SUMMER 2016 VOLUME 19 ISSUE 4 EYE2EYE 2the magazine of the leaders in collaborative eye care

IN THIS Highlights from New Fellows — the Collaborative care in Advocating for RANZCO 2016 next generation of diabetic retinopathy change: RANZCO NZ ISSUE: Congress ophthalmology Branch campaign

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EYE2EYE 2the magazine of the leaders in collaborative eye care Contents Message from the President 4 Censor-in-Chief’s Update 8 CEO’s Corner 14 Membership Spotlight 15 RANZCO 48th Annual Scientific Congress 34 Indigenous Eye Health 46 Policy and Advocacy Matters 52 34 53 RANZCO Museum 60 Feature Article New Fellows 62 Branch Musings 68 Special Interest Groups 70 RANZCO Affiliates 72 Ophthal News 74 Scholarship Report 81 RANZCO Office 83 Calendar of Events 85 62 81 Classifieds 86 Cover picture: RANZCO 48th Annual Scientific Congress, Melbourne 2016

Eye2Eye is published by The Royal Australian and New Zealand College of Ophthalmologists as information for its members. The views expressed in the publication are those of the authors and not necessarily of the College. The inclusion of advertising in this publication does not constitute College endorsement of the products or services advertised. Editor: Laura Sefaj Design and layout: Francine Dutton The Royal Australian and New Zealand College of Ophthalmologists A.C.N 000 644 404 94-98 Chalmers Street Surry Hills NSW 2010 Australia Ph: +61 2 9690 1001 Fax: +61 2 9690 1321 E-mail: [email protected] Website: www.ranzco.edu 4 Message from the President

Message from the President Excited about the journey ahead

Australian and New Zealand Cornea the pathology department so I was Society, Immediate Past Chair of the given a microscope for Christmas that Investment Advisory Committee year. Of course, as soon as I entered of ORIA and former Section Editor the hospital, that idea went out the and Board Member of Clinical & window as I experienced the highs Experimental Ophthalmology. and lows of working in health. Over His current appointments externally the years as a student, I had almost are Head of Corneal Clinic, Royal every job in a hospital from orderly Victorian Eye and Ear Hospital; Head and cleaner to serologist in the Blood of Surgical Research Unit, Centre for Bank and even a volunteer nurse Eye Research Australia, University of during the nurses’ strike. But it was Melbourne; and Honorary Professor at surgery that really appealed to me so Harbin University. as a junior doctor I tried each of the A/Prof Daniell is involved in teaching surgical specialties in turn. I was deeply ophthalmology to students, registrars impressed by the impact patients and Fellows and has been an examiner felt at the thought of losing their A/Prof Mark Daniell for ophthalmology (RANZCO Advanced sight and how effective eye surgery Clinical Examination) for over 10 years. Associate Professor Mark could be. After a research degree Daniell took up the role Q Can you tell us a little bit about in photodynamic therapy I was as RANZCO President in yourself and your family and your accepted into the training program path to ophthalmology? late November 2016 at at the Royal Victorian Eye and Ear Hospital (RVEEH) before heading to the College’s 48th Annual A I was always interested in science London to train for three more years Scientific Congress in at school and decided to work in medical research. My first taste of a lab at Moorfields Eye Hospital. In London Melbourne. was during work experience at school. I was lucky enough to work with both A/Prof Daniell has held a number of I was left with the impression that if the medical retina department and roles within the College including Vice I wanted to run a medical research the corneal service before returning President, Honorary Treasurer, Board lab, it was better to be a doctor rather to Melbourne to take up a position member and Chair of the Ophthalmic than try and do it as a scientist, so I in the corneal unit at the RVEEH and Research Institute of Australia (ORIA). applied for medicine. My family was the medical eye unit at the Royal He is also Inaugural Chair of the sure I would follow my grandfather into Melbourne Hospital. Eye2Eye Summer 2016 5

More recently, I decided to become Another challenge is addressing RANZCO is an educational more engaged professionally as well A the eye health inequalities suffered body and, as such, driving clinical as build up my research interests. by Indigenous people in Australia. standards in ophthalmology is always What started as a tap on the shoulder The recent National Eye Health Survey a priority. We also aim to promote to become Treasurer of ORIA has led published by Vision 2020 Australia and ophthalmology as a profession, to to a deep involvement with all aspects the Centre for Eye Research Australia raise awareness of the work that of our College and an understanding showed that, while progress is being ophthalmologists do and to achieve of the importance of professional made towards improving vision the best possible eye health outcomes societies in our medical system. and reducing avoidable blindness for people across Australia, New At home, I am kept grounded by in Australia, Indigenous people Zealand and more widely. There have my wife, Susan, and my three kids. My are three times more likely to have been a number of challenges to our eldest son Oscar has just finished his visual impairment or blindness than system, both from within and without, Masters of Ethics and is studying law. non-Indigenous people. and these need to be understood and Julian is in his final year of medicine We face an uncertain future addressed. We need to modernise and is trying to decide which way to from forces outside the profession. our education program, restructure, take his career. My youngest, Edward, The Medicare review could have a replace and improve where necessary. is just starting his Law Arts degree dramatic impact on the delivery of During my term as President, but seems to have enough time to services. The Medical Board seems I am keen that RANZCO remains keep me posted on all the footy certain to introduce some form of focused on continuously improving news. There is always a fair degree of standards in ophthalmology through revalidation. RANZCO’s role is to act as banter around the dinner table, with excellent education, innovation and the interface between the profession no quarter asked or given! advocacy. A particular goal is to and the regulators. We plan to assist in Q What did you like best about drive professional standards as well protecting Fellows from the excessive the many College roles you’ve held as clinical standards, ensuring that burden of regulation, ensuring that in the past? RANZCO Fellows are not just the best the system is sensible and practical. A One of my first roles in the College ophthalmologists they can be, but Q How do specialties like was as an examiner for the Part 2 (now also the best leaders and managers, ophthalmology navigate the rapid the RACE). I found I really enjoyed the the best collaborators and innovators changes that are occurring in our friendship and camaraderie of my and the best advocates for their healthcare environment (such as fellow examiners, who were passionate profession. those happening in the private about education and passing on Q What do you see as some of the health sector and with Medicare)? their knowledge. On the ORIA I came key challenges ahead? A Ophthalmology has been in contact with the academics and One of the biggest challenges quick to embrace change, rapidly scientists of the College, and on the A facing ophthalmology, as well as incorporating technological advances Board, the politicians and advocates. other medical specialties, in Australia such as phacemulsification for cataract, Ophthalmologists as a group tend to is workforce maldistribution. Overall intravitreal injections for AMD and be smart, dedicated and independent the supply of ophthalmologists is collagen cross linking for keratoconus. thinkers. We tend to work alone and about right in Australia, however the There is a constant need to evaluate solve most problems we face without vast majority of ophthalmologists these new technologies, encouraging needing to involve others. Despite our work in or around the major cities, the useful ones and discarding the many similarities, we all have our own meaning access to ophthalmology changes that do not pass muster. ideas and ways of doing things. So services is limited in rural and remote Data collection, analysis of outcomes, when we get together to share ideas, areas, as it is with other medical discussion and publication of the there are plenty of interesting things to specialists. results and development and talk about! Addressing this is a key priority for promotion of best practice are all I have been constantly impressed by RANZCO and for our Fellows. We seek essential activities. my colleagues’ diligence, dedication to do this both through innovative RANZCO constantly monitors and hard work for their patients and programs such as satellite clinics that the external environments that for the College. We all volunteer for have visiting ophthalmologists and by impact the delivery of eye health these committees and serve with advocating for government to create services and we seek to engage good grace and really try to make the policies that facilitate and encourage collaboratively and constructively system work better. specialists to operate in these areas. with government, regulators and the Q What do you see as your main This is one of the issues highlighted in wider industry. Through relevant role as RANZCO President for the our newly launched strategic plan for RANZCO committees we keep track next two years? 2017-2020. of technologies and innovations 6 Message from the President

and, based on the evidence available, On the weekends we try get down to Any free time I have I try and we advise the regulators and policy A Flinders. The peace and quiet (and golf) organise a game of golf. Golf is definitely developers. is needed to recharge the batteries a game for optimists; every time you Our aim is to ensure the best possible and gives me the chance to get some play you are sure you will do better. You outcomes for patients through a reading and thinking done. regulatory environment that allows would have thought that 30 years of ophthalmologists to deliver the highest experience would inject some realism, standard of care for their patients. but I keep trying. Q How do you unwind from all your I usually play tennis once a week and professional commitments — what try to keep active by walking to work do you like to do outside of work? across the beautiful Fitzroy Gardens.

Past President's valedictory reminiscences

been undertaken to measure the clinical efficacy of these guidelines. When we consider that the RANZCO/ Australian Society of Ophthalmologists v. the Optometry Board of Australia Supreme Court glaucoma litigation was settled in November 2014, to be at this point of collaboration two years later represents a remarkable turnaround and signals RANZCO’s confidence for our future. My two major learnings from my period as President are firstly, that RANZCO has an almost infinite pool of talent amongst its Fellows to solve any problem, whether it be the design of a Dr Brad Horsburgh with his wife, Dr Paula Horsburgh, and daughter, Ms Georgina Horsburgh, at the 2016 RANZCO Congress, Melbourne clinical efficacy study or the necessity to advocate for government policy along with other medical colleges, When I look back on the last changes. Secondly, these two years must pursue the necessary cultural two years, one word would have proven without a doubt that describe the experience – changes to ensure that we are meeting community expectations. collective emotional intelligence will intense. RANZCO has been the first College always deliver a better outcome than From day one, circumstances ensured to undergo a full Australian Medical that of an individual. that the pace of activity did not Council accreditation involving Although at times it has been very diminish, at all. The first six months extensively rewritten accreditation difficult, I will be forever grateful that were spent securing passage of guidelines in the face of governmental the Council saw fit to provide me with RANZCO's new Constitution, in SHBD concerns. RANZCO has been this opportunity to serve. I particularly the face of some strident criticism. reaccredited to train ophthalmologists wish to thank my fellow Board members Constitutional change is difficult, in Australia and New Zealand for for their support and counsel and for ‘the status quo’ enjoys a 3 to 1 a period of three years and the express my gratitude to Dr David strategic advantage, but change necessary changes are occurring. Andrews for his dedication in his role as had to occur. The College Fellowship August 2016 saw the launch of College CEO. passed the new Constitution with the RANZCO Guidelines Initiative; I will always consider this Presidency an 89% majority and we achieved a promulgating referral pathways to have been the pinnacle of my better constitution as a result of the for glaucoma, AMD and diabetic professional career and thank the process. retinopathy to all optometrists and Council from the bottom of my heart. Sexual harassment, bullying and GPs who wish to be involved. A major discrimination (SHBD) have become clinical trial, involving collaboration Dr Brad Horsburgh the Zeitgeist of our age. RANZCO, with a large optometric group, has Immediate Past President, RANZCO 7 8 Censor-in-Chief’s Update

Censor-in-Chief’s Update Talking ‘bout the next generation

Deciding where to start a either citizens or permanent residents Selection committees use a term as Censor-in-Chief is a of Australia or New Zealand. weighting scheme to score each challenge. Stephen Covey, of A minimum of two years’ component of a candidate’s postgraduate pre-vocational application, for example; curriculum the ‘7 habits’ fame, urges us experience must be completed by vitae, references and interview to begin with the end in mind. the intended start of ophthalmology performance. The College publishes The outcome of the Vocational training. Within that two years, its suggested weighting scheme Training Program (VTP) is applicants are expected to have had on its website, but each training the graduation of a specialist at least 21 months of non-ophthalmic network decides its own confidential ophthalmologist who is equipped medical, surgical and clinical practice. scheme. to undertake safe, unsupervised, While RANZCO manages the Advice of the outcome of each comprehensive general application process internally, the process and a report from the ophthalmology practice. What responsibility for selection – and the Regional QEC Chair are then more might the Qualification and employment arrangements necessary provided to RANZCO so that the Education Committee (QEC) put in for training to be undertaken – rests enrolment process can begin. place, starting with the selection to with the training networks and the VTP, to ensure that this can be relevant health departments. Who is selected on the achieved? The Chair of the Regional QEC sits VTP? on the selection committee, serving Over the last seven years, between Selection process as a liaison between the training 95 and 124 applications have been For most of us, selection is a distant network and RANZCO. Composition received annually for the 32 or so memory. Let me summarise the of the selection committee is places that were available. process briefly. determined by the training network. The requirements of the VTP are It generally includes a current trainee For 2017 published for the information of as an observer. Thirty-four trainees – seven of potential applicants on the RANZCO The QEC provides guidance via whom (just over 20 per cent) will be website and in the Guide to the Annual the RANZCO Selection Committee appointed in New Zealand – have RANZCO Selection of Basic Trainees. Handbook. All training networks have been selected. This is an increase The College accepts applications agreed to adopt its selection criteria. on the total number selected last from medical graduates registered to The selection criteria are based on the year when there were fewer training practice medicine in either Australia or seven key roles of an ophthalmologist posts available than is typically the New Zealand. Applicants must also be that underpin the VTP curriculum. case. Eye2Eye Summer 2016 9

Of the newly selected trainees To maintain the current high College will review selection criteria almost 40 per cent are women. standard of our graduates, there and selection processes to try to This rate has been relatively stable is no question that a certain level ensure that our ‘merit-based and fair’ year-on-year since at least 2011 and of academic ability must remain a system also takes into account the is proportionate to the number of prerequisite. We need to ensure that need to ensure diversity amongst applications received. those selected are ‘trainable’ and once the Fellows, representation from our Incoming trainees are typically about in training the assessment processes Indigenous communities and the 30 years old. This year, five have a PhD and pass criteria must remain rigorous. desire for more ophthalmologists in degree, and 18 a Master’s degree. But should we place more weighting rural and provincial centres. I have been reviewing the on other factors such as an Indigenous We will also look at the composition recommendations from the recent background or a rural upbringing? of selection committees as the AMC Australian Medical Council (AMC) There is ample research to indicate requires us to include lay and trainee accreditation report about RANZCO’s that selection criteria play a larger role representation, something which is selection process. It’s pleasing to see than term rotations in determining the not yet universal in all states. that the accreditation team finds the likelihood that a doctor will serve an I had the pleasure of observing the selection process “merit-based and Indigenous community or settle in a interviews for almost all the states’ fair”. The team has also suggested provincial location. selections this year and I was impressed further refinements of the selection In a U.S. study the ‘number needed to by the commitment to objectivity process. Among others, it asks teach’ in a rural immersion curriculum shown by the panels. An emphasis the College to consider ways that to result in one more rural practitioner was placed on the CanMeds criteria ophthalmology might be promoted was 17, while the ‘number needed to (scholar, expert, collaborator, manager, to Indigenous medical students be admitted’ was 6.1 A South African communicator, professional, advocate) and doctors from both Australia study showed that 45.9% of rural-origin to try to tease out those applicants and New Zealand. There is also a respondents were in rural practice, who will not only fulfil the academic need to consider our workforce compared with 13.3% of the urban- requirements of ophthalmology but issues and the difficulty we have in origin respondents (p = 0.001).2 A study will also be caring doctors and valuable attracting ophthalmologists to rural of 4112 Australian medical students colleagues. There were variations from and provincial posts. Together with confirmed that an intention to practice state to state in how the interviews the relevant stakeholders we will in a rural setting was more likely for were run and as part of the selection 3 re-examine our selection criteria and students from rural areas. review it would be appropriate to weightings to try to compensate for In New Zealand in 2004, following a consider if a particular methodology these deficiencies. government initiative, the Rural Origin is more effective and, if so, encourage Looking at those accepted Medical Preferential Entry program was more uniformity among centres. for training for 2017, one might instituted and four years later 25% of RANZCO selection is admirable in understand why there is a perception Otago and 20% of Auckland students many ways but improvements must that a higher degree is almost a were from rural backgrounds which always be sought and some changes prerequisite for ophthalmology means towns with a population of are required by the AMC. Now is a good training. This has arisen not because fewer than 20,000. Their criteria include time to undertake a thorough review having a higher degree necessarily having spent a significant proportion of of our selection criteria and practices to makes for a better ophthalmologist pre-secondary school education or at ensure that they are appropriate for the but because our selection grading least three years at a secondary school in outcomes we are trying to achieve for system finds it easier to objectively a rural area. the future of ophthalmology in Australia assess academic criteria. While such a program can never and New Zealand. The clinician scientist program guarantee a trainee will return to a rural is a pathway which allows a higher location, we need to at least consider Dr Justin Mora degree to be obtained in training by such options to try to redress the Censor-in-Chief, RANZCO those who really have an academic current imbalance. or research calling. While the College One can make the same argument must continue to foster outstanding for giving preference to applicants 1. Hseuh W, Wilkinson T, Bills J. What evidence- talent and encourage the pursuit of from Indigenous or under-represented based interventions promote rural health. NZ academic and research careers, this groups as there is good evidence that Med J 2004;117:U1117 2. de Vries E, Reid S. Do South African medical should not be at the expense of our people from a particular Indigenous students of rural origin return to rural prac- aim to produce competent general background are more likely to serve that tice? Afr Med J. 2003 Oct;93(10):789-93. ophthalmologists, some of whom we community long term. 3. Jones M, Humphreys J, Prideaux D. Predicting medical students intentions to take up hope will choose to practice in rural As part of the review of the education rural practice after graduation. Med Educ locations. system following the AMC report, the 2009;43:1001- 10 Censor-in-Chief’s Update

RANZCO Censors-in- Chief over the years

With the appointment of a new Censor-in- Chief in 2016, RANZCO Honorary Fellow Ms Margaret Dunn has been taking us through the College’s Censors-in- Chief over the years. In the last issue of Eye2Eye we featured Dr Ken G. Howsam, Dr Peter Rogers and Professor Frank Billson. In this issue, Ms Dunn provides an overview of Dr Barry Coote, Dr John Murchland and Dr Justin O’Day. Dr Barry Desmond (Des) Coote Dr Des Coote succeeded Prof Frank Billson as Censor- in-Chief in 1982 and remained in this role until 1987 during which time he made a distinguished contribution to the core activity of the College in the training and education program. Before taking on the role of Censor- in-Chief, Dr Coote had served on the Royal College of Ophthalmology (RACO) Court of Examiners from 1978 and continued in that activity until 1994. He was also Farewell to Penny Gormly Chairman of the Victorian Qualification and Education In October 2016 Penny Gormly left RANZCO Committee (QEC) during his time as Censor-in-Chief and served as Chairman of the Royal Australian College of after almost 11 years. This followed a Surgeons (RACS) Surgical Boards, as well as Inspector restructure of the Education Department of Training Posts for the RACO. In addition to these which resulted in her role of General demanding appointments, he held a teaching position Manager — Education and Training being at the University of Melbourne from 1976 and served made redundant. A new role of Deputy CEO as the College representative on numerous external and Head of Education was created. agencies including the Australian Post Graduate Penny made an enormous contribution to RANZCO. She Federation of Medicine. was instrumental in managing the process of education Barry Desmond Coote, or Des as he is known, gained that has produced many Fellows. Penny played a critical his MBBS from the University of Sydney in 1953 then supporting role to the Censor-in-Chief, Dr Mark Renehan, studied in the UK to gain FRCS (Edinburgh) in 1959. and the numerous Fellows involved in education and On his return to Australia he was awarded FRACS and training. She was highly respected within the Fellowship Member of the Australian College of Ophthalmologists and amongst trainees, and by senior educators in other (MACO) in 1961. He worked as Assistant Staff Specialist Colleges. She also had a good relationship with senior at the Royal Victorian Eye and Ear Hospital (RVEEH) from executives in various hospitals and health departments, 1960 to 1975 and as Senior Staff Specialist from 1975 to which are RANZCO’s key partners in the training process. 1992 while he ran a busy Private Practice in Collins Street, Penny was also well liked by many staff present and past, Melbourne. He also worked as Senior Staff Specialist and mentored them as they developed their careers. at the Austin Hospital from 1964 to 1990 and was made It is always difficult to measure the success of someone Emeritus Surgeon to both hospitals in 1993. like Penny who was around for so long and saw so many The publication and distribution of a booklet on changes. The length of tenure is in many ways a measure of General Information and Regulations on Training her success. It is also difficult to express the thanks felt by Requirements and Examinations (‘The Green Book’) many within the College as Penny’s role touched so many was made freely available to all intending trainees people. The fact that so many people contacted RANZCO to during 1983–1984. Progress towards restructuring express their support for Penny and wish her well probably the relationships between the RACS and RACO was says it all. We all hope that Penny finds an equally satisfying made during this time, with a view to the Conjoint role outside of RANZCO. Surgical Board in Ophthalmology being replaced by a Eye2Eye Summer 2016 11

