreign body uh, this is, uh, what's called an aura to dialysis. Where the air is route comes away from the edge, you know? And I just thought, You know what? That's quite nice. I don't have to order those blood tests. Um, I can quickly get to the diagnosis from a bit of history as you're looking at the patient. And whenever I referred the patient to the ophthalmologist, it was always very, very positive. You know, they always say, You know, that sounds pretty good. Send it to me in the morning. I'll take a look. I was like in the morning. Okay, that's that's pretty good. I want to be on the end of that phone call, you know, whereas if you're referring on to medic surgeons is always a bit of a was a bit of a drama, and they're often not that happy to take the patient. And so the decision was made to do off the mold is an example of a of a dense cataract as well as very visual. I diagnosed the problem, so it's a bit of a struggle to get in. When Isa, a super competitive, I tried to get an eye job somewhere. I couldn't get a job anywhere, so I I was unemployed for a couple of months after 80. So about what I did do is bumped up the CD. I did a couple of I courses. I did the part one eye exam, which you could do those days before getting an eye job. And then in 98 I got my first. My job in Bournemouth did that about nine months. And then I got onto, uh, Senior House officer rotation at the World Free Hospital in Hampstead, which was a two year thing. Uh, so back in those days, it was separated. You don't have run through training, so you have to do what's called S H O training for a couple of years to to get some of your exams and then you could apply to registrar training. And then so there was there was a sort of a competitive interview process to get into registrar training. But anyway, I managed to get into the Southwest Thames registrar rotation, Um, which is for four years, the highlight of which was now two program experience in Australia. A lot of opportunity to travel in ophthalmology. I had a letter one day from ophthalmologist in, uh, in Australia, saying, Do you fancy doing a swap? I'll do your job in the UK and you can do my job in Australia, So Okay, that sounds pretty good. So I did that. I was called an after program experience. I would strongly encourage you guys to think about doing that kind of thing. Impossible. So off I went to Australia and it was an amazing experience. I did three months in Sydney. There's the Harbour Bridge. There's the opera house. That's Bondi Beach. That's me. Back in the day. I had a bit more hair back then. That's your eye clinic Classic Christmas. So every three months in Sydney, Uh, and then the other part of the rotation was three months in a place called Broken Hill, which is, uh, literally the middle of nowhere in the outback. You had to take a propeller plane to get there. Um, that was quite an experience, and it literally is in the middle of nowhere. Um, there you go, like, literally bounds of red desert. That's the town of Broken Hill in the background. Yeah, and there was one hospital and There was about 25,000 people in the in the town and you're the only ophthalmologist there. So that's me that this is occasionally get a visiting ophthalmologist coming in from Sydney or Melbourne that this guy was called the DeKalb Ray. He was a nice guy, but yeah, mostly on your own 24 7 serving the whole community. So it was quite quite interesting. They filmed a lot of mad Max there, and then if you guys bring me too young but mad Max was amazing movie. Back in the eighties, that Mad Max car was still there. That's me on it. Interesting. The handbrake wasn't on. So I sat in the car and they started rolling backwards. The person I was with, it was just snapping away instead of going inside to get some help, because you got to get some help anyway, so we managed to get into position. The thing about Australia is a great coastline. You got to travel. Just explore. Beautiful beach is they learn to serve out there. Okay, It's a small way, but it's still a wave. Um, technically, you do learn stuff. They have a big problem with pterygium over there. That's a growth of Condi. Type a tissue on to the cornea, and there are several ways to remove it. Um, and they have sort of mastered that because they get so many. So that that was quite good technique to learn while I was out there. So anyway, so I came back. I finished up my registrar training, attending the professional exams and then in eyes. There are seven subspecialties within eyes. So you think the eye is just a small little thing, but actually super complex. You can sub specialize in cornea. The front of the eye you can specializes in the back of the eye. Medical retina, surgical retina. You can specialize in glaucoma, pediatric ophthalmology, ocular plastics and so on. So you have to make a decision towards the end of your training about what bit of the eye you want to specialize in sub specialize in. So for me, it was always cornea is an example of a corneal transplant. And I remember watching, uh, my first sergeant, which my consultant put in these stitches literally 10 0 nylon under the microscope for a graft. And that just inspired me, though. Okay, that is just awesome. That's what I want to do. And I never really deterred from cornea throughout my training. So other years finish it, uh, more fields at ST George's, where the teacher corneal transplant techniques, things like that. And then I went abroad, and I did a laser refractive surgery fellowship on the island of Crete. So there I am there with my boss. Yeah, Alyssa Slaney's. This was the outgoing fellow with his wife and child. So, Yeah, the thing with laser refractive is lasers. Laser eye surgery is quite an important component of cornea, and no one really is going to teach you. Teach it to you in the new case. So you do have to go abroad for that experience. That was incredible. Experience increase. I did that for a year. That was my certificate finished in 2007, and I was looking for consulting job. So I managed to get a local consultant jump at the wall free. Well, I did my situate training. Many of my old consultants were still there. And then there was an opportunity at Imperial, and I managed to get a substantive consultant job there