Mr Richard Bowman areas of expertise:

Professional statement

Mr Richard Bowman is an expert consultant ophthalmic surgeon based in London, who specialises in paediatric ophthalmology, neuro-ophthalmology, and strabismus. He studied medicine at Cambridge University and Guy's Hospital Medical School, and later trained in ophthalmology in Cambridge, Glasgow, Moorfields Eye Hospital and Great Ormond Street Hospital, where he has worked since 2010. He also did an observership at the Mayo Clinic in Rochester, Minnesota. Mr Bowman is actively involved in research. He has conducted studies into cerebral visual impairment (CVI) and paediatric cataracts, and his work has been widely published.

Doctor's articles

How to spot CVI

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Credentials

GMC: ‍3479357

Professional experience

• More than 30 years of experience
• Consultant Ophthalmologist, Great Ormond Street Hospital IPP (2010 - present)
• Consultant Ophthalmologist, Christian Blind Mission (2002 - 2010)
• Locum Consultant Ophthalmologist, Royal Hospital for Sick Children (2008 - 2009)
• Specialist Registrar, Moorfields Eye Hospital (1999 - 2002)

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Sub-specialties

• Paediatric ophthalmology
• Strabismus
• Neuro-ophthalmology
• Nystagmus
• Cerebral visual impairment
• Paediatric cataract
• Craneo-facial ophthalmology

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Positions in public associations

• Honorary Consultant Ophthalmologist, Moorfield Eye Hospital (present)

Teaching posts

• Honorary Senior Lecturer, Institute of Child Health UCL (present)
• Associate Professor, International Centre for Eye Health, London School of Hygiene and Tropical Medicine (present)
• Training Director, Department of Ophthalmology, Great Ormond Street Hospital (present)

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Education

• MB BChir, University of Cambridge (1991)
• MA, Cambridge University
• Trained as a specialist registrar at Moorfields Eye Hospital
• FRCOphth (Fellow of the Royal College of Ophthalmologists)
• MD, Cambridge University

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Professional membership

• Fellow of the Royal College of Ophthalmologists (FRCOphth)
• Member of the Paediatric Sub-committee of the Royal College of Ophthalmologists
• British Eye Study Group
• International Council of Ophthalmologists Examinations Board
• General Medical Council
• Medical Defence Union

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Languages spoken

English

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Diseases, Medical Tests and Treatments

Cataracts in children

What is it? The lens of the eye is usually clear, allowing it to bend light onto the back of the eye (the retina), which allows us to see. Whe ...

Cerebral visual impairment (CVI)

What is it? As opposed to vision problems caused by conditions of the eyes, cerebral visual impairment (CVI) refers to vision problems caused by th ...

Neuro-ophthalmology

What is it? Neuro-ophthalmology is a field of medicine which studies and treats diseases of the nervous system that affect the visual system. This ...

Nystagmus

What is nystagmus? Nystagmus is an ophthalmological condition characterised by an involuntary, repetitive movement of the eyes. The velocity of the ...

Paediatric ophthalmology

What is paediatric ophthalmology? This is the medical specialty that prevents, diagnoses and treats diseases that affect children's eyes and visual health. Good ophthalmic care is essential during childhood, as these are the years when visual problems may appear while the eyes of growing and may affect their future development. Children's eyes are constantly growing until they are about 8 years old. Diseases that are treated with children's ophthalmology The most common conditions which affect eyesight during childhood are: congenital diseases amblyopia (commonly known as lazy eye) strabismus inflammation infection It has been shown that academic performance can be significantly affected by vision problems that have not been properly diagnosed or treated, harming the child’s capacity to learn and develop vital skills. When to see a paediatric ophthalmologist Eye exams are essential throughout childhood. In the first few months of life, an eye examination can detect serious diseases such as retinoblastoma. Strabismus and eye motility problems in particular are diagnosed from the ages of one to four. After the age of four, refractive visual disorders such as myopia (nearsightedness) and hyperopia (farsightedness) are the most commonly treated pathologies, in addition to prevention or treatment of amblyopia or lazy eye. Annual check-ups are necessary up to the age of 15, to check the stability of the child’s vision and the development of the eye organs. ...

Strabismus (squint)