Committee of Liaison between RACO, Dr John Murchland subsequently Chairman of the the Ophthalmological Society of New Combined Education Committee of When Dr Coote stepped down as Zealand (OSNZ) and the RACS, and the Clinical Colleges for three years, Censor-in-Chief in 1987 he was changes were made to the method and also served on the Board of the succeeded by Dr John Murchland of appointment of examiners to the Ophthalmic Research Institute of who served in this role until 1990. combined FRACO–FRACS examination Australia (ORIA) for twelve years before Dr Murchland had a constructive interest Board. he became a member of a panel of in education, a passion for teaching In 1984–85, medico-political inspectors of training posts. During and a talent in the organisation and problems arose during the Hawke that time Dr KG Howsam provided an assessment of the competence of young Labor Government with Dr Neal inspection protocol for the inspection trainees. During his term as Censor-in- Blewett as Minister for Health. of training posts. Chief he worked on training programs Because of a reduction in funding for In 1988 the Federal Government’s with a special interest in modern the public hospital system, the high Medical Education and Medical teaching principles. He introduced new standards which were an integral Manpower Committee’s report was initiatives in training and qualification, part of the College’s role were under released. As a consequence of the and he anticipated the future needs of threat. Therefore, review of the whole medico-legal battles of the previous continuing education. concept of training and examinations years, and because of implications Dr Murchland graduated in Medicine was undertaken by the QEC with the at Adelaide University in 1954, and regarding the College’s role in future result that a more clinical bias to the after several years in country general training, during 1989 there was concern Part I syllabus and examination was practice he trained in Melbourne in the QEC about the changing nature introduced, with innovative changes in where he qualified for a Diploma of the hospital system with the prospect assessing, modifying and streamlining of Ophthalmology (DO) in 1960. Dr of trainees being left without adequate both the Part I and Part II examination Murchland was a Captain in the Royal supervision if Visiting Medical Officers systems. At that time, it was recognised Australian Army Medical Corps from left the public hospital system. that if trainees were to maintain the 1955 to 1967 and he set up in private Subsequently, the 1990s brought high standards set in the past, new practice in North Terrace, Adelaide about considerable changes methods of training would need to be and at Mount Barker in the Adelaide to the training requirements of developed involving private practice Hills. He was a founding member ophthalmologists. The reduction in the teaching of registrars. During of the College at its inception and, to two years from the three-year 1984–1985 negotiations were entered following further studies at the Wilmer period of pre-vocational training into with the Royal Australasian College Institute and other Retinal Centres, he in appropriately recognised and of Physicians (RACP) with a view to established the Retinal Clinic at the supervised hospitals was approved establishing a special training and Royal Adelaide Hospital in 1967 where by Council in 1990 while there were examination scheme for those trainees he introduced photocoagulation and an increasing number of candidates who wished to devote themselves to vitrectomy. Under College auspices he passing the Part I Ophthalmology medical ophthalmology as a specialty, organised the first Australia-wide Laser Basic Science examination. As a result, but ultimately this did not eventuate. Photocoagulation courses and practical selection of trainees was based on In 1986–87 considerable uniformity workshops in Adelaide in 1977, and other qualities apart from academic was achieved between the RACO and subsequently by invitation for South ability, with credit being given for the OSNZ in their approach to training East Asia in Singapore. As a member of time spent in teaching, research, and examinations whilst respecting an Australian team rotating over three family practice and ophthalmology. their essential individuality and special years he lectured in eye disease and At that time, it was recognised that needs. At that time the NSW Health ophthalmological manpower in Department planned an Ophthalmic trained local doctors to perform cataract relation to training would need to be Enhancement Program and the four- surgery in Bangladesh and presented year Vocational Training Program (VTP) papers in Indonesia, Singapore and addressed by both the RACO, in relation was introduced in January 1987. Flexible Malaysia. He also paid regular clinical to the number of candidates passing requirements for the fourth year were visits to several outback Aboriginal the Part I examination exceeding the considered on their merits including communities up until his retirement in number of jobs available, and by the unsupervised experience, field work in 1999. government, in relation to medical remote areas and other countries, and From 1970 to 1980 Dr Murchland immigration. research. Some of the training posts served on the College Council and were dedicated to fourth year posts on the QEC from 1981 to 1987, A/Prof Justin O’Day and a system of progressive assessment during which time he was also an Dr Murchland was replaced as Censor- of trainees was established in which examiner for the Part II Fellowship in-Chief by A/Prof Justin O’Day in supervisors submitted a report at the Examinations. Dr Murchland 1990. A/Prof O’Day remained in that end of each term. was College representative and position until 1993 before becoming 12 Censor-in-Chief’s Update

President in 1994. He believed that 1985 he spent one month each year medical students should be taught working in Africa on an onchocerciasis ophthalmology in their undergraduate project and, until 1983, one month curriculum to enable them to a year in South America. In 1992, diagnose, treat and refer patients with he became Head of the Neuro- ophthalmic problems which were ophthalmology Unit at the RVEEH common in general practice and to from where he retired in 2008. He also gain insight into ophthalmic disease served on the College Journal Editorial processes. He also considered that Board for 25 years, the ORIA Board from the act of teaching (by Fellows) 1986 to 1998, the Orthoptic Board of improved the level of expertise of the Australia, and on the Part II Court of teachers. Apart from having authored Examiners. many articles and several books, From 1992 to 1993, the QEC’s A/Prof O’Day was also a member of concerns regarding an oversupply government working parties on the of Part I graduates were addressed. ophthalmology workforce for the At that time a matching program Dr Barry Desmond Coote Australian Medical Workforce Advisory for first to third year trainees was Committee, and on ophthalmology proposed. Because the Federal clinical indicators for the Australian Government had no control over Council on Healthcare Standards. He specialist education and training, it was Chairman of the National Health had no control over manpower and and Medical Research Council Working had proposed that the universities Party on Diabetic Retinopathy, a become more involved in this through member of the steering committee the teaching hospitals with funding for the International Council of from the education ministry. To this Ophthalmology held in Sydney in proposal, ophthalmologists argued that 2002, and a Director of the RANZCO the medical colleges had been formed Eye Foundation from 2002 to 2009. in part because when universities had A/Prof O’Day advocated strongly for run the postgraduate courses they the two-year College Presidency that is had failed to keep abreast of modern currently in place. trends in medical curricula, and failed Justin O’Day was born into a medical to provide the necessary continuing family in Melbourne and was educated education to maintain standards. It Dr John Murchland by the Jesuits. He played the drums in was emphasised that it was important a rock group called the Wild Cherries for the College to be the foremost in the 1960s during his studies in authority on eye healthcare in Australia medicine, and gained his MBBS from and to set standards and develop Melbourne University in 1968. He was national goals. also a member of the Australian Youth The opportunity for more women Orchestra and continued performing to train as ophthalmologists arose from light operas after he graduated. He major changes in a society in which gained Fellowship of the RACP in the number of married women in the 1972 before travelling to Africa, and workforce had increased. he then spent three years practicing A/Prof O’Day had advocated that ophthalmology in Melbourne. Having the College should consider such been awarded a DO (Melbourne) in options as part-time training, extended 1976, he was awarded FRACS and training, and interrupted training in MACO in 1977, and then went to order to allow women to make choices London where he was awarded FRCS regarding commencing a family or to and FRCOph by examination in 1979. accompany their partner to another A/Prof Justin O’Day On his return, Justin worked at state. the RVEEH and St Vincent’s Hospital in Melbourne and became Head of Ophthalmology at St Vincent’s from We will be featuring the remaining Censors-in-Chief in the 1984 to 1997 with the closure of the next issue of Eye2Eye. eye department there. From 1979 to 13 14 CEO’s Corner

CEO’s Corner A notable year for the College

The end of 2016 saw another even if only for another three years. what we do. Ruth will, in due course, successful RANZCO Congress. The report lists 53 conditions that take on more responsibility for The Melbourne location RANZCO must meet by 2020, and operational activities within RANZCO an additional 25 recommendations meant we had a big crowd, so that I can concentrate on the global for change. Having said that, the strategic initiatives required under especially at the Graduation report is very complimentary of the our new Strategic Plan. A full profile of Ceremony. A special thanks educational standards as a whole Ruth can be found later in this issue of to the local Organising and in particular the Fellows that Eye2Eye. Committee led by Drs Xavier provide so much expertise and hours In the middle of 2016 we also saw Fagan and Daniel Chiu, the to the many different programs. I do changes to our Communications team, Scientific Program Committee not think this should be undersold. with Emma Carr joining as General led by Prof Helen Danesh- Taking into consideration the whole Manager, and our New Zealand report, which RANZCO has had Meyer, and the RANZCO Branch with the opening of a physical since mid-year 2016, the Board and team led by Sarah Stedman office (a shared space in Wellington I decided to make some changes to with the College of Radiologists) and and Alex Arancibia. This the Education team. This coincided employment of Helen Hunter as the Congress saw for the first with the appointment of Dr Justin support officer. I mention this together time a number of sessions Mora as the new Censor-in-Chief. I because they have both worked very focussed on important topics have restructured the team to have closely with the New Zealand Branch other than science. I think the a new role of Deputy CEO and Head Fellows in the later part of the year to of Education, to which we appointed reaction was mixed, but the push for greater funding for patients Ruth Ferraro. Ruth will have overall feedback in general is that to access services for chronic diseases. responsibility for the day-to-day This was a real team effort from a we need to have a forum to activities of Education, both the number of ophthalmologists in New address issues important to Vocational Training Program and Zealand. Results are yet to be seen, but the profession. education of Fellows, and how this is I think it proves we have the capability Another important event to end the supported by our many volunteers. and desire to be more involved in year was the release of the Australian She will take a strategic look at the advocacy on many levels. You will see Medical Council and Medical Council myriad of IT systems we already more in the future. of New Zealand accreditation have, and anticipate needs, to ensure reports for RANZCO. I am pleased we are providing an appropriate Dr David Andrews to say we have been accredited, service and not over complicating Chief Executive Officer, RANZCO Eye2Eye Summer 2016 15

Membership Spotlight Code of Conduct…Doctor–Patient (lack of) Communication Recently the College received was no real informed consent. As Junior Doctor a letter from a GP, writing as they were a practising GP they fully a patient, pointing out their understood what this means and how Positions in it should be communicated. displeasure with the process Sound familiar? In fact, I will admit New Zealand of receiving treatment from that I am guilty of being a little less one of our Fellows. The communicative at times and indeed I With the update of the person was at pains to point often don't use the College approved RANZCO website we have out they were very satisfied patient leaflets explaining particular been able to incorporate with the outcome, resulting procedures or conditions. As recently a page in the classifieds in saving their sight. The as last week, a patient told me “you section that lists all the don't talk much Dr Arthur,” to which I issue was the patient’s jobs available for junior replied “that's because I am thinking surprise at the side effects, deeply about your eye problem!” doctors in New Zealand. which they felt had not been In truth, we can all do a little It has been recognised by Fellows at all explained. In the role better in communicating, in in New Zealand that it is difficult as Chair of the RANZCO listening and having available more for junior doctors to easily find Code of Conduct Committee written information for patients. out where ophthalmology jobs I have received a number of Most importantly, we should all be are available. Junior doctors and medical complaints, some frivolous, providing proper informed consent students can use this resource some not so frivolous, and so that patients do not feel the need to express their displeasure. to find out which hospitals offer occasionally a complaint, experience in ophthalmology. such as the aforementioned Dr Arthur Karagiannis With only a week or two letter, which caused me to Chair, RANZCO Code of Conduct at medical school in clinical reflect on my own practices. Committee ophthalmology many junior doctors are keen to get more This letter was perhaps less of experience to help decide if it is a a complaint but more about career for them. the patient’s experience in the The information is available ‘ophthalmic system’ following a in the ‘Classifieds’ section on retinal detachment and observations the RANZCO website or via this about how things could be direct link: https://ranzco.edu/ improved. It should be pointed out classifieds/junior-doctor-jobs- that no names were mentioned and new-zealand. Departments may it was clear from the patient’s letter wish to refresh the information that the surgery went well and sight prior to the closing date in May was saved (well done Dr…, flat retina for public hospital jobs starting yet again). in December each year. For The main issues were more about further information, please email communication, or lack thereof, [email protected]. particularly with respect to written information about the surgery itself, potential complications and side effects. To quote “there was no discussion as he had, as usual, a waiting room packed with patients”. From the patient’s perspective there Dr Arthur Karagiannis 16 Membership Spotlight

Cultural Awareness

As a follow on from the brochure, Indigenous Committee members had the idea to film certain Cultural Learning aspects described in the booklet and the result Fellows and trainees may be familiar with is a short nine-minute video RANZCO Cultural Awareness — In the Clinic that explains in more the Cultural Awareness Booklet produced detail some of the considerations that need to be at the beginning of 2016 in conjunction kept in mind when consulting in a rural, remote with input from the RANZCO Indigenous or urban clinics with Australian Indigenous Committee. The brochure focusses patients. primarily on how to treat Indigenous The video was filmed in a live clinic in Western patients in a culturally respectful manner Australia and has been carefully edited to show from an ophthalmic perspective. The information about the following: • Language / translators, support people and booklet was recently uploaded onto the the importance of using Aboriginal or Torres RANZCO online learning portal (Moodle) Strait Islander liaison persons and is available to both Fellows and trainees • Creating a culturally safe environment as a downloadable PDF for easy viewing on • Ophthalmology waiting rooms laptops, tablets or mobile devices. • Obtaining and recording ocular history • Eye gaze and contact with patients • Ophthalmic instruments and other diagnostic equipment • Explaining a diagnosis and ophthalmic medications. To view this new resource, please log in to Moodle and play the short video from within your web browser. If you have any questions or issues accessing the video, please contact Adam Kiernan, Manager, e-Learning and Indigenous Health, at [email protected]. Dr Ashish Agar and A/Prof Angus Turner Chair and Co-Chair of the RANZCO Indigenous Committee NUCLEUS PROGRAM

Eye2Eye Summer 2016 17 NUCLEUS PROGRAM

government and to meet the Introducing requirements of Southern Cross the NUCLEUS Insurance contracts, we will soon be launching the NUCLEUS program. NUCLEUS will: Program – a A practice accreditation pilot had run with twenty volunteer practices • explain what is involved in vision of quality during August, September and evaluating your practice against the NSQHS October 2016 to test the resources The National Safety and Standards; developed by the Professional • assist in understanding the Quality Health Service Standards Committee. This proved NSQHS Standards; (NSQHS) Standards drive to be quite a difficult process for the implementation and many practices and the Committee • provide a directory of independent contractors thanks the Fellows and staff involved use of safety and quality who undertake accreditation systems and aim to improve for their tenacity in testing what surveys; had been provided. The Committee the quality of health service • provide a list of consultants learned many lessons from the pilot provision. who will (at your cost) assist practices, and subsequently are you with this process if you They were endorsed by Australian developing additional resources in wish; and Health Ministers in September preparation for launching NUCLEUS • assist you to develop the 2011, and over the last few years to the broader Fellowship. These necessary documents RANZCO has been working to stay additional resources include a required to meet external ahead of the game and contextualise comprehensive program guide and accreditation requirements. the Standards for ophthalmology. gap analysis worksheets to help Accreditation and adherence to the practices evaluate what policies, Standards is mandatory for licensed procedures and processes are hospitals and day procedure services already in place, and what they need NUCLEUS is offered to RANZCO in Australia, but not currently for to develop. Fellows free of charge, as is any ophthalmology practices. RANZCO NUCLEUS aims to assist Fellows support provided by RANZCO staff anticipates that this situation will and their staff to improve the members. Additionally, Fellows change in the next couple of years, safety and quality of the care they will be able to claim Continuing and is taking a proactive approach provide in their clinics using the Professional Development (CPD) by promoting accreditation and NSQHS Standards as a framework. assisting Fellows towards that goal. NUCLEUS may be used as a quality points for participation in the There are no requirements from the improvement tool in its own right, NUCLEUS program. New Zealand Ministry of Health for or to assist Fellows in preparing NUCLEUS will be launched in practices to be accredited, however the necessary documentation for the first quarter of 2017 and is a Southern Cross Insurance has stated accreditation against the NSQHS voluntary program. Practices may that “for office and room-based Standards. NUCLEUS attempts use the program to implement procedures the service location to present the required systems, quality improvement activities must comply with the standard/s protocols and documents at a level or may choose to undergo full produced by RANZCO which apply appropriate to ophthalmology clinics accreditation using the resources to the services provided under an and recognises that small, one or provided. For more information Affiliated Provider agreement”. two doctor practices, have simpler regarding NUCLEUS, please contact In order to satisfy the anticipated governance requirements to large Simon Janda, Manager, Professional requirements of the Australian corporate practices. Development at [email protected]. 18 Membership Spotlight

should not place a higher burden on surgical audit, however there are Revalidation doctors in terms of time or money, nor other activities that can satisfy this and Reflective should they require additional college requirement: resources. Further, any process to • Office Record Review (ORR) – An Practice – what identify ‘at risk’ doctors must be fair and ORR involves the retrospective managed with a view to remediation audit of patient's medical will it mean for rather than focusing on punitive records pertaining to history, me? measures. Our submission in response examination, investigation, to the discussion paper is available on diagnosis and management of The Medical Board of the RANZCO website in the Media and a specific condition. Fellows can Australia (MBA) has Advocacy section. claim 10 points for each ORR. • Peer Review Practice Visit – conducted research and RANZCO supports the guiding principle that “strengthened continuing Ophthalmologists may undertake consulted with various professional development should a peer review practice visit as stakeholders to propose a increase effectiveness but not an alternative to formal audit of model for revalidation in require more time and resources for surgical or medical care. Fellows Australia. participants.” 1 The RANZCO Continuing can claim 30 points as either a host or a visitor. The MBA has stated that “the Professional Development (CPD) • Medico-Legal Report – Fellows fundamental purpose of revalidation is Committee will be working to develop who specialise in medico-legal to ensure public safety in healthcare”1 more tools and resources to assist services may submit and/or peer and has identified two elements to Fellows participate in CPD in this review medico-legal reports to help achieve this aim: manner. Our CPD program is already fulfil the requirement and can 1. maintaining and enhancing structured to identify two levels of claim 10 points per report. the performance of all doctors activities: • Audit/Peer Review Meetings – practising in Australia through • Level 1 activities focus on Fellows can claim one point per efficient, effective, contemporary, increasing knowledge and skills hour for participating in a Peer evidence-based continuing and include the more traditional, Review Meeting. professional development passive activities such as lectures, relevant to their scope of practice; conferences and journal reading. The CPD Committee will also and • Level 2 activities focus on develop resources to assist 2. proactively identifying doctors implementing or facilitating non-surgical Fellows conduct clinical who are either performing poorly changes in practice and health and professional audits. All existing or are at risk of performing poorly, outcomes. Generally, these resources are available on the assessing their performance and, activities require more from the website under CPD Resources and if necessary, supporting their participant in terms of application Tools. Future resources will also be remediation1. of the concepts learned to their available in this section. practice. Examples of Level 2 The CPD Committee will be The MBA has consulted with the closely following developments medical community and the general activities include clinical audit, critical incident monitoring, regarding revalidation, and will make public during August to November participative workshops and adjustments to the CPD program 2016 via stakeholder forums and by patient satisfaction surveys. and resources as required. The releasing a discussion paper titled Committee will also be surveying ‘Options for revalidation in Australia’. In order to assist Fellows in applying Fellows this year, with the aim to The MBA plans to review the feedback ‘smarter, not harder’ principles to their evaluate the program and make by mid-2017 and subsequently CPD, resources will be developed changes to meet the needs of develop a more detailed approach for to support more participation in Fellows. a pilot or rollout. The MBA has stated Level 2 activities, often referred to as For more information regarding that they recognise the bi-national ‘reflective practice’. From the 2017 the CPD program, please contact structure of the majority of medical CPD year onwards, the requirements Simon Janda, Manager, Professional colleges and will aim to have similar for part-time Fellows will be brought Develoment, at [email protected]. requirements in Australia as those in into line with the requirements for New Zealand. full-time Fellows, i.e. 80 points in RANZCO has made a formal total including 30 points in Clinical 1. Medical Board of Australia, Expert Advisory submission in response to the Expertise Level 2. The CPD Committee Group on revalidation Interim report (2016), that any additional requirements part-time Fellows to participate in 2. Accessed 20 Oct. 2016. Eye2Eye Summer 2016 19

Practice Accreditation Pilot — “One of the most positive exercises we have ever completed.”

Jody Sayer, Northside Eye Specialists Practice Northside Eye Specialists staff members dressing up for Melbourne Cup 2016 Manager, proudly showing the Accreditation Certificate

The RANZCO Practice Right from the start, we had good You participated in the pilot for Q communication from QIP and from Accreditation Pilot commenced the RANZCO Practice Accreditation RANZCO. My contact from QIP, Jennifer in June 2016 as part of Project, can you tell us why you Mitchell, kept in touch via email and decided to take part? the College’s Practice always responded to my queries. Where Accreditation Program which A I have always been interested she didn’t know the answer she would is to be launched in the first in practice accreditation and I could check and respond. quarter of this year. see it being introduced in other In the same way, the RANZCO specialty practices. I could also see staff were always ready to listen and The pilot involved practices the changes accreditation made respond to any queries I had. utilising the documents provided to general practices and in many The journey became more exciting by RANZCO, which included policy, ways, they led the way. As well, when we realised it was achievable procedure, schedule and other the practitioners agreed and were and we started to note each step as an templates. These documents were supportive. I think this is a major achievement. designed to assist practices in initiative of the College and I am Perhaps one of the most exciting meeting the requirements of the proud to be involved. parts of our journey was to work National Safety and Quality Health with Ms Anna-Maria Gibb from My Service (NSQHS) Standards. Practices Q Tell us more about your Practice Manual and to actually submitted evidence of meeting journey from start to finish. What develop a document map listing the the NSQHS Standards to Quality steps did you go through and what Policy from our manual and its related was your experience with each Innovation Performance (QIP), who documentation requirements. step. then assessed the evidence and The impossible became possible and accredited practices accordingly. A Like many projects, you start out once we submitted to self-assessment Colleen Sullivan from Northside knowing very little, being unsure and we began to be excited. Eye Specialists, one of the 20 cautious. As you work through the What was the most difficult part practices to trial the program, process, you become more confident Q of the process? agreed to share her experience with in what you have been doing in us hoping that it will be of benefit your practice and how much better A Understanding the Standards, to others considering practice everything in the practice will be having never worked with the NSQHS accreditation. once you achieve accreditation. Standards at a practice level. In many 20 Membership Spotlight

instances, we found we were actually documentation. It helps us to manage differently. We are meeting specific complying but the complex language control and access and we are Ophthalmology Standards relating meant that we had to interpret the confident we are not using outdated or to the quality of the services we offer. meaning before we were comfortable incorrect material. They are very proud of their part in proceeding. The staff became involved in the journey and the recognition of As a first time user of the QIP self- the whole accreditation process their role in the practice achieving assessment process, it seemed lengthy. through participation, discussion accreditation. Their involvement, However, in hindsight it worked well. and involvement. They gained an contribution and understanding of understanding of Standards and Were there any other accreditation benefits everyone. Q Quality for our ophthalmology practice. challenges? What is your advice to those Patients are also benefitting from Q A I would say getting started. Initially, the clear guidelines we have that are considering undergoing practice it felt a little overwhelming with all of linked to improving the whole patient accreditation? the information and not knowing where experience, information, awareness and A I would definitely recommend to start. service. embracing practice accreditation. It is a We did have a hiccup with the delivery What do you think needs to be very positive experience for everyone of the materials and the online access to Q improved? in the practice. Use the process as resources but this was a one-off. It was an opportunity to review existing the first time they had been sent and A Some of the Standards and procedures and consider whether they any issues there will not happen again. self-assessment items seemed more need to be updated. Ensure that the We did find the RANZCO policy and relevant for larger organisations or policies and procedures reflect the other supporting resources very helpful. hospitals, for example, the use of accreditation requirements and the identification bands for patients. What were some of the benefits decisions that have been made. Involve Q • It would be helpful for there to be (for the practice, staff members and the practice team in the decision a system that allows office based patients)? making process; then they will have practices to indicate an item is not ownership of the decisions and will be A There are just so many benefits. applicable without having to justify much more likely to comply. Some tips I do think this has been one of the why every time. for other practices include: most positive exercises we have ever • In some instances, the • read all of the information completed and this is at all levels of the requirements to comply were not carefully; practice – patients, staff, the practice clear. For example, the number • highlight the relevant points; and the practitioners. of patient health records and the • use the support at QIP – they are The accreditation process became frequency required for the Patient only an email or phone call away; a confirmation, an affirmation of the Clinical Records Audit need to be • start with Standard 1; quality of care we are providing in the clearly identified. practice. • Discussion is needed regarding • talk to others who have completed We have reviewed our processes the benefits of accreditation their accreditation; and and systems. We were fortunate to RANZCO Fellows and their • celebrate as you go! that we were already using a web practices. Q Any other comments? based practice manual (My Practice • Education around accreditation Thank you for the opportunity Manual) where we were used to the through a series of Webinars, A to reflect on our journey with GP Standards as the basis for quality allowing practice staff the accreditation. It has been a privilege practice management. We were able opportunity to watch videos to incorporate the Ophthalmology together and plan their journey to be one of the flagship practices. Standards across the whole of the would be useful. We have learnt a lot along the way practice documentation and this in turn • Perhaps some of the pilot practices and we have achieved so much. We has given us more comprehensive and could become mentors for others. need to acknowledge all parties who practical documentation. • Online forums where practices can are involved in bringing practice Using My Practice Manual, we have share experiences and ideas. accreditation to ophthalmology developed an audit schedule with • Develop a set of checklists that and to our practice in particular. reminders set for all of or our legislative would assist practices. This includes RANZCO; QIP and and regulatory due date requirements especially Susan Francis and Jennifer What was the feedback from to ensure these are current. Q Mitchell; Northside Eye Specialists, practice staff? Also, the ability to commit to record in particular Ms Jody Sayer and all of keeping. We now have a document A Staff have gained so much from the ophthalmologists and staff, and and record control policy that gives us revisiting many of our systems Ms Anna-Maria Gibb from My Practice a consistent approach to managing and processes and seeing things Manual. 21