in September 2007. So that's 15 years ago now. So what's life like as a consultant? But it's pretty daunting when you first start, but it's also very exciting. You're setting up a new service, always setting up a new Cornel service. You got a bid for equipment. You're bringing new techniques to the trust that haven't been there. So you're really helping. Patient's out with visual rehabilitation, bringing improvements to what's already there. There's also opportunity for clinical leadership. I did the clinical director role from 2016 to 2021. That's five years and then as a consultant. There's opportunities for private practice. Uh, that eventually led to the set of Oversee of Vision, which will come until later. Let's talk a little bit about the clinical director. Also, after nine years of being consulted, there was an opportunity came up to apply for the clinical director. It was part of a prosperous structure. Um, there were basic significant challenges within our department that was highlighted, and the division wanted to address some of the things that we're facing with with a series of never events. These are events that shouldn't really happen. We had three of them proceeding 18 months, quite a few serious incidents as well that issues with governance meeting structures needed improvement. There were poor uptake of trust initiatives. We, as a service, were isolated from the main trust. Trainees were unhappy. There are poor admin and material support, and better. Director's office at the time asked the college to do an external review, which they did. Um, so anyway, they encouraged me to apply. Applied for the job, the loss of encouragement for colleagues. I was appointed as CD 2016, along with a new management team. And then, you know, no one really gives you leadership training. That's something you do have to learn as you go along. You read a couple of books through a couple of courses, but there are general changes you can make, which can make a difference. Some of the basic things are just responding to emails in a timely manner, setting up Axion logs as well as minutes from meetings with accountable personnel for each. I like to ignore trainees and all the processes because I just found that really innovative. They're great ideas, and if he involved them often, they kind of invested to improve the service with all of us. That was quite good. We we we recalibrated expectations. And then we expand a lot of leadership roles within the department. So that was like our team and Imperial looked like That was the general manager that's myself. And then we had a senior nurse, and then we had all these people underneath in various roles, which really transformed the service. What do we achieve? Well, the biggest thing, I suppose that we went paperless, so we were using paper all the time. So we were the first department in the trust to go paperless. We were an exemplar, so it was really good to to achieve that. We appointed 10 consultants of that over that five year period. Bought new equipment, etcetera, and I actually got involved in a bit of research as well. What was the biggest challenge? Well, covid was the biggest problem we were faced with because everyone faced with at the time, so we all know broke out in Wuhan, China 2019 worldwide spread basically spread everywhere. It was a nightmare all around main issue being the, uh, the demand on critical care beds, which in turn causes the cascade of problems. I mean, as a department, we had to ramp down activity. Still, look after our urgent emergency patient's. We had reduced staff for various reasons. We had to change a lot of our pathways. We had to go to your team, zoom meetings and then once restrictions eased. Then we have to wrap things up again. And of course, you're dealing with people with significant have a significant backlog of care to manage. And there are several cycles of that down, up, etcetera. And there were developments occurring all the time. So, you know, it was important to keep up with communication as departments were daily updates to everybody. So that did take its toll. Also got covid myself, but managed to get get through it. What it teaches you, uh, NHS leadership and just working the interest in general is basically get things done. You need the three piece positivity, persistence and patient's. That's just sort of take whom things for getting things done in the NHS, as you'll find when you start working in it. Other career highlights and reason to do eyes, uh, one of the things I really enjoyed, um do my training and as a consultant was the charitable. I work so that huge opportunities for child to work around the world, particularly a cataract surgery. So this is a group of us who went to Ghana? Uh, that was one of the first trips we went on. Uh, that's me operating an environment with a whole lot of audience. So we're dealing with really bad cataracts. People who can't see h m stands by hand movements. P l stands for a perception of light. So you're dealing with people who are clinically blind, and the reason is they've got these kind of rocks in there. I there's no one to do the surgery for them. And they basically, if you leave a cataract for too long, it develops to such a point that the patient's are effectively blind. Um, so it's very rewarding to do that kind of work. You know, you get them from perception of light vision to, you know, they're seeing pretty much the driving standard vision. Uh, just as a person is really sort of, uh, good for the heart to do. Um, this is just an example of people we've helped also fosters. Team works really good to get involved with the local teams. A lot of these individuals we go out with, some of these are trainees. They're all now consultants, which is, which is all great to see, uh, one of the highlights of the channel, which, which was a trip to Bali. So there I was, teaching cataract surgery. There's another example of patient with the cataract. You see the white reflex in there? I difficult. So that's because the kit can be quite poor. Uh, but also it's Yeah, it's challenging, but it's, uh, quite rewarding. The interesting thing about this trip was while I was on the island. Um, there was an elephant park up in the hills and they heard that the Western