An interview with Jack Kanski at the time of the publication of the 5th edition of Clinical Ophthalmology

OPTICIAN clinical editor Bill Harvey describes a conversation with renowned ophthalmologist and author Jack Kanski, which includes some strong and candid views about the role of optometrists. I spoke to Jack Kanski recently, keen to learn a little about the man responsible for the textbook that optometrists and students alike are probably most familiar with. The expression 'learn Kanski' before an ocular disease exam is commonplace; so much so that Kanski's name is almost synonymous with the subject.

Now retired from his position as consultant ophthalmologist at the Prince Charles Eye Unit of King Edward VII Hospital, Windsor, Mr Kanski is obviously not a man ready to don the carpet slippers and watch daytime television. Our conversation begins with his recent visit to the Ukraine.

Have you heard of Vision 2020?, he inquires? This is a charity run by experts such as Moorfields ophthalmologist, Tim Ffytche and has the sole aim of eradicating preventable blindness worldwide by 2020. Mr Kanski's visit had the aim of improving the state of ophthalmology in the old Eastern block.

It soon becomes apparent that this reference is inspired by the fact that he was born in Poland and spent his early years there. I couldn't speak a word of English until I was six years old, when I arrived in England with my mother he explains. He is clearly pleased with the fact that Polish is one of many languages into which his groundbreaking book Clinical Ophthalmology has been translated. Clinical Ophthalmology, out of the many books Mr Kanski has put his name to, is the one most familiar to optometrists. It was first published in 1984, he tells me, and the fifth edition is nearing completion presently.

The main market for such a book is obviously optometrists and ophthalmology speciality doctors but apparently not general practitioners. GPs buy no books, he exclaims, and there is sadly no specific training in medical schools in ophthalmology. In 27 years as a consultant I have known only one GP diagnose an eye disease.

This comment prompts the inevitable question about optometrist direct referral schemes. A very good thing, he replies. A GP will have no idea about an eye condition, he adds, but he then makes the first of several references to the need for adequate training of optometrists.
Having had experience of some schemes such as a diabetic referral scheme, he believes that the level of over-referral from optometrists gives an impression of a lack of confidence in dealing with ocular disease.

When I started as a consultant, you did everything, he explains, but my primary interest was with retinal detachment and uveitis. Regarding medical photography, Mr Kanski claims not to know one end of a camera from another. However, he cannot move from one end of my office to the other for the number of slides he has collated. Specialist photographers work with him and all his books include references to colleagues who provide him with pictures.

Bearing in mind his readership among optometrists, I was keen to learn more about Kanski's view of our profession. Optometrists don't get enough exposure to patients during training, he says, being quite particular to point out that a lack of confidence in the subject is illustrated by the persistent use in optometry syllabuses of the term 'ocular pathology' when what is referred to is actually ocular disease, which is quite different.

I know from personal experience that Mr Kanski has contact with pre-reg optometrists, and here he felt strongly that there was scope for increased access to patients. In a grossly overburdened and understaffed eye clinic the pre-reg optometrist tends to bung up the whole clinic and so is not taught properly. Optometry teaching institutions should teach more ophthalmology according to Kanski, who feels that while optometrists in general - particularly in areas such as contact lenses - are highly trained, they are weak in ophthalmology. The standard in the US is much better.

Continuing the theme, I ask his views about the potential expansion of prescribing rights to optometrists. He is generally favourable, though reinforces the fact that one can only treat a condition if you know the diagnosis. There is no equivalent of an eye GP and for optometrists to fulfil this role would be 'fantastic'. I raise the subject of shared care schemes he says that it would be a godsend if optometrists were able to monitor ongoing eye diseases, though he adds that this would require better training. There should be increased access to patients organised by the College or teaching schools - it should not be just down to Jack.

So, what changes are to be found in the fifth edition of Clinical Ophthalmology? It is expanded to 20 chapters and will include a separate section on systemic diseases. They get a whole new chapter. This will include the ocular significance of many diseases often poorly understood, such as sarcoidosis. There will also be an update on newer surgical procedures such as corneal refractive surgery, though these will state the facts. He would not be drawn about his views on these techniques.

It was refreshing to be able to talk with a man obviously a leader in his field but also a good conversationalist not afraid of stating his views. Let us hope optometry continues to benefit from Kanski.

This interview in its entirety was published in Optician Magazine.