Did You Know?
The eye is the only organ which provides us with a view of the body's blood vessels and nerves, simply by using a lens. It isn't just "the window to the soul" you can also see a reflection of the body's health and clues which uncover diseases. There are doctors who are trained in both Ophthalmology and general internal medicine, who can use these clues to diagnose and treat patients.
"The eye is amazing and we are discovering more and more about how it can reflect health in the body", says Dr Nima Ghadiri, who has recently joined St Paul's as a consultant Medical Ophthalmologist, and is working at both the Royal and Aintree sites. Nima has trained in Cambridge and the East of England, and has spent periods of advanced fellowships at St Thomas' Medical Eye Unit and Moorfields Eye Hospital. He has worked as a consultant at Moorfields and Great Ormond Street Hospitals before starting here.
He is interested in the interface between systemic medicine and ocular diseases in both children and adults. This requires understanding of not only ophthalmic medicine but also expertise with other specialities, such as respiratory medicine, cardiology, neurology, gastrointestinal medicine, rheumatology, endocrinology, haematology, nephrology, infectious diseases and dermatology (and the list goes on).
"Sometimes, eye inflammation may be the first sign of a body condition, and then it is crucial that the whole patient is investigated and treated, not just the eye"
Within all of these specialities, there are diseases which can affect the eye in different ways. Therefore a physician's approach and training can be crucial in investigating and managing both the systemic (full body) problem and the eye, and to ensure that patients receive integrated care. This bridges and interfaces hospital ophthalmology, inpatient and outpatient medical care and community care. Therapeutic options can be very effective, and in some cases the need for potentially risky surgery can be avoided. The United Kingdom is also unique in being the only country in the world which provides specialisation in this person-centred, integrative form of medicine.
Detective Work and Integrative Medicine
“Sometimes, a patient's eye and body symptoms can be a mystery”, says Nima. “Medical ophthalmology requires a detective’s approach to pick up the cross-disciplinary clues in patients who have been previously undiagnosed or whose medical problems straddle different specialities. Taking a patient's history, simply listening to what the patient says, is crucial as many clues can be obtained - and a diagnosis often made - before even looking at the eye. As a physician it is also really satisfying diagnosing a systemic (full body) disease from clear pathology in the eye, especially for patients who may have struggled for a while to be diagnosed. Sometimes, eye inflammation may be the first sign of a body condition, and then it is crucial that the whole patient is investigated and treated, not just the eye.”
"Treatment should incorporate the overall health and wellbeing of the patient"
Nima’s speciality deals with diseases such as uveitis, scleritis, thyroid eye disease, lung diseases, strokes, brain inflammation, pituitary diseases, vasculitis, rheumatoid conditions, infections, cancers, bowel and even skin problems. He also deals with vascular diseases such as high blood pressure and diabetes, genetic diseases and all the complications relating to these conditions. “The most important aspect of practice is teamwork - with my colleagues in Ophthalmology and other specialities."
"At the core of Medical Ophthalmology is the tenet that each patient case presents individually, and the reasons why a condition has manifested in the eye and the body can have many factors. Treatment should incorporate the overall health and wellbeing of the patient.", continued Nima.
Nima is also interested in a number of non-medical areas that are intimately linked and influence the practice - these include the use of technology, particularly immersive technologies, to help patients contextualise their condition and holistic aspects of patient empowerment, education and experience when visiting hospitals, such as the incorporation of art and green spaces in hospital environments. Such is his passion for this he wrote an article in the Guardian about his seven favourite healing NHS gardens in the UK.
"On the value of plants and space in healing, Florence Nightingale said, “People say the effect is only on the mind. It is no such thing. The effect is on the body too”. said Nima.
"One of the most enjoyable aspects of my job is to get to know patients over time"
Hopes and challenges
Nima has an exciting challenge in joining up ophthalmic outpatient services with inpatient specialties in a city which has much of its specialty services divided on separate sites. He is looking forward to forging links with colleagues in many different specialties around Liverpool and the North-West. Dr Ghadiri is a member of the national group for eye inflammation (Uveitis), as well as the WHO technical working group, and hopes to ensure that Liverpool develops as world-renowned centre of eye and systemic inflammatory diseases, and that patients in this region have a say when it comes to the future of eye inflammation research and treatment.
His ambition is to establish a Medical Eye Centre within St Pauls, which would be a centralised hub for multi-disciplinary management and cutting-edge treatment, together with a centre for education, training and outreach.