Why is it important to collaborate in vision loss research?

Professor Pearse Keane: “Collaborations are where the magic happens. The magic happens at the intersection between different disciplines, at the intersection between academia and industry. It's a sharing of ideas; it's a sharing of expertise, it's a sharing of resources. And then also maybe it's about impact and dissemination.”

“Sometimes you can do things in one institution, but if you do it across other national institutions or other international institutions, maybe you get to spread, to share what you've done and have knowledge exchange and impact.”

Professor Alastair Denniston: “None of us has all the answers. One of the things I learned quite early is that if you're ultimately focused on the mission of discovering the answer, whether that's a new treatment, new diagnostic test, or whatever, you want to get the top team. Hopefully you're part of that top team, and you want to choose the people who are going to most help you get there, tp achieve that target. And often for me and Pearse that has included each other, but not just each other. It’s a whole team of people.”

Professor Pearse Keane: “There was a TV show on Netflix. I think it was about tidying your house and things like that. And she had this phrase ‘does this item spark joy?’. What good looks like is, does it spark joy? I think so. So, if I have meetings and I'm looking forward to a weekly or monthly meeting or I'm on the meeting and I feel like we're like ideas are bouncing back and forth and we come off the meeting with a feeling like, ‘oh, we're making progress here’. We're all rowing in the same direction here. That's to me what good collaborations look like.”

Alastair Denniston: “That first Fight for Sight grant, which was so important to us both was only £14,000, which may sound like a lot of money if you're not in research, but doesn’t go that far. But it did enable us to move to next step. And that led to a couple of papers at that time. But I think at the last count piece, you and I have 90 papers together over the last 15, 16 years.”

Pearse Keane: “We were able to get these grants from Fight for Sight at the crucial kind of idea stage for collaborations. It's like we're starting to build a collaboration. We get this grant. This grant [was] to look at better ways to measure inflammation in the eye using advanced imaging. That led to a bunch of papers, and it led to further funding, and it led to building a big team and led to lots of other collaborations.

“Amazingly, it wasn't just this one grant. There were other grants we have from Fight For Sight. We got a small grant. Looking at using the eye to detect Alzheimer's disease. And that led to so many big things. And that led to this collaboration [with] Alastair, where he coined this term Oculomics to describe using the eye as a window to the rest of the body.

“Now when you go to big conferences in the US and other places, there's like whole sections of the conference dedicated to Oculomics. And this was only because of the collaboration that we formed and because of the support from Fight for Sight at that, key initial stage.”

Pearse Keane: The pathway to impact to real impact in patients is a long one. And we are still on that journey, but I don't think we're anywhere close to where we want to be in terms of saving the sight of people around the world at scale.

In terms of patient impact, a patient of mine at Moorfields called Elaine. Elaine was this amazing woman who I met more than 10 years ago. And she was receiving treatment for age-related macular degeneration. And I’m saying this information because she's talked about this publicly and she's been a big advocate for her research.

Elaine had lost sight in her left eye before there were good treatments for age-related macular degeneration. And then when she started to develop wet AMD in her good eye she faced delays in being seen and treated. And I can only imagine what that would be like, because imagine you're losing sight in your good eye, your only eye. There's now treatments available, but somehow, you're being told you need to wait for weeks to even be seen to begin those treatments.

“Now, fortunately, Elaine was able to come and get seen and receive anti-VEGF treatment and save the sight in her good eye. During this I really got talking to Elaine and got inspired by Elaine to think about can we use technologies such as AI to try to prioritize those people with the most sight threatening disease to try and get them the treatment at the earliest possible point and thereby to save sight.

Elaine passed away in July of this year. Both Alastair and I are committed to delivering what she felt so passionate about, which is doing ophthalmic research to save sight.

Alastair Denniston: I think generally in life, if you're trying to be very controlling and spend all your time worrying about whether you get the credit for what you're doing, I don't think you go very far.

Wherever you are in your career think of yourself as a volunteer, contributor and certainly as a team player towards that greater goal, in this case, to understand why sight loss happens and to do everything we can to address that and to improve people’s lives.

