Moorfields consultant and former deputy director of research, Professor John Dart, looks back over more than 30 years at the hospital and reflects on why it is a world-leading centre for ophthalmic research
I didn’t start out as an ophthalmologist. In fact, my first degree was in Zoology, but as I progressed I realised that my main interests were in the medical aspects of the work. So after completing my first degree, I started my pre-clinical training at Trinity College Cambridge.
I qualified in 1976, and began my residency at Moorfields in 1980 after 2 years at the Oxford Eye Hospital and a stint in Melbourne. At that time, a resident was able to do a huge amount of surgical training. I think I carried out over 90 retinal detachment operations as a junior: these are not done until Fellowship training today.
I then spent some time working with Dr Dan B Jones at the Cullen Eye Institute, in Texas, and Prof Doug Coster in Adelaide, on a fellowship in ocular infection. When I returned to Moorfields in 1984, I took up a job in the contact lens department under Professor Roger Buckley as a clinical lecturer in ophthalmology at the Institute of Ophthalmology, which at that time was not part of UCL.
The department was a great place to do get clinical experience and start some research, and this nourished my interest in corneal disease, disorders of the lids and their lining tissue (conjunctiva), and severe infections and inflammation at the front of the eye.
As soon as I was in post Professor Buckley went away for an operation for nearly a year and I was given the job of running the department. Looking back, it was pretty crazy. I was newly qualified and I had responsibility for 25 staff. I was promoted to honorary consultant in 1987.
It was incredibly difficult to get a permanent consultant position then because you had to wait for someone to leave or retire. After two failed applications for jobs in provincial teaching hospitals I considered leaving Moorfields and emigrating to Australia, but decided to hold on. Eventually, a consultant retinal surgeon left to take up a chair in Manchester, and I was appointed (as a corneal specialist!) to his job.
This gave me an opportunity to start to build up my own corneal service, almost from scratch. Working with Peter Wright, I was able to explore my interest in chronic external diseases including those causing scarring, such as pemphigoid.
Many of the diseases we saw in clinic were obscure and not recognised in other hospitals, so patients with rare diseases were often referred to Moorfields. However, until the late 1980s we could only ameliorate the effects of these illnesses, as the use of systemic immunosuppressive therapy for these diseases had not been introduced. This happened in the late 1980’s and we pioneered the use of these treatments for these conditions in the UK, which further grew our patient base.
In the early 1990’s we had an outbreak of very severe Acanthamoeba corneal infection. My colleague, Mr Frank Larkin, also at Moorfields and the Institute of Ophthalmology, had conducted a ground-breaking study on the use of polyhexanide to treat this disease which is a chronic protozoal corneal infection, often associated with wearing contact lenses and exposure to contaminated water. It was very resistant to treatment with known antimicrobial drugs and the majority of patients used to go blind or lose useful vision, sometimes in spite of multiple corneal transplants.
Recognising the potential of polyhexanide, we applied to Imperial Chemical Industries (ICI) to start using it in ophthalmology. Initially the company refused, but after Moorfields agreed to accept any indemnity for problems, polyhexanide was rapidly introduced and has since been used world-wide, off label, in the treatment of Acanthamoeba keratitis. We currently have an EU funded grant to carry out the studies needed to licence polyhexanide as a treatment for this disease.
Throughout my clinical career, I juggled my research interests around my commitments to my patients. At that time, there were no joint research/clinical posts, and so I fitted in what I was doing wherever I could until some research funding became available for a day per week in about 2000. It’s only since I discontinued private work in 2012, and part-retired from the NHS in 2014, that I’ve been able to devote more time to my research, which is mainly focussed on understanding the pathology of, and treatment for, amoebic keratitis and the scarring eye diseases.
The gift of additional time has really helped me to progress, and we have made some significant breakthroughs. We have made great progress towards developing a new drug for scarring eye disease. We are about to start the randomised controlled treatment trial, in several centres in Europe and the UK, of a new formulation of polyhexanide for Acanthamoeba keratitis and are nearing the completion of studies identifying behavioural and genetic risk factors for this disease.
Throughout my career, Moorfields has been a wonderful place to work. It’s so special to work in a hospital where everyone understands how integral research is to providing a good clinical service, and where everyone is invested in research as the primary means by which we can offer new and better treatments to our patients.
Because Moorfields is a specialist hospital, we see the really difficult problems here, and this spurs us on to find better and more effective ways to treat those patients. It has been fascinating and incredibly rewarding.