An AMH test result is used to decide which treatment protocol to use.
A blood sample will be taken from you to measure the amount of a hormone called AMH. The result of that test will help us decide which drug stimulation protocol is best for you during your treatment.
Please note that your AMH test result will not be used to decide whether you are offered treatment or not.
A high AMH level raises the possibility that you may over-respond to your treatment (i.e. too many eggs will be produced), increasing the risk of ovarian hyper stimulation syndrome.
A low AMH level raises the possibility that you may respond poorly to your treatment, i.e. only a few eggs are produced.
Contact us
Address
Assisted Conception Service
Main Outpatient area Clinic Area B Ground Floor Queen Elizabeth Building
Glasgow Royal Infirmary
Alexandra Parade Glasgow G31 2ER
We are constantly striving to improve the quality of our service to you and value your opinions about how we could do that. In particular, if you have any comments and suggestions about the content of this website and any of ACS’s information booklets, pamphlets or leaflets, please let us know using the postal address quoted above.
Phone
Treatment bookings: 0141 201 3478
Nursing Staff: 0141 211 8545
Laboratory team: 0141 211 8549
Medical Secretary: 0141 201 3436
Reception: 0141 211 8535
Opening Times
Monday – Thursday: 7.45am – 7.00pm
Friday: 7.45am – 3.30pm
Saturday: 8.00am – 3.00pm
Sunday: 8.30am – 3.00pm
For any emergencies out with these hours please contact your GP, NHS 24 (telephone number 111) or the on call gynaecologist via switch board (telephone number 0141 211 4000).
How to find us
The Assisted Conception Service (ACS) is located in the main Outpatient Area, Clinic Area B on the ground floor of the Queen Elizabeth Building, Glasgow Royal Infirmary. Enter the hospital via the Alexandra Parade entrance. If you need further assistance please ask at the ‘reception and admissions’ desk in the entrance foyer.
The Assisted Conception Team
Dr Helen Lyall, Consultant Gynaecologist
Dr Lyall is a Consultant Gynaecologist and lead clinician for the ACS Unit at Glasgow Royal Infirmary. She qualified in 1988 from the University of Dundee and has always worked in the field of obstetrics and gynaecology. She has been directly involved in assisted conception and reproductive medicine for 20 years. During her training Dr Lyall also worked in Edinburgh, moving to Glasgow in 1995. Dr Lyall has published widely and was awarded a MD from the University of Dundee in 1994. She has been a member of a number of national groups looking at the provision of assisted conception treatment, most specifically equity of access, and is a member of the National Infertility Group, convened by the Scottish Government.
Joanne Leitch – Person Responsible & Lead Embryologist
Joanne has gained over 10 years of experience in Clinical Embryology in both public and private health care settings. In her current appointment as the Person Responsible & Lead Clinical Embryologist, she plays a key role in the largest IVF clinic in Scotland. Joanne is a Diplomat of the Royal College of Pathologists and previously an Executive Board member of the Association of Clinical Embryologists.
Professor Scott Nelson, Professor of Obstetrics & Gynaecology
Scott is the Muirhead Professor of Obstetrics & Gynaecology at the University of Glasgow and HFEA licence holder for Glasgow Royal Infirmary ACS unit. Professor Nelson is a prominent international specialist in reproductive medicine, and world renowned for personalised ovarian stimulation.
Dr Susheel Vani
Dr Vani is a specialist in the field of Reproductive Medicine and Assisted Conception. He completed most of his training in Obstetrics & Gynaecology, including Subspecialty Training in Reproductive Medicine & Surgery, in Edinburgh.
As a part of this training he completed research studies on the endometrium and he was awarded an MD from the University of Edinburgh. Dr Vani moved to Glasgow to take up a full time post as a Consultant Gynaecologist in the ACS in 2010.
He is the lead gynaecologist for the Male Infertility service which is run in conjunction with the Urologists. He is also actively involved with undergraduate and postgraduate medical training.
Dr Aparna Sastry
Dr Sastry is a consultant in infertility with special interests in Paediatric and adolescent gynaecology, Surrogacy, Fertility preservation and Reproductive endocrinology (Turner’s syndrome, Premature ovarian failure, Differences in sex development, gender dysphoria, post cancer reproductive care etc).
She has over 15 years experience in this field and has worked in Australia, Wales and England. She runs a dedicated fertility clinic at Victoria infirmary. She is an honorary senior clinical lecturer at Glasgow University and is also involved in ultrasound training at Caledonia university.
Dr Claire Banks
Dr Banks is a Consultant Gynaecologist, and qualified in Medicine in 2002 from the University of Glasgow. She has worked in the field of obstetrics and gynaecology throughout her postgraduate career, with a special interest in assisted conception since 2007. Before studying medicine, Dr Banks completed a law degree, graduating from the University of Glasgow in 1996 with an LLB Honours degree in Medical Law and Ethics.