ophthalmologist was in Bali and they wanted someone to come and have a look at a special patient of theirs, and they offered to give me a helicopter ride to go and see them. Okay, I got a tour of the island. Why not? Let's go. So there we go. That's that's a picture of Bonnie. And this is the patient. So basically, it's an elephant who, uh, couldn't see out of one of their eyes that my hoods on top of the elephant when they did the signaling what you did to the left elephant return, which you did the right, it wouldn't turn. And they wondered what was going on there. One and after world. Just have a look at that. I'm no, I'm no veterinary ophthalmologist. I'm trying to look at this elephant, and this is flapping ear going on. And there I am, trying to hold its eyelid open and looking with the torch. Uh, I look at the other, I think I don't know. I can't see anything. What would I do if this is a human patient, I'll put some drops in. I'll put some dilating drops in. So I had some drops and they put some drops and had a beer with the owner came back and had a look. And there you go, Like elephant has a cataract. They're in one of his eyes. That's the reason why they couldn't see this is quite interesting. So elephants don't have tear ducks. They they, um they just have tears dripping down their their their face, which just evaporates. Anyway. The elephant went on and had cataract surgery and did very well. Other opportunities for travel. You get to go to lots of meetings. This is me in Argentina just talking about Cornel graph surgery. It was invite I had just before covid, actually 25th of October 2019. Obviously, when you're there, you take the opportunity to, uh, see the homeland of Maradona and messy. And then I do recommend the the steak and the malbec wine, uh, in credible out there. If you do get to go, what is my typical week look like? So I have 45 minutes a week of the 23 operating sessions a week One I've been day. I'm gonna call one in 10 and on call weekends 2 to 3 per year, and it's very rare to be called in, uh, in off the monetary is one of the appeals of doing it. So you don't have to be, uh, in house. You can be on call from home and most things that I can wait till the next day. Um, so surgery is great, you know, You get up to use the microsurgery cataract lens surgeries. It's sort of a bread and butter for most of thumb ologists if he's subspecialty subspecialty, cornea What I do, you get Corona transplantation and then there's trauma I reconstruction and laser vision Correction is another thing I do privately, they're gonna give you example of some of the surgery that I do. So, uh, some of it's quite interesting. This is a patient who had significant trauma, felt something going in there. I and we set up the cornea here, and then you see, there's a sort of a reflex of something, and we take it out and it actually turned out to be a seven millimeter splinters of wood that was in their eyes. That was, uh, probably one of the most interesting cases we were faced with. Um, so you get to do that kind of thing. It was so interesting that we got approached by the Discovery Channel who heard about it. And they did a special feature, uh, in their program called Body Invaders. But we want to see it at somewhere. YouTube channel. Just highlighting the story of this individual. Uh, this is another trauma case. I'm just going through This is quite interesting. So this patient felt something going in there. I and that's a remnant again of a piece of wood that had gone in in this area here there was putting a diet. This is the lens we're looking at here with a ruptured lens capsule. That's the opening where the foreign object had entered. So I'm just giving it a bit of a wash. And then what we do here, I'm putting a stitch in to, uh, close the wound because it was leaking. So I'm burying the not there. So once the stitches in place, we then move onto the lens aspect. The people here is dilated so you can see the edge of the iris There. Here, I'm making a little opening in the lens capsule, Um, which is not straightforward because it's it's traumatically damaged. And then we apply a bit of fluid to free up the main lens content. Uh, here, What I'm doing is aspirating that lens, so I'm removing it. It's gone cloudy because of the trauma, you can see the red reflex now coming through. And if you leave an eye without a lens, they don't see. So here we're putting in an artificial lens, putting it in position, picking up the sort of jelly supporting substance and then putting a little stitch, and that completes the procedure is a digest to ensure there are no leaks. But this patient had his vision restored back to 2020. So I was really had a rewarding thing today. Um, you get faced with weird stuff over the years. This is, uh, something called an artificial iris. And this is something that it's not ce mark not approved in the US or the UK or Europe, for that matter. But some people are desperate to change the color of their lives, and they will go to great lengths to do so. So there are these lenses available, Uh, in country like India, North Africa, they're unlicensed. They're not recommended. But people pay a lot of money to go off and have these lenses put in there. I I mean, I did not look particularly great to me, but anyway, they do create lots of problems, and I ended up removing quite a lot of them over the years. So much so that I'm not creating a method at the technique of removing them, called the tab technique, uh, which we've published. And it was also on my YouTube channel. So what we do, we enter the I We make a little incision in these implants, like said, And then you see me grabbing this thing here, they're okay. We're going to grab it and then literally just put it out. There we go. Out it comes. That's the natural like a underneath. And this is the the artificial Harrison. Look at these spikes here. These patients end up with all sorts of problems. Um, yeah, that's interesting. This lady is quite interesting. Um, this She was in a nightclub in Mayfair, and they were taking pictures with wild animals, including snakes. So she had her picture taken. And as soon as the flash went the snake bitter in the eye, Uh, you can see the snake being thrown off into the nightclub is just