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1145.1 11/16 0735 22 Membership Spotlight

of ethical concern. One of the key the Professor of Neuro-psychiatry Human questions posed was, “How does from Nagasaki University) a chapter Research Ethics the committee separate out ethical on medical ethics from a Japanese processes from ethical principles?” perspective for a series of publications Committee In answer to that, there are specific put out by the World Psychiatric questions within different online Association. As a result I became Workshop applications which ‘error trap’ the interested in how medical ethics are Training Day research applicant into properly filling influenced by culture; in particular out the various parts of the form. about how something that may be As part of the professional Therefore, in theory, ethical processes appropriate in one culture (or setting) development of Human can be somewhat streamlined and can be inappropriate in another, and error free by having clever software that how we solve the contradiction while Research Ethics Committee automatically checks for inconsistencies at the same time protecting the subject (HREC) members, a triennial or missing fields. The NHMRC ‘Human and patients involved in a study. As workshop was organised by Research Ethics Application’ (HREA) a result of pressure from US research RANZCO and convened by form will eventually replace the granting bodies and publications, I Praxis Australia. ‘National Ethics Application Form’ soon became involved in developing (NEAF) and has, built into its software Professors Paul Komesaroff, Ian human research ethics committees for code, error trapping functionality which Kerridge and Colin Thomson led our university in Japan. will go some way to improving the discussions and posed thought- In 2013, I was asked to consider the overall quality of submissions. provoking questions around various role of Chair for the RANZCO HREC. Ethical principles are governed ethical dilemmas faced by tertiary I see my role on the Committee as somewhat by committee member education providers and ethics being made up of three functions: (1) experiences and expertise and committees registered with the To work with College staff to ensure therefore there are often differing National Health and Medical Research that our review processes are efficient, views on issues within an application. Council (NHMRC) in Australia and timely and conform to the NHMRC Coming to a consensus around overseas. Guidelines; (2) to work with other scientific study proposals is part of the The workshop was broken down members of the Committee to ensure committee’s internal process which into three sessions: research design there is appropriate discussion and occurs at meetings and through and its ethical considerations, the role consideration of all applications and email correspondence. Decisions and of the HREC in reviewing research, and proposals in a timely and efficient recommendations by the Committee manner; and (3) where appropriate, improving the practice and processes members are then summarised and contribute both scientific and of the committee. forwarded to the principal investigator clinical comment on the applications Workshop participants were given who then makes the required changes submitted.” the chance to see the evolution of to his or her application. We anticipate interviewing another the ‘National Statement on Ethical Feedback from Committee members HREC member in the next edition of Conduct in Human Research’ which, indicated that the workshop was Eye2Eye. not surprisingly, had its origins a worthwhile learning experience back in early Greek Aristotelian and and had provided some excellent Ptolemaic medicine. The Nuremburg knowledge around ways to improve Code and twelve basic principles of the overall ethical decision making the Declaration of Helsinki have also processes. influenced the ‘National Statement’ as have the 1982 CIOMS / WHO HREC Member’s Profile International Guidelines. The Australian In the last edition of Eye2Eye we Health Ethics Committee NHMRC Act profiled HREC member Dr Alex BL of 1992 was also a guiding document Hunyor (FRANZCO). For this edition we for the principles contained in the were able to talk to the Chair, Professor ‘National Statement on Ethical Mark Radford. Conduct in Human Research’ which in “My involvement with medical its current form was first published in research ethics started while I was 2007. doing my PhD, and with the first draft The workshop initially focused on of the Australian National Statement discussions around what constitutes a on Ethical Conduct in Human scientifically sound research proposal, Research. During my medical studies which of itself could potentially be in Japan I was asked to co-write (with Dr Mark Radford Eye2Eye Summer 2016 23

Ophthalmology Clinical Course The Complete Package Dunedin, New Zealand, was once again THE COMPLETE VIEW delighted to host the annual Dunedin Capturing 200° of the retina, in a single non-contact image Ophthalmology Clinical Course (DOCC), or ‘Part 2 Course’, from 31 October to 11 November 2016. This two-week course has been running for almost 3 variants now available 20 years, championed by Associate Professor rg / af rg / af / fa rg / af / fa / icg Gordon Sanderson and now convened by Dr Logan Mitchell. However, the DOCC is truly an example of Color Fundus  the wider Fellowship helping train and assist their future colleagues - 21 speakers from South Australia, Central Pole Fundus  Tasmania, NSW, and throughout New Zealand. They Red Free  all contributed greatly of their time and knowledge to deliver 11 full days of lectures on all RACE topics. Choroid  This year 37 senior trainees attended, 32 from Fundus Autofluorescence  across Australia (including Perth!) and five from Fluorescein New Zealand. They were hosted by Keith Procter, Angiography  from Designs for Vision Ltd, for the course dinner at Indocyanine Green Angiography  St Clair beach, and we were also delighted to have *Products each sold separately RANZCO welcome the registrars at the RANZCO Contact Us Reception - hosted by Dr Justin Mora, newly T: 08 8444 6500 appointed Censor-in-Chief and a long-time lecturer E: [email protected] VISIT: http://bit.ly/2aWTKGy to find out more! at the DOCC, and Ms Ruth Ferraro, newly appointed © 2016 optos. All rights reserved. Optos® , optos® and optomap® are registered trademarks of optos plc. P/N GA-00281 AU / 1 RANZCO Deputy CEO and Head of Education. The registrars found the course extremely valuable, appreciating all of the excellent exam- and clinically-focussed lectures provided, as well as the ever popular Mock OSCEs run over eight of the lunch-breaks. Dunedin looks forward to hosting next year’s attendees! Dr Logan Mitchell Consultant Ophthalmologist, Dunedin Hospital

The DOCC RANZCO Reception - hosted by Dr Justin Mora and Ms Ruth Ferraro, Dunedin 2016 24 Membership Spotlight

Advocating for change: RANZCO NZ Branch launches campaign to address eye health care crisis

Ophthalmology services highlighting the story of a young spectrum, including conversations in New Zealand have been man with glaucoma who lost vision with and letters to the Minister of under increasing pressure completely in one eye and partially Health from MPs. There were also in the other because of delays to his questions asked of the Minister in due to insufficient resourcing follow-up appointments. In addition, Parliament by Labour Deputy Leader and waiting time targets that key RANZCO spokespeople were and former Minister of Health Annette are not fit for purpose. With identified and given media training. King MP. people across the country The spokespeople, Dr Shenton Chew With this pressure being placed needlessly losing their sight, and NZ Branch Chair Dr Stephen Ng, on the Government, and with media RANZCO’s New Zealand then worked with RANZCO’s General attention and public awareness very Manager of Communications, Emma high, RANZCO was contacted by Branch decided it was time to Carr, to refine the key messages ahead both the Chief Medical Officer and take decisive action. of media outreach. the Minister of Health to arrange The New Zealand Ministry of Health’s The media outreach was planned meetings. waiting time targets primarily focus to occur alongside the Health Quality RANZCO Fellows met first with on first specialist appointments and Safety Commission’s (HQSC’s) the Chief Medical Officer and then, meaning that District Health Boards publication of their annual report, directly following RANZCO Congress, (DHBs) must focus funding on these which would highlight the issue of with the Minister of Health, Hon. appointments to the detriment delayed follow-up appointments and Dr Jonathan Coleman MP. These of follow-up appointments. This identify ophthalmology as a key area meetings, especially the meeting with causes serious delays in follow-up of risk. The team were in discussion the Minister, proved to be productive. appointments. Ophthalmologists with the HQSC to coordinate media RANZCO Fellows were able to get the throughout the country have engagement to achieve maximum message across that there is an eye witnessed serious and irreparable impact. However, RANZCO Fellows and health care crisis in New Zealand and harm to patients who have had the HQSC discovered that a number action needs to be taken and left the delayed follow-up appointments. of DHBs, aware that they would be meeting quietly confident that the With demand for ophthalmology named in the HQSC’s report, were message had been received. services increasing rapidly – due to planning to release statements ahead But, of course, the campaign the impact of the anti-VEGF drugs, an of the publication. Knowing that doesn’t end there. The next steps ageing population and the increasing there would only be one chance to are to maintain pressure on the prevalence of diabetes – and funding secure media attention for this issue, Government to ensure that steps are for ophthalmology services stagnant, the team brought forward the launch taken to address the problem and RANZCO recognised the need for date and went out immediately to the to ensure that the situation is never ophthalmologists to come together to media, targeting TV, radio and print allowed to repeat itself. We will be address the problem. media. continuing to engage directly with the Working closely with the RANZCO This proved to be a hugely Minister and the Ministry of Health communications team, the New successful approach, with RANZCO’s to ensure that swift action is taken. Zealand Branch launched a campaign key messages and spokespeople We will be keeping MPs and the to raise public and political awareness dominating the media commentary media updated on progress so that of the devastating impact that the for much of the week. they ramp up pressure if action isn’t government’s policy and budgetary Alongside the media engagement, taken. Finally, as funding allocations decisions are having on people with the team engaged directly with and policy decisions to help relieve chronic eye conditions and to call on politicians. This entailed developing a the backlog are implemented, we will the Government to take urgent action. parliamentary briefing explaining the be communicating with eye health This campaign included targeted issue, the background to the problem teams and their patients to ensure that media activity to raise public and potential solutions. The briefing the people that most need support awareness of the problem and direct was then sent, along with a letter and receive it. engagement with politicians to put the patient case study, to each MP in Finally, thank you to all involved in pressure on the Government. Parliament and to the Chief Medical this campaign. The successes so far, For the media activity, the team Officer at the Ministry of Health. and those we hope to see in the near developed key messages, a media This resulted in a show of support future, are testament to the dedication release and a patient case study, from MPs from across the political and perseverance of all those involved. Eye2Eye Summer 2016 25

Update from the Diversity and Inclusion Committee

The RANZCO Diversity and as to whether these mentoring reporting. Over the coming months, Inclusion Committee met at activities could be used to the College will be trying to collect Congress in November 2016 accumulate Level 2 CPD points, more diversity markers from trainees with the aims of defining a though this will need to be and Fellows; we hope you will not be vision for the College and discussed by the CPD committee. affronted by the College asking what setting some priorities for the • Submit a proposal to the can be personal questions – of course, Committee. RANZCO Board for a session at you are under no obligation to answer The Committee has agreed on the 2017 Congress that deals these. the following Vision: Create an with generational issues in environment within RANZCO that ophthalmology. The Diversity and Inclusion embraces diversity. The College is The Committee is aware that diversity Committee comprises: committed to fostering a culture of spans a huge number of topics: • Dr Brad Horsburgh, Past inclusiveness where all individuals gender, religion, race, age, culture, President and Committee Chair are respected, are treated fairly, feel sexual orientation – to name just • Dr Di Semmonds, Vice President like they belong and can thrive. a few. Initially the focus will be on • Dr Cathy Green, Director They also agreed on priority actions for age and gender diversity but not • Dr Sam Lerts, Director meeting the Vision: to the exclusion of other types of • Publicise statistics on the diversity. Moreover, there is little point • Dr Justin Mora, Censor-in-Chief percentage of women in leadership increasing diversity in leadership roles • Dr Nisha Sachdev, Younger roles in the College. if individuals don’t feel comfortable Fellows Advisory Group Chair • Explore the use of mentoring and and secure in ‘being themselves’. Thus, • Dr Emmanuel Gregory, Senior forums as a means to promote there is a strong focus on inclusiveness and Retired Fellows Chair communication, informal so that no one feels pressured to • Dr Nick Toalster, Trainee education and understanding confirm to the status quo. representative across all sections of the College, If you visit the RANZCO website, you • Judi Gorrie, Lay-Person from trainees through to senior will see that the first priority is well representative Fellows. Enquiries will be made underway with much better statistical 26 Membership Spotlight

Clinical & Experimental Ophthalmology

Predatory Publishers: a warning from Clinical and Experimental Ophthalmology

RANZCO Fellows involved listed on a journal’s website despite Predator journals defraud authors in scientific research and requests for them to be removed. and damage our reputation and publication are advised to A recent and disturbing trend has name, but more importantly been the mimicking of an established they allow the scientific literature be wary of disreputable journal’s name. Predatory publishers to be contaminated, thereby publishers and the journals such as this often have falsified or risking damaging our collective that they promote through non-existent Impact Factors. understanding and treatment of their spam email campaigns. As well as looking out for these disease. The role of a specialist society practices, how do authors identify a The term ‘predatory publisher’ was peer reviewed scientific journal predatory journal? Since 2010, Beall’s coined by Jeffrey Beall, a librarian such as Clinical and Experimental list has published a list of ‘potential, and researcher at the University Ophthalmology is to remove poor possible, or probable predatory of Colorado Denver, to describe science, based on false premise scholarly open-access publishers’. publishers of open-access journals and flawed methodology. The Authors should also check whether which fail to provide the reviewing, responsibility of the RANZCO journal is a journal is listed in the Directory editing and publishing services to curate that portion of the scientific of Open Access Journals (DOAJ). expected from a reputable academic literature that comes our way, with DOAJ membership is only granted journal. the expertise of the College Fellows as to publishers who adhere to their Authors who naively engage the editors and reviewers. declared best practice publishing In summary, we recommend taking services of these journals often end guidelines. For more information great care if responding to invitations up paying fees to have an article on navigating the pitfalls of open published, however these journals do access publishing see the Think, that arrive as emails, particularly not provide an adequate peer review Check, Submit website (http:// from open access journals. It is good process, and the content is often thinkchecksubmit.org/). practice to establish the credibility of a not listed in legitimate databases Academic researchers and journal before engaging with them. such as PubMed. So although they reputable publishers who have To give your research the forum it are available on the journal website, been frustrated at the growth of this deserves, make sure that your articles they are essentially invisible to fellow industry will be pleased to learn that are submitted to the real Clinical and researchers. the US Federal Trade Commission Experimental Ophthalmology. What are the characteristics of a recently filed a complaint against For more information, see the predatory journal? They often include OMICS group, a predatory publisher editorial ‘Authors beware! The rise an aggressive email campaign inviting which claims to host 3000 annual of the predatory publisher’ in the scholars to submit their papers. ‘scholarly’ conferences and operate November 2016 issue of Clinical and They usually include a dubious or 700 ‘peer-reviewed’ journals Experimental Ophthalmology. non-existent peer review process, including the familiar-sounding and publication charges that are only Journal of Clinical and Experimental revealed after a paper is accepted. Ophthalmology! Time will tell if Note: RANZCO members have free online access to the full text of Clinical and Experimental Editorial Board appointments are often the complaint is upheld, and if the Ophthalmology. (Please refer to the following made without permission and remain journals can be shut down. page for more details.) 27 Did you know?

RANZCO members have free online access to the full text of Clinical & Experimental Ophthalmology (CEO), RANZCO’s scientific journal.

Image 1 Clinical & Experimental Ophthalmology

Login to the RANZCO website www.ranzco.edu with your username and password.

After you login, your ‘Dashboard’ will appear. Scroll down to ‘Other Services’ and click on ‘CEO Journals’ (image 1).

You will be Image 2 redirected to the CEO Journal homepage on Wiley Online Library. This process may take a few seconds. Then simply select the issue of the CEO journal you would like to access (image 2). Tip: Clicking on ‘See all’ will list all CEO issues dating back to 1973.

If you need any help accessing the CEO journal, please email [email protected]

CEO-flyer.indd 1 12/12/2016 10:03:50 AM 28 Membership Spotlight

Marching to the beat – the proud history of RANZCO’s processional music

Sitting in a grand hall, surrounded by excited ophthalmologists about to join the ranks of RANZCO Fellows, their proud families and friends watching on, it is easy to wonder about their stories, what led them here, what drive and determination fueled their many years of study and hard work. It’s easy to find yourself wondering where their careers will take them and what impact they will have on the world. What a difference they will make. Elena Kats-Chernin But it is not just the people at this as months and then years passed husband left Krakow and moved graduation – the RANZCO Fellows new without Elena learning to speak. to Australia to make a new life for and old, the families and friends who At the age of four, Elena would sit themselves. Elena’s family would have supported them throughout in on her older sister Larissa’s piano eventually follow. their long training and through their lessons, captivated by the music. Elena’s father, David, and Maya busy careers – that have stories to One day, when her sister finished her were very close and the distance was tell. The music that accompanies the lesson, Elena shocked everyone by hard on them when she moved to procession also has a story, one that is sitting down at the piano and playing long and interesting and that begins, Australia. He attempted to visit her quite appropriately, with the daughter back all that she had heard – the first but permission to leave the country of an ophthalmologist. sign of her prodigious talent. This was not granted by the Russian Each year, as the RANZCO quiet little girl who barely spoke a Government with the explanation Graduation Ceremony begins, some word had finally found her voice. that, as a civil engineer, his knowledge of Australia’s and New Zealand’s most Remarkably, Elena went on to of building sites was confidential. distinguished ophthalmologists march compose her first piece of music at Unable to visit their family on slowly in time to heraldic sounds just five years old. She continued with holiday, and with unsettling times of the brass band. The processional her music lessons, dedicating all of her driving a wave of Jews to emigrate being played was written by one of spare time to nurturing her new found from Russia, Elena’s parents made the Australia’s most notable and awarded talent. She studied at the Yaroslavl decision to leave for good, making the composers, Elena Kats-Chernin. Music School before moving away move to Australia in 1975. Like the new Fellows about to from her family at just 14 years old Elena continued her musical studies embark on their careers, Elena’s story to attend the Gnessin State Musical at the New South Wales Conservatory, involves many years of hard work and College in Moscow, where she would graduating in 1981 and then moving dedication and an overwhelming spend most of her days mastering her to Germany to study with renowned desire to make an impact. Elena was piano skills. composer Helmut Lachenmann in born in Tashkent in what was then “The study was intense,” says Elena Hanover. She lived in Germany for 13 the Soviet Union (Tashkent is now of her time in Moscow. “We studied, years before moving back to Sydney the capital of Uzbekistan) before her practiced and performed all the time. in 1994. family moved to Yaroslavl about 160 But it was a great place to learn, and Meanwhile, Elena’s parents found miles from Moscow. From an early I was never happier than when I was it difficult to find work, having to first age Elena showed an affinity to music sitting in front of a piano.” learn English. David initially worked in that she didn’t have for other forms of In the early 1960s, Elena’s aunt a factory making clothes. Eventually, communication. Her parents worried Maya, a concert pianist, and her Polish after a couple of years, he found work Eye2Eye Summer 2016 29

as a civil engineer at the Department my mother was incredible and so to be Each year since then, the piece has of Civil Engineering in Sydney. He writing for the College felt right. Di came been the soundtrack for RANZCO’s would work there for the next decade, to my home with Professor Frank Martin annual graduation ceremony welcoming until he eventually retired. and Dr Emmanuel Gregory and their many new Fellows into the College. Elena’s mother, Bertina, an wives to discuss what was needed, what Since creating that first piece of experienced ophthalmologist in the piece would be used for and what it music for RANZCO, Elena’s career has Russia, was unable to practice as an should represent. It’s important for me taken off in Australia, and around the ophthalmologist in Australia due her to understand the purpose of a piece world, proving her mother right that qualifications not being recognised and what it needs to say.” it was only a matter of time. As well as by the Australian system. Instead, Dr Semmonds recalls “We asked privately commissioned pieces, like the Bertina found work as a doctor in the Elena to include an Australian flavour RANZCO piece, Elena’s has produced outpatient department at Sydney to the music. She sat at the piano and music for large scale events, including a Eye Hospital. It was here that she met this music just came pouring out of piece called Deep Sea Dreaming for the RANZCO’s Dr Diana Semmonds. her hands. It was amazing to witness 2000 Sydney Olympic Games Opening Dr Semmonds remembers the genius of it! She added a subtle Ceremony which was performed by a Elena’s mother extremely fondly. reference to Waltzing Matilda. children’s orchestra and choir. She has “She was a skilled and empathetic “This piece was first played as the also written music for the Rugby World ophthalmologist who brought special processional at the opening ceremony Cup opening ceremony and to mark 75 skills to the outpatient department of the Congress in Sydney in 1997.” years of the Sydney Harbour Bridge. and taught us registrars, patiently, how In 2010 Dr Semmonds went back to Elena also still plays piano, with to refract,” recalls Dr Semmonds. “One Elena and asked her to update the music 16 concerts currently scheduled for of the many things I remember is how so that it could be used as the College’s next year. She is also now the resident she would talk about her daughter. processional music at the annual composer for the Melbourne Symphony Elena had been called the little Mozart. graduation ceremony. Orchestra, the first resident composer Bertina was so proud of Elena and Elena and Dr Semmonds both in the orchestra’s history. She also loved to tell people how she was recall, with obvious amusement, Dr still composes music, often for ballet getting on. When Elena moved back to Semmonds marching across Elena’s or opera. Her latest premiere was a Sydney, I remember her mother saying living room while Elena played versions concerto for eight double basses for that she was famous in Europe, but of the music on her piano. the Australian World Orchestra, which she wasn’t known in Australia, yet. It “We had to see it in action,” laughs each year brings together Australian was definitely only a matter of time.” Elena. “We wanted to make sure it was musicians from around the world. It “When I came back to Australia,” possible to walk to the music. After all, recalls Elena, “I had to start from what good is a processional that you was performed in September 2016 at scratch. I went to concerts and met can’t walk to?” the Concert Hall of the Sydney Opera people, networking, just to find out “I can’t image how we must have House and travelled to the Esplanade in what was going on and to try to get a looked,” recalls Dr Semmonds with a Singapore. foot in the door. I was slowly building smile. “I marched back and forth across With so much going on in her up a commissioning process – one the room, while Elena played the same professional life – not to mention in her commission in one year, then two, then piece over and over again with a slight personal life: Elena has just become four. I was building up a business, and note change or a slightly different a grandmother for the first time – is that takes time.” tempo.” this the end for her relationship with Elena’s mother was as dedicated Speaking of the music itself, Elena RANZCO? to her work as Elena is to her music, explains that it is supposed to be “Not at all,” says Elena. “After all, music working at the Sydney Eye Hospital into understated. “It is used for a grand event is a living thing, styles change and the her seventies, and only retiring when and it can’t overshadow that. The music way we use music changes. I’d like to see sickness demanded it. is designed to be in the background, how the music is being used and see if In 1996, when a piece of music was with people walking and people I can add to it, change it up a bit to suit needed for a RANZCO event, the famous talking as it’s played. Elements of the what is needed today. I’d like to make musician with an ophthalmologist music provide the possibility of being sure it is still relevant.” mother came to Dr Semmonds’ mind. repeated or cut, so that it can be made So, it seems the story of RANZCO’s She looked Elena up and asked if she longer or shorter depending on what’s processional is not over yet, and only would be interested in composing a needed. The beginning is the most time will tell what its next iteration will piece for the College. Elena jumped at catchy moment and everything else is be. the idea. a deliberation on that. It is supposed Emma Carr Elena remembers being delighted to to add to the occasion rather than General Manager, Communications hear from Dr Semmonds. “The link to overpower it.” RANZCO 30 Membership Spotlight