What is strabismus? Strabismus, also known as crossed eyes, or a 'squint', is the deviation of the line of sight of one of the two eyes. Whilst one eye directs its gaze towards a particular object, the other is pointed in another direction. This is both a visual and aesthetic problem. Strabismus can be classified into two types, based on the direction of the eyes: Converging strabismus : It occurs when the eye points inward. Diverging strabismus : It occurs when the eye points outward. Prognosis: In most cases, the problem can be corrected if it is detected and treated early. If treatment is delayed, permanent vision loss may occur in one eye. If amblyopia or commonly known as ‘lazy eye' is not treated by age 11, it is likely to be permanent. About one-third of children with strabismus will have amblyopia as the underlying cause. Symptoms of strabismus: Symptoms of strabismus may include: Crossed eyes Double vision Impaired vision Uncoordinated eye movements (eyes do not move together) Loss or decreased depth perception Medical tests for strabismus: A physical examination, including a detailed examination of the eyes, is usually performed. The following tests are performed to determine how misaligned the eyes are: Corneal reflex when exposed to light Cover/uncover test Examination of the retina Standard ophthalmic exam Visual acuity test (tests how well you can read from a distance) A brain and nervous system (neurological) examination will also be done if other symptoms present. What causes strabismus? Many adult patients who suffer from strabismus experience this condition from childhood, although in a controlled manner. However, in most cases, strabismus has its origin in other diseases such as: Diabetes Thyroid disease (Graves' disease) Myasthenia gravis (a neuromuscular disease) Central nervous system tumours Head trauma Stroke: heart attacks or bleeding in the brain Occasionally, strabismus may result following eye surgery, such as cataract surgery, retinal detachment surgery, eyelid surgery, etc. due to unwanted involvement of the extraocular muscles during these procedures. Can strabismus be prevented? Strabismus is a disease that cannot be prevented. The best option is to treat it from its diagnosis to avoid possible loss of vision. If your child suffers from amblyopia, make sure it is treated. Treatments for strabismus: As this is a deviation that occurs from a very early age, it is crucial that measures are taken as quickly as possible to prevent it from leading to complications. To treat this disorder there are multiple techniques such as: Wearing an eye patch Eye exercises Wearing special glasses Corrective lenses Surgery to correct certain eye muscles. This is usually reserved for more severe cases that have not responded to other treatments. Which specialist treats strabismus? Ophthalmologists are in charge of preventing, diagnosing and treating diseases that affect the eyes and the visual capacity of the patient, such as strabismus. The eyes are the essential organ of vision and are susceptible to many abnormalities throughout life. ...

Amblyopia

What is a lazy eye? Amblyopia, better known as a lazy eye, is a common sight disorder where vision is decreased in an eye, and is not correctable by glasses or contact lenses. The eye suffers reduced vision because the brain is not acknowledging the information sent by that eye properly. It usually manifests in one eye, with the brain choosing to mainly accept visual information from the other, although in certain cases it may manifest as reduced vision in both. It is a childhood disease, so it is highly important that it is corrected during early ages so that it does not end up becoming chronic. What are the symptoms of amblyopia? Most lazy eyes do not cause symptoms, with many children being unaware that there is a problem, and younger children often being unable to explain what is wrong. Some older children may have difficulty reading, writing, and drawing. Sometimes, the eye may look different, although this is usually a direct symptom of another condition, which may be the root cause of the lazy eye. Such conditions include: The weaker eye may look in a different direction than the stronger one (strabismus) Childhood cataracts Refractive errors, such as myopia and astigmatism Actions such as rubbing the eyes often, winking eyes or constantly blinking eyes are also indications that the child (or adult, in those cases not detected in time) suffers from a lazy eye. Causes of a lazy eye The main cause is an underdeveloped nerve pathway from the eye to the brain, formed during childhood. These nerves transmit information from the retina (the light-sensitive layer at the back of the eye) to the brain, which interprets this information as vision. During the first eight years of a child’s life, this connection from the eyes to the brain is built, as the eyes show the brain images, and the brain learns to make sense of them. The brain may not be able to build strong pathways in the following situations: If a low amount of light is entering the eye (caused by cataracts, for example). If the eye is unable to focus light well (refractive errors). Where the images sent by the two eyes aren’t the same (e.g. in the case of strabismus). Can a lazy eye be prevented? As amblyopia is a predictable and treatable condition, it should be detected quickly. It is advisable that all children have a complete eye exam at least once between 3 and 5 years of age. Parents should watch out for the signs listed above. What is the treatment for amblyopia? If a lazy eye is a consequence of another condition, that condition must first be treated. Glasses can be used to treat hyperopia, myopia or astigmatism, while cataracts will have to be removed to allow light to enter the eye properly. The child must then be encouraged to use the weaker eye to improve its connection to the brain. This can be done by reducing the brain’s reliance on the stronger eye, either by covering it with an eye patch, or temporarily blurring its vision with eye drops. Treatment is usually effective, but gradual, usually taking months to work, and should not be stopped too soon, as progress can be lost. After 7 or 8 years of age, the effectiveness of this correctional treatment is uncertain. ...