Dr Samra Khan
Dr Khan qualified as a doctor in 2003 and completed her core obstetrics and gynaecology training in Oxford and Glasgow. To pursue her special interest in subfertility, she joined the assisted conception unit in Glasgow Royal Infirmary in 2011 for advanced training in this field. She attained a certificate of completion of training in 2013 following which she continued to serve as a consultant within the same unit.
Besides offering tertiary level care for management of infertile couples she also leads the oocyte donation service at Glasgow Royal Infirmary and also provides a fertility service for the south side of Glasgow through a dedicated fertility clinic at Victoria hospital. Dr Khan is very enthusiastic about her specialty and committed to provide a high quality care to her patients.
Isabel Traynor, Lead Nurse
Isabel is the Redesign Manager of the Assisted Conception Service. She graduated from Caledonian University in 1992 with BA Honours in Health and Nursing Studies and had an extensive gynaecology career in Western Infirmary, Glasgow. She worked there for 10 years, in a variety of roles ranging from staff nurse, research nurse, ward manager and clinical nurse manager in gynaecology across North Glasgow NHS Trust. Following this experience, she took up post as the Senior Charge Nurse in the Assisted Conception Unit in Glasgow Royal Infirmary in October 2002.
This challenging role includes clinical and service management, with a research and education component. This experience has been transferred to a clinical environment ensuring that evidence based practice is delivered locally. A range of nurse led services have also been developed within the unit. She has completed several post graduated qualifications in Infertility, Ultrasound Scanning and Non Medical Prescribing.
She has had the privilege of both presenting and being chairperson at several national Infertility meetings for nursing and multi-disciplinary groups. She is the previous chairperson of the Senior Infertility Nurses Group.
Joanne McNabb, Senior Charge Nurse ACS
Joanne qualified as a Registered General Nurse in 1981 then as a Certified Midwife in 1982. Her career in midwifery progressed to a Community Midwife then three years later to a Labour Ward Sister.
After a short break she returned to Glasgow Royal Maternity (Rottenrow ) as a Bank Midwife before joining the Assisted Conception Team at Glasgow Royal Infirmary in 1993. As Senior Charge Nurse In the department Joanne leads an excellent team of nurses and HCSWs, helping to plan and deliver the care that provides the best possible experience for patients using the service.
Frances Roebuck, Quality Manager
Frances has 10 years of experience working in Clinical Embryology in a variety of public and private fertility clinics. Frances’ career in embryology began in 2012, with enrolment in the Association of Clinical Embryologists (ACE) certification programme.
She then progressed to attain Clinical Embryologist certification in 2018. She has extensive experience in Quality Control across 3 fertility laboratories and is currently completing an MSc in Healthcare Quality Management Systems.
As Quality Manager, Frances ensures that the clinics quality management system is implemented, maintained and effective whilst co-ordinating awareness of the clinic user’s needs and requirements.
Craig Spinks, Clinical Services Manager
Craig graduated with a Business Management Honours degree and has significant experience working across various NHS sectors which include Golden Jubilee National Hospital and Oral Health Directorate. He commenced current post in July 2014 and has a wider remit across Women and Children’s directorate in addition to Business Manager role within Assisted Conception Service.
Alison Elliot, Counsellor
Alison has been working at the ACS since May 2016. She has worked for NHS as a counsellor for over thirteen years and is an accredited member of British Infertility Counselling Association (BICA), and accredited member of the British Association of Counselling and Psychotherapy (BACP), Counselling Supervisor and a member of Scottish Infertility Counselling Group.
She studied at Glasgow University spending a year at University of South Florida on an exchange programme to graduate with a degree in Sociology 1994. She worked in the field of complex trauma in Florida, USA and Perth, Australia before returning to Glasgow to study a Masters in Public Health.
She was employed by Glasgow City Council Education Services to progress the Scottish Government’s prevention strategy on Gender based violence before returning to education to study to be a counsellor and worked for the Centre of Women’s Health.
Lesley Miller, Counsellor
Lesley has over 26 years experience, having undertaken counselling and psychotherapy training between 1992-1996. Prior to becoming a counsellor Lesley worked within nursing and the field of mental health. Lesley is both BACP and BICA accredited. Over the years she has been employed within a number NHS, Local Authority, residential and community settings.
Before concentrating on her career within the field of fertility counseling she established and managed a therapeutic stress management and crisis service for adults and young people across Glasgow for a period of 21 years up until 2013. In addition to the development of therapeutic skills, Lesley has experience from a depth of understanding and a high level of compassion for her work.
Here at the ACS Lesley endeavors to support individuals and couples with their personal issues arising from infertility and the stress of navigating through the treatment options and process. With her aim being to facilitate a safe, confidential and collaborative relationship, supporting each client to reconnect with their personal strengths, learn new coping skills, build resilience in dealing with the difficulties they are facing, learn effective emotional management techniques and to come to terms with very challenging life events.