Book review Curim Sickness Belong Eye — a deeply inspiring memoir detailing an eye surgeon’s dedication to helping those in need

“From my first visit to the Pacific I knew that the only way to achieve good results was to apply the same standards as I would apply at home.” Dr Dick Galbraith, retired Fellow from Victoria and former President of the Royal Australian College of Ophthalmologists, wrote the book Curim Sickness Belong Eye which chronicles his annual surgical trips to the Solomon Islands over the course of 20 years. A journey that passes through his early years as a medical student to his training at Moorfields Eye Hospital, crediting some well-known figures and amusing events that influenced and contributed to his surgical career in ophthalmology, Dr Galbraith provides a detailed account of his remarkable story. Intertwined with a balanced touch of humour and filled with vivid and colourful characters, Curim Sickness Belong Eye makes for an excellent read. For 20 years Dr Galbraith led an annual eye team to the Solomon Islands and other islands in the Pacific to help treat those who otherwise would not have had access to health care. He recounts his journey with great honesty, passion and gratitude and, at times, Curim Sickness Belong Eye is published with sadness as he takes the reader behind the scenes of his by Strategic Book Publishing and many adventures. The use of Pijin, accompanied by the English Rights Co. and is available as: translation throughout the book, offers an insight into the lives 1. a paperback or in Kindle format and experiences of the many people Dr Galbraith encountered on amazon.com and helped throughout his time spent in the Pacific. 2. through the publisher’s website: Dr Galbraith is quick to talk about his failures as well. In the http://sbprabooks.com/ prologue he talks about a disastrous incident that almost ended his DickGalbraith surgical career in the Pacific before it even began. It is this honest and humble account of events which make Curim Sickness Belong Eye a highly vivid and engaging memoir. Laura Sefaj Senior Communications Coordinator, RANZCO

Dr Galbraith to spend a few weeks About the author at the Essen Eye Clinic, one of the Dr J.E.K. ‘Dick’ Galbraith graduated leading centres of eye surgery from the Melbourne University Medical in Europe. Later Dr Galbraith was School in 1955. After two years at awarded a Harkness Foundation the Alfred Hospital in Melbourne Fellowship which allowed him to he travelled to England, where he spend three months visiting the remained for six years. leading eye centres in America. He completed his three-year Dr Galbraith returned to Australia training program as an eye surgeon and joined Professor Gerard Crock at Moorfields Eye Hospital in at the Melbourne University London and was appointed by Department of Ophthalmology. In Professor Barrie Jones as Senior 1996 he was appointed to head of Lecturer in Ophthalmology at Prof the Eye Clinic at the Royal Melbourne Jones’s department. A Lawford Fund Hospital where he remained for 22 Dr Dick Galbraith Fellowship from Moorfields enabled years. It was during this period that Eye2Eye Summer 2016 31

Dr Galbraith became interested in working in the developing world — influenced by Prof Barrie Jones. ANNUAL REPORT 2015-2016 For the next 30 years Dr Galbraith worked for a month each year in the RANZCO nations of the South Pacific as part of the Australian South Pacific Aid Annual Report Program. For nearly 20 years he worked 2015–2016 in the Solomon Islands after which the Department of Foreign Affairs The College Annual Report expanded his program to cover other for 2015–2016, as issued at independent Pacific nations. the Annual General Meeting Dr Galbraith’s Pacific career ended during the Congress in when he retired from surgery. He Melbourne, is now available then developed a five-day teaching on the RANZCO website. program in Basic Ophthalmology which he taught in Kiribati, Tuvalu, Fiji, Vanuatu and Tonga. Dr Galbraith finally retired at the age of 80 and devoted himself to writing this book about his Annual Report 2015_2016_final.indd 1 8/11/2016 1:05:17 PM experiences in the Solomon Islands.

34 RANZCO 48th Annual Scientific Congress

RANZCO 2016 Latest research, technologies and innovations in ophthalmology

Southbank, Melbourne, November 2016 More than 1500 delegates, the attendance and quality of the RANZCO international scholarship sponsors and exhibitors conference. The full spectrum of participants from Laos, Papua New from Australia, New Zealand glorious Melbourne weather was on Guinea and Cambodia about the display and delegates also had the issues they have advocated for locally. and further afield gathered opportunity to visit the tattoo and The workshop, which was opened by on the banks of the Yarra quilt manufacturers conference.” Dr Anthony Bennett Hall, Chair of the River at the Melbourne RANZCO International Development Convention and Exhibition Workshops Committee, also featured talks from Centre for the RANZCO 48th The Congress unofficially kicked off Amanda Davis and Damien Facciolo Annual Scientific Congress on the Friday with the RANZCO – from the International Agency for the Prevention of Blindness and from 19 to 23 November Vision 2020 Australia International Development Workshop on RANZCO Fellow Geoffrey Painter, 2016. ‘Advocacy: Influencing Change and among others. The afternoon was With an outstanding scientific Eye Health Sector Development’. dedicated to an interactive advocacy program, excellent social events The workshop explored examples workshop facilitated by RANZCO and plenty of networking activities which have influenced a change Board member and Chair of the in some of Melbourne’s top venues, or achieved improvement in the Leadership Development Committee, RANZCO’s Congress continues to be quality and reach of eye health Dr Cathy Green. Participants explored a key event for ophthalmologists and services. Keynote speaker Prof advocacy processes and tools to the ophthalmic industry. Hugh Taylor gave an excellent develop an advocacy approach RANZCO Co-Convenors Drs Daniel presentation about his experience to a set challenge. Feedback was Chiu and Xavier Fagan were thrilled of influencing changes to improve incredibly positive with participants with the response to the event eye health. The audience of over saying that they would take away saying “We were delighted with 70 attendees also heard from useful learnings from the event. Eye2Eye Summer 2016 35

Saturday morning saw many the GP Workshop which covered a delegates gathering at the range of practical topics designed Convention Centre to attend to assist GPs with the management All three referral the various associated meetings, of patient care, including a session guidelines that were among them those of the College dedicated to the use of the Fundus Qualification and Education camera to test for diabetic retinopathy. discussed are available Committee and the College Council. The Optometry Workshop, chaired on the RANZCO website Congratulations are in order for by RANZCO Past President Stephen at Dr Di Semmonds who was Best, showcased the RANZCO referral https://ranzco.edu/ unanimously elected RANZCO Vice pathways and offered participants the ophthalmology- President at the RANZCO Council opportunity to discuss collaborative Meeting. care and best patient outcome. and-eye-health/ Saturday also included a special collaborative-care. workshop for GPs and a separate one for optometrists. RANZCO Past President Dr Bill Glasson chaired

Welcome Reception The Welcome Reception provided an opportunity for Fellows to start the Congress with some collegial interaction. The reception proved to be a great experience for attendees, featuring vivid street art inspired by the city’s famous Flinders Lane and City Square, and a live performance by local hip hop dancers from the not for profit performing arts organisation Outer Urban Projects. The backdrop and entertainment tied in perfectly with this year’s Congress theme ‘Where culture and innovation meet’. Local artist performing at the Welcome Reception Scientific Program The Congress Scientific Program officially kicked off on Sunday with RANZCO Immediate Past President Dr Brad Horsburgh opening the College Plenary sessions just after the annual general meetings of ORIA, ASO and RANZCO. The Scientific Program Committee, led by Professor Helen Danesh-Meyer, incorporated nine invited local and international speakers, over 20 symposia and courses, and more than 200 rapid fire presentations, posters and films. The breadth of ophthalmology was covered, from glaucoma, cataract, uveitis and neuro-ophthalmology. RANZCO 2016 plennary session 36 RANZCO 48th Annual Scientific Congress

Named Lectures Council Lecture College Fellow Prof Gerard Sutton delivered the first of the four named lectures. The title of ‘Synergy and Serendipity’ in innovative cornea therapy highlighted the important collaboration amongst clinicians, scientists and the Eye Bank in achieving a world-class and sustainable cornea tissue bank and surgical service, as well Prof Gerard Sutton Prof Denis Wakefield as his own serendipitous academic journey of a self-proclaimed ‘accidental’ professor. Sir Norman Gregg Lecture Prof Denis Wakefield provided a most informative update on HLA-B27 related uveitis, with a thorough discussion on this ubiquitous antigen and the intricate pathogenesis of its associated diseases hence a journey in discovery of some of the latest ideas on treatment strategies with new immunosuppressive drugs. Prof Maarten P. Mourits Dr James Muecke Hard science not for the faint hearted! Ida Mann Lecture Prof Maarten P. Mourits spoke on the challenges of Graves’ orbitopathy, sharing with us his extensive research findings on the common orbital inflammatory disease, firstly in his cohort of the Dutch population and then in his renowned world- wide experience in the grading and management in this common disorder. Hollows Lecture Dr James Muecke gave a powerful and eloquent lecture on how ophthalmologists can deliver high impact and sustainable solutions to reduce blindness in the developing world, with the example of his long journey in delivering solutions to one of our poorest neighbours, Myanmar. In his mesmerising speech mixed with visually stunning and unforgettable photo slides, the audience became thoroughly enthralled by his decade long endeavour of ophthalmology in the developing world. Truly one of the most memorable oration befitting the traditions of the Hollows Lecture. Eye2Eye Summer 2016 37

Prof Keith Martin

Update Lectures

Glaucoma Update Lecture options of presbyopic corrections and Prof Keith Martin from Cambridge their associated challenges. Finally the Prof Boris Malyugin discussed some of the early researches audience was confronted on choosing in techniques to protect and between the presbyopic Brad Pitt and regenerate the optic nerve in glaucoma the glasses-less George Clooney! patients, using gene therapy, stem cells Retina Update Lecture and other approaches. Regenerative medicine in ophthalmology holds Prof Ursula Schmidt-Erfurth introduced much promise in many blinding to us the research findings on her diseases, and models in glaucomatous team’s work on big data analysis and optic neuropathy will inspire many machine learning in analysing the bright researchers in the young fine detailed data on OCT imaging generation of clinician-scientists. His in tailoring anti-VEGF therapy, in resourceful lecture gave us a glimpse of particular volumetric analysis of Dr David Hardten the future of ophthalmic treatment in intraretinal and subretinal fluid the coming decades. exudation, offering tremendous insight in the understanding and help Cataract Update Lecture in optimising the treatment burden Prof Boris Malyugin provided an associated with the expanding need of overview of many situations that macular disease management. complicate cataract surgery, focusing Neuro-Ophthalmology particularly on his approaches in small Update Lecture pupil scenarios, and offering tips from his surgical repertoire in using pupil Dr Fiona Costello of Calgary Canada, gave an eloquent lecture on the expansion devices. He also provided Prof Ursula Schmidt-Erfurth a very nice overview of Russian connection between optic nerve ophthalmologists’ contribution in the diseases and the central visual pathway, field of refractive surgery. and highlighted the research findings in the roles of ophthalmologists Refractive Update Lecture in helping the diagnose and Dr David Hardten, an experienced prognosticate visual dysfunction and surgeon in the field of refractive long term visual outcome in visual surgery, updated us with his experience pathway compressive disorder. Her in navigating the myriad of refractive dissertation reinforces the important surgical landscape, tips in meeting and leading role ophthalmologists patient expectation with long term have in the management of many planning, and analysis on the many neurological disorders. Dr Fiona Costello 38 RANZCO 48th Annual Scientific Congress

Graduation and Awards Ceremony and President’s Reception

Mural Hall was the striking venue for Sunday evening’s Graduation and Awards Ceremony and the President’s Reception. At the ceremony, new Fellows were welcomed into the College and a number of prestigious College awards were presented (Award winners are listed on the following page). The Guest-of-Honour for the evening, Dr Helen Szoke, CEO of OXFAM Australia, delighted the gathering with her memorable opening address focusing on achieving greater gender equality in the field of medicine and the workforce more broadly. Dr Helen Szoke, Guest-of-Honour, Graduation & Awards Ceremony Congress Dinner The social finale for the Congress came on Tuesday evening, when delegates and their partners gathered at the Olympic Room of the famous Melbourne Cricket Ground for the Congress dinner. The ceremonial section of the dinner was opened with the witty repartee of Congress Co-Convenor Dr Xavier Fagan and a live band provided music and entertainment for the guests throughout the evening. Dr Horsburgh handed over the Chain of Office to A/Prof Mark Daniell, welcoming him to the role as RANZCO President. The Scientific Program came to a close on the Wednesday afternoon where Dr Brad Horsburgh handing over the chain of office to A/Prof Mark Daniell Poster, Film, Audit and Paper prize winners were presented with their awards (Prize winners are listed on page 41). Throughout Congress, the Industry Exhibition Hall offered guests the opportunity to explore the latest developments, products and innovations in the ophthalmic industry. The RANZCO Board extends a sincere and warm thank you to all the individuals, organisations, sponsors and exhibitors that contributed to RANZCO’s Congress. We thank the Organising Committee headed by Drs Daniel Chiu and Xavier Fagan and the Scientific Program Committee led by Prof Helen Danesh-Meyer. Guests enjoying the view of the Melbourne Cricket Ground Eye2Eye Summer 2016 39

Award and Prize Winners College Awards College Medal Professor Minas Coroneo AO was awarded the College Medal in recognition for his service to the College and his dedication to the ophthalmic profession for many years. Honorary Fellowship Professor Mark Radford was awarded RANZCO Honorary Fellowship for his commitment and service to the College over many years, benefiting both the ophthalmic profession and community.

Dr Justin Mora, Censor-in-Chief Trainers of Excellence The following trainers were nominated by trainees for exemplifying excellence in planning, communication, assessment and evidence-based professional practice. • Dr Kimberley Tan (Prince of Wales Network) • Dr Yves Kerdraon (Sydney Eye Network) • A/Prof Anne Brooks (Victoria Network) • Dr Tim Henderson (South Australia Network) • Dr Dimitri Yellachich (Western Australia Network) • Prof Geoffrey Lam (Western Australia Network) • Dr Stephen Ohlrich (Queensland Network) Prof Minas Coroneo receiving his award • Dr David Squirrell (New Zealand Network)

Prof Mark Radford receiving RANZCO Honorary Fellowship A/Prof Anne Brooks 40 RANZCO 48th Annual Scientific Congress

New Fellows

Graduating RANZCO Fellows 2016

Dr Nicholas Andrew Dr Kate Leahy Dr David Gunn Dr Emil Kurniawan

Doctors admitted as Fellows by • Matthew Little • Georgia Cleary examination: • Michael Chen • Jason Cheng • Abhishek Sharma • Michael Hogden • Lourens van Zyl • Alison Chiu • Rachael Niederer • Rasha Altaie • Antony Clark • Robin Jones • Shivanand Jayesh Sheth • Anu Mathew • Shenton Chew • Swati Sinkar • Bhagya Amaratunge • Sing-Pey Chow The Filipic Greer Medal • Brent Skippen • Sonia Moorthy Dr Nicholas Andrew and Dr Kate Leahy • Chameen Samarawickrama • Tani Brown For overall excellence in the • Christolyn Rajakulenthiran • Thomas Edwards Ophthalmic Pathology examination. • Christopher Qureshi • Todd Goodwin The KG Howsam Medal • Edwina Eade • Tricia Drew Dr David Gunn • Gaurav Bhardwaj • William Cunningham For overall excellence in the RANZCO • Helen Do • Zoe Gao Advanced Clinical Examination. • Jed Lusthaus Doctors admitted as Fellows by • Judy Ku assessment: The Cedric Cohen Medal • Khoi Anh Tran • Bryan Matthews Dr Emil Kurniawan • Kuo Luong Lee • Dania Qatarneh For overall excellence in the • Lana Del Porto • Dustin Pomerleau Ophthalmic Sciences examinations. Eye2Eye Summer 2016 41

Industry Scholarship Congress Prize Best Surgical Technique Film: Dr Elaine Chong for ‘Descemet Winners Winners Membrane Endothelial Keratoplasty: Allergan/RANZCO Paper Prizes An Experiment with Different Scholarship The Gerard Crock Trophy for best Techniques’. Dr Justin Sherwin, Glaucoma paper presentation from a senior Best Overall Film: Fellowship at Oxford University ophthalmologist: Dr Shong Min Voon for ‘A Novel Hospital. Awarded to Prof Jamie Craig Method for Rapid Production of Basic Dr Amy Pai, Fellowship at Moorfields Diagnostic Ophthalmic Equipment’. The John Parr Trophy for best Eye Hospital in Medical Retina, paper presentation from a junior Audit Prize Genetics and Uveitis. doctor: The Audit Prize highlights the Bayer/RANZCO Scholarship Awarded to Dr Elisabeth De Smit importance and effectiveness of Dr Nathan Kerr, Glaucoma Surgical Best Poster Prize sponsored clinical audit and peer review as Trials Fellowship at Moorfields Eye by Zeiss strategies for improving standards in Hospital. medical and surgical care. Best Overall Poster: Dr Vivek Pandya, Vitreoretinal Surgery A/Prof Chi Luu for ‘Dark-adapted The Congress Audit Prize: Fellowship at the University of British chromatic (two-colour) perimetry in Dr Aaron Ng Columbia, Vancouver. age-related macular degeneration’. Abbott/RANZCO Film Festival Prizes Scholarship sponsored by Allergan Dr Alex Hewitt, position of study at the Best Community Ophthalmology Electrophysiology Laboratory at the Film: Department of Optometry and Vision Ms Emily O’Kearney for ‘Kuru Palya Sciences, The University of Melbourne. Good Eyes’.