riding around on the nightclub floor. You can imagine the scene screams etcetera, and she's there with her. I, uh, in agony. So she comes to us to the casualty. The listener hospital. Here, you see blood within the I some kind of trouble hemorrhage, and then on high mag. You see, this is where the the teeth of the snake had bitter within the cornea. So this was a leaking wound we had taken to theater and stitched this up. Thank God she did very well under restored her vision. It's kind of strange thing, you see. Uh, so you ended up in the in the paper. The paper somehow got the story. So this is her. You can see some of the scars there. Scars of woman who's bitten in the eye by a python. Um, the lady who went to change her eye color. The first one I saw, she also made the paper she was in that daily mail paid 8000 lbs. So I think in Mexico, Central America, she went to to have those things put in, uh, and then we end up fixing it on the NHS. As you do. Um, the other aspect of my job is the private work. So we this is a laser sweet at OCR vision, and this is really a really enjoyable aspect doing laser vision correction The feeling when you when patient's see things when they're out of their glasses for the first time Pretty Incredibles this lady who just had a I just wanted to It's the boss to look at the clock. As you can see, it was like, Wow, that's amazing. Public. Yeah, that's really rewarding. Um, the other you get to see is is hang out with famous Cropsey and treat famous individuals. This is let's spread Man used to play for spurs and Newcastle for England export Ballplayer, Uh, this is the late, great Professor Hawking as a credible experience to to meet him. Um, So I'm gonna talk about the OOCL vision journey, so this is, um, took a lot of NHS stuff. So this is basic private side of things as a consultant. Busy do NHS work, But there's an opportunity to to do private work. And as you progress, um, uh, if you're if you're any cure you any good, you get busier. Very. You're busy very quickly. Um, so I'm an opportunity came up along with my colleagues. That's ramesh. I'm gonna Well oh, my new through training. Alan Barsa also knew through training was one of my fellows. Very good. Um so we sort of decided to join forces. It was always in the back of our mind to have our own clinic. It's not something easily done, but we had the plan. We joined forces with Juliet, who's a credible operational manager, and we found the premises. So this is our premises on 55 new car industry between a Harley Street Ruble Street. Sort of impressive building. Um, says Juliette with the keys. Um, when we first got it, got the lease, and then basically, we did a whole design job. Designed it as we liked, put the environment in the that we wish to put in and make it an enjoyable space for patient's. That's what it looks like. Typical diagnostic green. Typical consultation room. This is me down in the laser room. So this is where we're planning where to do our laser eye surgery. That's minutes. Okay, We're gonna have the bed there. We're gonna have one laser there. One laser there That was literally just mapping it out with cardboard on the floor. You got to have the vision for these things where it comes together, and there's the laser suite there. So, you know, from that aspect to this, it was just an incredible process. That's also the opening party. I'm just thinking about the standard. Sophie. Um, so talk a little bit about this slide here, so a lot of people will just see this aspect of these guys have just done it. It's a major. It's an easy thing to do. But you know what? People don't see what it takes to be successful. What is it that the dedication, the hard work, the habits, the disappointment you have to face to sacrifice the failure. You got to deal with the persistence. You just got to keep up with things, and eventually you do get the reward quite like this. The iceberg collusion slide works for most things in life. Easy to look at the success, but a lot of people just forget what it takes to get there in any field. Really? So just to summarize, I mean ophthalmology, an incredible career choice. It is competitive, but also it should be rewarding. It does have a great combination of medicine surgery. That's a uniqueness about it. The medicine with eyes is really interesting, but then you get the surgical aspect as well, and you know, you don't have to do what I did. You could do oculoplastics. So if you like eyelids, you can do that. You can do glaucoma surgery or retinal surgery. There's many different aspects you can get into with eyes. In terms of the surgery, there are a lot of opportunity for charitable broke. I've done about some day trips I've been to India, Ghana, Madagascar, Burma, barley. Uh, that's incredible thing to do. To help individuals around the world has lots of opportunity to travel. There's meetings all the time, various places around the world. Um, it gives you good work, life balance. So, you know, when you're on call, you're you're at home. Uh, the hours are pretty reasonable. You know, you're not dealing with a lot of truma. It's, uh it works for a lot of people. I would I would say that you don't get a lot of exposure to it as a medical student. So you do need a bit of faith to go into it when you do go into eyes. There's a lot of basic science to learn beforehand, so you would learn, you know? Okay. Anatomy, ocular biochemistry and physiology. Ocular embryology. Uh, and then once you understand that, then you can understand the ocular pathology, but it is incredible. You learn a lot during your first year or two. A little bits basic. But, uh and then the other thing you're learning is how to use all the kit. So don't be too disillusioned. If you, for example, can use your telescope. We hardly ever use your telescopes in ophthalmology. Uh, funny enough, even though it's like your your start a bit of kit. As a medical student, we hardly ever use it. We use something called a 19, the lens or various other lenses to look at the back of the, uh It gives you a better view. Yes. I don't be disillusioned if you can't use enough that musket. Uh, we teach you all the all the stuff you need to learn on the job. Um, and it's a great specialty. I mean, for me personally, I was at