The Sunil Mamtora episode

Sunil is an academic clinical fellow at Bristol Eye Hospital and the University of Bristol, host of the Royal College of Ophthalmologists’ Eye to eye podcast, and founder of YouTube channel, Slit lamp studios.

His current main research interest focuses on how slit lamp imaging can be used to enhance patient care and bridge the interface between primary and secondary eye care. By his own admission, Sunil is “obsessed to an unnatural level” with the slit lamp.

Here are four things we learned about Sunil when recording The OT Podcast.

1 Sunil fell in love with ophthalmology during his time at medical school

Sunil describes ophthalmology as a “specialty which is really unlike any other.”

“[As ophthalmologists] we’re really almost in a bubble of our own, and I love the fact that we can really get into the minutia of detail,” he shared.

The ophthalmologist told OT that, as a side note, his father is a retired optometrist, and he is often asked if that is the real reason he decided to specialise in ophthalmology. The honest answered is he does not know. “Maybe on a subconscious level, talking about these things whilst growing up, maybe it made it more likely,” he said.

“I remember when I was planning on applying to medical school my dad was teaching me about interpreting fundus photos and OCT, and I did find that very interesting,” he added.

However, for Sunil, he believes he decided to tread the ophthalmology path due to his passion for vision. “I genuinely believe with the wholeness of my heart that sight is something that’s so incredibly precious. It’s a magical and incredible thing to have… Being in a job where you can help people to see better is so rewarding, so I think that's the biggest thing for me.”

2 Sunil loves the slit lamp an “unnatural amount”

Sunil describes himself as “a bit of a geek” who loves technology.

“In optics, generally, there are so many technological advances, toys and gadgets.”

He finds joy in attending conferences across the UK and globally, simply to look and “play” with the different devices that are being developed and researched.

When OT spoke to Sunil, he had recently returned from the Royal College of Ophthalmologists’ Annual Congress meeting. One of his favourite things about the meeting, he said, was “going and playing with all of the new microscopes that have been released recently.”

Reflecting on his career path, paired with the technological side to ophthalmology, Sunil enjoys the combination of medical and surgical skills that the role provides, as well as teaching.

He shared that when he teaches medical and optometry students, he often begins sessions with a game to try to identify a specialty that does not have a link to ophthalmology and the eyes.

“I think it’s genuinely quite difficult to find a specialty which doesn’t have at least some form of tenuous link to ophthalmology, be it a medication that’s used which has a side effect that’s related to ophthalmology, or the manifestation of a disease or syndrome which has a finding or sign in the eye,” he shared.

3 Sunil currently spends 40% of his time investigating artificial intelligence (AI)

Currently Sunil divides his time between practising at Bristol Eye Hospital and working on anNHS AI clinical fellow scheme, which sees him funded to spend 40% of his time working on AI – the programme sees him receive dedicated training in AI.

“I’m learning so much about this field,” he shared, explaining: “We all know that AI’s going to play a huge role in the future in the way that we deliver care to our patients, but truthfully I didn’t feel as though I knew enough about this subject to be able to consider evaluating it or implement it into practice.”

Through the course, Sunil is learning how to interpret a research paper that has been written about an AI tool, as well as how to appraise a tool to evaluate how useful it might be to clinical practice, and how AI can be implemented in clinical practice. Alongside this he works in Bristol hospital’s intensive care unit in order to develop his generic skills in how to appraise an AI tool and implement it.

Discussing AI further, Sunil shared his opinion that “nothing is beyond the scope of AI.”

“You have to think of these things in terms of anything that a human can do in terms of interpreting imaging, an AI can do too – maybe not now, but maybe at some point in the future,” he said.

“If you think about it: if I was to watch a slit lamp video and I could tell you that a person’s got cataract or any other condition, for example, an AI can do that too,” he added.

However, Sunil admits that AI and slit lamp use is not straightforward.

He explained: “I think interpreting a slit lamp video with a machine learning tool is a lot harder than looking at a fundus photo or an OCT scan. While these imaging modalities are relatively standardised, slit lamp videos by definition are very unstandardised –everyone uses a slit lamp in a very different way.”

On the balance in workload, Sunil reflects that the 60–40% split works well for him as he can learn and upskill in a new area, while maintaining his core clinical skills.

“I wonder whether if I did any less than that I’d almost be at risk of, not deskilling, but not having enough clinical time to develop as much I need to at this level, which is really important for me,” he said.

4 Ophthalmology and community optometry

Sunil emphasised that he values the relationship between ophthalmology and community optometry.

“I think we’re really lucky to have a close link to the community. It is very nice to be able to develop relationships with optometrists in the community to co-manage patients,” he said.

When talking about his research on referrals and joined up working between optometry and ophthalmology for retinal diseases, Sunil highlighted that more work needs to be done in the patient journey and joined up care for anterior segment issues. More than 60% of presentations to emergency services are related to anterior segment, he shared.

He noted that for retinal disease cases, structures that have enabled image sharing and consultant review steps between community optometry and ophthalmology have proven effective. He added that a process using slit lamp video imaging did not seem impossible for enabling joined up primary and secondary care for anterior segment cases.

However, Sunil highlighted currently there is no evidence to support this, which is difficult.

He explained: “I think what we really need to do, first of all, is generate robust evidence that really demonstrates to funders and decision-makers that if we did have a slit lamp camera, for example, and we did send videos to the hospital, and we did find time for consultants in hospitals to review all these videos, and we bought everyone said camera as well, how many face-to-face appointments would be saved, how much capacity would that generate, and how would it affect outcomes for patients.”

“I think that evidence is lacking currently, and I think we really do need to do the work to evaluate that formally,” he emphasised.

Sunil reflected: “I really do imagine a near term future where patients have a lot of their care being delivered in the community overseen by the hospital where required.”

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