Noemi Lois is a Professor of Ophthalmology and Honorary Consultant Ophthalmologist and Vitreoretinal Surgeon. In her line of work, Noemi’s main area of expertise is diabetic retinopathy where she supports people living with diabetes who have sight-threatening complications of diabetic retinopathy.
My days at the hospital
The research I lead is within the field of diabetic retinopathy – I have led and am currently leading large trials and clinical studies in the UK and Europe on therapies for diabetic retinopathy and its complications, as well as prognosis and diagnostic studies.
A typical day for me can vary greatly depending on whether the day is hospital-based through clinics and surgeries, or university-based, focusing on research projects.
Within the hospital setting it tends to start around 7.30-7:45am with evaluations for any patients undergoing surgery that morning. Due to the nature of diabetes, I may know these patients already through clinical appointments although on other occasions, people may have been referred to me with urgent problems requiring immediate surgery.
For my patients I like to start off by explaining what diabetic retinopathy means, what complications the condition may bring, and how we can treat them.
If surgery is taking place on the day, I like to ensure my patients have a good understanding of what the surgery entails and what we wish to achieve with it. As with any surgery there can be a risk of complications however, I explain to patients how I can solve them if they were to occur to help put their mind at ease.
Once everyone has been prepped for surgery, I then head into a busy day of surgeries. After that, there is time for a quick lunch and then I’m straight into clinics for the day which may run until 5.30-6pm in the evening.
My days at the university
While that is one aspect of my work, I then have the other through my academics at the university. Here my days start anywhere between 7-9am and finish by 4-6pm.
Due to the nature of this work, I do often find myself working quite a bit after hours, on weekends, and even during holidays as there is a vast amount of reading and writing required.
In the field of research things are constantly changing so updating our knowledge through study is vitally important, in addition to engaging with people in other fields.
Preparing grants to secure funds for research projects can be very time intensive as there is a lot to study, prepare and organise. These studies also include many experts from different specialities which is great in strengthening the work we do.
For us a big part is also including people living with diabetes as they can advise on what is important to them and what the things are that we may want to do, or not do as part of the clinical studies/trials.
Once planning for these projects is finalised, we then need to secure funding through grant applications which is always a challenge and involves a lot of work. Obtaining funding for a large clinical trial could take six months or more of intensive work. All in all, it is well worth every single minute.
Challenges within diabetes care
For me, I consider there to be two main challenges in diabetes care.
Firstly, we are supporting a condition that relates to a high number of people – diabetes is a very common and chronic condition in our society. This challenge is then paired with the difficulties we face with limited numbers of healthcare professionals to look after them. Sometimes this can lead to us feeling that we’re not as efficient as we would like to be (and could be) in delivering care.
Secondly, it is challenging to know that we do not have treatments for complications of diabetes such as retinal ischaemia which causes damage to the vessels in the retina. It’s vital that the field of research continues to work towards how we can solve the complications of diabetes for which, at present, we do not have any treatment.
Unfortunately, the COVID-19 pandemic had such an impact on us and our patients with appointments being delayed. While alternative appointment methods were used during this time, it’s vitally important for us to be able to examine our patients’ eyes and determine if urgent treatment is needed.
For people that have received treatment and are now stable, photos and scans of the back of their eyes can be taken. These images can then be reviewed by someone trained in diabetic retinopathy who may then determine whether the patient needs to (or not) be seen by a doctor in clinic.
Our EMERALD NIHR-funded UK diagnostic study showed this way of looking after people with treated and stable complications of diabetes is safe and can support the NHS in meeting demands.
Relevancy and importance
Ultimately, what matters the most to me is being able to provide excellent care to people with diabetes and diabetic retinopathy – being able to do the best I can for them to keep their sight. Very often we are successful at achieving this and I honestly can’t think of anything more rewarding that contributing to saving people’s sight.
Within the field of research, it’s also really important to me that the clinical studies and trials we do are important and relevant to people living with diabetes. I have been extremely lucky to have had the support of the Research Partnership of Diabetes UK for many years.
This has not only improved the quality of the research I do – addressing matters that are important to people living with the condition – but also importantly, to be better for my patients.
The interactions I have had (and continue to have) with people living with diabetes and members of the Research Partnership have made me a better researcher and a better doctor, and I am indebted to them for their collaboration, support and friendship.
A holistic approach
In my profession, I would like us to be able to deliver ‘holistic’ care to people living with diabetes, as it is a condition that can affect many organs in the body. At present, people have to attend numerous appointments with different specialists, and this can be very difficult for them.
How wonderful would it be if we had centres specialised in diabetes where people could attend and, depending on their personal situation, could see all specialists they need to see at once?
Where the different specialists could interact with each other and discuss what may be best for each patient, in a personalised manner. In this space we could offer social and psychological support, where they could also support each other – it would be a place where people feel we are all there for them.
Positive outlook
I think it is important that people living with diabetes know that the majority of them will do well, and this is especially the case if they do their best at controlling risk factors such as their sugar levels, the fat we carry in our blood – which we call in medical terms ‘lipids’ – and their blood pressure.
Technology has helped us tremendously as there are now sensors that can measure the level of sugar in the blood automatically, so people do not need to ‘prick’ themselves all the time to know what their sugars are like.
In my own field, we have many treatments we can offer to people with the sight-threatening complications of diabetes. Many academics like me continue to search for better ways to beat the complications of this condition.
So, I am sure many other treatments will come in the not-too-distant future. I think it is important for people living with diabetes to have a positive outlook; even when things are difficult, it is important to keep that positive attitude. Don’t let diabetes beat you. Be strong; beat the challenge – beat diabetes. We will be there with you and for you.
I would like to express my gratitude to all the people who take part in clinical trials. Without them, there would be no progress and no treatments for any of us. I am also very grateful to Diabetes UK and the team within Northern Ireland for all the help and support they provide to people living with diabetes and the advancement of science in this field.
Finally, I am indebted and most grateful for all the support I received for the research I conducted over the past 10 years from Miss Elizabeth Sloan; Rest in Peace, in Memoriam.
On a personal note: what advice would you give yourself if you were starting out now in your first job?
Work hard, study, learn and be enthusiastic about your work. Be knowledgeable, supportive, understanding, and empathetic for your patients. We are very lucky to have this incredibly rewarding and fulfilling profession.