The official Congress photographer, Mr Jeff McEwan from Capture Studios Photography New Zealand, captured the memorable Congress images, some of which appear in this issue of Eye2Eye. Additional photos as well as videos of the plenary sessions can be viewed on the RANZCO 2016 Congress website at http://ranzco2016.com.au/. 42 RANZCO 48th Annual Scientific Congress

Senior and Retired textbook of ophthalmology and what we can learn from his early works. The Fellows second day talk was by Dr Kaufman The vibrant city of Melbourne who showcased with enthusiasm some interesting ophthalmic proved the perfect location curiosities from the museum website. to bring together our senior On the third day, Dr Richard Travers Fellows under one roof as presented a fascinating session on well as explore the beautiful the Diseases of Books – an excursion and exciting city surroundings. into bibliopathology. Thank you to the RANZCO’s Senior and Retired Fellows speakers for committing their time to once again had a dedicated space in present to our Fellows. the exhibition area next to the RANZCO The senior Fellows and partners also Museum where they could have a enjoyed a presentation in the main cuppa and catch up with colleagues scientific program by Dr Henry Lew on and old acquaintances, view displays Art and Ophthalmology. The seating arrangements for the at the Museum and hear talks at The Senior and Retired Fellows Lounge lunch time. I would like to express seniors at the opening and graduation my gratitude to RANZCO Museum ceremony held at the beautiful Mural away since the last dinner in Wellington Curators, Dr David Kaufman and Ms Hall of the Myer building on Sunday and Dr Frank Cheok entertained with Caroline Ondracek for their continuous evening were well appreciated. his music skills. dedication and passion year in and The Senior and Retired Fellows’ The Seniors Lounge, lunch time talks out in putting together the displays at dinner held at Taxi Riverside next to the and dinner will be featured again at the Congress. breath-taking view of the Yarra River, next RANZCO Congress held in Perth 2017 and we greatly look forward to The lunch time talks at the lounge was an outstanding success with over seeing everyone there. were well attended and enjoyed by 70 Fellows and partners attending. all. The first day talk was by Dr Joseph Attendees complimented on the great Dr Emmanuel Gregory Reiche who enlightened the audience food menu. I gave a short welcome Senior and Retired Fellows’ Group about George Bartisch and the first remembering those who had passed Chair

Practice Managers’ as well as supporting our growing social joined the Committee. The addition of events for practice mangers to network these members brings the Committee to Conference with each other in a less formal and a strong group of 10 who are excitingly more relaxed environment. planning for the next conference as The RANZCO Practice Mangers After two years as the Chair of the well as building better resources and Committee would like to thank Practice Managers Committee, Lisa educational materials accessible for the all of the 130+ attendees at Hartley has decided to step down from practice managers. our recent Practice Managers’ this role. During the Practice Managers We had a strong interest from Conference in Melbourne. Annual General Meeting, Kharissa Cain attendees at the conference wanting was appointed as the new Chair with to join RANZCO as a Practice Member The conference was a great Lucy Peters appointed as Deputy Chair. Associate. Application forms and details success and we would like We would like to thank Lisa for her of joining can be obtained from the to especially thank all the dedication and hard work over the last RANZCO office at presenters for committing two years and are happy to announce [email protected]. There are many their time to our conference. Lisa will remain a valued member of the great perks of becoming a member, Practice Managers Committee sharing most notably is the conference We would also like to take this her skills and knowledge. Sadly, we’ve concession rate and opportunity to join opportunity to express our gratitude had to say goodbye to Moira McInerney, the Practice Managers Committee. to our sponsored speakers as well past Committee Chair, who has resigned Lastly, we appreciate the feedback as Inservio, Intercharge and Surgical from the Committee. We thank her for given to us in our surveys by the Partners for helping fund the Practice her contributions whilst serving on the attendees; this will guide us in our Managers dinner and drinks. We hope Committee and in her role as Chair. With planning and selection of the next we can continue to have sponsored every departure comes a new arrival and Practice Managers’ Conference to speakers involved with our program, we give a warm welcome to Lara, Gail, be held in Perth – we hope to see adding educational value to our topics Judith and Alison who have recently everybody there again! Eye2Eye Summer 2016 43

73rd Orthoptics Australia Annual Scientific Conference

The 73rd Orthoptics Australia Melbourne Park Function Centre, Annual Scientific Conference right in the heart of Rod Laver and was held from Sunday 19 to Hisense arena. Tuesday 21 November 2016. Award winners at the conference included Julie Barbour (TAS) who won Orthoptists from all around the Zoran Georgievski Medal that Australia and New Zealand commemorates the life, professional gathered at the Melbourne career and outstanding commitment Convention and Exhibition to the orthoptic profession. Gareth Centre in Melbourne, Lingham (WA) won the Emmie Russell Australia. Prize for his talk on Early Life Risk The conference tied in with RANZCO’s Factors in Amblyopia, Strabismus 48th Annual Scientific Congress and and Anisometropia in a Young Adult orthoptists were treated to an array Population and Cem Oztan (NSW) Paediatric Orthoptic Award winner Cem Oztan and Emmie Russel Prize Winner Gareth won the Paediatric Orthoptic Award of talks by a variety of speakers. Lingham Dr Laurie Sullivan, Dr Dermot Cassidy, for his presentation on A Novel Dr Graeme Pollock and Professor Method for Measuring Nystagmus. Jonathon Crowston were highlights We also saw the La Trobe University from the scientific program. Myra Student Orthoptics Society win the McGuinness, Jane Schuller, Donna Orthoptic Video Competition with Corcoran and Karen Mills did an their video titled What is Orthoptics, outstanding job putting together the which will be used during Orthoptics scientific and social programs, making Awareness Week and World Orthoptic this conference one to remember. Day 2017. We congratulate all award Orthoptists mingled at both winners for 2016! social events, which was a great On behalf of Orthoptics Australia, opportunity to establish new we look forward to the 74th Annual working relationships and network Scientific Conference to be held in with other orthoptists around the Perth this year. nation. Welcome drinks were held The conference organising and scientific at the iconic GPO building and the Allanah Crameri committee: Donna Corcoran, Karen Mill, Jane conference dinner was held at the Orthoptics Australia PR Coordinator Schuller and Myra McGuinness

Re-energising ophthalmic nursing in Australia

This year, RANZCO Shaw - both from the UK, and The traditional one-day biennial partnered with the attended by 62 senior ophthalmic conference, opened by RANZCO Australian Ophthalmic nurses, and advanced nurse Immediate Past President Dr Brad practitioners not involved in eye care Horsburgh and AONAVIC President Nurses Association Victoria (i.e. general Emergency Departments Heather Machin, re-energised Chapter (AONAVIC) to host and GP practices), who find and re-defined the ophthalmic ophthalmic nursing events themselves managing and triaging nursing space in Australia, with spanning three days, with an eye care needs in their daily work. the 110 delegates exposed to an attendance of delegates from For AONAVIC, who hosted the event unprecedented number of quality, in partnership with the Australian nurse-led presentations - with the all over Australia, the UK, College of Nurse Practioners, this intent to promote and encourage New Zealand and Peru. marked a new partnership that other ophthalmic nurses to consider Activities commenced with a has opened the door to future new possibilities and forge new workshop on Friday, 18 November opportunities of continuing education collaborations. The event also presented by international nurses and eye care promotion within the allowed the community to celebrate Professor Janet Marden and Mary wider non-ophthalmic nursing sector. and acknowledge other nurses doing 44 RANZCO 48th Annual Scientific Congress

outstanding work across the eye Such steps create the foundation, The nursing series concluded on care and global blindness prevention and stepping-stones needed for Sunday with all Ophthalmic Nursing sector. ophthalmic nurses to support and Associations of Australia hosting a Dr Horsburgh and Ms Machin work towards the Global Action Plan combined national nursing meeting. set the tone for the day, as a 2014–2019 goals of the International As AONAVIC hands over RANZCO collaborative force focused on Agency for the Prevention of 2017 to AONA-Western Australia, emphasising to ophthalmic Blindness, through opening up lines of under the leadership of Gina nurses their significance and communication from nurses to others Storey and team, AONAVIC would the importance of their role and involved in eye care delivery, and like to thank their members, involvement in eye care both locally, allowing for new opportunities and non-members, sponsors, presenters nationally and internationally. approaches to service improvement. and Dr Horsburgh, Sarah Stedman A significant emphasis of the Keynote speaker, Professor Janet and Alex Arancibia for their support program was also designed Marsden, sponsored by Alcon, and and partnership in the lead-up to re-energise the ophthalmic other presenters, continued to echo to this milestone series of events nursing community and re-engage these statements by showcasing a for AONAVIC and the extended opportunities within the nursing wide range of nursing roles across ophthalmic nursing community. sector itself, as well as renew the globe and the opportunities (and relations with other eye care educational resources) available to Heather Machin providers and stakeholders. nurses in Australia. AONAVIC President

RANZCO 2017 This year’s Congress will be held at the Perth Convention and Exhibition Centre, Perth, Australia from 28 October to AA CC 1 November. C The Organising Committee Chaired by A/Prof Angus Turner and Dr Fred Chen and the Scientific Program Committee have planned an exciting cultural and scientific program. Abstracts and registration The call for abstracts opens on 3 April 2017. Registration opens in May, with early registration closing 1 September. Visit www.ranzco2017.com for more information and updates. Congress managers Think Business Events Level 1, 299 Elizabeth Street Sydney NSW 2000 Australia Tel: +61 (02) 8251 0045 Fax: +61 (02) 8251 0097 Email: [email protected] www.thinkbusinessevents.com.au PERTH CONVENTION & EXHIBITION CENTRE 28 October - 1 November 2017

46 Indigenous Eye Health

Indigenous Eye Health

(From L-R): A/Prof Mark Daniell, Ms Patricia Turner and Prof Hugh R Taylor at the launch of the Annual Update on the Implementation of the Roadmap to Close the Gap for Vision, RANZCO Annual Scientific Congress, Melbourne 2016 Annual Update on the Implementation of the Roadmap to Close the Gap for Vision

The 2016 Annual Update on outcomes with the rest of the Australian the Indigenous patient journey the Implementation of the population. from primary through to tertiary Roadmap to Close the Gap The Roadmap was released in 2012 care, including cataract surgery and following extensive consultation with treatment for diabetic retinopathy. for Vision was launched at Aboriginal community and key sector A number of exciting milestones a special event during the stakeholders, including RANZCO. have been reached through the RANZCO Annual Scientific The Roadmap is a sector-endorsed, collective efforts of the many Congress on Monday 21 evidence-based policy framework stakeholders working in Indigenous November 2016. that is being translated into practice eye health. Sixty-two per cent of 139 RANZCO President Associate Professor to deliver equity in eye care between activities outlined in the Roadmap Mark Daniell introduced the launch Indigenous and mainstream Australians. recommendations have now been event, which marked the fifth update Implementation of Roadmap completed, together with a total of 11 of the Roadmap to Close the Gap for recommendations is currently being out of 42 recommendations being fully Vision (the Roadmap). Ms Patricia undertaken in 18 regions across implemented. Turner, CEO of the National Aboriginal Australia, covering an estimated 40% of The Annual Update noted the Community Controlled Health the Indigenous population. findings of the Indigenous Eye Health Organisation, formally launched the The 42 Roadmap recommendations Survey 2016, where blindness rates had Annual Update, which highlights key promote sustainable improvement reduced from six times to three times achievements and progress made of access to eye health services, and as common for Indigenous adults as over the last 12 months on activities include priorities for governance, compared with non-Indigenous. It also to close the gap for vision between monitoring and evaluation, health highlighted the reduction in trachoma Indigenous and non-Indigenous promotion and financing for prevalence in endemic areas from Australians. Professor Hugh R Taylor Indigenous eye health. A major focus 21% in 2008 to 4.6% in 2015 (National AC also spoke of the need to maintain is improved service coordination and Trachoma Surveillance and Reporting progress to reach parity in eye health systems improvement to facilitate Unit 2016). Eye2Eye Summer 2016 47

The introduction of new Medicare Although several key initiatives The 2016 Annual Update on the item numbers for diabetic retinopathy have been implemented, there still Implementation of the Roadmap to Close screening on 1 November 2016 is remains important work to be done. the Gap for Vision demonstrates that regarded as a ‘game changer’ to The Commonwealth government real progress is being made to improve facilitate regular eye checks at primary contributed funding in 2016 to the eye Indigenous eye health outcomes across care level for Indigenous people with health sector for a range of activities Australia, and all stakeholders in the eye diabetes, and ensure they receive including oversight, coordination, eye health sector have a role to play to close any required treatment for diabetic surgery support initiatives and the the gap for vision. retinopathy. The Australian Institute provision of additional equipment To view the Annual Update and the of Health and Welfare will also begin within Aboriginal Medical Services. Roadmap to Close the Gap for Vision reporting in 2016 on key indicators to A crucial area for ophthalmology is reports, please visit http://mspgh. monitor progress on Indigenous eye to ensure that their services are, where unimelb.edu.au/centres-institutes/ health outcomes. Another important possible, bulk-billed for Indigenous centre-for-health-equity/research-group/ achievement is the establishment of patients. This is particularly important indigenous-eye-health#roadmap-to- jurisdictional Indigenous eye health for Rural Health Outreach Fund- close-the-gap-for-vision committees, now being funded supported ophthalmologists, where by the Commonwealth, to provide private gap fees can sometimes be Uma Jatkar oversight on regional and statewide prohibitive for Aboriginal patients in Melbourne School of Population and eye health activities. rural and remote areas. Global Health

The Lion’s Vision Van in Albany framed by a double rainbow on Miss Harris’ first day of work experience The Vision Van - an interesting place to do work experience

I am a year 11 student in brain-child of A/Prof Turner character and a one in a million find Melbourne and I recently who designed the truck and for the Vision Van. She has all the had the opportunity to raised the money to have it skills and life experience that makes her ideal for the job. She started out spend a few days in Albany built so that this service to driving trucks in the air force and then the community could become Western Australia doing work trained to be a paramedic and a nurse experience with A/Prof Angus a reality. It was great to be and along the way somehow learnt Turner and his team on their able to see the team at work the skills of a mechanical engineer, new Lion’s Outback Vision on the truck with my mother, a motor mechanic and an IT expert. Van. The truck was in Albany, Prof Robyn Guymer. Sharon drives the almost 20-meter truck (so not really a van) throughout the last stop on its maiden When I arrived I met the team, including Drs Lucy Dobson and Irene outback Western Australia and trip, delivering eye care to Tan who are junior doctors assigned doubles as outpatients clerk, vision remote and rural Western to work on the van as part of their tester and general trouble shooter. Australia. The truck was the training, and Sharon Brown, a real A/Prof Turner and Dr Hessom Razavi 48 Indigenous Eye Health

round out the team as the two are always in need of volunteer when things weren’t quite going to ophthalmologists working on the ophthalmologists and even junior plan in the middle of nowhere. truck. doctors to help out. It was really It was very kind of the team to fit me The truck is no ordinary truck. It has interesting to hear that Lucy and into their busy schedule and I would been purpose designed and is referred Irene have this fantastic and diverse love to go back one day and see the to as ‘the transformer’ as when Sharon job for the whole year as part of their van at work in a really remote location starts her up, things happen, pieces of post-graduate medical training. Not and see how the team is going. the sides of the truck fold out or down only were they learning about eye Miss Gillian Harris or extend. It even has a lift to allow diseases but also how to think on Year 11 Caulfield Grammar School, patients who can’t manage the stairs their feet and how to be resourceful Melbourne to access the van. On the van I saw rooms full of up to date eye equipment such as a laser and a retinal camera, which can take angiograms. They had quite full clinic lists of patients expected on the van each day, along with several unexpected ‘walk ins’. They coped very well in the confined spaces. It was amazing that they could perform fluorescein angiograms on the van and do eye injections as well. One lady, who just happened to have sudden bleed in her eye from age related macular degeneration (AMD), saw her optometrist in Albany in the morning and by the afternoon was on the truck having an angiogram and an injection before the day was finished. She could not believe her luck that all this expertise was in Albany when she Drs Lucy Dobson and Irene Tan in one of the examinations rooms on the van needed it. I was introduced to the term ‘telehealth’ on this trip and to the complexities of funding for seeing patients using this service. However, it was clear that it was a vital tool in the outback, with A/Prof Turner being able to help people using a regular time slot reserved for ‘face time’ to talk to patients and he could see their scans on his computer. These people would not have had this access to a specialist opinion without telemedicine. It was great to see how everyone had their particular job on the truck when patients were being seen and to see my mother in action giving a talk on AMD in the back room of the truck, which doubles as the lecture theatre, to the local optometrists and rural medical students as well as the two van doctors. The van and team are due to do Prof Robyn Guymer chatting to local optometrists in the back room of the van ‘the lecture their circuit again this year and they theatre’ Eye2Eye Summer 2016 49

“Fixing the leaky pipe”: Barriers to Indigenous cataract surgery

The 2016 National Eye Health Survey (NEHS) states that after age-adjustment, the prevalence of vision impairment was three times higher in Indigenous Australians (13.60%) compared to non-Indigenous Australians (4.57%). Similarly, the age-adjusted prevalence of blindness in Indigenous Australians was three times higher compared to non-Indigenous Australians (0.36% versus 0.12%).1

Table 1. Main causes of bilateral presenting vision impairment and blindness in the NEHS.

Indigenous non-indigenous Main cause of vision impairment n(%) 95% CI(%) n(%) 95% CI (%) (<6/12-6/60) 116 124 54.59, Refractive error 55.96, 70.37 (63.39%) (61.69%) 68.44 Cataract 37 (20.22%) 14.65, 26.77 28 (13.93%) 9.46, 19.50 Age-related macular 2 (1.09%) 0.13, 3.89 18 (8.96%) 5.39, 13.78 degeneration Diabetic retinopathy 10 (5.46%) 2.65, 9.82 3 (1.49%) 0.31, 4.30

Glaucoma 1 (0.55%) 0.01, 3.01 3 (1.49%) 0.31, 4.30

Combined mechanisms1 3 (1.64%) 3.39, 4.72 1 (0.50%) 0.01, 27.40

Other2 2 (1.09%) 1.32, 3.89 8 (3.98%) 1.73, 7.69

Not determinable3 12 (6.56%) 3.43, 11.17 16 (7.96%) 4.62, 12.61

Total n 183 201 Main cause of blindness (<6/60) Refractive error 0 0

Cataract 2 (40%) 5.27, 85.34 0 Age-related macular 29.04, 0 5, 71.42% degeneration 96.33 1Combined Mechanisms = ophthalmologists assigned Diabetic retinopathy 1 (20%) 0.51, 71.64 0 2 or more causes of vision impairment or blindness 2Other = macular dystrophy, retinal dystrophy, Glaucoma 0 0 optic atrophy, retinochoroidal scarring, retinitis pigmentosa, myopic retinochoroidal degeneration, Combined mechanisms 1 (20%) 0.51, 71.64 0 keratoconus (only 2 cases) Optic atrophy 1 (20%) 0.51, 71.64 1 (14.29%) 0.36, 57.87 No indigenous participants with VI or blindness were found to have trachoma. Not determinable3 0 1 (14.29%) 0.36, 57.87 3Indeterminable = ophthalmologist could not ascribe a main cause of vision impairment blindness CI = Total n 5 7 Confidence Interval

Source: National Eye Health Survey, Foreman et al., 20161

Cataract accounts for 54% percent of non-refractive compared to 61.47% of Indigenous patients1. The reduced vision and blindness amongst Indigenous situation has improved, as the difference in procedure patients compared to 33% amongst non-Indigenous1. rates has decreased: between 2010–11 and 2013–14, Cataract surgery coverage rates from NEHS give an the age-standardised rate of cataract extraction among index relating to access. The numerator is those who Indigenous Australians increased from 5.6 to 7.3 per are waiting for surgery while the denominator is those 1,000 population while the rate for other Australians who have had cataract surgery. Here the comparison was relatively steady at 8.6 to 8.9 per 1,000 population2 is 87.63% of non-Indigenous have accessed surgery 50 Indigenous Eye Health

Figure 1. Cataract extraction by Aboriginal and Torres Figure 2. The ‘leaky pipe’ in the patient pathway for eye Strait Islander status, 2010-11 to 2013-14. care.

Rate (number per 1,000) 12 Indigenous Australians Other Australians 10

8

6

4

2 0

2010-11 2011-12 2012-13 2013-14 Year

Source: AIHW National Hospital Morbidity Database 2013–14 Source: The Roadmap to Close the Gap for Vision summary data quality statement. Canberra 2015.2 report 20116

In Australia there are a total of 230,000 cataract Regular regional Indigenous cataract surgery removes procedures done each year.2 Projections from the the cork from the pipe. Even if surgery is once a year National Institute of Environmental Health Sciences then it is seen as predictable and achievable by patients. (NIEHS) suggest that currently about 3234 Indigenous Done four times a year, blinding cataracts are cured in a adults have bilateral vision loss due to cataract and timely fashion, returning patients to their normal lives. that a total of about 4320 operations per year would Dedicated Indigenous operating lists are a community bring the cataract surgery rate amongst Indigenous activity, supporting one another and celebrating together Australians to the same level as for the country as a then providing positive community feedback on their 3 whole . return home. Indigenous people do not like to leave It is cost effective. PricewaterhouseCoopers estimates their ‘country’ so regional surgery is important. In some the elimination of unnecessary vision loss for Indigenous regions, intensive or ‘blitz’ surgery lists are still necessary Australians will generate a return of $1.60 for every $1 of where demand outstrips regular list capacity but, in the funding for eye care4. long term, more regular surgery funding is indicated7. Good rates of cataract surgery transform a community enabling elders to better nurture the young and freeing Ideals for regional service provision: overcoming carers to go to school and work. Those who have had barriers, sealing cracks in the pipe. the operation will tell you it is one of the most exciting. 1. Continuity of care: The ophthalmologist who works This provides great positive feedback to the whole at the state health regional surgical hub also visits Indigenous community that inspires better use of the Aboriginal Medical Service (AMS) primary care regional eye services. and completes the patient’s surgery at a local surgical Why, in our first world country, is access to cataract facility. surgery low amongst Indigenous Australians? Blinding a. Better care of diabetic retinopathy pre and post cataract are 12 times more common in Indigenous adults operatively is important for the best vision results. but rates of cataract surgery are seven times lower. b. All patients, but especially Indigenous Waiting times for cataract surgery are 56% longer than patients, like to know their doctor and receive mainstream and Indigenous Australians are four times continuity of care in the AMS and the theatre. more likely to have to wait for more than one year for Cultural awareness training and doctor patient 5 cataract surgery . relationships that are built over time are important Indigenous Australians almost entirely use public when committing to surgery. cataract surgery pathways while most non-Indigenous c. When two eye doctors are involved there are cataract surgery is done efficiently in private day more visits needed, repeating similar work, and a surgeries. Analogous to a leaky pipe with a cork in the greater chance of patients being lost to follow up. end, current cataract surgical pathways are failing with 2. Fund holder flexibility when choosing the surgeon patients falling through the cracks that are the barriers and operating facility. to care6. a. The theatre can be public or private: the facility chosen cooperates to give value for money and timely surgery by the surgeon who visits the AMS. Eye2Eye Summer 2016 51

b. Local or visiting ophthalmologist: if the AMS 1. Rural Health Outreach Fund contracts regarding ophthalmologist is not able or willing to provide specialist outreach funding, should require surgeons to surgery for the patient then the state health bulk bill Indigenous patients and visit the AMS regularly. ophthalmologist is offered funding for surgery at the 2. Public hospital administrations should be encouraged to public or private facility. include regular outreach clinics to the local AMS by their 3. Sustainability of ophthalmology visits to the AMS. ophthalmologist. It is necessary to work at the AMS to access many 3. Coordination from the fund holder partnering with the patients who won't visit the state health facility AMS, Hospital and Health Services and surgical facility three to five times to get their surgery. The reasons to make ophthalmologists and optometrists AMS visits for this are complex and can include patient, facility productive and manage the surgical pathway to ensure and workforce barriers. In Queensland the IDEAS better access to regional surgery by fixing the leaky pipe. Van, a mobile ophthalmology clinic, brings the best 4. Proper funding for patient travel and accommodation to standard of care to the door step of the culturally regional hospitals for surgery is required. appropriate AMS improving compliance and Dr Rowan Porter preventing blindness. The surgeon who is willing to visit the AMS 1. National Eye Health Survey, Foreman J et.al.; 2016 should have first right of refusal to do the surgery 2. AIHW National Hospital Morbidity Database (NHMD) 2013–14 data and receive the financial return that improves long quality statement. Canberra 2015 3. National Indigenous Eye Health Survey Team (NIEHS). Taylor HR et. al.; term financial viability of the AMS service and job 2009 satisfaction. If the surgeon at the state facility refuses 4. The Value of Indigenous Sight: An economic analysis. to do the challenging bulk billed clinic work at the PricewaterhouseCoopers Australia (PwC); 2015. 5. Cataract in Indigenous Australians: the National Indigenous Eye Health AMS then ideally he would only be asked to do the Survey; Clinical and Experimental Ophthalmology; 38: 790–795, Taylor surgery if the AMS ophthalmologist is not available. HR; 2010. Recommended solution: 6. The Roadmap to Close the Gap for Vision. Taylor HR et al; 2011. 7. Cataract surgical blitzes: an Australian anachronism. Taylor HR et al Regular regional Indigenous cataract surgery lists removes MJA; May 2015. the cork from the pipe. This above all else will make the flow of Indigenous cataract surgery improve. 52 Policy and Advocacy Matters

