In this interview, Dr Alexander Silvester, Chief Medical Officer at SpaMedica, discusses the SpaMedica Training Award (presented this year at ESCRS 2026), the company’s ongoing partnership with Rayner, and how ophthalmology companies and industry might collaborate more closely to ensure better standards of surgical training and best practice.
Can you tell us about the SpaMedica Training Award?
SpaMedica is the UK's largest independent provider of NHS cataract surgery and, for the last three or four years, we’ve made a significant contribution to training. We think it’s a duty that if we’re doing a significant proportion of NHS (National Health Service) cataract procedures, we should also be training the surgeons of the future.
As well as being CMO, I chair our European Medical Board. SpaMedica is part of Veonet – we’re the largest ophthalmology group in Europe. The training award idea emerged when I was chairing one of these meetings. We gathered experts from all over Europe and talked about how we can engage with our trainees – what can they learn, and how can we share that knowledge and experience?
We came up with the concept of an observership, which will see a trainee selected through a competition in each of the countries. The winning trainee can then go to any country within our group and spend up to 10 nights, all paid for, in a subspecialty of their choice – whether that’s to Spain to learn about refractive surgery, medical retina in Switzerland, or oculoplastics in Germany. It’s an opportunity for a doctor to learn more from our European colleagues, in addition to what they’re doing in the NHS and at SpaMedica.
It’s the next level up – a real opportunity to expose NHS trainees to some of the best ophthalmologists in the world.
What does the recipient experience as part of the award – and what do you hope they will take away from it?
It has to be an observership, in that they can’t actually do surgery. That’s because of the regulations and the differences between the countries – it makes things a little more challenging from an indemnity and governance perspective.
However, there’s a real benefit to observerships – you get an overview of a system, process, and pathway of a given country. I also think it’s important, particularly for NHS trainees in the UK, to learn some soft skills, because there are things beyond actually doing surgery that are really important to being an ophthalmologist.
So, it’s really about that broader experience, learning more about a specialty and also getting a holistic view of what’s going on elsewhere.
How did the partnership between SpaMedica and Rayner come about?
We’ve been working with Rayner for a few years, particularly around some of their latest technology. There was a lot of excitement a couple of years ago around the Galaxy lens, and now Rayner has brought out the hydrophobic version, which I think is going to attract even more interest.
One of the things we did was trial the lens across the group. We were able to get really useful data from all the countries about their use of the lens and their outcomes.
Rayner obviously has a lot of heritage with the intraocular lens, and its lenses are made in the UK. From a sustainability perspective, for a UK business, being able to source a product that’s made in the UK is very positive, especially when you think about supply chains.
Veonet operates across several European ophthalmology markets. How does that create opportunities for sharing different approaches to surgical training and best practice?
I think it’s fair to say that most European countries still look towards the Royal College of Ophthalmologists as a source of guidance and best practice. The College, alongside the American Academy of Ophthalmology, are two of the main places people look towards.
We are working with our European colleagues to set our own standards. We have our own benchmarks across the European board to ensure that everyone is doing the same thing.
Some of these countries don’t necessarily have the same duty of candour. In the UK, duty of candour and Never Events are a significant part of governance. So, for me, being able to take some of that important UK governance and spread it across Europe is really exciting.
From an educational perspective, where does Rayner's involvement add value? Is there a role for industry that extends beyond providing technology and products?
Absolutely. Our surgeons work with Rayner, and our in-house optometrists have also had training with Rayner. It’s important to be upskilled on the specific lenses: how they work, the pros and cons, but also, most importantly, patient selection – which patients are likely to benefit from particular lenses. Rayner has got a wide range of lenses, and we’ve worked with them to establish our own criteria around which patients would benefit from which options.
It’s great to have a good product, but you want that product to be used in the best possible way by surgeons. For example, I know that Rayner doesn't want the Galaxy lens in every single patient. The company wants the Galaxy lens in those patients who are going to benefit most from it. Those who don’t, for whatever reason, have the option of a different lens.
Product specialists such as Rayner are able to support us with that, and that’s why we’ve very good patient-reported outcomes. We measure that through RayPRO, a patient outcome monitoring platform that Rayner provides, where the company will contact patients weeks and months later.
One of the key questions for patients is: did your outcome meet your expectations? Because it’s all well and good clinically – the vision might be good, the refraction might be perfect – but at the end of the day, it’s about the patient, how they perceive it, and their overall experience.
If we’ve selected the right patients, counselled them properly, managed their expectations, done the surgery safely, and they’ve achieved what they expected, then we’ve done the best job we can do. We can’t improve the pathway much beyond that.
How do you judge whether a training initiative like this has been successful?
We have all sorts of key performance indicators; we use the same kinds of measures for our trainees as we do for our senior surgeons.
What delights me particularly is that the refractive outcomes and visual acuity outcomes we get from our trainees are just as good as those from consultants. I presented an abstract at the Royal College meeting this year showing that around 96% of patients who had surgery performed by a trainee achieved driving-standard vision or better, compared with a College benchmark of 95%.
For refractive outcomes, the College benchmark is 85%, and 94% of our patients were within one dioptre when their surgery had been performed by a trainee. So, outcome-wise, it’s as good as – if not better than – you might expect.
When a trainee starts, we also do an audit to understand what they want to achieve, what their complication rate is like, and what experience they already have. We then review that when they finish the six-month rotation and again, it’s very reassuring to see the significant improvements.
In 2023, there were concerns around a GMC report showing that only 30% of year-three trainees had achieved the number of cataract procedures they needed. That report was re-run this year, and now more than 70% of ST3 trainees are getting the numbers they need – in fact, they are exceeding the cataract numbers they need.
A big part of that has been independent-sector providers such as SpaMedica opening up our doors and getting trainees onto our lists.
Is there anything you would like to add?
I’m excited that we got to bring all this together at this year’s ESCRS. The fact that the event was held at Tower Bridge was also very fitting. ESCRS is a Congress “where innovation meets experience,” and that summarises the Veonet group. When you bring experience and innovation together, you get fantastic outcomes.