Virtual Tour
If you have difficulty viewing the above video please click the link below to view it on YouTube.
There are several ways you can access our service:
GP: You can ask your GP/Doctor to refer you if you and your GP are within Greater Glasgow and Clyde health board.
Hospital doctor/clinic: You may be referred to us through another NHS service e.g. orthopaedics.
Paper copies are also available from your local physiotherapy department or GP surgery.
NHS Staff: If you are a member of staff within NHSGGC and wish to refer to physiotherapy, please go to the Occupational Health webpage on HR Connect
We are unable to accept a self referral if
You are not registered with a GP within NHS Greater Glasgow and Clyde.
You are under 14 years old – please ask your GP to refer you to Children’s Services.
You are currently pregnant – please self-refer to Maternity Physiotherapy, if you do not have the contact details in your maternity pack, please contact your midwife.
You are currently attending or are under the care of Rheumatology – please self-refer to Rheumatology Physiotherapy by contacting the self-referral line on 0141 531 3703.
You have attended Accident and Emergency or Minor Injuries Unit within the past 2 weeks for condition – we need a referral from your hospital clinic.
Your condition is due to a fracture or break within the past 3 months – we need a referral from your hospital clinic to make sure physiotherapy is appropriate.
You have had surgery for this condition within the past 3 months – we need a referral from your hospital clinic to make sure physiotherapy is appropriate.
You require a home visit – please ask your GP to refer you to Community Rehab Services.
As a new donor, you need to complete our screening process before donating. If you have stored milk, please complete the form for the period of the stored milk.
By completing the screening form, you agree that you have read the pre-screening information and:
Understand milk cannot be returned once donated
Consent to a sample of blood being tested for HIV, HTLV, Hepatitis B and C and syphilis
Consent to a positive blood result being shared with your GP
Consent to information about you, your health and donations being stored on a database
Consent to your milk being used for research purposes
We can’t accept milk from you if you:
smoke, or are using nicotine replacement therapy or are vaping
regularly drink more than 1 to 2 units of alcohol once or twice per week
take certain medications including antidepressants, high blood pressure medication and certain pain killers
We also ask that you keep your caffeinated drinks (tea, coffee, soft drinks) to a minimum.
Completing Donor Screening
Please answer the questions accurately as donation depends on the answers and the results of your blood tests. Answering yes doesn’t mean you can’t donate but we may need extra information.
As we can’t use antenatal blood results, we will send you a kit for a new blood sample to get taken at your GP practice. You post this back to us in a prepaid Royal Mail box. We test you for: HIV, Hepatitis B and C, HTLV 1 and 2 and Syphilis. We can give you more information on these tests if required.
If your blood test gives a positive result for any of these infections, we will refer you for advice on any issues which may affect your own health. A positive test means you can’t donate.
How long can I donate for?
It’s best to establish your own milk supply, usually around 6 weeks postnatally, before expressing for donation. You don’t need to express more than once a day and you can donate until your baby is around two.
Donations of already expressed milk are also accepted if the milk has been stored and frozen appropriately, is less than 90 days old and is a reasonable amount (around 3 litres or more).
Data Protection
The Milk Bank keeps a record of your information on a secure computerised database. This database is used to communicate with donors and to record your donation details, including your blood sample test results.
All your information is treated in the strictest confidence. Families whose babies receive donor milk can’t access your information at any point. Your information may also be used for research to improve our knowledge about the milk donor population, for clinical audit and to assess and improve the quality of our service. We may contact you for feedback on the service we provide.
We may use some of the information you give us for other reasons and sometimes the law requires us to pass on information if there is a genuine need (for instance in matters of Public Health). Whenever we can, we will remove details which identify you. All information and data that is processed by the Milk Bank is in accordance with the provisions of the Data Protection Act (1998). Everyone has a legal duty to keep all information confidential, and everyone who receives information from us is also legally obliged to keep it confidential. You have a right of access to your donor records. If you want to access your records, contact our Donor Coordinator.
Donor Screening Form
Once you have read all the information, please complete the screening form:
Your milk should be expressed by hand or breast pump. ‘Drip milk’ that leaks while you are feeding your baby from the other breast is not ideal as it tends to have less fat, protein and calories.
Your equipment for expressing does not need to be sterilised but good personnel hygiene, hand washing and clean preparation areas are important. Your expressing equipment should be washed in hot soapy water and clear of all milk debris, then rinsed in cool water, dried and stored in a container lined with paper towel and covered with a lid between uses. Please use paper towel for drying your hands and equipment.