a real crossroads, not knowing what to do. Got very demoralized. But once I got into eyes, I never looked back. I just shifted gears, and that was the best thing I ever did. And I'm just Yeah, I think it's incredible career. And I hope this talk inspired a couple of couple of you, if not all of you to go into it. Uh, Thank you very much. I've been taking any questions. Don't stop sharing. Thank you very much. That was so interesting. Um, if he has any questions, you can pop them in the chat, or you can unmet yourselves. Question. Um, so you're out of program experience in Australia? How did you hear about it? Yeah, I got I got a letter from a colleague from a doctor in Australia. She just dropped a letter to one of the consultants hoping for some interest. So she just like, is anyone out there want to do a swap? And I think what transpired? She didn't want to do her Broken hill been, you know, being the ophthalmologist on your own in the town of 25,000 people. But also, she wanted to travel and then around Europe. So she wanted to just experience that, uh, experience, you know, in the UK, uh, then so to to affect that, you got to then white, the Dean aree and then also like, Well, you know, this is what your timetable is gonna be is the experience you're gonna get. You're gonna get approval. You're gonna plan it out. Then you got to work out where you're staying. So it does take a lot of organizing, but it's definitely worth it if you can do it. Uh, I still have friends there to this day, and I've been back, you know, quite a few times actually came close to taking a job out in Australia, an opportunity to, uh, work out in Brisbane. Um, but then the job at Imperial came out at the same time. So I'm not taking the imperial deal until, Yeah, I would recommend it. Uh, if you can do have a program experience is definitely not worthwhile. Mhm. Thank you. There's a There's a question in the chat. Um, what sort of things can we do as medical students to get a head start buff up our CVS for ophthalmology? That's a good question. Uh, one of things to do is that there's there is the Duke Elder exam eye exam. Uh, so if you get a chance to do that, do that, and that helps you. I mean, you need to study a little bit for it, so you get a little bit of idea what you're getting into. That's quite good to do, And, uh, there may be some I basic, I course is that the world culture of them will just run. It's probably worth looking into that. Basically, what you want to show if you want to do is is that you're interested in eyes. Um, if there are elective opportunities, I think you still have an opportunity. Don't elect it. You could do that. And, you know, with some ophthalmology, uh, experience there, get some, Get some input from that. That's quite good to do. Um, yeah. So just looking at all angles to show your your interest in your own time, you could see if you can shadow some eye clinics, learn how to use just little lab. You know, basically, just want to bulk up that c v put things on it, you know, and the other you could do is just get interested in it'll Look at the YouTube channels your eye surgery's about learn about the anatomy, etcetera. So as long as you got to get through your medical training, but yeah, you just got to try and work out what things you can put in your c d. To make yourself competitive or more competitive. Mhm. Uh oh. Sorry. There's another question. Um, what are your thoughts on medical of technology? Yes. So that if medical family that that means ophthalmology without surgery. Uh, I suppose that's that's the question. Um, that's fine as well. I mean, there is a There is a space for that. There are plenty of people who do the ophthalmology side of things. The medical side of things, the diagnostics. Without the surgical component, you don't have to do the surgery. I mean, during the training, you do get exposed to the surgery. But not everyone is a natural surgeon. So you know, you're gonna What you don't know is how are you going to be during surgery? You know, we we don't. I mean, I didn't know what was going to be a good surgeon. You guys don't know. You know, you kind of hope that when you get there, you can do it. But it's like everything else. There's a bell shaped curve. You're gonna have a lot of average. You're gonna have exceptional. You have people who can't. You can't do surgery for whatever reason. Um, suppose the difficulties working out, having the insight to know where you are and then gear your career accordingly. Just accept that. You know, uh, there are more surgical self specialties compared to others. So you can the other beauty of ophthalmology. You can decide what area you want to go into. Mhm. Hello. Question just popped up from Malik. He says hi, Mr Mersa, I'm a fan of your instagram bits and edits. Um what are your thoughts of off till training in the UK versus us? A. Okay, good, good. Thank thank you for much looking at my stuff. Um, yeah. I mean, the instagram and the, uh, all the edits. I I quite like all that. I'm on tiktok as well as, uh I love all that creatives side. Um, and it does allow you to bring in a bit of humor, Uh, 22 things. And you know how people learn that way, but, yeah, One of my thoughts on training off the UK versus you were saying, I mean, in the u. K. You're gonna get more surgical exposure for sure. Uh, at the moment in the USA, you don't get as much surgery. So you I would say, on average, you finish your us a training with about maybe 100 to 200 cataracts if you're lucky. Whereas in the UK at the moment you're getting about 2300 when I finished. I've done 1000 cataracts in my training before. I even took up consultant job. I think I've been squeezed on a little bit now, but you're still better off here. In terms of the the surgical numbers, they've also reduced the training a little bit. You know, you got to run through training now, which is understand, seven years, which is probably about right, to be honest. And then you got the opportunity for fellowship training to really hone your skills and decide what some specialty you want to do. I've got the chat here, check. And so, in some ways, to to get consulted. Post is PhD quite common prerequisite these days, I would say no, not really. Um, you know, people assume that