Q&A: Professor Harminder Dua CBE

Professor Harminder Dua, from the University of Nottingham, has been appointed a Commander of the Most Excellent Order of the British Empire for services to eye healthcare, health education and to ophthalmology in the Queen’s Birthday Honours.

What was your reaction to finding out you had received a CBE?

I wondered if it was true at first. [The CBE] is a great honour and was a pleasant surprise. I got to know three weeks in advance by official letter. I had to formally accept it, but it was confidential until the day it was announced. It was really hard to keep it secret.

What have been some of the highlights of your career to date?

Being elected as president of the Royal College of Ophthalmologists was a highlight. The honorary fellowships I have received from the Royal College of Physicians, College of Optometrists and Royal College of Ophthalmologists were also high honours because they are rarely awarded.

I would say that the research that has made a major difference in our practice is the discovery of this layer of the cornea called the pre-Descemet’s layer or the Dua’s layer. The initial reaction is always mixed but now it is well-established and it is in many textbooks.

We were the first to discover the antimicrobial peptides in the eye of any species. This group of molecules had been described elsewhere in the body but for the eye that was the first time. That is an area of research which has now been taken up by many other groups across the world. I think this research could lead to the next generation of antibiotics. There will be almost no chance of resistance. These are all defining moments of my team’s work.

How does your research help patients?

My research is mostly translational. You see a problem in a patient’s eye and you try and understand it. When you can’t find an answer in the books, you find one through research and it makes a direct difference to the treatment plan of patients. Many other ophthalmologists start using that technique and it becomes the established approach across the world.

One example is when you get a lot of blood vessels in the human cornea, these blood vessels are very difficult to treat. We started looking into this a few years ago and published our own classification of corneal vascularisation and its characterisation. We discovered that anti-VEGF treatments are only effective for active vessels. For the established vessels, we had a technique called fine needle diathermy which has proved very useful. That technique has been around for 15 years now.

My work is like a hobby. That is why I don’t see myself retiring at all

Another technique we developed is alcohol delamination for treating recurrent corneal erosion syndrome. A researcher in Australia did a randomised controlled trial using a laser, which was then a gold standard, and this new technique. They found that the two techniques were similar in their efficacy, but the alcohol delamination was an office procedure which was very cheap and quick.

What are your predictions for the future of eye care?

One of the problems with ophthalmology is that we cannot discharge a patient back to the GP. We either hang on to them over the course of the disease process, which in glaucoma can be the rest of their life, or we send them home. We get snowed under because there are just not enough ophthalmologists.

I think we are struggling in the UK because of the sheer numbers of patients across the country. Our way of delivering eye care will move more and more into the community. I have always been saying that we have a workforce of more than 15,000 qualified optometrists; we have to involve them more in the direct care of our patients.

The second area of change is that eye care is becoming more private. The NHS is stretched too far in all specialities. New treatments cost a lot more than they used to and we don’t have enough doctors to administer those new treatments. We will find that private medicine will come in, but it has to be properly controlled because at the moment there is a lot of cherry picking and the NHS struggles with the more difficult cases.

I have always been saying that we have a workforce of more than 15,000 qualified optometrists; we have to involve them more in the direct care of our patients

I think there will be more telemedicine and virtual clinics. Artificial intelligence (AI) will play a big role, but in the intermediate rather than immediate future. I think AI is an exciting example of how we will be able to diagnose and monitor a huge number of patients in areas like macular degeneration and glaucoma.

What is the best part of your job?

I enjoy everything really. For me, my work is like a hobby. That is why I don’t see myself retiring at all. I could have retired two years ago but I said, ‘No, I will carry on.’

I love teaching and teach all over the world. It is as rewarding as when you restore sight in a patient’s eye when you can see the enlightenment in a student’s face when they understand a subject. No matter where you go in the world it is the same kind of experience.

Image credit: Laurence Derbyshire