Botulinum toxin (Botox™)

What is botulinum toxin (Botox™)? Botulinum toxin, more commonly known as Botox™, is a neurotoxin that, despite being released by the microbe that causes botulism (a type of food poisoning), is also a drug used for medical purposes to treat various conditions. It is also used as a cosmetic treatment. It is administered via injection. Botox™ was the first drug developed to use the botulinum toxin, but others have also been developed. What is botulinum toxin used for? The most common uses for the botulinum toxin are: To reduce the appearance of facial wrinkles To treat repetitive neck spasms (cervical dystonia) To treat excessive sweating (hyperhidrosis) Chronic migraines Eye twitching Lazy eye Bladder dysfunction (urinary incontinence caused by an overactive bladder) What do botulinum toxin injections consist of? The botulinum toxin acts by temporarily paralysing certain muscles, for example, when used for facial muscles this smoothens their appearance. This also has the added benefit of preventing certain facial expressions, such as wrinkling your forehead which acts as an anti-ageing measure. Botulinum toxin injections weaken and paralyze certain muscles, blocking some nerves. They are injected with thin needles and the number you receive in a treatment session will depend on what they are being used for. The effects of the injection are not immediate, they begin to reveal after three or four days have elapsed, depending on each patient. The results can be highly satisfactory. In addition, depending on the patient, the effect of botulinum toxin can last between four and eight months; so, to keep the same look regular treatments would be required. Preparation for botulinum toxin injections: Pregnant or breastfeeding patients cannot undergo a botulinum toxin treatment. Although the injections are not too painful, some patients will prefer to have the skin numbed beforehand using topical anaesthesia. Aftercare: You can usually resume normal activities the same day as your treatment. You should avoid rubbing or massaging the treated area as this can move the toxin to other areas within the surrounding skin and muscle. Possible side effects of botulinum toxin injections include: Pain at the injection site Headache Flu-like symptoms Droopy eyelid Crooked smile Dry eyes or tearing ...

Diplopia (double vision)

What is diplopia? Diplopia, also called double vision, is an eye condition in which the images perceived by the eyes are not processed in the brain as a single spatial image, and instead, the brain sees two images. Depending on its origin, it can be of two types: binocular: the most common type, where the eyes do not line up with each other correctly. It is usually related to strabismus. monocular: a much less common form that is characterised by double vision generated only by one eye. It is related to an abnormality of the eye, such as astigmatism or a type of cataract. In terms of symptoms, diplopia can be categorised as: horizontal: the images appear side by side. vertical: the images appear one on top of the other. diagonal: the images appear misaligned both horizontally and vertically. What are the symptoms of diplopia? Apart from double vision, other symptoms can include: pain around the eyes pain during eye movements in one or both eyes headache nausea weakness (usually in the eyes) drooping eyelids What causes diplopia? There are many things which can cause diplopia, including: problems with the eye muscles such as Graves’ disease or myasthenia gravis eye injury from scars, dry eyes, or infections lens problems such as cataracts nerve problems as a result of diabetic retinopathy or multiple sclerosis brain damage due stroke, tumour, or alcohol congenital problems such as strabismus Can diplopia be prevented? Some causes of diplopia can be prevented, for example, by using the seatbelt in the car to avoid trauma, or by putting on glasses and head protection during any sporting activity or at work, if necessary. In addition, people with diabetes can lower the risk by controlling their blood sugar level. What is the treatment for diplopia? The treatment will depend on the causes of the disease, so it is important to first come to a definitive diagnosis through thorough eye testing and in some cases, blood tests or scans. Treatment may include medication or surgery to correct damage to the eye. If the double vision cannot be fully cured, you will be prescribed special glasses to improve your vision. ...

Optic neuritis

What is optic neuritis? Optic neuritis (ON) is the swelling or inflammation of the optic nerve. The optic nerve is responsible for transmitting the image from the retina to the brain. It is one of the most common disorders of the optic nerve, others include glaucoma, eye atrophy, or drusen. Disease prognosis Patients who get optic neuritis and do not have a linked disease, such as multiple sclerosis, have a higher chance of full recovery. However, although people with an autoimmune disease have a more negative prognosis, they may still regain vision in the affected eye. What are the symptoms? If the neuritis affects the eye nerve fibers then it could cause short or long term vision loss. There can also be changes in the way the eye reacts to bright lights, a chromatic vision loss, and the patient may also have pain with eye movement. Tests for optic neuritis To rule out other diseases, the patient will be given an eye colour test, a visual acuity test, visual field test, a brain MRI, and an indirect ophthalmoscopy to examine the optic disc. What causes it? The exact cause for optic neuritis remains unknown, but it is quite often linked to the following diseases: Multiple sclerosis which is a chronic neurological disease that causes inflammation and demyeliation of the nerve fibres. Optic neuritis is often the first symptom of the disease, while it is estimated that half of all people with MS will develop optic neuritis at some point. Cryptococcosis Respiratory infections Autoimmune diseases such as lupus Bacterial infections such as meningitis Viral infections such as chicken pox Vitamin B12 deficiency Leber’s optic neuropathy When it develops with no known cause, it is known as idiopathic neuritis. How can it be prevented? Consult an ophthalmologist and a neurologist so that they can study each case and detect risk factors. Quite often a brain MRI will be done if it is suspected that the patient may have one of the related diseases. What is the treatment? Treatment for optic neuritis will vary depending on the related disease; sometimes intravenous or oral tablet form corticosteroids are used to shorten the duration of symptoms and accelerate visual recovery. In some cases, vision may return within 2-3 weeks without any treatment. What specialist should I see? The specialist that diagnoses optic neuritis is an ophthalmologist. ...

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Other information about Richard Bowman

https://richardbowman.co.uk/

Publications in the National Institute of Health