they get a teaching hospital post. You need a B, sc, MD this and that. But yeah, it helps. It helps you get shortlisted, but it's not the be all and end all I mean, my example. Personally, I didn't do a BSC in medical school at the point I did it, I had a choice and I decided that actually, I just wanted to go on and be Do I love the clinical side? So I didn't do one. I didn't do an MD, but what I did do is lots of, uh, clinical research. So I published a lot. I started off with case reports in case series. Any of G d. I can even an audit. I kind of turned into a public publication, so I went to that imperial interview with over 20 publications. Now I was competing with people with MDS, PhDs and all sorts, but they didn't have as many publications as I did, and I didn't even have a formal research degree. But by having having those publications, it does allow you to get on the short list. And then it's about then it's about the interview, isn't it? One would hope, you know, an imperial I was. I was up against six other candidates went to a presentation. Thankfully, I went through, but yeah, so to go back to the question that PhD is not required. It's more about you know how much you publish how you come across where you got to bring to the department what technical experience you have. What training? You've had that kind of thing. Um, will a copy of the report and be available to view, please? That's one for you. And guess Astrid. Yeah. So we are recording it. So it will be available online when we finish the the meeting. Yeah. Bryant, Um, here we go. What are your? You surely motivated me to pursue ophthalmology. Brilliant. What are your thoughts on the future of private working ophthalmology in the UK? Yes. Very interesting question. Uh, yes. The field is changing in private ophthalmology, I think. Yeah, it's gonna be as probably. I mean, corporate corporate entities are buying up a lot of private ophthalmic centers. I mean, they already run a lot of private hospitals when I first qualified as a consultant, and you probably work out to work in a private hospital, get privileges and do work there. But I think what will happen is you'll probably move towards private hospitals or entities. Uh, taking on people and pain them accordingly are sort of a fee for service. So it should actually be a little bit easier. There are pros and cons. So, for example, our unit OOCL vision we take on new new consultants who are interested, and we run their practice for them. So secretarial support, billing support, we mentor them being senior consultants. Uh, and they quite like that. And then we build them up to a good level, and I mean now are ideas to try and incentivize them and then give them ownership ultimately of their destinies. And the practice is are sort of direction. And the reason why we set up OOCL vision with with my colleagues is that you get you know, you you're a master of your destiny. I mean, our idea to expand. So we've already we've done London. We've expanded to L Street. We wanna expand a little bit more. So watch this space. But we do want to take people on, give them the opportunity to, uh, have a vested interest, uh, in their teacher and also have something intangible that they can sell it in their careers. Because right now, uh, previously you would do your you would have a career. You finished with the NHS. You get that tension. You finished privately, and that's it. There's nothing you don't sell. There's nothing to sell. You're not selling anything. Whereas if you're part of an entity, you can then sell your share in the business. And that's another sort of your retirement taken care of. Of that kind of answer that that question? Um, what else have you got here? Thank you for your talk to any tips on for building portfolio for ST One. Yeah, again. It's just like what I did. I mean, I managed to I did the exam. First part, one exam. I don't if that's allowed now, but if you can, that's quite good to the at least to the stain for it. Um and then any sort of I related course can go on, approach your local eye department, see if you can do an observer, ships it in and clean. It's, uh, all that kind of helps with these CVS. You can do some kind of audit, even if you're doing basic stuff. If you can put that on your on your application, it all helps, Um, over there love eyes. Not very good at featuring size. Are there any techniques? Tips that help help you? Um, it's just practice, Really. I mean, when I did it, I was. I used to go out of hours and just use the microscope with, like, a pan Doreen or some kind of feel big stitches and just hours and hours and hours of under the microscope just getting those hands working all about repetition. Nowadays you got virtual simulator. Uh, that you can practice on the Royal College. Have one. They do tutoring courses. A lot of teaching hospitals have the simulators in house, so you can spend time doing that. It's just like it's just like like anything else in life. You know? You want to shoot hoops, you got to practice the basketball stuff. You know, it doesn't just come. You got to You got to put the hour then. And the more you put in, the more training you put in, the better you get. And again, it goes back to that success iceberg. You know, you just see the top of year. You can shoot her in two seconds. You know why? Why can't I do that? Why can you do that? Because you spend hours. You know where perhaps others haven't. Um, you know, stayed behind after work sacrificed going to wet labs that what you needed to do and just kept at it till you till you cracked it. Um, yeah, that's that's, uh, that's that question. Do you think it's possible to get inside regarding whether it will take to microsurgery? Or is it just a case of hoping things work out when we start? Another great question. How do you know if you're going to be any good? That's tough, isn't it? Um, my son likes computer games, and he reckons playing fortnight gives him hand eye coordination. Uh, may be helpful with a few chance. I don't know if you're good at computer games. Does that help you? Maybe. I mean, the thing with micro surgery is that it's a bit like driving. You're looking straight ahead down a microscope, and your hands are doing stuff in front of you, and your feet