We will provide sterilised collection bottles and labels for your milk. When collecting your milk, be careful not to touch the inside of the bottle or lid. Leave a 2cm gap at the top of the bottle as the milk will expand when frozen.
Where possible you should freeze your milk after expressing. If this is not possible, you can keep it in the fridge and frozen within 24 hours. It doesn’t matter if there is only a small amount of milk in a bottle at the end of each day. These can be topped up with chilled freshly pumped milk.
All your stored milk should remain frozen. We ask you to record the temperature of your freezer every day (preferably in the morning) and provide a thermometer for this. Store your milk in your freezer separately from food in the plastic bag we provide.
You should contact the milk bank staff to discuss donation if you:
develop a temperature or have been exposed to a virus that causes a rash such as chicken pox or German measles (rubella)
start taking medication
develop breast lesions or infections such as mastitis
travel outside the UK
Requesting Milk Collection
Remember milk must be processed within 90 days. You can request a collection and extra bottles and labels using the Milk Collection Form
Are incontinence pads provided for bodily fluids other than urine and faeces?
No. Incontinence pads are made differently to sanitary wear. Therefore they are not supplied for bodily fluids other than urine and faeces.
I’m in a wheelchair, will the clinic be accessible?
Most Health and Care Centres are accessible, but not all. Please contact us if you would like to discuss your individual access needs.
Why didn’t I receive an appointment nearer to home?
Please note that we don’t run clinics out of every Health and Care Centre across NHS Greater Glasgow and Clyde. We make every effort to give you an appointment near to home, but sometimes we might offer an earlier appointment at a venue a bit further away so you get seen sooner – please contact us if you have difficulty attending a particular venue and we will do our best to accommodate your needs.
Is it just my age?
Whilst age can be a factor in bladder and bowel control, there will be other reasons for your symptoms and age is not a barrier to successful treatment.
Why do you scan my bladder and what does the scan show?
We scan your bladder as part of our assessment to make sure it is emptying properly and make sure you get the right treatment.
Can my bladder or bowel symptoms be cured?
There is every likelihood that your symptoms can be improved and the possibility that they can be cured. That is why we ask you lots of questions about your bladder and bowel symptoms and examine you physically, check your urine and scan your bladder.
How do I access a urine sample container if I have nothing I can use at home?
You can get a urine sample container from your local pharmacy or GP surgery.
If I need a reassessment of my continence needs, how do I go about this?
You should contact your GP, who will make a re-referral.
What is a Behavioural Intervention Group (BIG)? Will I be expected to talk at it, or share any personal information? Will there be any men there?
The Behavioural Intervention Group consists of a small group of women. At this group one of our nurses will give you information about bladder symptoms and treatment options. You will not be expected to speak or to share personal information.
Why did you check my urine? What might show up and what does this mean?
We routinely test your urine to rule out any abnormalities, e.g. urinary tract infection. If we find anything abnormal we pass this to your GP for action.
Can I get pads?
Only after a thorough continence assessment, it may be necessary to prescribe pads for you. This is often only as a temporary measure whilst you are undergoing treatment.
The NHSGGC SPHERE Bladder and Bowel Service provides a professional, caring, confidential and supportive approach to people with bladder or/and bowel symptoms.
The aim of the team is to treat bladder and bowel issues and also promote continence. By empowering the individual to self manage their symptoms, by teaching behavioural and lifestyle changes that can promote bladder and bowel health. To provide this support, the service has two specially trained teams across the city.
These teams include specialist nurses and physiotherapists who can advise and support the person on improving their bladder or/and bowel symptoms or prevent any deterioration by facilitating and providing rehabilitative treatments.
If you wish to be referred to our service and able to attend our clinic please contact your GP, who can arrange the referral for you.
Take the Continence Challenge to find out about your attitudes and beliefs towards continence.
How to reorder Incontinence Pads
Please be aware that Ontex customer service cannot amend prescriptions.
For anyone who has symptoms of bladder and/or bowel dysfunction, a referral can be made into the SPHERE Bladder and Bowel service by their GP.
It is the responsibility of the referrer to over-rule all red flags prior to referring into the SPHERE Service. These can be found within the relevant NICE guidelines below.
N.B. As per the Continence Referral Pathway, all housebound patients should be referred to the District Nurses initially for first level assessment and our team will support, should more specialist intervention be required.
This section summarises the different treatment options available for intraocular and extraocular tumours. After leaving clinic, you may have forgot to ask a question about the treatment advised. This is very common when being faced with a diagnosis of eye cancer. We hope this section will help answer your questions. Please see the different treatment options below.
Intraocular Tumour Treatments
Below is the list of treatments available to us for tumours that grow inside the eye. The most common tumour that grows inside the eye is melanoma. The most common treatment for this is plaque radiotherapy. If the tumour is too big for this treatment we may consider proton beam radiotherapy. We aim to select the best treatment suited to each patient as an individual. Unfortunately this sometimes means having to remove the eye (enucleation). Please see the different treatment options below.
