Roxanne Crosby-Nwaobi

1. Tell us about your journey into ophthalmology.

In 2009, I worked as a diabetes link nurse on a Urology ward in Sheffield Teaching Hospitals. I had just completed my MSc in Advanced Practice and wondered what next. I gave a presentation on my MSc work at a “Sharing Best Practice” day and I was encouraged to undertake a doctoral degree. Focussing on my interest in diabetes, I applied for a PhD studentship in the South East London-Diabetic Retinopathy (SEL-DRS) study with Prof. Sobha Sivaprasad and Prof. Angus Forbes at the Florence Nightingale School of Nursing and Midwifery, King’s College London. Hence began my journey in ophthalmology….

2. What is your current research about?

My area of research focuses on developing and evaluating interventions to improve patient access to care, reducing health inequalities and improving quality of life. My Health Education England /TOPOL Digital Health fellowship seeks to increase the uptake of diabetic retinal screening in patients who have not attended the screening programme for 3 years. In patients who do not attend screening, there is a 3 fold risk of developing sight-threatening disease. We know from the literature that there are several barriers to screening attendance, including an aversion to dilating eye drops, low socioeconomic status, language and culture in ethnic minorities and inability to travel to the screening centre. Although these patients have not attended the diabetic eye screening service, they may still attend their GP for other causes, for example, a medication review. The Behaviour Change Wheel (Mitchie et al 2014) encourages an examination of behaviour in terms of capacity, opportunity and motivation to determine possible areas for intervention and sustainable behaviour modification. Therefore, we hypothesised that by relocating the screening service to the GP surgery, teaching the practice nurses to conduct the screening, using a non-mydriatic (no dilating drops required) ultrawide field retinal camera (OPTOS), using the patients modifiable risk factors to provide real-time, on the spot education about retinopathy risk including a demonstration of this risk as a function of a red-amber-green display and using a teleophthalmology electronic medical record system (Big Picture Medical) capable of uploading the retinal images and a targeted clinical history for remote review by a specialist, we would be able to increase attendance in non-attenders. Preliminary results have been positive.

3. How has your work been supported by the NIHR?

I was recently awarded a NIHR Integrated Clincial Academic Clinical Lectureship to enable me to continue my life-long training as a clinician and as an academic with the ultimate aim of improving patient outcomes. The Research and Design Service has been invaluable in the preparation of the application and for the interview. I have also had the support of the NIHR Moorfield Biomedical Research Centre in the form of Patient and Public Involvement advice for my application. The North Thames Clinical Research Network and the NOCLOR teams also received several panicked phone calls and emails to which they have replied with efficiency. As a recipient of one of the NIHR70@70 senior research nurse leader fellowships, I have had access to a wide range of resources in terms of written information and colleagues and mentors.

4. What do you think the future holds for ophthalmology?

In 2017-2018, the number of ophthalmological outpatient appointments attended surpassed those for trauma and orthopaedics, with estimated of 7.6 million, accounting for £5.5billion in direct financial costs (NHS Digital 2019). This does not include other costs to the patients and their carers. People are living longer, therefore we have to treat conditions for longer including the impact of sight loss. Teleophthalomology, the use of apps and genomic medicine all have a role to play on our future. We need to practice preventative medicine rather than reactive medicine. Additionally, if we truly increase the involvement of patients in their clinical care including co-designing our research, we will have outcomes directly applicable to and accepted by patients. Therefore, we need to adopt and implement initiatives to prepare the workforce to undertake these challenges