Policy and Advocacy Matters National Eye Health Survey report launched

The National Eye Health Survey (NEHS) report was launched on 13 October 2016 at Parliament House in Canberra, to coincide with World Sight Day. The NEHS is the most comprehensive Australia-wide survey of eye health outcomes and prevalence of vision impairment and blindness to date. Altogether, over 4,800 individuals volunteered to participate in the study. The report’s findings suggest that there is an overall decline in vision impairment and blindness in Australia, when compared to earlier eye health population group studies. However, the report also identifies that there is still a significant gap in eye health outcomes among Indigenous Australians, who are three times more likely to suffer RANZCO staff members (L-R) Guy Gillor, Emma Carr and Gerhard Schlenther at the launch of from vision impairment and blindness the NEHS, October 2016 compared with non-Indigenous on the significance of these findings: Aboriginal Community-Controlled Australians (13.6% and 4.57%, “Of those with vision loss, at least 75% Health Organisation, as well as specific respectively). can be easily treated through spectacle Aboriginal Medical Services throughout The report also shed light on correction or cataract surgery. It is Australia, allowed researchers to assess the lingering toll of preventable important that we improve access to vision impairment and blindness key prevalence data in Aboriginal and basic eye health services, particularly in in Australia. The report reaffirmed Torres Strait Islander communities. regional and remote areas in Australia. that AMD remains the leading cause The study is led by Principal Keep in mind that most vision loss of blindness for non-Indigenous Investigator Dr Mohamed Dirani caused by major eye conditions, such Australians, while cataract is the of CERA, and the investigator team as diabetic eye disease, can be avoided leading cause of blindness among includes a number of RANZCO Fellows, with timely eye examinations.” Indigenous Australians. Two-thirds including Dr Peter van Wijngaarden, of vision impairment is attributed to The NEHS project is a result of a large Prof Jonathan Crowston, and uncorrected refractive error, in both collaborative effort led by the Centre Prof Hugh Taylor. Indigenous and non-Indigenous for Eye Research Australia (CERA) and Australians. The report also shows Vision 2020 Australia, with support that Australians who live in remote from a large number of national and areas are more likely to suffer from state/territory based organisations. The The full report and a summary of preventable vision impairment, which large number of collaborators allowed findings can be accessed via the is partly attributed to poor access to the researchers to capture prevalence CERA website at services and regular eye examinations. data in a variety of urban, rural, and http://www.cera.org.au/category/ national-eye-health-survey/ The study’s Principal Investigator, remote locations. In particular, the Dr Mohamed Dirani, has commented collaboration with the National Eye2Eye Summer 2016 53

APAO LDP participants and faculty (Image by Leslie D. MacKeen) APAO LDP a culturally and educationally rich experience

The Asia-Pacific Academy from the usual distractions of life. Ulan rolling hills and fields filled with horses of Ophthalmology (APAO) Bator is a relatively new city, with all the and goats, and an exceptional lunch Leadership Development hallmarks of Soviet planning. Available was provided by some of the senior cuisine included an opportunity to Mongolian ophthalmologists. They Program (LDP) for 2016 sample North Korean food without displayed an extended skill set that I’m started at the APAO Congress having to visit Pyongyang. sure doesn’t appear on the RANZCO in Taipei in March 2016, where The masterclass provided formal education competencies: the ability we had the opportunity to training in topics including effective to slaughter and butcher a lamb, see the presentations of the communication, the practicalities of then cook it in a pressure cooker with 2015 alumni and to undertake negotiating relationships outside of vegetables and stones. Delicious. standard clinical ones, and a series of the first training sessions This February we head to Singapore tools relevant to advocacy. As is often of the LDP. The group of for the third and final face-to-face the case, much learning occurred of the APAO 2016 LDP, at which 2016 includes participants outside the classroom, where the each participant will present their from Bangladesh, Chinese opportunity to spend time with a personal project which forms an Taipei, Hong Kong, Indonesia, group of ophthalmologists from a important part of the LDP. The APAO Japan, Malaysia, Mongolia, diverse range of countries, cultures LDP has been successful in assisting Philippines, Singapore, and health systems provided a fertile interested ophthalmologists to move context for comparative discussions into leadership positions; to date Solomon Islands, Sri Lanka, of the strengths and weaknesses of 31 alumni have taken up positions Thailand and Vietnam. different health systems. Such a trip on standing committees of APAO. I After Taipei, our next meeting was the wouldn’t be complete without a cultural would recommend the program to masterclass: a three-day retreat from social evening, where we experienced any interested ophthalmologist who 2 to 4 September 2016 in Ulan Bator, traditional Mongol instruments, and wishes to extend their skill set outside Mongolia. The masterclass is often a contortionist whose one-handed of the clinical sphere in which we are hosted by a national ophthalmological handstand was far superior to anything already so well versed. society that might not have the I’ve seen at the Bondi Beach muscle opportunity to host a full APAO park. Dr Mitchell Lawlor conference, and Ulan Bator certainly On the final day we headed out to provided an interesting location away Terelj National Park for hiking through 54 Policy and Advocacy Matters

MBS Update

On 1 November 2016 several complementary technologies. in the full document, which is available new retinal imaging item Items 12325, 12326 – non-mydriatic on the RANZCO website. numbers were listed: fundus photography screening for diabetic retinopathy for Indigenous MBS Review Item 11219 – Initial Optical Coherence patients and those in rural or remote The MBS Review continues, and at Tomography (OCT) scan to determine areas. These long awaited items are present the third tranche of clinical eligibility for PBS-listed intravitreal for use by practitioners other than committees has been determined and therapies. ophthalmologists and optometrists, commenced work. Ophthalmology is in Item 11220 – OCT scan following and are aimed at increasing diabetic the fourth tranche and optometry is in administration of PBS-funded retinopathy screening rates in under- the fifth tranche. Fellows will be advised ocriplasmin. resourced areas of Australia. when the composition and timeframes There are significant limitations Full details of the listings are available for these committees are known. and problems associated with the in the online Medicare Benefits Schedule The listing of OCT (above) and also OCT scan item 11219, which does (MBS), and on the RANZCO website. recent changes to some skin cancer not accurately reflect best practice item numbers were independent of use of this technology. These were Minimally Invasive and not related to the MBS Review drawn to the attention of the Glaucoma Surgery process. Oculoplastic surgeons have Department of Health at the time of Following previous correspondence raised concerns regarding unintended public consultation regarding the from the Department regarding the consequences arising from the latter changes, and the Medicare Advisory proposed items. RANZCO was not increasing use of the goniotomy Committee is seeking the advice of the advised in advance of the timing of item number (42758), the Australian Australian and New Zealand Society of the introduction of these new items, or and New Zealand Glaucoma Interest Oculoplastic Surgeons in this regard. of changes to Pharmaceutical Benefits Group New Devices Subcommittee Scheme (PBS) approval procedures. produced a discussion paper and Medicare Advisory Concern has also been expressed recommendations regarding the Committee AGM that the change in PBS requirements appropriate MBS items associated with for Authority approval, which Minimally Invasive Glaucoma Surgery This was held during the RANZCO 2016 were introduced in parallel with (MIGS) procedures. In summary, it was Congress in Melbourne. Having served the above items, may mean that considered that implantation of the six years as Chair of the Committee, some ophthalmologists may not currently available Therapeutic Goods I have now stepped down from this use fluorescein angiography to Administration approved devices position and Dr Brad Horsburgh was confirm diagnoses (in particular for iStent and Hydrus be associated unanimously elected as the new Chair. The membership of the Committee neovascular macular degeneration) with MBS item 42758, as goniotomy remains unchanged. where clinically indicated. The forms a part of the procedure for Australian and New Zealand Society implantation of the device. Further A/Prof Alex P Hunyor of Retinal Specialists is developing a information regarding other devices RANZCO Medicare Advisory position statement on the use of these and associated procedures is provided Committee Immediate Past Chair Eye2Eye Summer 2016 55

Eyes on collaborative care in diabetic retinopathy: improving access to specialist care in remote regions and Indigenous communities

As part of an ongoing series about collaborative care in diabetic retinopathy in Eye2Eye, the RANZCO Policy and Programs team caught up with two pioneering ophthalmologists, Professor Hugh Taylor and Associate Professor Angus Turner, to talk about their work to advance collaborative care arrangements for diabetic retinopathy, particularly in the context of remote regions and Indigenous communities. These interviews are both timely as 2016 saw some significant steps in advancing collaborative care arrangements to improve the scope and quality of diabetic retinopathy assessment and management in Australia, in response to an ongoing increase in overall diabetic rates. This includes the release of two new MBS item numbers for GPs to screen diabetic patients for retinopathy using non-mydriatic retinal cameras, as well as the release of the RANZCO Screening and Referral Pathway for Diabetic Retinopathy (see more details on the RANZCO referral pathways on page 59). The Eye2Eye series about collaborative care in diabetic retinopathy will continue in the next issue with an interview with RANZCO Fellow Dr Rowan Porter, who discusses his work with the Indigenous Diabetes Eyes and Screening (IDEAS) Van project in Queensland.

would start on the 1 November 2016. Interview with The initial application process A All in all, it took a lengthy 22 years began in 1994, and following Professor Hugh Taylor to get the application approved, even three unsuccessful applications though there were approximately On November 1, two new MBS to the Medical Services Advisory a hundred pilot or demonstration Committee (MSAC), a forth application item numbers were introduced projects funded in Australia to see was developed in 2008. It took for General Practitioners how retinal photography works as approximately a year to finalise the to screen diabetic patients a screening program. While these application with all the required projects had all been outstandingly for retinopathy using non- components, however the application successful for the one, three or five mydriatic retinal cameras. needed to be redone as the forms years they had been funded for, This introduction followed a had been revised. The resubmission without ongoing funding these using the new application forms took lengthy process and concerted screening programs stopped except some time but, once finalised in 2010, advocacy by the eye health for one or two such as one in the MSAC apologised that the system had sector, and in particular by Pilbara region with funding from changed yet again and the application mining companies. the Indigenous Eye Health needed to be redone yet again. Unit – Minum Barreng at the By this time, the department could Q Do you envisage a particular University of Melbourne. We understand the polite frustrations impact on screening in rural and spoke with Head of the Unit expressed from ‘a little academic remote areas as a result of the new item numbers? and RANZCO Fellow Professor group on their own trying to do a good thing’ and offered some The new item numbers will have Hugh Taylor about the process A assistance in completing the a big impact across the country leading up to the introduction submission, which then went on to including the rural and remote of the MBS item numbers, and the Pharmaceutical Benefits Advisory area. What was evident in the first its potential impact on diabetic Committee (PBAC). The subsequent National Indigenous Eye Health retinopathy screening and economic assessment took a further Survey conducted [as part of the outcomes in Australia. year with the submission approved survey], was the unmet needs including in November once returned to MSAC. examination for diabetic retinopathy Q Tell us about the Medical Following that, it took more time to in both rural and remote areas. In Services Advisory Committee get the wording of the descriptor Fitzroy [inner-city Melbourne suburb process - the story of how the items right and after laying dormant for the where the Victorian Aboriginal Health were developed and the application majority of 2015, it was announced in Service has been operating since 1973] submitted the May 2016 budget that the funding and Fitzroy Crossing [a town in the 56 Policy and Advocacy Matters

Kimberley region of Western Australia] clinics. Particularly in public settings, mechanism for this critical screening to as an analogy. In Fitzroy the Aboriginal ophthalmologists also need to ensure be done in the primary care setting, and Health Service is only half a mile from that both their clinic and booking staff to free up the ophthalmologists to be The Royal Victorian Eye and Ear hospital, are aware of the importance of triaging able to see the patients who really need the largest eye hospital in the southern those with diabetes especially those treatment and proper management. hemisphere, so there is no shortage of with sight threatening retinopathy. [The 2016 update of the Roadmap to medical professionals but there is a lack The role of ophthalmologists is very Close the Gap in Vision was launched of access and utilisation for services. In important in being able to provide the at the RANZCO 2016 Congress in Fitzroy Crossing, again you have a lack primary care services with the timely Melbourne. More information on the of access and utilisation but also a lack referral services needed for the patients Roadmap is available on the Indigenous of appropriate coverage of medical who have been screened and who have Eye Health Unit website: professionals. problems. http://bit.ly/2gabluw]. Retinal photography being based in Q What would be defined as a Interview with primary care or diabetic clinics hopefully success for the new item numbers? will get everybody with diabetes Associate Professor looked at, and those with poor vision A We look forward to the reduction in blindness and vision loss from Angus Turner or abnormalities will be referred to diabetes, with the immediate indicators the ophthalmologists or optometrists As Director of Outback Vision being the percentage of people with so that the eye care professionals are diabetes who have had necessary eye at the Lions Eye Institute, seeing the patients who really need examinations. The Australian Institute RANZCO Fellow A/Prof Angus to be seen rather than screening all of Health and Welfare is expected to Turner is actively involved diabetic patients. More patients needing publish statistics on eye examination in the delivery of specialist proper attention and management of rates in people with diabetes for both diabetic retinopathy will be helped by Indigenous and non-Indigenous people. outreach services to remote this effective triage. The data will inform Primary Health and Indigenous communities In terms of funding for retinal cameras, Networks who have a key responsibility in the Kimberley, Pilbara, the Commonwealth is providing for the coordination of primary health Goldfields, Great Southern, funding for new equipment only care with specialist care and reporting and South West regions. One for the Aboriginal Medical Services. of examination rates. Aboriginal Health of Outback Vision’s outreach The Department has committed to Services and other primary care clinics reviewing the uptake of the new item would also be tracking the examination projects is the Lions Outback numbers and the processes to see if rates of their diabetic patients to ensure Vision Van, a mobile eye after a 12 or 24-month period there will they are getting the regular eye exams health clinic that allows for be a need for tweaking or adjustment. that they need. service provision in remote Q As the item number is currently Q How do the new item numbers fit areas in Western Australia. limited to GPs, how do you envisage within the Roadmap to Close the Gap Eye2Eye spoke to A/Prof in Vision? training and clinical support for GPs Turner about the introduction so they are comfortable in making use A The new item numbers fit in very of the new MBS item numbers of and/or diagnosis with equipment? nicely with the Roadmap and, of its for diabetic retinopathy 42 recommendations, 35 relate to It is imperative that GPs are A diabetes. The recommendations cover screening. comfortable with diagnosis and use of a wide range of issues including the What are the particular challenges equipment. Every medical student, in Q coordination of eye care provision, in relation to access to specialist care theory at least, is trained how to use an and assessing whether the number of (and particularly, ophthalmologists) ophthalmoscope. There are accessible optometry visits and ophthalmology in remote areas in general and online courses, for example through visits funded are adequately balanced for Indigenous communities in the Indigenous Eye Health Unit as well and met, particularly in the remote particular? as the Remote Area Health Corps, with health outreach areas. Retinopathy further online courses planned. screening fits in perfectly with the A Australia’s population density We, as ophthalmologists, need to be streamlining of eye examination and geography means the specialist mindful that when we receive diabetic of diabetic patients - their referral, workforce is an ongoing issue for the retinopathy referrals, particularly those treatment and the overall monitoring rural and remote areas. In the last few with the sight threatening retinopathy, and coordination of the system. years, a real challenge is providing we see them and process that quickly – These item numbers have the the best levels of care for retinal and ensure that there are good referral potential to be a real game changer conditions needing anti-VEGF therapy. links with the GPs and the primary care as they provide a sustainable funding The traditional model of two to three Eye2Eye Summer 2016 57

visits a year has to be reconfigured into more frequent but shorter trips. For Indigenous patients, whether in the city or the rural areas, these barriers are also present for accessing specialist care. Fortunately, there are culturally appropriate settings often provided in regional towns and in the city, particularly the Aboriginal Medical Services (AMS). The AMS can be accessed more easily and it is worth considering eye health services being connected into these health services. In Western Australia, nearly all of the services have a connection with an eye health service, including in the city. The encouraging news is that there are inroads being made for Indigenous eye health. The recent results from the National Eye Health Survey demonstrated improvements since 2008 with a halving in the prevalence of blindness, though there is still much work to be done while the gap still exists. In May 2014, Mavis Arnott saw her granddaughter for the first time. Brianna, aged 14, is no newborn but until recent cataract surgery, 75 year-old Mavis, a Scheme. The optometrists provide sharing of information for improving Martu woman from Jigalong, was blind. much of the diabetic screening while patients’ health, and seeing a larger role Surgery restored Mavis’ sight, enabling helping the patients with immediate for the integration of ophthalmologists, her to see Brianna for the very first time. vision impairment with glasses. In GPs, and optometrists. I am a firm addition, they facilitate telehealth Looking forward and building believer in continuing education Q with the patients to help consent on the success of the Outback Vision and developing ongoing training to directly for surgery. This saves Van are you able to share any lessons colleagues, and when on the road I unnecessary travel and waiting times learnt from this program? always take the opportunity to offer just to meet the specialist in clinic training sessions to both GPs and A The Outback Vision Van has and enables the patient to attend for optometrists on the roles they can completed two full circuits of the surgery directly. Collaboration provide. Western Australia in 16 regional between ophthalmologists and OCT is becoming a standard part communities since March 2016, optometrists is really important. It is of our practice. Centres providing treating 1600 patients. The Van is a all about exactly how we get through outreach ophthalmology will need to unique new service model that delivers the work so that, when a specialist use OCT more as a standard part of their ophthalmology clinic-based care for is visiting, the time used for treating equipment. The cost of OCT machines all major eye conditions close to where patients is not spent on check-ups has significantly decreased in recent people live. This service is provided in that can be done by optometrists. years, and now that machines are often addition to the usual outreach so has If this work can continue to be integrated with the retinal photograph assisted patients by preventing city integrated, this would be much more they are a really useful part of outreach transfer for many conditions where efficient as the patient can get to see visits, aside from being very easy to more specialised equipment is the person they really need. required. use. Q What is your vision 10 years from I am positive about the support The Van travels great distances to now for the system of screening service the 16 towns and specialist and momentum achieved in rural and management, collaborative care, and outreach services, but there are still Indigenous eye health and trust that, referral network? places the Van doesn’t currently with continuing efforts from many on reach. However, more towns are A I look forward to seeing big the team across this country, great reached with the Visiting Optometry advancements in communication and inroads will continue to be made. 58 Policy and Advocacy Matters

The evolving e-environment for collaborative care and clinical communication, privacy and duty of care Media attention concerning the 2001 (Vic) and the Health Records that records documenting clinical recent privacy breach by the (Privacy and Access) Act 1997 (ACT). assessment, decisions and plans for a Red Cross highlights privacy The Privacy Act regulates the patient are available. Ophthalmologists collection, use and disclosure of are required to: risks with health information. “personal information”1. • maintain legible, contemporaneous The Red Cross has one of the best In addition to reputational issues patient records; brands in the world, with its donors, as experienced by the Red Cross, the • ensure that clinical notes are dated volunteers and blood donors really penalty for a serious and repeated and that the author is identifiable; embracing the importance of its vision. breach of the Privacy Act can be up to • ensure operation notes outline the So when the Red Cross had an electronic $1.8 million for a body corporate and procedure performed, including any data privacy breach of half a million $360,000 for an individual. specific problems encountered; blood donors’ health information, Under the Privacy Act, every private • document a postoperative plan that donors in the media were repeatedly sector medical practitioner is required includes treatment until the patient quoted saying, “It doesn’t matter, to have and make available a Privacy is next to be reviewed; and because it’s simply more important to Policy setting out how the practitioner • comply with privacy legislation and ensure records are not subject to give blood”. collects, uses and discloses personal unauthorised access. The increased use of technology information, how the individual may is revolutionising modern medical access their personal information It is a breach of the Code to breach the practice. Health care providers are held by the practitioner or make confidentiality of the doctor patient required to uphold high standards for a complaint, and whether the relationship by making records available protecting patient privacy, whether in practitioner is likely to disclose the to others not involved in the care of hard copy or electronically. They need personal information overseas. the patient or without the patient‘s permission (other than as may be to ensure that they have appropriate Overseas disclosure may be relevant, required by law). privacy and security risk management for example, if the practitioner stores These obligations equally apply to strategies in place concerning how information in the cloud. new technologies. they collect, use and disclose personal Further, each practitioner must The Office of the Australian information. take such steps as are reasonable Information Commissioner has stated in the circumstances to protect the that “email is not a secure form of What is personal information? information from misuse, interference Personal information is information communication and you should develop and loss and from unauthorised or an opinion about an identified procedures to manage the transmission access, modification or disclosure. 2 individual, or an individual who is of personal information via email”. In addition to privacy obligations, Looking ahead, the RACGP and reasonably identifiable: medical practitioners owe obligations of a. whether the information or opinion Optometry Australia have called for the confidentiality to their patients. end of faxing within three years, with is true or not; and all correspondence to be sent through b. whether the information or opinion Industry Codes and Guidelines Many medical professional organisations secure electronic systems. is recorded in a material form or not. have guidelines relating to patient Health information is ‘sensitive Duty of care in relation to confidentiality and privacy, including medical records and referrals information’ and as such requires a in the emerging needs for electronic In relation to communications between higher level of privacy protection than communications. ophthalmologists and other clinicians, other personal information. The Medical Board of Australia – ‘Good there are a number of legal duties, Medical Practice, A Code of Conduct for The legal framework including the following: Doctors in Australia’ requires medical underpinning changing norms a. The law recognises that a doctor practitioners to ensure that their The key legislation articulating the has a duty to warn a patient of medical records are held securely and levels of protection required for all are not subject to unauthorised access a material risk in the proposed health information in the Australian (paragraph 8.4.2). treatment. A risk is material if, in the private sector is the Privacy Act 1988 RANZCO’s Professional Code of circumstances of the particular case, (Cth) (Privacy Act). Conduct sets the policy framework a reasonable person in the patient’s There is also state and territory on communication and electronic position, if warned of the risk, would legislation including the Health communications. Under the RANZCO be likely to attach significance to Records and Information Privacy Act Code, in relation to record keeping, it or if the medical practitioner 2002 (NSW), the Health Records Act ophthalmologists are required to ensure was or should reasonably be Eye2Eye Summer 2016 59

aware that the particular patient, ongoing symptoms and second require modern, secure and accurate if warned of the risk, would be by not creating a follow up system. communication between all those likely to attach significance to it. However, the courts recognise that involved in patient eye care – including Therefore, if the patient has a serious if a patient knows of the risks but ophthalmologists, optometrists, GPs and medical condition then the medical makes their own decision not to hospital eye services and, in some cases, practitioner should advise them of undergo testing, then provided the patient themselves. the seriousness of the situation and that the medical practitioner has Clinical innovation and information the importance of attending further established that they appropriately technology offers significant advances referred tests, and appointments etc. advised the patient of the risks, the in modern health care and improved communication with patient outcomes. b. There is a duty to ensure that the medical practitioner will not be Patients are demanding the best and medical records are accurate, and negligent.6 latest technologies with appropriate this would include ensuring that A person practising a profession privacy protection. medical records communicated to (“a professional”) does not incur a other clinicians are accurate.4 liability in negligence arising from the Dr Kate Taylor, Chief Executive c. A medical practitioner has a duty of provision of a professional service if it is Officer, Oculo care to find out the outcome of a test established that the professional acted Alison Choy Flannigan, Partner, referred by the medical practitioner in a manner that (at the time the service Health, aged care & lifesciences, and to inform himself/herself of the was provided) was widely accepted in Holman Webb Lawyers test results and to offer appropriate Australia by peer professional opinion as 1. Privacy Act 1988 (Cth); My Health Records 7 treatment to the patient in light of competent professional practice. Act 2012 (Cth); Health Records (Privacy and Therefore, the use of technology Access) Act 1997 (ACT); Health Records and the report.5 Information Privacy Act 2002 (NSW); and d. There is also a duty of care to follow which enables practitioners to store Health Records Act 2001 (Vic). up a patient who does not return and send information securely and 2. https://www.oaic.gov.au/agen- includes a follow up system can assist cies-and-organisations/guides/ for further testing or consultation guide-to-securing-personal-information despite being asked to do so. There practitioners with their duty of care. 3. Rogers v Whitaker (1992) CLR 479 4. Kite v Malycha (1998) 71 SASR 321 can be two types of negligence, Quality communication is 5. Kite v Malycha (1998) 71 SASR 321 first, an allegation that the doctor critical for collaborative care 6. Kite v Malycha (1998) 71 SASR 321; Grinham v was negligent by failing to tell the The College’s Strategic Plan (2017-2020) Tabro Meats Pty Limited; Victorian WorkCover Authority v Murray [2012] VSC 491 patient to return in the appropriate puts collaborative care as a clinical and 7. For example, Civil Liability Act 2002 (NSW), timeframe regardless of their health systems priority. Success will section 5O