Plaque Radiotherapy
Plaque radiotherapy is a form of internal radiotherapy. A radioactive piece of metal known as a plaque is attached to the sclera (white part of the eye) next to the tumour. This is around the size of a 5 pence coin (please see picture above). This is done in the operating theatre and is left in the eye between 3 and 7 days before being removed. Patients usually stay in ward 1C for this treatment. The tumour starts to shrink around 4-6 months after the plaque is removed.
The effects can last for several years. Although being an effective treatment, the radiation can sometimes damage other parts of the eye. This may cause cataract, retinal detachment, nerve damage, or macular oedema (swelling of the back of the eye). New blood vessels may grow after treatment; these can sometimes block the drainage angle in the eye causing glaucoma. If we are unable to control this, we may have to consider removing the eye. Although there are risks of plaque radiotherapy, this treatment can stop growth of the tumour in around 80% of cases.
Proton Beam Radiotherapy
This is where radiation with charged particles called protons are targeted at the tumour from outside the eye. This treatment is used if the tumour is too large or located too far back in the eye for plaque radiotherapy to work. As this treatment is highly specialised, the Douglas Cyclotron Unit, Clatterbridge, Liverpool is the only centre in the United Kingdom where the treatment is given.
If proton beam radiotherapy is the best option for you, we will organise transport to Clatterbridge and accommodation for you in near the Hospital (please see the team photo of the Clatterbridge team and the hospital above). This involves two separate visits to the Clatterbridge. At the first visit a treatment mask is made and fitted- this helps the team target the radiotherapy at the correct part of the eye. At the second visit, one to two weeks later, the treatment is given. You will likely travel down Sunday evening and return Friday later that week. Final measurements are made on the Monday and then the radiation is given over the remaining four days during (Tuesday to Friday).
Each treatment session takes around 20 minutes and is pain free. Before going down to Liverpool, however, we have to perform a small operation on the affected eye in Gartnavel General Hosptial, Glasgow. This is where we stitch tantalum markers (small metal discs smaller than a paper clip- please see photo above) to the sclera (white part of the eye) next to the tumour. We usually do this under General Anaesthetic. This helps the team target the radiation treatment more effectively when you go down to Clatterbridge. Proton beam radiotherapy takes a little longer to work than plaque radiotherapy.
We usually wait six months to see if the tumour starts to decrease in size. Although effective at treating tumours, the radiation can also damage normal parts of the eye and tissues around the eye when given. This may cause loss of eyelashes, loss of pigmentation of the eyelids, and inflammation of the conjunctiva causing a watery eye. Sometimes small blood vessels can grow at the back of the eye and into the drainage angle at the front of the eye. This can cause the pressure to build up in the eye and cause glaucoma. If we are unable to control the pressure and the eye becomes very uncomfortable, unfortunately we may have to consider removing the eye.
External Beam Radiotherapy
This is where radiation from a machine is targeted at cancer cells from outside the body. We find this treatment useful in patients that have cancer else where in the body that has spread to the back of the eye. On the other hand, if there has been a large tumour inside the eye that has grown behind the eye, we may choose to use radiotherapy after removing the eye. This treatment is spit into fractions.
This means the treatment is divided into smaller doses and spread out over a few days. This gives healthy cells in the body a chance to recover between treatments. If we are using radiation to treat the eyes or lymph nodes around the head and neck, then a special mask is usually made for patients. This mask is worn during treatment and helps aim the radiation at only the cancer cells. Although this helps prevent damage to healthy cells around the tumour, treatment may still cause loss of eyelashes, loss of pigmentation of the eyelids, and inflammation of the conjunctiva causing a watery eye.
Laser Transpupillary Thermotherapy
Transpupillary Thermotherapy (TTT) uses an infrared laser beam to heat the tumour up and kill the cancer cells. This technique is useful if there is uncertainty if the suspicious area is a melanoma or a naevus, or if the choroidal melanoma is small and radiotherapy is inappropriate due to poor health.
This treatment is sometimes combined with plaque radiotherapy as it reduces swelling and leakage from the blood vessels. After TTT the tumour gradually shrinks down if successful. Repeat treatment may be required at 6 months.
Possible complications from this treatment include retinal detachment, blockage of blood vessels, growth of new blood vessels, iris burns and cataract. Unfortunately tumour recurrence after treatment is common. This is more likely to occur if the melanoma is thick, close to the optic nerve, or non-pigmented.
Photo Dynamic Therapy
A light sensitive dye is injected into the blood stream. As the dye travels through the blood vessels to the back of the eye through the blood vessels, a special light is shined into the eye. This activates the dye and causes the abnormal blood vessels to close, shrink, and stop leaking.