are doing stuff as well. Your feet control the microscope may control, like the ultrasound pedal of the baker machine. Um, so, yeah, it's it's difficult to know. I mean, you need good binocular vision. Um, so there's that, but yes, it's really hard to discern. Are you going to be a good microsurgeon. That's there's no really easy answer to that. I mean, you could put your hand down and see if you've got a shake or not. I said, My quite rudimentary test. It's Yeah, there's no easy solution. There's no easy answer for that. I mean, I'm sure there's sort of practical test you could do. But is it reflective of the real life scenario? Who knows? But like I said, if you're not cut out for surgery, there are other aspects within ophthalmology. You can do which are, you know, rewarding. Um, okay, so but yes, it's a it's a It is a worry. Worry for everyone who goes into any surgery, any surgical field. You know, you just kind of worry. Have I got it? And you will be disillusion at the early stages because you know, you're gonna be you're gonna have setbacks. You're gonna have complications, you know, because I've never done it before. It will play with your mind, you know, You got to You got to really a lot of mental aspect. You're gonna be able to work through it. Accepted. Get up on my horse again. Get in there. I mean, you will support it during training. So that's the real good thing that you know, senior registrar consultants there with you during the surgery. And you've now got simulators, which we didn't have before. So it is a lot better. And you got access to YouTube videos. Whole lot of media out there that we didn't have access to. Kind of prep your mind. Ready for the century? Uh, email again. It's I'll put it here. I'll put it in the chat. It's just Ali. Uh, O C L vision dot com. That's my email to feel free to email me if you wish for any other questions, for the recording will make it online on our social media. Excellent. Brilliant. Yes, please let me know when it's done. I'll post that as well. Share the share the link on my socials. We'll do? Yeah. You guys have a YouTube channel. It does, But maybe we should make coin. Yeah. Otherwise I'm happy to put on mine and and reference you guys let me know. How do you go about revising for the ophthalmology exams? And you could resources to learn about ophthalmology content? Yes, the part one is tough. I had a study colleague, so we kind of did it together. I found the okay anatomy pretty hard. I mean, it's quite intense, you know, You think as a medical student you learn as you know, the cornea, the retina, the lens, you know, But when you go to the mall and you learn, the cornea has five layers, each with different function. Retina has 10 layers, each with a different function, etcetera, etcetera. It goes into quite minute detail. Then you got to learn all the pathways of nerves, all the muscles, what they all do. I mean, it is it is fascinating, but it's a lot of work now. I mean, again, there's more resources. Now you got you got three D animations you can look at for anatomy. We had snails, ocular anatomy back then, Uh, the other thing I find you. So we had a what's called anatomy Coloring book. And if you guys have heard of those, But you get a you get a coloring book for anatomy or kill anatomy and whereby you color the pathways of the nerve, for example, and for some reason that kind of helps determine, uh, say I mean that that kind of work for me and then just testing with the colleagues and things as a whole little, well, resource out there nowadays. Okay, Next, out of interest. What were the never events that you mentioned earlier in the talk? Okay, Yeah. They were a specific to Catholic surgeon. So you do cataract surgery, you take out the natural lens, you leave the lens capsule behind and you have to put a lens in the old capsule. Now that lenses calculated for each patient. So you measurements. We work out the lens power, we choose a lens power. Then we put it in in the eye, so we shouldn't really get that wrong. So that's never events are situations where you shouldn't really. There should be enough steps in place to prevent that kind of problem occurring. So, ophthalmology putting the wrong lens implant is classed as a never event. It's similar to like if you operate on the wrong, I over the wrong foot will take a kidney at You know that. You know, I suppose that is a never event. So that's defined, I think. The Department of Health, health education, England, the NHS, so yeah, for us. It was We had several incident where the wrong lens was put in, which then resulted in a bad outcome for the patient. And that means more surgery, potentially taking the leads out, replacing it. Um, so that yeah, that that those were the improvements that we were we were dealing with. And the way we dealt with that was basically, like, I'm just gonna put a system and process in place. So we did something called the lens selection sheet. So you wipe down the lens power on that sheet, you make sure it matches with the measurements before and before you operate on a patient, everyone in the operating room goes through that sheet. So, you know, as part of the time out, who checklist, we check the lens power. So what are we putting in this patient? We're putting in the 20th after lens. Here's the, uh, calculation sheet. The biometry it matches, but that matches the patient. It matches with the I would do, thank you very much. We put that one lens in the operating room, and that's the only lens there. And since we did that, we didn't We didn't have any other. Never events afterwards related to, uh to your wrong implants. Um, another question here. Thank you for share ing. Whether any pivotal, significant experiences prior to entering formal family trained that a friend in your decision and interested ophthalmology. Um, I would say it was a bit of the disillusionment, uh, with my house jobs. So I finished medical school, as you guys will. Then you come into the big bad. Well, I did respiratory medicine, and I did general surgery and neurology for my for my house jobs. So for general surgery, I mean, I just didn't enjoy doing P r. S. You know, you got to put your finger up the, you know, that's just part of the job. You got to do that. I just didn't