Pearse Keane: One rule that I try to live by is if you can, if someone asks you to help them in some way and you're able to help them in under two minutes, you should just automatically do it. I think that also speaks to other aspects of how to build good collaborations, which I think is as which you've alluded to, like an openness to, to approaches. I've approached a lot of people with ‘cold-call’ emails, and I get a lot of approaches. I do my best to try to answer all those approaches.

If you're doing a collaboration like the one that I set up between Moorfields and Google DeepMind, I think you need to have senior leadership and high level support, but also you need to have like on the ground a team working closely together doing stuff from the ground up. I would highlight is you need to have the trust elements.

You've got to be reliable and that means you answer emails in a timely fashion. And you do what you say you were going to do. And if you can't do what you say, what you were gonna do, you just tell people. Just being reliable is the secret sauce to making collaborations work. 

Pearse Keane: I've been fortunate to have good friends and collaborators and mentors at every stage. And so, people that immediately come to mind for me, I think someone like Professor Sir Peng Tee Khaw at Moorfield and UCL. He is just this like amazing visionary who is the type of person that if you come to him with an idea, he will go, oh my God, that's the coolest thing ever.

In more recent years I've been very fortunate to have mentorship from another ophthalmologist Professor Tien Yin Wong who's based in China now but was in Singapore. He's just provided a lot of, advice and support and that's really helped me in terms of thinking about how to build global collaborations.

Alastair Denniston: We’ve already mentioned some of the Birmingham team that were very instrumental for us such as Prof. Murray and Prof Rauz.

Also for me on the ophthalmic research side, Professor Andrew Dick. He's always been a great mentor and friend. Once, he was my external examiner for my PhD, so he wasn't a friend before then. It should be said that he gave me a very hard time on that [the PhD viva]. I moved to work with his group for six months or so before becoming consultant – he has a willingness to just try things and not be afraid whether something might not work.

Alastair Denniston: A phone call is always better, if there's an email that I don't understand. I think transparency Is really important as well. I hope with all our collaborators we are respectful and open about these times when maybe we're not including each other because, there’s good reasons not to. Just say to them, “For info, I'm doing this thing, I'm working with this people over there”.

Pearse Keane: It's very tempting sometimes with emails to send something which you think you're being smart but can be passive aggressive.

Pearse Keane: I think if I'm looking for a collaboration between, for example, junior members of the team from different institutions or different teams, I'm looking to see where the chemistry is. Who are the people from my team who are most engaged and enthusiastic, and who are they connecting with in the best way?

Alastair Denniston: I think at the individual level we are both privileged to lead teams made up of fantastic researchers at different stages in their careers. I think we both see our role as to guide and steer and enable and empower people to be amazing. So, I think we both give a lot of autonomy to our team members or at least try to.

Pearse Keane: I think that the order of things should be people, ideas, and then processes and not processes, ideas and people. So, it's about getting the right people and then getting the right vision and then worrying about the processes.

Alastair Denniston: There are ideas that I can think back to that I remember getting really excited about and, potentially not being able to sleep at night. One was when we started to think about how OCT scanners could be used in different ways.

The process to inventing the OCT scanner has really transformed ophthalmology, that was a long pathway, but of course now they're widespread and the idea of repurposing something that's already there and has regulatory approval and could be used in clinics to solve real problems in patients that we were seeing every day that was exciting.

And I remember getting excited about oculomics, which is built on the in a longstanding concept about the eye as a window. But that idea of, okay, what does this mean in that AI era, in the high resolution imaging era?

Then seeing Pearse and the brilliant Sigfried Wagner take that forward, looking at how standard retinal imaging can detect signs of Parkinson's disease seven years before clinical diagnosis, that, the gap between us talking about oculomics and that paper coming out was several years, but that's still amazing.

Pearse Keane: Maybe the advice that I would give is to just be interested in things like leadership and collaboration and think earlier about ways that you can build your skills in things like leadership.

Alastair Denniston: I think, it's probably something about not worrying too much what other people think. Get feedback but allow yourself to align to that sort of big mission or that north star in terms of your research. If you're fortunate enough as Pearse and I have to find somebody that you spark within research terms, but also trust and actually even became a friend, that's precious and you don't have to be working exactly the same area.