This is useful in patients with a naevus or melanoma that is leaking fluid and building up at the back of the eye (macular oedema). Although this is not the main treatment for choroidal melanoma, we may find it useful in some cases where radiotherapy treatment is not possible.
Removal of Eye: Enucleation
Enucleation is the medical term for removing the eye. This is recommended when the tumour is too large for other treatments or has started to invade behind the eye. Removing the eye along with the tumour is sometimes preferred if there is a lot of pain and discomfort in the eye. This can be due to high pressure inside the eye caused by blockage of the drainage angle by tumour or new blood vessels grown after radiotherapy.
The idea of having your eye removed is scary. With current technology, however, we can get excellent cosmetic results with uniquely designed and fitted artificial eye implants (please click below to see photos). Our artifical eye clinic is run in Gartnavel General Hospital, Glasgow. Alternatively, some patients may prefer to just wear an eye patch after the tumour is removed.
After removing the eye, although this gets rid of the tumour growing in the eye, unfortunately this does not prevent the tumour growing else where in the body later in life. The most likely place for melanoma to regrow is the liver. For this reason we may decide to organise a liver ultrasound scan every year at your local hospital to screen for cancer growth.
Artificial Eyes
After the eye is removed, a temporary cosmetic shell is fitted in the operating theatre (see first picture above). We choose a colour to match the patient’s other eye. Although not a perfect colour match, this temporary shell will remain in place until the final artificial eye is made.
Once the eye socket has healed, the temporary cosmetic shell is removed and the final artificial eye implant can be fitted. This is done in the prosthetic eye department in Gartnavel General Hospital, Glasgow. The team will take photos of your normal eye. The artificial implant is then painted in fine detail to match the photo of your healthy eye. Please see the two other photos above (note both the healthy eyes have been dilated in clinic to examine the back of the eyes so the pupil sizes do not look symmetrical).
Removal of Eye and contents of Eye Socket- Exenteration
Exenteration means removing the eye with the tumour and the soft tissue around the eye. This treatment is required if the cancer has spread behind or around the eye. Sometimes the eyelids or part of the bone around the eye have to be removed if the tumour has invaded here. If this is the case, we will likely perform the operation at the Queen Elizabeth University Hospital with the help of our Oral and Maxilofacial Surgeon colleagues. Sometimes this treatment is combined with radiotherapy or chemotherapy. Our medical oncology team will help us choose the best treatment for you.
Excellent cosmetic results can be achieved after the tumour is removed. This involves further reconstructive surgery and being fitted with an artificial eye. Some patients, however, may prefer just to wear an eye patch or leave things as they are instead of having further surgery. After the cancer is removed we can plan treatment that suits your needs.
Extraocular Tumour Treatments
Please see below the list of treatment options for tumours that grow outside the eye. Every case is different. In clinic we will discuss the best treatment or combination of treatments for you.
Surgical Excision of Eyelid Tumours
This can be performed under local or general anaesthetic and as a day case. After tumour removal as much normal tissue is left behind to help keep the eyelid looking as normal as possible. The tumour is sent to the pathology laboratory to confirm the type of tumour and if it has all been removed. Eyelid tumours (mainly basal cell carcinomas) may be removed by a dermatologist (skin specialist). This is where a small part of the skin is removed then inspected under a microscope straight away. If cancer cells are still visible, then more tissue is removed and inspected again. This is repeated until there are no more cancer cells seen under the microscope. This helps remove as little normal tissue as possible mean while ensuring all the cancer is removed.
After the tumour is removed the eyelid is reconstructed to get the eyelid looking and functioning as normal as possible. If the tumour removed was small then this can usually be done on the same day. If the tumour removed was large and a lot of the eyelid had to be removed then reconstruction may be done on a different day. Skin or tissue can be taken from the other eyelid or from other parts of the body to re-form the eyelid. We commonly use the skin in front of the ear or from the inner surface of the upper arm. Sometimes we use tissue from the inner surface of the cheek- this heals very well after surgery. As there are many options, we aim to choose the best treatment option for you.
Freezing treatment: Cryotherapy
This freezes the tumour helping destroy the cancer cells. This can be used in combination with surgical excision, or on its own if surgery is not an option. Cryotherapy can is usually done the operating theatre under local or general anaesthetic. Treatment lasts several minutes. Although helping prevent tumour growth, no samples are sent to the lab so confirmation of tumour death is not always possible. If this is the case, we will monitor you carefully in the clinic. Sometimes we have to repeat this treatment more than once.
