Case study: CRN Kent, Surrey and Sussex Clinical Director shares her path in research

Why did you choose ophthalmology as your specialty?

In my second year of medical school in India, I did a two-month clinical placement in ophthalmology. I remember going into the ophthalmology theatre and I was absolutely fascinated by the cataract surgery operation and seeing the different kinds of eye diseases in the outpatient clinic. The blend of surgery and medicine really attracted me to ophthalmology and I haven’t looked back since.

Where did your research journey start?

My research journey started whilst doing my postgraduate training in ophthalmology in Ahmedabad under Professor Abhay Vasavada who was trained in the UK. He encouraged me to do small research projects and then present and publish the results. I won the Smt Sankuntala Shroff Gold Medal and rotating trophy for my work with him on corneal melting syndrome.

I continued research during my Vitreoretinal fellowship under Dr P.N. Nagpal and subsequently as a Vitreoretinal consultant in Kerala. My innovative research projects won me many regional and national awards including the Dr K C Sankara Menon Gold Medal in 1990 and the national Lt. Col. Rangachari Gold Medal in 1991. My first steps in research in the UK started by working as an Honorary Research Registrar at Moorfields Eye Hospital under Mr Bill Aylward and I greatly benefitted from the training.

Development of research unit

When I started my job at Frimley Park Hospital, I decided to establish some clinical trials in ophthalmology. The first clinical trial was a commercial one called the Mont Blanc study and then the second one was a study that I designed myself, this was in 2007. It was a study involving 100 patients where we were testing a drug called Avastin (which was licenced for intravenous use for the treatment of colon cancer) and injecting it into the eye to treat macular degeneration. My study was a randomised controlled trial with two arms looking at the dosing schedule.

At that point I had no idea about the idiosyncrasies that are involved in research, I did all the protocol writing myself, wrote all the information including patient information leaflets, and the ethics application - there was no Integrated Research Application System (IRAS) at that time.

After the study was nearly complete, the Medicines and Healthcare products Regulatory Agency (MHRA) inspected our hospital and they decided to inspect my study. That was when I finally realised what I had got myself into. I remember having a three- to four-hour interview with the MHRA inspector and coming out of that room feeling completely flustered. But, luckily for me, I knew everything about this study. The MHRA inspector was really surprised as he had not yet come across a chief investigator who could remember exactly what happened to their one hundred patients. Luckily, for us, we had no major findings at that visit and it gave me that kick-start that I required to set up the clinical trials unit at Frimley. The commercial trials bloomed once companies knew that I was delivering on my studies. I have been Principal Investigator for more than 75 studies and Chief Investigator for six studies.

My research is now focused on age-related macular degeneration, diabetic eye disease and retinal vascular disease. My research programme covers areas of clinical trials from Phase 2 to Phase 3 trials resulting in research collaborations.

With the help of a highly motivated team I have placed Frimley on the international research map. Under my leadership as Head of the Ophthalmology Clinical Trials Unit at Frimley (2008 to date) I managed to get the unit from its fledgling status to a unit of international standing and it is now recognised as a clinical research centre within the European Vision Institute Clinical Research Network (EVICR). We were awarded first place, or the most responsive and best organised clinical site for the IVAN study, which was a national flagship trial. We were the runner up for the CRN KSS Striving for Excellence (team) Award in 2016.

I was the Director of Research and Innovation at Frimley Park from 2012 to 2018 with responsibility for quality and safety. During this time I have gained knowledge of trials across many specialties and experienced first hand the challenges of delivering research. Working with colleagues across all specialties I have managed to double our funding over the last 10 years. We have 145 trials spread over different specialities. I have developed a mentorship scheme for new Principal Investigators to support them in undertaking research projects.

In 2016 I was awarded the RCP-NIHR Award of Excellence for Excellent Research Leadership in the NHS.

Supporting research across the region

I was Ophthalmology Specialty Lead for what was formerly known as Surrey and Sussex Clinical Research Network (SS CRN) for six years since its inception in 2008. During this period I boosted research in the region and under my leadership in 2013 SS CRN became the second highest recruiter nationally enrolling 800 patients mostly to industry trials. I have helped increase ophthalmology research in the region by 79 per cent.

Following my success as national Ophthalmology Specialty Lead I was appointed the Lead for Division Six for the Clinical Research Network Kent Surrey and Sussex from 2014 to 2017. I was responsible for improving research in 10 subspecialties including Ophthalmology, Anaesthetics, Critical Care, Infectious Disease & Microbiology, Ear Nose Throat (ENT), Surgery, Respiratory Medicine, Emergencies & Injuries, Hepatology and Gastroenterology,

I have been the Clinical Director for Clinical Research Network Kent, Surrey and Sussex since 2016 which I do as a job share with Dr Mark Hill a consultant medical oncologist at Maidstone Hospital. Besides research and my clinical work, my other passion is education and training. I am the Postgraduate Dean at Health Education England across South London and I wanted to do both roles. Job sharing with Mark has been fantastic.

With my team I have increased recruitment in our region and raised the profile of research.
Of course, my research journey has been challenging. I remember, when I took on the role of Ophthalmology specialty lead going around Kent, Surrey and Sussex as a woman of colour trying to get my white male colleagues interested in research! It didn’t always go down very well! . As Research and Development director, trying to make sure that people follow the research governance that we had set up was hard work too. But I had the grit and passion so I persisted.

What advice would you give to other ophthalmologists who are considering a career in research?

My advice to them would be to go ahead and nurture that passion because I think research is something that gives you a lot back. It gives you something to look forward to in your job day in and day out. Something that is different and exciting!

Research is about hope. Twenty years ago, I would have sat across the table from a patient with macular degeneration and told them that ‘sorry, there's nothing much we can do about your condition. You're likely to get the condition in the other eye, and then when that happens we will have to register you as visually impaired’. That is what would still happen had it not been for research and the new treatments that have been trialled. Now my conversation is, ‘there's a 90 percent chance that I could stabilise your sight and stop it from getting worse and a 30 to 40 percent chance that I could improve your sight’. Research has done this.

I think it also helps you get into research when you see role models, and for me my role model was my professor in India who was so keen on introducing me to research and creating a passion for it. That passion followed me to the UK. I have tried to be a role model for others and nurture researchers in the unit at Frimley and across the region.