Collaborative care

RANZCO is committed to and the RANZCO Referral Pathway for As part of the process for analysing working collaboratively with Diabetic Retinopathy are available on the outcomes from the use of these all optometrists and GPs to the RANZCO website (https://ranzco. guidelines, RANZCO has agreed a edu/ophthalmology-and-eye-health/ Memorandum of Understanding (MoU), achieve the best possible collaborative-care). or statement of intent, with Specsavers eye health results for people These referral guidelines do not (Australia and New Zealand) to run across Australia and New favour, and are not dependent upon, a two-year pilot program. Given the Zealand. any particular practice referral system number of Specsavers optometric To this end, RANZCO has launched or methodology. They simply provide practices in Australia and New Zealand, glaucoma, diabetic retinopathy and a resource for optometrists, in the this pilot will allow us to efficiently AMD referral guidelines which have main, which lays out a suggested gather significant metrics and data been developed with the guidance of referral pathway if they identify certain to assess the effectiveness of the Prof Stuart Graham, Prof Robyn Guymer symptoms. The aim is to ensure patients guidelines. and Dr John Downie, respectively. receive the best care possible, in the Working with Specsavers on this Many Fellows have contributed to the most appropriate timeframe and from project does not limit the availability development of the referral pathways the appropriate health care provider. of the referral guidelines, and they are and work continuously on refining RANZCO wishes to ensure that the being promoted and made widely the documents, monitoring progress, limited funding for healthcare, both available to all optometrists and GPs and educating optometrists and GPs. public and private, is used in the most across Australia and New Zealand. The RANZCO Referral Pathway for efficient manner. This requires good To provide feedback about the Glaucoma Management, the RANZCO collaboration by ophthalmologists, referral pathways, please email us at Referral Pathway for AMD Management optometrists, GPs and patients. [email protected]. 60 RANZCO Museum

A year in the RANZCO Museum

The Museum has received many donations at an increasing rate. Thousands of surgical instruments as well as very large pieces of equipment ranging from giant perimeters through early phacoemulsification machinery and fundus cameras are stored at the CAVAL centre, La Trobe University. Many pieces of equipment require cleaning and restoration before storage. RANZCO Congress displays take months to prepare and design. The layouts are mocked up before transport to the conference site where the exhibit is assembled in a tight time frame. Many thanks to our donors and helpers. Dr David Kaufman, RANZCO Museum Curator and Mrs Kirsten Campbell Eikanometer being stripped and realigned

Items are on public access display on the RANZCO Museum website at https://ranzco.edu/museum.

Museum Congress display set-up team

62 Feature article Eye2Eye Summer 2016 63

New Fellows - the next generation of ophthalmology

To become an ophthalmologist relocated to Auckland. Having a one must undergo a minimum family from a medical background of 12 years of study and probably guided my own path to medicine and I became passionate training. The RANZCO about a career in ophthalmology Vocational Training Program after my first exposure to it as an makes up five of those years undergraduate. After my medical as RANZCO trainees undertake degree, I worked towards a exams and assessments postgraduate diploma in ophthalmic anchored by placement at basic science, as well as a doctorate accredited training posts. in medicine looking at optic nerve injury and retinal ganglion cell gap A Graduation and Awards junctions. I completed my ophthalmic Ceremony is held at the training in the Auckland and Waikato RANZCO Annual Scientific regions and my subspecialty training Congress to celebrate the in glaucoma at Moorfields Eye achievements and future Hospital, London. prospects of the newly Dr Rachael Niederer I first had my interest in graduating RANZCO Fellows. Dr Zoe Gao Drs Zoe Gao, Shenton Chew, Rachael ophthalmology sparked working Niederer, Antony Clark and Anu Mathew with Dr Stephen Best as a medical were among those who graduated student and was hooked following an at the 2016 RANZCO Congress and elective attachment with Professor have agreed to share with us their Helen Danesh-Meyer. I loved research goals, passion and drive for a career in and after a few small projects during ophthalmology. prevocational training I started a PhD with Professor Charles McGhee Q Tell us a little bit about yourself looking at how corneal nerves and how you came to medicine and regrow following corneal transplant. ophthalmology. The PhD had one third clinical time, which gave me a great intro into the Dr Zoe Gao profession. I actually never intended to study medicine! My dad always joked that I Dr Antony Clark was so good at arguing as a child that My family are not at all medical but I I would make an excellent lawyer. I was always interested in science and had this romantic idea that I would be fascinated by how the body works, in a courtroom like the TV show ‘The so when it came time to choose a uni Practice’. It wasn’t until I was putting in course medicine seemed like a good my university preferences that I realised fit for me. I fell into ophthalmology as Dr Shenton Chew a legal career would be very different. I a Resident Medical Officer when I was chose medicine because I loved science Dr Shenton Chew nearly heading down the cardiology subjects but I had no idea if I would like I am a glaucoma subspecialist training path. I liked that most things it. It turned out surgery really appealed who commenced full-time public in ophthalmology you diagnose by to me. My interest in ophthalmology employment in January of 2016 in seeing the disease process before your was sparked by my grandpa being Auckland, New Zealand. I was born own eyes. There are a lot of very cool diagnosed with glaucoma. Now, I love in New Zealand and spent some of innovations and the high-tech aspect my job and I can’t imagine myself my formative years in the rural North of ophthalmology appealed to my doing anything else. Island, after which time my family inner geek! 64 Feature article

Dr Anu Mathew Region. I hope that I can continue to My parents travelled to Borneo to be be involved in both these areas in the among the first medical specialists future. there in the 1980s. As education SC The transient nature of the training options were limited, I went to a British scheme as well as overseas fellowship boarding school in India from the age time means that I am excited about of eight. Back in Malaysia, my mother the continuity of care that the saw an advertisement in the local responsibility of being a consultant newspaper for permanent residency brings. Establishing rewarding long- applications to New Zealand, so she term relationships with my patients applied for the whole family. I moved is something I am looking forward to, to New Zealand at the age of 15 and as glaucoma is a discipline where one stayed with a local homestay family really grows old with their patients! as my parents decided to stay and My plans include remaining highly work in Malaysia. It was something committed to the public health system of a culture shock to say the least. with the aim of improving the delivery But I eventually made a good group of glaucoma care in Auckland, having of friends. Having parents as doctors a significant role in registrar teaching made medicine an obvious choice and training, and I would love to set Dr Antony Clark for me. I attended medical school in up a clinical glaucoma fellowship in Auckland as an undergraduate. Auckland. I initially wanted to do general surgery but I came to my senses in the 5th RN Following my fellowship in London year of medical school. I decided I returned to New Zealand to take up that I wanted to pursue a career that a consultant position in Auckland. I’m allowed for a mix of surgery, medicine loving being back in the country and and lifestyle, and ophthalmology living by the beach again. It is fantastic was the obvious choice. After an to be working in my specialty – I think internship, I was lucky enough to you learn as much in the first few years be able to organise a great research back as a young consultant as you do project studying trachoma in the on fellowship. I’m lucky to have some Pacific Islands. The project allowed me exceptional mentors to help me along to travel, get a taste of epidemiological the way. research and also live in Melbourne. I AC I completed fellowships in met my to-be-husband on my second glaucoma and paediatrics and am busy day at the Centre for Eye Research establishing my public and private Australia. I was fortunate to get on the practice in these areas. After all this Melbourne training program and I’ve time studying and working for others been here ever since. I’m most excited about finally setting up my practice the way I want it. Q Having recently graduated as Dr Rachael Niederer a fully qualified ophthalmologist, Is there an area of ophthalmology Foundation Fellowship, I was Q what are some of your plans and you are particularly interested in? lucky enough to work with Dr Tim what are you most excited about in Henderson in Alice Springs. This ZG I have subspecialty interests commencing a career in this field? was an amazing experience with an in oculoplastics, paediatrics and ZG I have recently returned to Hobart, entirely different set of challenges strabismus. However, cataract Tasmania and am starting to build up to try and improve outcomes for the surgery is still my favourite private practice which is both exciting Indigenous population. I also went to operation. It is so satisfying and and challenging. The autonomy is the Pacific Eye Institute in Fiji where rewarding both for me and my extremely refreshing and I’m really I was actively involved in teaching patients! And this extends to enjoying having much more time for the local trainee ophthalmologists. the developing world. Having my patients. It was very rewarding seeing the performed Manual Small Incision I also want to continue to work trainees’ progress and I hope my little Cataract Surgery in Fiji and seen the in central Australia and be involved contribution will have an impact on outcomes, you just can’t beat the in international development. the future of providing sustainable eye surprised happiness on your patients’ Having completed the Fred Hollows care to our neighbours in the Pacific face when they can see again. Eye2Eye Summer 2016 65

Oculoplastics is quite different from before I become affected. begin to make our lives much more cataract surgery but I like the challenge efficient in the clinic. We’ve spent a lot SC In terms of glaucoma, there is of reconstructing the eyelids and, of our time being put off electronic a plethora of minimally invasive again, seeing the results is always very medical records by their clunky design glaucoma procedures, which I have rewarding. Australia is severely lacking in slowing down clinic flow but newer been fortunate enough to have paediatric ophthalmologists and I hope systems are coming around that will been trained in. As the evidence that I can help to fill this void in Hobart. aid rather than hinder our practice. base for this grows, this could lead Harnessing the wealth of health data RN I love uveitis! I really enjoy the to a paradigm shift in the surgical created by these systems will provide detective work and the interaction with management of glaucoma, which us with a greater insight into our other medical specialties. Surgically, is exciting. The role of computer- clinical practice that will undoubtedly uveitic cataracts can be a challenge, and based artificial intelligence in clinical lead to improved clinical outcomes. help me keep my skills up. I trained with decision-making is also going to be an Professor Susan Lightman at Moorfields interesting field to follow. AM A greater understanding of Eye Hospital in London which was genetics and the implementation RN Ophthalmology is a technology- fantastic as she sees patients from all of genetic therapies will change heavy specialty and I can see it over the country, and often brings in the practice of ophthalmology and becoming more so, which is exciting cases emailed to her from colleagues all especially paediatric ophthalmology. for us, as the more information the over the world. I saw a lot of pathology As imaging technologies improve, better when making difficult decisions. during my time there. becoming more portable, faster and AC I’m a little biased towards having greater resolution, we will AM I love paediatric ophthalmology. glaucoma but I think we can expect develop a better understanding of The specialty allows me to do a bit of to see some significant advances in disease processes, and thus we will be strabismus, retina, cataract, glaucoma, this area, particularly in terms of new able to modify treatments accordingly. oculoplastics … all in just a younger pharmacologic agents and advances age group. It is very difficult to get What changes do you hope to in micro-invasive surgical techniques. Q bored doing paediatrics, especially see in your professional lifetime? These changes will hopefully give with the varied caseload at the Royal glaucoma specialists more options ZG I would like to see females have Children’s Hospital. However, it is to choose from before having to turn more of a presence in leadership nice to have a change of scenery and to traditional filtration surgery. I’m roles within the College. I am one of I enjoy the complexities of adult also optimistic about their potential only four female ophthalmologists in strabismus at the Royal Melbourne impact on paediatric glaucoma, Tasmania! With the number of female Hospital. For a change of pace, I also which has always been a great trainees now basically equalling male see general ophthalmology patients at challenge to manage and is sorely in trainees, I would hope that within my the Royal Melbourne and the Western need of a breakthrough in treatment. professional lifetime, this will happen. Hospitals. On a broader level, I think we are at I would also like to see the Q What innovations do you see a time where e-health initiatives will elimination of avoidable blindness happening in ophthalmology over as per the Vision 2020 initiative. the next few years? I remember reading an editorial by Dr Bob Casson in Clinical & ZG I think telemedicine and the Experimental Ophthalmology increasing use of smartphone where an alien comes to earth technology will hopefully make a and cannot understand how, if we difference to patients in remote areas have a solution for cataract related accessing care. As we all become blindness, it could still be the leading more connected, new issues involving cause of visual impairment on the privacy and security will need to be planet. This was a very poignant addressed. The advances in stem cell moment for me and hence my keen therapies and specifically targeted interest in undertaking the Fred gene therapies are exciting. The rapid Hollows Foundation Fellowship and development of new technologies is desire to continue in international one of the aspects which attracted me development. to ophthalmology in the first place because it is forever-changing. Our SC Revolutionary breakthroughs jobs will never stagnate and be boring! in treating previously irreversible Personally, I would love to see blindness are certainly what I better options for the management would love to see. Nothing is of presbyopia in the next ten years Dr Anu Mathew worse than counselling a patient 66 Feature article

with first presentation advanced by the use of the RetCam and find a way of achieving more with less glaucoma that they do not meet teleophthalmology in Victoria. time, whether that involves smarter use driving requirements and this cannot I am involved in the Leadership of technology, increased partnership be restored. To see techniques for Development Program run by with other health professionals, or successful visual pathway regeneration RANZCO and my project for the course streamlined treatment pathways. We would be amazing. is to try and come up with a strategy want to provide the best possible care to implement this goal. RN I can see a rise in more personalised for our patients and are loathe to cut I would also like to have better medicine over time. Particularly services, so we will have to be inventive. collaborations with various where some of the new and very AC Navigating the challenges of subspecialties at both the Royal expensive therapeutic options are delivering high quality healthcare Children’s and the Royal Victorian Eye available, we are likely to see the in the face of dramatically rising and Ear Hospital. For instance, we have use of these more targeted to the costs, dwindling health budgets and started a multidisciplinary uveitis clinic patient’s disease process and genetic increasing regulatory burden will be at the Royal Children’s Hospital. This makeup. Uveitis is still a speciality in its tough. The ‘grey wave’ of our aging clinic has a rheumatologist, paediatric infancy, with many diseases defined population will only exacerbate this and ophthalmologist and, hopefully in by a clinical description rather than is undoubtedly going to make life very the near future, a uveitis subspecialist an understanding of pathological busy! process. I hope to see greater insight in the same clinic to see all complex into disease processes and subsequent uveitis patients. AM At present, my biggest challenge is leaps forward in treatments. Another improvement I would balancing work and my commitment like to see is developing a better to my husband and toddler. One of my AC I’d like to see trabeculectomy an working relationship with our other challenges is finding time to keep operation of the past! optometry colleagues. To that end, up with the literature and with advances Q What improvements and as a representative of the Royal in both general ophthalmology and my differences do you, yourself, hope to Children’s Hospital, I have been relevant subspecialties. in communication with various make? Q What advice would you give to optometrists to explore referral SC I would love to see improved access those still undergoing training to pathways to reduce our clinic waiting to quality tertiary level eye care. At a become an ophthalmologist? lists, to offer our patients more hospital level, this can be improved affordable options and to collaborate ZG During training years, it can be with the effective use of available on research. easy to lose perspective of the bigger resources and I am fortunate to be picture. Often you are totally focused on What do you see as some of the part of the ophthalmology service Q the next exam, and particularly RACE, challenges in this career? improvement steering committee in which can be very consuming. I would one of my district health boards. We will SC Our hospitals already have limited say whilst you do have to put in the explore how to best streamline current resources for the volume of patients effort and dedication to passing, don’t pathways for patient care, and how to that we service and this problem is lose sight of what you are doing this best integrate things like virtual clinic only going to worsen with the aging all for. In the end, our patients are most services and optometric collaborative population. It has been a privilege important and it’s their appreciation of care. to be able to highlight this issue as how you treat them that will make an RN I’ve continued my passion for a spokesperson for a recent public everlasting mark on your career, not an research and completed several advocacy campaign launched by exam paper. Finally, I would reiterate papers during my fellowship. I want the RANZCO New Zealand Branch. what previous young consultants have to continue to contribute to the Lobbying for more government said to me – really enjoy and take full understanding and management awareness about the national nature advantage of your fellowship time. It is of disease and, if I’m lucky enough, of this problem and the need for more a unique period in your life when you to improve practice. I also want to support and funding is a necessary and have relatively few responsibilities but play a role in registrar teaching in the difficult task. If more resources are not an amazing opportunity to learn. I am future, I was lucky enough to have available, having to make tough calls so thankful for my supervisors who have some excellent teachers during my about the rationing of treatments and taught me skills which will be invaluable registrar training and I’m keen to help care would be particularly challenging. to my ability to practice as a consultant new registrars coming through where RN It’s an interesting time for ophthalmologist. possible. ophthalmology at present. The ageing SC I would suggest to them to have AM I hope to help make retinopathy population combined with tightening pride in their level of training. Having of prematurity screening more of health spending is really stretching seen the level of similarly experienced readily accessible and standardised, departments. We are all going to have to international colleagues, I think that Eye2Eye Summer 2016 67

we are fortunate to have a distinct day at work becomes so much more children. I swim whenever I have the edge in ability and competency. rewarding. chance, and I am returning to running This can only be continued by What do you like to do in your again, trying to improve my half giving back to the registrar training Q spare time? Do you have any hobbies marathon time. My husband recently program and I would urge them or favourite activities? bought a boat so apparently I am about not to forget this as they take to take up sailing… up consultant roles throughout ZG I love cryptic crosswords and Australasia. puzzles. I would love to become fluent AC My husband and I have a two-and- a-half-year-old boy and so my spare RN Training is an amazing time to in French as I think it is a beautiful observe other consultants, not just language and I would like to have more time is spent playing and having in their clinical decision making time to play the piano and become a fun with the family whenever I can. and surgical skills, but also how better photographer. Now that I’m back Swimming and running are good ways they interact with patients and in Tasmania, I am also keen to get out to let off some steam at the end of a colleagues, and how they structure and do some more bushwalking. busy day. the various demands on their time to SC I enjoy golf and tennis, and try AM At present, most of my spare time their best advantage. Watch closely! to keep in shape with regular gym is taken up by an active, cheeky toddler. AC Work hard, study smart and try to sessions. However, when I do get some time enjoy your time as a trainee. It’s easy RN I love the beaches and the weather to myself, I enjoy playing the piano, to get too focussed on exams but at in New Zealand – that was a big factor playing European board games with the end of the day it’s your patients in returning from the UK. I live about my husband (e.g. Catan) and trying that teach you the most and make a three-minute walk from the beach new recipes. learning the most satisfying! and I can often be found there out of AM If you find a subspecialty or a working hours, usually in the company geographic area of need, then every of my husband, Fraser, and our three Tips from Senior Fellows to New Fellows

DR EMMANUEL GREGORY (RANZCO Past President) DR ALEX BL HUNYOR

Your work/life balance is often the hardest to get Keep up to date with your chosen subspecialties right, because there are so many ever-changing 1 but with an eye on general ophthalmology. 1 aspects of this.

Try to dictate reports to your referring You may already have a wife/husband/partner and 2 practitioners as soon as possible after the 2 maybe even children. This may mean two careers consultation as some of your thoughts may not at different stages, the need to support each other have been recorded as well as you might have and be a cohesive team whether in childrearing, felt. general home duties, common or individual outside interests and common overall life goals.

When in doubt about the appropriate medical or The balance between ‘what’s in it for me’ and 3 surgical decision always consider that the patient 3 for the remainder of the family is also not could be your parent, sibling or offspring and static, and so will be different at various stages always remember the patient comes first — so and sometimes you are the giver and later the how would you want them to be looked after? receiver.