Radiotherapy
This treatment involves targeting the cancer with high energy radiation beams. This kills the cancer cells and stops them multiplying. This is used if surgery is not possible, for example, if the patient is too unwell or desperately does not want surgery. It may, however, be the preferred treatment of choice; for example, in lymphoma. This treatment is performed as an out-patient. This treatment is spit into fractions. This means the treatment is divided into smaller doses and spread out over a few days. This gives healthy cells in the body a chance to recover between treatments. If we are using radiation to treat the eyes or lymph nodes around the head and neck, then a special mask is usually made for patients. This mask is worn during treatment and helps aim the radiation at only the cancer cells. Although this helps prevent damage to healthy cells around the tumour, treatment may still cause loss of eyelashes, loss of pigmentation of the eyelids, and inflammation of the conjunctiva causing a watery eye.
Chemotherapy
Mitomycin C (MMC)
This is a chemotherapy drug that is applied to the surface of the tumour in theatre. MMC works by sticking the cancer cells’ DNA (the cell’s genetic code) together, stopping the tumour or cancer cells from growing.
This is applied to the surface of the cancer cells and therefore side effects of chemotherapy such as nausea, vomiting or hair loss are not experienced.
If MMC eye drops are being used, however, this can irritate the eye. We may give lubricant or steroid drops to treat this.
5-fluorouracil (5-FU)
This treatment, also called imiquimod, is a chemotherapy drug which is applied to the surface of skin tumours. Sometimes we use this to treat eyelid tumours. This drug causes the body’s immune system to produce a chemical called interferon. This attacks and kills cancer cells. It may irritate the skin when applied, this means the treatment is working. It is applied 3 – 5 nights a week and treatment can last up to 6 weeks.
Our service is located in the:
Ophthalmology Out Patient Department Gartnavel General Hospital 1053 Great Western Road, Glasgow G12 OYN
Please click on “travel” below to help plan your journey. If you plan to travel the day before the clinic, please click on “accommodation” below.
Travel
We have bus and train links that travel to Gartnavel General Hospital daily.
Traveling by Train
Hyndland Station is the nearest train stop to Gartnavel General Hospital. We are a 5 to 10 minute walk from the Hyndland Station. Trains leave both Glasgow Queen Street Station and Glasgow Central Station every 10-15 minutes. The journey takes roughly 10 minutes to get to there. The following websites will help you plan your train journey if you are traveling from else where in Scotland:
Buses run frequently to from Glasgow City Centre to Great Western Road; this is a 5 minute walk to the main entrance to the hospital. Travel time may take up to 30 minutes during rush hour. The buses run every 10-15 minutes from the city centre. Please see the following links for time tables and to plan your journey:
When visiting family members on the ward, people who are elderly or live with a disability may find the evening hospital visitor transport service useful:
Parking is extremely limited at Gartnavel General Hospital. A maximum four hour stay operates in patient and visitor car parks from 7.30am until 4.30pm Monday to Friday. If there are no spaces, the Glasgow Pond Hotel next to Gartnavel General Hospital offer parking at reasonable rates. There is a designated drop off points outside all the entrances to the hospital. Please avoid parking on disabled spaces unless you hold a valid badge, and also taking care not to park on ambulance car parks or yellow lines.
Accommodation
We appreciate that patients and relatives may be travelling a long distance to attend the clinic. If you choose to travel the day before, Leonardos Inn Hotel is next to Gartnavel General Hospital. Please see their website for reservation and bookings.
The Scottish Ocular Oncology Service is run by Dr Cauchi, Dr Chadha and Dr Connolly, experienced consultant ophthalmologists with a specialist interest in ocular oncology. Over the years we have a built up a close team of doctors , nurses, and non-medical staff from different backgrounds. These include:
Ophthalmologists (Eye doctors, both at consultant and registrar level)
Radiologists (Experts in CT, MRI, and Ultrasound scans),
Oncologists (Cancer specialists),
Pathologists (Experts in analysing tumours)
Specialist ophthalmic nurses (Nurses trained in counselling and able to answer questions about your diagnosis and treatment).
Anaesthetists (Experts at putting you to sleep for your operation)
Service Coordinators
Medical Photographers
Every Thursday morning we have our multidisciplinary team meeting (MDT). This is where we discuss patients who were listed for treatment the week before, and new patients coming to the clinic that day. Below are synopsis of the doctors and nurses from our team.
Ophthalmologists
Dr Cauchi
Dr Cauchi graduated from the Royal Free Hospital, University of London in 1996. His first interest in ophthalmology developed as a medical student, following in the footsteps of his grandfather who was also an ophthalmologist. He then did extra training in oculoplastics, orbits and ocular oncology. Dr Cauchi is one of the consultant ophthalmologists who run the Scottish Ocular Oncology Service.
Dr Chadha
Dr Chadha graduated from the University of Delhi in 1997 and underwent his basic and higher specialist training in ophthalmology at Edinburgh before doing a Fellowship in Ophthalmic Oncology and Oculoplastic Surgery at Glasgow in 2008-2009. He has been a Consultant in the West of Scotland since 2009 and is now one of the Consultants responsible for delivering the Scottish Ocular Oncology Service.
