“The eye can be used as a window into the brain to look at different diseases”: Meet Professor Francesca Cordeiro

Professor Francesca Cordeiro, consultant ophthalmologist at the Western Eye Hospital, gives an insight into the innovative research work being carried out by the Imperial College Ophthalmology Research Group (ICORG) clinical trials unit, and details how the eye can be used to identify and treat diseases in other areas of the body.

What is your role at Imperial College Healthcare?

I’m a consultant ophthalmologist at the Western Eye Hospital and professor of ophthalmology at Imperial College London. My main role at the Trust is director of the Imperial College Ophthalmology Research Group (ICORG) clinical trials unit, and co-lead for the North West London Clinical Research Network (NWL CRN) in ophthalmology.

What inspired this particular career path?

Four out of the five brothers on my mother’s side are doctors and one of my uncles was an ophthalmologist, so you could say that I come from a medical family! As a medical student my short elective was at Moorfields Eye Hospital, and I was privileged to be under Professor Alan Bird who mentored me to pursue a research career in ophthalmology. I was drawn to ophthalmology because I saw it as a compromise between general physician training and general surgery training – meaning that I could do a bit of everything.

What does a typical working day look like for you?

I don’t have one! However, Wednesday is when we have our ICORG meetings which is where we run through the current clinical trials at the unit and catch up on day-to-day issues that need to be resolved. Then on Friday mornings, the Western Eye acts as a regional centre for training registrars, and this is something that ICORG is heavily involved in as we are keen to expose budding ophthalmologists to research.

What are your research interests within your field?

I am extremely passionate about being a clinical academic – focussing on both clinical practice and research – and I regret that current ophthalmologists are not encouraged to pursue research as part of their training.

My focus has always been on translational research, which involves taking a concept from bench to bedside. I have received continuous funding from the Wellcome Trust since 1996 to pursue this kind of research.

One project has stemmed from a piece of technology that I developed which offers a new way of identifying disease at the back of the eye. DARC technology works by looking at single cells that are stressed or apoptotic (dying) and using these cells as a measure of disease. We have shown that this technology can be used to look at eye conditions such as glaucoma and macular degeneration, and that the eye can be used as a window onto the brain to look at disease processes involved in Alzheimer's, Parkinson's and multiple sclerosis to name a few. This is because the eye comes from the same part embryologically as the brain and there are parallels between a patient’s retina and brain activity.

At the Trust, mainly, we have used this technology on around 200 patients, and we are currently trying to embed it into clinical practice as a decision-making tool. This technology gives a measure of real time disease activity, so could say whether a patient is on the right treatment and whether they need to come into hospital or not. You can also use this technology to look at the development of drugs, as we are doing at the moment, and whether a drug works in a matter of weeks as opposed to the current standard of years. Lastly, it is cheaper and more accessible compared to a brain scan to look at other diseases – we have just received a grant from the Michael J. Fox Foundation in America to use this technology to look at Parkinson’s patients at the Trust which is exciting.

Another project we’re working on is manufacturing eye drops for patients with macular degeneration that contain the same protein we currently inject in the eye, and which can be self-administered by the patient. This is called the AVID project and we will be starting clinical trials for this next year.

I am also working with a PhD student at Imperial College London to develop a tear assessment test – like a Covid lateral flow test – so that tears can be used to measure disease. All the above is aiming to identify disease much earlier so that we can prevent functional damage occurring in the first place.

What are the benefits of such research for staff and for patients?

For patients, we can streamline their experience so that they don’t have to wait long to know if they have a disease or not, or whether they are on the correct treatment or not.

For staff, it is hugely satisfying to do something new and innovative – all the while benefitting patients and improving their quality of life. Research also promotes collaboration between colleagues – the ICORG unit assists different teams and departments around the Trust through cross disciplinary clinical trials. For example, Professor Nick Oliver and I are working on pancreatic transplants into the eye as a way of providing insulin to diabetics.

This month the NHS turned 75. What does it mean to you to work for the NHS?

For me, the NHS means opportunity. Being able to run innovative clinical trials with real patients is an opportunity that you don’t have in other countries. I am proud that the NHS is one of the few health systems where everything is done for the benefit of the patient.

In chronic diseases and ophthalmology, especially in macular degeneration, there have been monumental changes in the technology that is available to help people in the last 10 years. It is an exciting time because newer and newer therapies are coming to the market, and this could stop blindness occurring in the first place.

However, it is no secret that the NHS is currently under a lot of pressure – we urgently need new funding, more manpower and improved infrastructure etc. I hope that we can go back to the basics of why the NHS was formed – to provide care for all – and use this as the driving force to improve things going forward.

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