David Nutbrown-Hughes, Clinical Director at Rowe Veterinary Referrals, has spent 30 years in veterinary medicine, with a focus on ophthalmology. With a RCVS certificate in ophthalmology, he leads the skilled team at Rowe Vets Referrals. David's clinical interests include tear film health and corneal surgery in brachycephalic dogs, he shares why he loves teaching, his work with the IVC Evidensia Academy, and his passion for eye health.
I’ve been a vet for 30 years as of this year! I started off in a mixed practice doing an equal mix of small, equine, and farm animals. They were lovely people, but it was quite a tough job. but I look back on it now and know that it gave me loads of skills for the future.
After that, I had a complete change and went to work for the RSPCA. The job was to set up a neutering clinic in an animal centre. There was also a wildlife centre which was good because it taught me how to work in a larger team. I was there for a couple of years and then moved to Sussex just before I got married. I was in Sussex for 12-13 years, and that's where I developed an interest in ophthalmology, which started because my mum worked in an eye clinic! It was the one part of my job we could talk about and share, and that led me to complete a certificate in ophthalmology.
My interest developed by visiting veterinary ophthalmologists and I was very self-driven, it felt like a hobby because I enjoyed it so much. I started seeing cases with my colleagues in the practice, and then that became seeing cases from other practices in the area.
For various reasons, I moved to Bristol to work for Rowe Vets as part of the referral team, and I’m now the Clinical Director here.
When I came to Rowe, I found it to be a much bigger practice than I was used to which was exciting. I got to meet so many people, from all over the world. Being part of the wider IVC Evidensia network is also useful, it’s what allowed us to expand to where we are now, equipment and facilities-wise. It’s also fantastic to be able to meet different, skilled veterinary professionals from across the group. I'm on the Referrals board and I teach within the network too. There are definitely opportunities that would have been much harder to find without the opportunities the IVC Evidensia network provides. I enjoy teaching and meeting people, giving my opinion on future projects and things like that. There are lots of They're exciting things that if I’d stayed in a small practice, I would never have got to do.
It’s great because when a patient is brought to you with an issue, you can look at exactly what you’re dealing with. If you've got the right equipment, you can physically look at everything. You can look into an eye and see the optic nerve and decide whether that nerve looks healthy or not. There are not many other disciplines where you can look at real-life blood vessels pulsing! If you're lucky, you can see individual blood cells going through blood vessels. It blows my mind that you can see things going on in real-time, changing before your eyes.
The other reason is that it involves both medicine and surgery. You’re thinking about the whole animal because a lot of eye problems are symptoms of bigger problems. I enjoy surgery and I'm quite a perfectionist! I like small, fiddly things. I enjoy suturing an eye with those sutures that you can hardly see.
I also know the massive difference my work can make to a patient. Sometimes you get a dog coming in that can't see and then they leave the practice able to see which is amazing. It’s not every case you can do that to, but having the opportunity is amazing.
There are so many pathways! If they want to make a total career of ophthalmology, then there's the internship/residency pathway. We do offer intern training positions at Rowe, for example, but there are other places as well. To get on those, you need to have a bit of experience. I would suggest reaching out to other ophthalmologists and sharing that you have an interest and would like to come and see what they're doing. We have lots of early career vets who come for a few days to Rowe.
It's also very easy to become the vet in the practice who knows the most about something. If you're interested, get some CPD, join the British Association of Veterinary Ophthalmologists (BRAVO), and come to the meetings. That's one of the key things I did because there are people there who are more than happy to spend a whole weekend talking to you about their passion! If you're keen but want to stay in a specific practice and become an advanced practitioner, there's support in IVC Evidensia for doing that as well. Don't hold back, show an interest, and get involved. If you're stuck, ask for help. There will always be someone who's more than happy to support you.
Brachycephalic dogs, like pugs and French Bulldogs, have short noses and faces, which creates problems. These dogs have eyes that are more exposed and less protected, they can't blink properly and have poor corneal sensation, leading to various issues. They get corneal ulcers because for example their tears evaporate quickly and the tears are poorly distributed, affecting the surface of their eyes. Having a cornea with poor tears and eyelids is like having a windscreen with poor wipers and no washer fluid. The whole ecosystem of the eye doesn't work well.
My interest is in what we can do to make their lives better. We do a surgery called medial canthoplasty, and we're keen to see if it makes the health of the surface of the eye better. It's not just about making the eye smaller to reduce tear evaporation; but improving the way the eyelids and the eye interact; it's about improving the ocular surface health.
I’m interested in finding ways to address these issues, which would ideally be by changing the shape of their faces through responsible breeding practices, but we can help by improving eye health through surgeries and other treatments.
I always look back to my first job, where the vets were kind and generous with their time and patience. I want to give that same support to young vets.
At IVC Evidensia, our Academy is an amazing opportunity for young vets to get the support they need and access to ongoing CPD. Teaching is satisfying because you can help someone do something they couldn't do before.
The first time I did teaching, I was absolutely petrified! But I really enjoy it, particularly with ophthalmology you get that satisfaction of helping someone be able to do something they couldn't do before.
The way the Academy is structured is great because it offers practical skill development. These days, you can acquire knowledge to some degree through online CPD or reading a book, but practical skills still have to be taught. I’ll be helping our vets refine the skills they need to succeed.
The secret to success is being able to do nice stitches that end up how you intended them to, especially for eye surgery as it’s not very forgiving; you must get the stitches right for it to work. We'll be doing a lot of going back to basics, making sure everyone's happy with stitching and suturing the eyelid correctly. Simple stuff like closing an eyelid wound becomes a natural progression once you get the basics right.
Sadly, a lot of eyes must be removed, and that can be quite stressful for early career vets. We'll be going through how to do that, how to reduce the amount of bleeding, and what to do if it does bleed.
Surgery can be straightforward but doing it well is something the Academy aims to ensure and to make what can be a common source of stress less stressful.
I'm really proud of the team I work with and I'm proud of Rowe Referrals. The joy of my working day is to ensure our team functions as best as it can.
I also always wanted to do intraocular surgery, like cataract surgery, but I was cautious about ensuring I could do it to the best of my ability. Now, I'm thrilled to be doing it well.
I have four children, so I spend a lot of time taxiing them around! I enjoy walking my dog Mo, who is a black and white Jack Russell I adopted as a stray. He's the best, he's a very easy dog. He sleeps all day and is happy to see you when you come home.
I play the saxophone and used to be in a band, but haven't played much since moving to Bristol.