like that. The surgery. I mean, I held him retractor back for hours. It was smelly like that. My boss at the time said, Come to the clinic. I'm gonna have a look. See what I do. The consultant. So he was there putting sigmoidoscope. So people's backsides and I didn't really enjoy Enjoy that. And that kind of put me up completely. Um, getting surgery with urology. You got to put catheters in people's anatomy didn't enjoy that. I just I just didn't like it. You know, I just I just hated it, actually. I was really sort of thinking I made the wrong choice here doing medicine. Uh, that's why I did casualty, and that was more interesting. But, you know, the shift work is I mean, that is full on If you've ever done an attachment casualty, you're doing, you know, 8, 10, 12 hours and it's full on morning to evening all the way. And I just, you know, do I really want to be in my forties fifties? You're married with kids and on the shop floor at night, You know, and stuff like that. I just, you know, again, that really disillusionment as actually to the point where looking at a career change, I was thinking of doing management consultancy or some kind of occupational health. I remember looking at a an add to work for British Airways as the occupational health consultant. Um, but thankfully, it was actually in casualty the pivotal moment where I just remember looking at any eye complaint that would come in, actually enjoyed looking at looking at them and just seeing the pathology. And I like the fact that it's so visual. I like the fact that you have to get a whole lot of blood tests You didn't need X rays. MRI s. You know, um, it was pretty clean. You don't have to undress anyone. You don't get your hands. It was It seemed pretty, uh, you know, I don't know. It just seemed very nice. And then when I spoke to the ophthalmologist for advice, they're always really friendly. Really? Good vibes coming from them. Just have generally good feeling enough. But you know what? I don't know much about it, but I like it enough to give it a go and my decision with you know what? I'm going to give it a go, And if I don't make it, then I'll probably change careers. Uh, but thankfully, I got in, and when I started doing it, I just realized it was like a EpiPen it, You know, I thought, This is it. This is what I was trained to do. This is what I love. I'll never looked back, never questioned anything. Loved the training. Yes. There were difficult times. You have based difficult times, but I just enjoyed all the learning learning about some specialties. I love the travel component. It was Yeah, I love the surgery. Um, but yeah. So it's a journey, but it's an enjoyable journey. And even as a consultant, I've loved that as well, you know, had its own challenges from the director role. You got to deal with colleagues, management and 26 consultants to manage. It was challenging setting up a clinic that was challenging. So I'm not that a different phase of your career, you just go through different, different phases every time. Oh, yeah. So the decision. Yeah. So that was the affirmation, I suppose, Or during casualty kind of gave me the nod, and then I pursued it and then never looked back. Um, are there any other questions? Um, that looks like it. Then, um, excuse my sore throat voice. Um, I'll send out the feedback phone to you. Well, um Oh, sorry. There's one more question. I was reading something that currently there's a shortage of the ophthalmology. Consultants', do you see this being tackled in the future? In some capacity? Um, yeah. They're trying to get more trainees through Um, yeah. So hopefully more of you guys do it. We will plug that gap. Uh, there's always working ophthalmology because everyone's living longer and everyone gets gets Catholics. You know, you live long enough. You always get a cataract, you know? So 65 How many? 7. 88 million people in this country. That's a little work out there. That's just cataract surgery. Let let all the other substances. So, yeah, we need you guys in off the multi trained up, ready to go, ready to fire When the time comes. What have you probably do? My cataract. And there's one more question. What's the AI Tech side of after looking like, uh, looking amazing? That's another really, uh, amazing aspect of of thumb ology. It just get better and better every year. So, uh, in terms of the lens we use, for example, in cataract surgery, we can now use bionic type lenses which, correct for far and near can give you distance as well as reading vision. Get people out of their glasses. There's various varieties of those laser vision correction. That's an amazing bit of technology. The ladies have got faster. The whole thing is safer. You can correct someone's vision. Literally 10 minutes. Um, it's arguably, say, for the contact lenses these days, um, and then and then the other tech in terms of getting lenses out of the eye. Ultrasound technology that's becoming credible and the other real big jump is imaging, So the imaging now is incredible, so you can take pictures of pretty much every aspect of the eye. The measurements are are awesome. Someone's talked about the AI, and someone mentioned a I artificial intelligent that's coming into the multi as well. So in our private clinic were using. Actually, even in the NHS, we're using artificial intelligence to determine the appropriate lens. Powerful individuals. We can also use it now to advise on diabetic retinopathy how often the patient should come back with the treatment they need and so on and so forth. So it's a it's a it's a great space. And, yeah, we love our tech, and it's There's a lot of tech lot of imaging, a lot of technical with the surgery, So if you are techie, it does feed that side of you. Okay, it doesn't seem like there's many more questions. Um, were saying things. So, guys, is there any anything else you want to ask? Mm. Okay. So thank you so much for the talk. Um, you've inspired a lot of people today. Me included. Um, would, um Are you going to send out the feedback phones on? Uh, and then, uh, yeah, it'll get emailed to everybody. Mhm. Perfect. And we would appreciate if you could feel them. Um, yeah. Have a nice evening, everyone. Thank you, guys. Hope that was helpful. Who's really helpful for you, Okay.