Re(1): Jack Kanski passed away

Working with Kanski
Melanie Kell | 31 July 2012

When the world’s best known ophthalmologist, Dr. Jack Kanski, first asked Dr. Brad Bowling to co-author a textbook read by optometrists and ophthalmologists around the world, he politely declined. But soon after, he and his wife found themselves sitting in their car outside Dr. Kanski’s living room window, plucking up the courage for their first planning meeting.
Brad Bowling was just 35 when he was first approached to work with Dr. Kanski.

Dr. Bowling’s first book, Ophthalmology – An Illustrated Colour Text, co-authored with Mark Batterbury, had just won the Medical Writers Group of the Society of Authors Asher Award in 2000 and this had captured the well-known ophthalmologist’s attention.

“I think he (Dr. Kanski) was impressed that my first book had taken out one of his minor books in the contest for the Asher Award,” said Dr. Bowling with a wry smile.

“It was a fantastic honour to be invited to work with Jack Kanski, and though I was really in awe of him I initially turned down the opportunity to work on the book because I was too busy at the time
to be wholeheartedly committed,” said Dr. Bowling, who recently emigrated from the United Kingdom to practise in Australia with Vision Eye Institute.

“He kept asking me and eventually we went ahead. The opportunity was too good to miss. He’s a great person to work with – he has so much experience, ability and enthusiasm.”

The two had met when Dr. Bowling went to work at Windsor as the senior registrar in charge of teaching sessions. “Windsor was Dr. Kanski’s eye hospital and although he was retired, he’d come along to my sessions every week. He’d slip into the back row, listen intently and fire questions at the trainees. His breadth of knowledge is incredible and it was quite daunting to have this legendary figure there in the lectures.”

Their first project together, entitled Ophthalmology in Focus, was published in 2005. Dr. Bowling worked as the main author, Dr. Kanski edited the text and selected the illustrations. The book has been translated into several languages and continues to sell well around the world.

Writing the Bible
Three years after writing Ophthalmology in Focus, Dr. Kanski offered Dr. Bowling the chance to be involved in the seventh edition of his landmark book, Clinical Ophthalmology: A Systematic Approach. This was the first time he’d invited anyone to co-author the book in its decades-long history.

“Essentially the book is a template for examinations and general practice in ophthalmology – if you were to learn it from cover to cover, you’d have all the knowledge you needed to get through training,” said Dr. Bowling. “It contains, probably, too much detail for optometrists but many use it widely because it’s extremely useful clinically, they can rapidly access information on diseases they encounter in the course of daily practice and read up on every aspect of ocular health. There are lots of pictures, which really helps in diagnosis.”

Dr. Bowling, who’d studied the second edition of Kanski’s book at university, said it took approximately 18 months of spare time plus six weeks of dedicated time to complete the update. “I looked through all the latest research, starting with summary articles and I took it from there, moving on to detailed papers as required.

“When I first bought Kanski 20 years ago, it was under 300 pages long; the seventh edition is 1,000 pages – it’s grown every year as areas have been addressed in greater detail, new topics have been added and new treatments discovered.”

Dr. Bowling estimates that he re-wrote about half of the text from the sixth edition to complete the seventh, taking into account all the new information available. “Ophthalmology is a constantly evolving field and new research and treatments are being identified all the time. Even after the few months it took for the proofs to
come out, there were things that had to be updated.”

Of course the only way to keep a textbook of this nature absolutely up to date is to publish it online, which is something he and Dr. Kanski have considered.

“We really wanted to produce an online edition and the publisher offered to make it available, so we started writing an extended version of the text for this purpose but unfortunately we encountered prohibitive technical constraints. With the next edition we’ll do this and include interactive segments with Q and As.”

For now, purchasers of the book can access an online version that is the same as the printed text.

Dr. Bowling is currently proofreading a smaller project, Synopsis of Clinical Ophthalmology, which will be published within the next few months.

“This is a shortened version of the main book – much like study notes for students. It’s also very suitable for optometrists for day-to-day clinical use because it contains all the key facts without going into the depth required by ophthalmologists. It’s a great book, with lots of pictures and information… and it will look great on the shelf!”

Settling in Australia
Dr. Bowling is also busy settling his young family into Australia and establishing a career here as a practising ophthalmologist with the Vision Eye Institute in the Sydney suburbs of Bondi, Hurstville and Drummoyne.

“My sister emigrated to New Zealand a couple of years ago and she loves it. Since then she’s been trying to get me down to this part of the world. A former colleague from Oxford Eye Hospital, Dr. Simon Chen, has been working with Vision Eye Institute for three or four years and encouraged me to move to Sydney.”

Dr. Bowling added that as well as lifestyle benefits, there are significant professional advantages to be enjoyed in Australia.

“When you practise as an ophthalmologist in the UK, there are a lot of constraints – both financial and in terms of what you can do. For instance, if you want to adopt new equipment, you have to battle your way through the National Health Service bureaucracy – you have to submit a very detailed justification for using the new equipment to a committee and it can take about three months before approval to use it comes through. Here, when I wanted to introduce an innovative glaucoma surgical valve for instance, I rang the supplier and asked for a trial. They immediately provided training, after which I was able to use it straight away.”

Additionally, he says, the heavily overbooked UK health system is difficult to manage and can be highly stressful to work in.

“Then there is the economy, which is tough in the UK right now, and, faced with the spillover of the European crisis, unlikely to get any better for some time.

“So there are several significant disadvantages to working in the UK, whereas it’s a pleasure to work in the system here – I look forward to coming to work every day,” added Dr. Bowling.

Although now practising on the other side of the world, Dr. Bowling said he’s looking forward to working on the eighth edition of Clinical Ophthalmology and “would welcome the opportunity to take over as sole author when Jack Kanski decides to retire from writing”.

Contributing Care
“By writing this, and other books on ophthalmology, I can contribute to the care of so many more patients than I could ever see personally. Ophthalmologists around the world have taken their treatment cues from ‘Kanski’ for a generation and it’s an amazing privilege to be part of that. For instance, when Simon Chen was doing voluntary work in Cambodia recently, he emailed meto say the doctors he was working with there were using the book as their sole treatment guide. It was humbling. They couldn’t afford the book itself but were accessing an online version – and they followed it to the letter. Similarly, the Kilimanjaro Community Eye Clinic uses the Illustrated Colour Text.

“When I look online and find my books being used by communities around the world, it gives me a real thrill… apart from the intellectual challenge of putting the information together in the first place, which certainly is great for keeping me up to date with current practice,” he said.

Brad Bowling

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