Dr Connolly
Dr. Julie Connolly started her career in academic research, completing her PhD from the University of Glasgow before undertaking further research roles in the Beatson Institute for Cancer Research. She subsequently graduated from University of Glasgow medical school before completing Ophthalmology specialty training and a fellowship in ocular oncology and oculoplastics in the West of Scotland Deanery. Dr Connolly is one of the consultants responsible for delivering the Scottish Ocular Oncology Service.
Oncologists
Dr Ritchie and Dr Schipani are the two Consultant Oncologists that work with the Scottish Ocular Oncology Service.
Dr. Schipani
Dr Schipani graduated from the University of Milan (Italy) in 2001. He underwent his Clinical oncology specialist training from 2002 to 2006, University of Milano-Bicocca (Italy) and worked as a consultant oncologist in Italy for three years. After taking a consultant job in Glasgow in 2009, Dr Schipani has developed a specialist interest in treating eye cancers and joined the Scottish Ocular Oncology Service team since September 2016.
Dr. Ritchie
Dr Ritchie after receiving her medical degree from Glasgow University started her clinical oncology training in 1986. She became a consultant oncologist in 1993 and has a specialist interest in radiotherapy treatment for eye cancers and skin tumours around the eye. She is one of the two consultant oncologists that help decide the correct treatment for patients with eye cancer.
Radiologists
Dr Cram is a consultant radiologist who has a specialist interest in Ocular Radiology. Below is the background of his career to date.
Dr Cram
Dr Cram graduated from St Andrews University in 2003 and received his medical degree from Manchester University in 2006. He decided to become at radiologist in 2007 and studied radiology in the West of Scotland Deanery. After becoming a full time consultant in August 2013 he is now one of the two Radiologists who work with the Scottish Ocular Oncology Service.
Pathologists
Dr Roberts and Dr Thum are both consultant pathologists that work with the Scottish Ocular Oncology Service. A summary of their experience to date is outlined below
Dr Roberts
Dr Roberts graduated from the University of Glasgow in 1991. During her training in general pathology she undertook a fellowship at the University of Illinois at Chicago undertaking research for her MD in ocular toxoplasmosis. On returning to Glasgow she completed her training in ophthalmic pathology under Professor William Lee before taking up a consultant position in 1998. She is a member and former secretary and president of the British Association of Ophthalmic Pathology and a member and former secretary of the European Ophthalmic Pathology society. In conjunction with Dr Thum she provides eye pathology input for the Scottish Ocular Oncology Service.
Dr Thum
Dr Thum graduated from medicine in Aberdeen in 2001. After years of practising ophthalmology, he decided to pursue a career in Pathology and started his training in Edinburgh in 2007. He became a consultant pathologist in 2015 and has been working with the Scottish Ocular Oncology Service for one year. Dr Thum is one of the two pathologists in our team who examine cells and tissue from tumour samples to help us select the best cancer treatment.
Nurses
Our team of nurses play an integral role in counselling and caring for patients throughout their diagnosis and treatment. Below is a summary of Agnes, Julie, Gayle and Nichola’s experience and training to date.
Agnes Macleod
Charge nurse Macleod trained in the Western Infirmary, receiving her nursing degree in 1989. She has been working with the Scottish Ocular Oncology Service team since 1994. Having had completed the Professional Studies Ophthalmic and Counseling Skills courses, she provides care and support to eye cancer patients attending the clinic and staying on the ward.
Gayle Williamson
Staff nurse Gayle Williamson trained in Stirling University and graduated from nursing in 2012. She has completed her post-graduate Eye course in 2018 and her counselling course in 2019. She has been part of the Scottish Ocular Oncology team since 2016 helping provide care and support to eye cancer patients attending the clinic.
Nichola Campbell
Staff nurse Nichola Campbell trained in Glasgow Caledonian University and graduated in 2010. She began working in the ophthalmology ward in 2012 and has been working with the ocular oncology team since 2014. She plays an integral role in seeing patients through their initial diagnosis, treatment, and post-operative care.
Fiona Wallace
Staff nurse Fiona Wallace trained in Edinburgh Napier University and graduated from nursing in 2003, she has completed her post-graduate Eye course in 2021. She has been part of the Scottish Ocular Oncology team since 2008 helping provide care and support to eye cancer patients attending the clinic.
Scientists
More information coming soon….
Service Coordinator
Susan Ewan
Susan Ewan is the service coordinator for the Scottish Ocular Oncology Service. She has been providing comprehensive secretarial and administrative support to the Scottish Ocular Oncology Service since June 2004. Susan is the main point of contact for Health Professionals and patients alike. She arranges new appointments, scans and any treatments that may be required along with travel arrangements and transfer of information to the Douglas Cycloton Unit for patients having proton beam therapy.
