What Mr Jaheed Khan does at Clinica London and how he detects diabetic retinopathy
Mr Jaheed Khan is a medical retinal and cataract ophthalmic specialist at Clinica London. In these blog posts, we learn all about Mr Jaheed Khan and about two of the common eye conditions he treats, diabetic retinopathy and cataracts.
Jane: How long you have been at Clinica London now?
Jaheed Khan: I joined Clinica London in 2014, I think, maybe late 2013 or early 2014.
Jane: Is that when you became a consultant ophthalmologist at Moorfields?
Jaheed Khan: That’s right. I was a locum consultant at Moorfields in 2011 and had a substantive post in 2012 and started private practice soon after.
Jane: And what did Moorfields appoint you to do?
Jaheed Khan: My appointment was a consultant specialising in medical retina diseases and cataract.
Jane: Tell me, what is the ophthalmic speciality called medical retina diseases?
Jaheed Khan: Medical retina disease encompasses all of the conditions that affect the retina which is the film at the back of the eye. Common conditions that can affect the retina are things like diabetes and which produces diabetic retinopathy, macular degeneration which we see in our elderly population and which is related to ageing changes of the retina. We also see blockages in blood vessels of the retina such as vein blockages, which we call vein occlusions or artery blockages, which we call arterial occlusion. These can produce blurred vision secondary to macular oedema.
Jane: How would a patient know they have got any of these things: diabetes, age-related macular degeneration, vein blockages and macular oedema?
Mr Jaheed Khan on detecting Diabetic Retinopathy
Jaheed Khan: All of our diabetic patients in the UK should get screened for early signs of retinopathy. A lot of our patients do not experience eye symptoms. Instead, they get picked up through a screening programme.
Jane: Tell me a little bit about diabetes and screening programmes, who does that and where is that done?
Jaheed Khan: Screening is available in the UK for all people who have diabetes over the age of 12. They receive the offer of an appointment for photographs of the back of the eye every year, and they go into a clinic, they have their pupils dilated and have photos taken.
Jane: Is this done in an optician’s clinic or an NHS doctor’s clinic?
Jaheed Khan: NHS doctor’s clinics do not screen. It is set up under the umbrella of the NHS as part of on allied screening service they deliver through opticians in the community.
Jane: Do you do any diabetic screening?
Jaheed Khan: I do not, specifically no. I receive referrals from screening programmes.
Jane: What sort of patients who have diabetes to you do get to see, are they usually already diagnosed?
Jaheed Khan: The patients they are referred to hospitals are referred to medical retinal specialists when they require further investigations or treatment of conditions like diabetic retinopathy which may lead to problems with their eyesight if they go untreated.
Jane: So, say I have diabetes, and I have not got it under control, and my vision is getting blurred, and I am referred to you here at Clinica London, what would I expect to happen?
Jaheed Khan: Well, we would, first of all, take a detailed history of what type of blurred vision you have and why. I would want to know if you smoked. We will take a history of any eye problems as well, and the examination would investigate you for all of those other risk factors, such as heart disease and ischaemic issues. We would examine your eyes, and that involves looking at the front of the eyes as well as the back of the eyes just to make sure that you do not have any complications with diabetes.
The main complications of diabetes are cataract formation and retinopathy at the back of the eye. Retinopathy means that blood vessels are damaged in the retina, and if your blood vessels are damaged they can cause blurriness due to swelling of the retina. We would dilate your pupils. We put in drops in your eyes to make the pupils nice and large and then we would use a particular machine to look into the back of the eyes using a magnifying glass essentially and then a microscope and then an illumination system to look at the retina. We would also take some photographs.
Jane: What is that machine called?
Jaheed Khan: That is a slit lamp examination. And we use indirect ophthalmoscopy.
Jane: And then a machine that takes the photographs?
Jaheed Khan: Yes, the photographs are an assisted digital photography machine called the OCT and SLO.
We can use different imaging techniques. A basic photograph is what opticians do for screening, and we would repeat that just for our records, but also what we would provide is a detailed analysis of the retina so we can look at the retina in cross-section. Optical coherence tomography is the scan that we offer at Clinica which allows us to look at the layers of the retina in cross-section and Scanning Laser Ophthalmoscopy (SLO) uses wide angled viewing and when we see that swelling affects the retina very subtly in certain cases.
Jane: And in diabetes, you get vessel leakage and swelling, do you?
Jaheed Khan: Correct.
Jaheed Khan: And swelling can lead to blurred vision and if you get significant swelling that then treatment is obviously an option and can prevent further visual problems.
Jane: Thank you. For our next post, we’ll discuss diabetic retinopathy and what treatments Mr Jaheed Khan can offer them here at Clinica London.