Despite the pressures of overheads and financial Always try to have regular family holidays and 4 issues always take sufficient time to listen to your 4 remember that job satisfaction and patient care are patient and understand their expectations. more important than money. 68 Branch Musings

Branch Musings New South Wales Chair: A/Prof Andrew Chang Vice Chairperson: Dr Robert Griffits Hon Secretary: Dr Daya Sharma Hon Treasurer: Dr Christine Younan Country Vice Chairperson: Dr Neale Mulligan The AGM of the RANZCO NSW Branch was held on Monday, 14 October 2016 at the Board Room of the Establishment. The event was Dr Penny Browne (Avant) addressing an attentive audience of NSW Fellows at the AGM well attended by NSW Fellows. A/Prof Andrew Chang, Chair of the NSW Branch, reported on the financial position and Branch activities during the year and thanked the efforts of the Committee. Guest speakers were: • Dr Iain Dunlop,Chair of the Ophthalmic Prosthesis Clinical Advisory Group, presented on the ‘Future of the Prosthesis list’. We learned of the pressure from Private Health Insurers to control access to more expensive intraocular lenses. • Dr Penny Browne, Senior (From L-R): Dr John Downie, Scott Dunn (Zeiss), Emma Carr (RANZCO) and A/Prof Andrew Medical Advisor with AVANT, Chang promoting diabetic retinopathy screening during National Diabetes Week, November 2016 gave a stimulating talk on the medicolegal traps facing Ophthalmologists and provided Fellows, Dr John Downie, ophthalmologists. She covered grant funding for the Ophthalmic Prof Mark Gillies, Prof Samantha the pitfalls of privacy issues. Her Research Institute of Australia Fraser-Bell and A/Prof Chang talk reinforced that health insurers application by a researcher from (supported by Emma Carr and Bobak are attempting to influence the NSW. Researcher Dr Sook Chung, Bahrami) met with MPs to explain the activities of all sectors of doctors. who was the 2016 recipient of the importance of screening for diabetic • Dr Brad Horsburgh addressed grant, presented on her research retinopathy. It was much appreciated and welcomed questions from into an animal model of macular that Scott Dunn from Zeiss provided Fellows regarding the RANZCO/ telangiectasia. a non-mydriatic camera to perform Specsavers memorandum of understanding concerning National Diabetes Week photographic screening of diabetic retinopathy. co-management of glaucoma. RANZCO joined Diabetes NSW in The NSW Branch continued support promoting National Diabetes Week at A/Prof Andrew Chang of the Australian Society of Parliament House in November. NSW Chair, RANZCO NSW Branch Eye2Eye Summer 2016 69

Cases are triaged and referred onto Last year we brought forward our Queensland either Royal Perth or Fremantle annual Pathology Imaging meeting Chair: depending on the problem; as there to the end of September rather than Dr Russell Perrin is no theatre facility for eye cases, holding it in December. The full day Hon Secretary: any surgical work necessitates a meeting had over 70 participants transfer. The trickiest aspect of this Dr Anil Sharma and the quality of the presentations arrangement is managing inpatients Hon Treasurer: was excellent, particularly the cases in the State Burns Unit that have Dr Oben Candemir presented by the registrars. We Stevens-Johnsons Syndrome. With were fortunate in having Associate After protracted negotiations our new management protocol being Professor Fiona Pixley from the with Queensland Health, the two developed by Dr Tom Cunneen, we are Pharmacology Department as the accredited registrar training posts trialling those that require ammonitic Eye Surgery Foundation Lecturer. Her have been reinstated at Royal Brisbane membrane as bed-side procedure. talk on the ’ibs and abs’ of modern Hospital. Drs Dianna Conrad and It may be some time before the biological therapies made a difficult Maria Moon are to be congratulated FSH eye services are upgraded topic clear in an impressive way. Our on their hard work and determination to a satisfactory situation; in the next meeting is the Inter-Hospitals in achieving this outcome. meantime we are working to avoid Meeting to be held on Friday 10 Organisation is well under way for a major management catastrophe. March at the Harry Perkins Medical next year’s Queensland Branch The complicating matter is the split Research Institute hosted by Royal Scientific Meeting. The theme will be of the Southern Area Health Service; Perth Hospital. This will be followed at ‘All Things Retina’. An excellent panel Royal Perth is now the hub for the 5pm by the Branch General Meeting, of international and local speakers is new Eastern Area Health Service and at which Branch Executive and Federal confirmed. This will include Dr Cathy we expect further changes to the Council positions are up for renewal. Egan, Dr Nicholas Jones, Prof Paul health services as the smaller district The Congress in Melbourne Mitchell and Dr Adnan Tufail. The hospitals become ‘re-purposed’ or in November 2016 had many meeting will be held at the Sheraton de-commissioned. Fellows from the West attending. Mirage on the 4-5 August 2017 to The health service restructuring in As a Branch we were pleased to take advantage of Queensland’s Western Australia was a concern to the see that the Australian Society of delightful winter weather. As always, College Training Post inspection team Ophthalmologists had established Queensland welcomes our interstate who recently visited all our training an annual Andrew Stewart Lecture colleagues. positions. Whilst all positions were as part of their meeting on the successfully re-accredited, of concern Dr Russell Perrin Saturday. I was proud to see a number to Prof Geoff Lam is the up-coming Chair, RANZCO Qld Branch of fine presentations on the Branch opening of the new Children’s Hospital, Collective Audits at the meeting. Dr Jo as we may be short two theatre Richards has worked hard to produce sessions which could result in the loss Western some great CPD opportunities for our of one of the registrar training posts. Branch members. Australia We thank Prof Glen Gole and The Melbourne meeting will be a Prof John Crompton for their hard Chair: hard act to follow, but our Convenors, work in inspecting our training posts, Dr Nigel Morlet A/Prof Angus Turner and Dr Fred which also necessitated a trip to Chen, and the Branch look forward Hon Secretary: Bunbury in the southwest of the state. Dr David Delahunty to greeting our inter-state colleagues In July, RANZCO organised a half at the RANZCO Congress in Perth this Hon Treasurer: day Cognitive Institute workshop year. For those also keen to investigate Dr Tom Cunneen on ‘Dealing with difficult colleague the southwest, stay on and join us at Over the last twelve months the interactions’. A/Prof Mei-Ling the WA Branch Meeting in Margaret Fiona Stanley Hospital (FSH) has Tay-Kearney, Chair of the local River the weekend following. We have continued with the ad hoc ophthalmic Qualification and Education some great recreational activities service, fortunately without major Committee, and Dr Steve Colley, planned for the Wednesday afternoon incident. There are no consultant Director of Training, along with that week such as cycling, golf and ophthalmologists attending the around half the clinical tutors and the ever popular sailing event on the hospital, but Dr Jean-Louis De Sousa supervisors, attended this worthwhile mighty Swan River before you head and A/Prof Dimitri Yellachich have session on dealing with potentially south. ensured that the clinic is manned by volatile high-stakes situations. Further a registrar rotated out of either Royal training in this important area is Dr Nigel Morlet Perth Hospital or Fremantle Hospital. planned for this year. Chair, RANZCO WA Branch 70 Special Interest Groups

Special Interest Groups

Not long to go until ISOO 2017 comes to Sydney

I am pleased to extend the oculoplastic surgery. Although the two pathologist and he is assembling warmest of welcomes to meetings will be separate, there will an international team of world you all to the next Annual be one 90-minute combined session renowned ocular pathologists. This workshop should be of interest to Scientific Meeting (ASM) of on the morning of Saturday, 25 March, the theme of which will be how our general ophthalmologists, ocular the RANZCO NSW Branch to knowledge of ocular melanoma can oncologists, oculoplastic surgeons, be held in conjunction with benefit from the study of cutaneous ophthalmology registrars and others the 18th Biennial Conference melanoma. The session will feature who want to update themselves in of the International Society of six lectures, with three from ocular this subject which is the foundation Ocular Oncology (ISOO) from oncologist ophthalmologists and three of our specialty. The workshop will 24 to 28 March 2017. from Australian medical experts in the be for a whole day and will run in field of cutaneous melanoma. parallel with the plenary session. The venue for the combined Four didactic 90-minute sessions The workshop is open to delegates conferences will be the newly and have been organised by our visiting attending the RANZCO NSW Branch completely rebuilt International international experts as follows: ASM as well as to those attending Convention Centre on Darling Harbour, ‘Retinoblastoma and its Differential ISOO 2017. a state of the art facility on the The social program will feature waterfront in the centre of Sydney. Diagnosis’ run by Dr Jerry Shields from a welcome cocktail reception on Numerous good hotels are situated Philadelphia, USA; ‘Lymphoma’ run by the evening of Friday, 24 March at within an easy walking distance from Dr Bertil Damato from San Francisco, the Darling Harbour International the convention centre. USA; ‘Conjunctival Tumours’ run by Convention Centre. This will also be The RANZCO NSW Branch ASM will Dr Carol Shields from Philadelphia, attended by ISOO delegates and run from 24 to 25 March and ISOO 2017 USA; and ‘Eyelid and Orbital Tumours’ will be a great opportunity to meet will run from 24 to 28 March. The two run by Dr Santosh Honavar from international leaders in the field of separate conferences will take place Hyderabad, India. These experts have ocular oncology. simultaneously in two separate side- each organised an international panel Dr Gina Kourt is chairman of by-side auditoria, each with a capacity of speakers to assist them during each the RANZCO NSW Branch ASM to hold 400 audience members and of their sessions. component of our combined separated by a sliding wall. On Friday, 24 March there will be conference and she joins with me in The theme for the RANZCO NSW a workshop on ‘Ocular Pathology’ this welcome. Branch component of the combined run by Dr Hans Grossniklaus from meeting will be ocular oncology/ Emory University, Atlanta, Georgia, Dr Michael Giblin, Convenor, ISOO oculoplastic surgery, focused on USA. Dr Grossniklaus is both an 2017 and Dr Gina Kourt, Convenor ocular oncology as it relates to ophthalmologist and an ocular RANZCO NSW Branch ASM Eye2Eye Summer 2016 71

ANZGIG The Australian and New Zealand Glaucoma Interest Group (ANZGIG) was active at the RANZCO Annual Scientific Congress held in November 2016 in Melbourne. A highlight at the meeting was the talk given by the Congress invited speaker, Professor Keith Martin from A/Prof Anne Brooks (ANZGIG Chair), Prof Keith Martin, Dr Guy d’Mellow (ANZGIG Deputy Cambridge, United Kingdom. Prof Chair) with other attendees at the Glaucoma Breakfast Lecture Martin gave a number of lectures glaucoma. He illuminated us on research ideas. The meeting will be including the Glaucoma Update some of the difficulties of managing held in Brisbane from 4 to 5 February, Lecture, a lecture on protecting and uveitic glaucoma and shed some preceding the ARVO-Asia meeting. regenerating the optic nerve, and new thoughts on the management, This will give visitors the opportunity the Allergan sponsored ANZGIG to visit two world class meetings glaucoma breakfast. Allergan also particularly emphasising the in one city. ANZGIG 2017 promises supported other ANZGIG education importance of managing these to be an exciting event delivered activities this year with the Allergan difficult eyes with our physician in a welcoming and collegiate Save Sight Years Quality of Life Audit colleagues. In the glaucoma update environment. and the ANZGIG meeting, USB CPD lecture, he seamlessly went from To register, please visit the ANZGIG activity. clinical to laboratory science and, in 2017 website. Registrations are open In his series of talks Prof Martin particular, gene therapy in glaucoma. until Friday, 3 February. was able to effortlessly traverse Prof Martin will return to Australia We look forward to seeing you in from clinical management to this year as the invited speaker for Brisbane. laboratory science with expertise. the annual ANZGIG meeting, where The glaucoma breakfast talk was on we will be able to hear more of his Dr Ridia Lim the surgical management of uveitic insightful clinical and world leading Secretary ANZGIG

33rd Clinical & Scientific Meeting & NeuroVision Training Weekend NOSANeuro-Ophthalmology Society of Australia 14-17 September, 2017 at Sheraton on the Park, Sydney

Guest speakers: Prof Nancy J Newman and Prof Valerie Biousse Both these superb clinician researchers and educators are from the Emory University School of Medicine, Atlanta, Georgia, USA.

Program highlights will include: Leber Hereditary Optic Neuropathy: from bench to bedside What’s new in Giant Cell Arteritis

For more information please check online: www.nosa.com.au 72 RANZCO Affiliates

RANZCO Affiliates

Dr Peter Sumich, Dr Ashish Agar and Mr Kerry Gallagher, at the ASO AGM, Melbourne 2016

of Ophthalmologists’ (ASO) Annual jump is, I believe, proof positive that ASO Update: our General Meeting. The opportunity to the work ASO is doing to engage great profession report on ASO activities for the year is ophthalmologists at all stages of an important one. To me 2016 was a practice and in all parts of the country After more than 40 years’ year of great progress for the Society. is having traction. practice as an ophthalmologist Having overhauled our operations ASO is led by a cohesive, youthful, it is wonderful to be able to to become a Company Limited, ASO and committed Governing Board is now functioning as a more modern and its focus is clear: to be a voice say I am as passionate about organisation — one geared towards for ophthalmologists practising in my profession today as I was outcomes and efficiency. Australia. back when I was a wide-eyed We had some important wins in Every new member of the Society registrar fascinated by one 2016, the most notable of which adds to our lobbying muscle. I of the body’s most beautiful was our success in highlighting the thank those doctors who chose to organs. threat of managed care posed by the join ASO in 2016 and give them the introduction of Specialist Eligibility same commitment we give to each This passion always seems to be Forms by a number of private health and every member of the Society: heightened when I am among my peers funds. we will strive to support you in your at a gathering like the RANZCO Annual Thanks to the efforts of ASO work as medical specialists and Scientific Congress. these forms have been identified as business professionals, both with Having at the time of writing just inappropriate for use. This issue serves our own resources and through been in Melbourne, our buzzing cultural as a strong warning to health funds our membership of the Council of capital, for five days of soaking up all that doctors simply will not accept Procedural Specialists, of which we that Congress has to offer I feel renewed. any outside interference in the sacred form a pivotal part. We will advocate 2016’s Congress program was doctor-patient relationship and that all for you and your patients to ensure jam-packed with opportunities to providers of healthcare must be held that excellence in ophthalmology learn, explore, interact, and even accountable for their actions. care is safeguarded and that equity of relax. I definitely came away from the Strong growth in membership of access to services is maintained. experience more knowledgeable and as ASO has been another highlight for ASO looks forward to a dynamic always grateful to be a part of a specialty the Society in 2016. 2017. that is constantly seeking advancement. Last year we recorded an 18% Congress was, of course, also the increase in membership — our Dr Michael Steiner setting for the Australian Society biggest spike for some years. The President, ASO Eye2Eye Summer 2016 73

Representing the interests of ophthalmologists and their patients throughout New Zealand

In the public hospitals such issue has been unfathomable. ONZ ONZ update initiatives have resulted in a is working towards a more balanced Ophthalmology New Zealand displacement of patients with chronic process for us to effectively advocate illness from follow-up clinics. ONZ (ONZ) is the independent on behalf of our patients in order has helped shape the New Zealand for them to be able to access these member organisation for ophthalmology response to the treatments within their policies. ophthalmologists in New increasing workload, recognising that Like other New Zealand medical Zealand. Like the Australian ophthalmologists want to be more practitioners, we have struggled to Society of Ophthalmologists, than just part of a collaborative eye have any effective influence on the it works with RANZCO in care team, but that their expertise changing model of private health areas that ophthalmologists puts them at the centre. Our private insurance, being led by Southern practices recognise this approach but are passionate about. Cross, towards a more managed it seems it hasn’t been recognised care system. As with many things, ONZ advocates from a different so well in public hospital practice. our strength (and that of ONZ) is perspective to that of the College, Fortunately, most New Zealand for our common goal of better when ophthalmologists can find ophthalmologists work at least ophthalmic care for New Zealand. the common ground that unites us. part-time in public hospitals in the Many of the ONZ board are Other agencies are keen to exploit our prevailing salaried system and as a ophthalmologists who have had group we have capacity to contribute differences to meet their agenda. or still have roles with the College more if resourcing allows the District We recently sent out a survey to and appreciate the need for an Health Boards to employ us. assist us in identifying where ONZ organisation like this as a separate Recently RANZCO has looked to should be putting its energies over entity. ONZ input on the current campaign to the next year. This is important to us, With the announced retirement of raise awareness in New Zealand of the as with limited resources, we need to our Executive Officer, Cameron McIver, under-resourcing of eye care which know our activities are focused where the board considered several options has shown itself in the blow-out of the majority feel they should be. for the ongoing direction of ONZ. Membership of ONZ is open to all We have engaged Moira McInerney follow up cases. as our new Executive Officer. Moira We also represented ophthalmology ophthalmologists on the New Zealand was CEO of the large private practice, together with RANZCO in a New specialist register and trainees. Auckland Eye, a year ago, and is now Zealand Medical Association initiative There is good support from RANZCO doing a variety of roles in New Zealand on the governance of complaints Fellows, but we are aiming for 100% and Australia. We thank Cameron about medical practitioners’ fees in membership. for his work with us in getting ONZ New Zealand. For example, at present If you are not a member, we established and wish him the best in there is no process in New Zealand for urge you to become so. Whilst the his retirement. complaint management, which is led ophthalmologists on the board and Improvements in access to cataract by the medical profession, if there was executive of ONZ contribute their surgery in the public health system a concern about overcharging. time voluntarily, the funds to address announced by the Minister of Health An area that needs attention our campaigns and gain advice and is medical insurers refusing to has been led by ophthalmologists. assistance are vital to our ongoing fund procedures for their clients This has at its core a threshold system operations. for care and New Zealand private (our patients). Procedures such as For more information, please email practice ophthalmology has a large intravitreal injections and cyclodiode [email protected]. role to provide care to the unmet laser are an expected part of need such as second eye cataract ophthalmic care and available in Dr Michael Merriman surgery. the public health system. So far this Chair, ONZ 74 Ophthal News

Ophthal News Dr James Muecke receives Eye Health Hero award RANZCO Fellow Dr James Muecke, has been recognised as one of the 2016 Eye Health Heroes for his hard work in treating and preventing vision impairment across the Asia- Pacific region. The Eye Health Heroes program is an initiative of the International Agency for the Prevention of Blindness, in partnership with L’OCCITANE Foundation, designed to celebrate eye care practitioners and front line staff whose everyday efforts behind the Dr James Muecke with a boy who was cured of retinoblastoma at the Vietnam National scenes are making a real difference Institute of Ophthalmology in Hanoi towards universal eye health. “The most rewarding achievement He received an ‘Outstanding Service Dr Muecke is co-founder and Chair for me so far has been our training of to the Prevention of Blindness’ award of Sight for All, a blindness prevention the first paediatric ophthalmologist from the Asia-Pacific Academy of organisation operating in Australia and for Myanmar — Dr Than Htun Aung Ophthalmology in 2011, was awarded internationally. Through Sight for All is now treating 20,000 children each a Member of the Order of Australia Dr Muecke has contributed greatly to year and is using the expertise he (AM) in 2012 and received a South blindness prevention in a number of acquired during his fellowships in countries in Asia by supporting local Australia to train his own paediatric Australian Community Achievement eye care specialists and their teams. His ophthalmologists back home,” said Dr Award in 2013. In 2015 Dr Muecke was efforts have empowered communities Muecke. the national recipient of the Ernst & to deliver comprehensive, evidence- Dr Muecke has received wide Young Social Entrepreneur of the Year based, high quality eye care. recognition for his humanitarian work. Award.

Professor Ian Constable AO recognised at UWA A newly created senior academic role at the University of Western Australia has been named after RANZCO Fellow Professor Ian Constable AO in recognition of his contribution to the prevention of blindness and eye disease. The Ian Constable Chair in Discovery and Translational Ophthalmic Science will focus on new treatments for major blinding diseases such as cataract and macular degeneration. The endowment will found a constellation of research positions. Professor Constable was a fundamental contributor to changing the practice of ophthalmology in Western Australia. He was appointed as the Lions Eye Institute’s first managing director in 1983. The Institute is now recognised internationally as both a centre for clinical excellence and a leader in scientific research. Prof Ian Constable Eye2Eye Summer 2016 75

Vision 2020 Australia and advocacy for better access to anti-VEGF therapies for diabetic macular oedema

Diabetes Australia estimates 2. the administrative processes to DMO and central or branch retinal that 1.7 million Australians obtain PBS authority. vein occlusion. This exciting announcement will work to were living with diabetes In response to these barriers, Vision address the first barrier identified in 2016 and forecasts show 2020 Australia developed a formal by the Working Group, and fulfils position statement, outlining four that this figure is expected to recommendations 1 and 3 put key recommendations to eliminate grow to 2.45 million by 2030. forward by Vision 2020 Australia. these barriers and improve access to Also in October 2016, Vision 2020 The National Eye Health Survey these sight-saving therapies: Australia’s CEO, Carla Northam, wrote told us that more than 453,000 1. permit fundus photography as to the Chair of the Pharmaceutical Australians are blind or vision documentation (rather than Benefits Advisory Committee impaired. Studies have also shown fluorescein angiography) for the (PBAC), Professor Andrew Wilson, that diabetes-related eye diseases, purpose of Authority approval drawing attention to the position such as diabetic macular oedema of anti-VEGF medications statement and in particular the (DMO), account for a significant (currently ranibizumab third recommendation regarding amount of vision loss for Aboriginal (Lucentis) and aflibercept amendments to the treatment and Torres Strait Islander people and (Eylea)), until Optical Coherence criteria to allow for another medical working age Australians. Tomography (OCT) has MBS practitioner to obtain Authority It is estimated that the total indirect listing and is available in rural approval for Lucentis or Eylea on cost of vision loss associated with and remote areas; behalf of an ophthalmologist. DMO to the Australian economy was 2. allow for another medical Following the November meeting $2.07 billion in 2015. Eye health practitioner to obtain Authority of the PBAC, Vision 2020 Australia outcomes are particularly poor for approval for Lucentis or Eylea on was advised that the PBAC had those living in rural and remote behalf of an ophthalmologist, responded positively, recommending locations where there is a lack of easily with the caveat that the the amendment as put forward by available and coordinated access treatment must be prescribed Vision 2020 Australia. to specialist services, such as those by an ophthalmologist or Vision 2020 Australia’s attention provided by ophthalmologists. in consultation with an will now turn to advocating for In early 2016, in response to these ophthalmologist; the provision of OCT equipment concerns, Vision 2020 Australia 3. expedite the implementation to ensure that anti-VEGF therapy is convened a working group of experts of a Medical Benefits Schedule delivered according to best practice to consider barriers of access to (MBS) item for OCT (as standards. ophthalmology services in rural recommended by Medicare By combining expert advice with and remote locations. In particular, Services Advisory Council); and effective and collaborative advocacy, the working group considered the 4. secure funding for OCT Vision 2020 Australia and members availability of existing anti-VEGF equipment to ensure that treatments for diabetic eye disease. are working hard to ensure that anti-VEGF therapy is delivered Taking into account the impact systemic barriers to accessing eye according to best practice of diabetes on eye health and health and vision care services, standards. vision care, the growing number of particularly for Aboriginal and Torres In October 2016, RANZCO Australians living with diabetes and Strait Islander people and those received correspondence from the the gap in eye health and vision care living in rural and remote locations, Commonwealth Department of outcomes for Aboriginal and Torres are reduced wherever possible. Strait Islander people in comparison Health, advising that an MBS item to the non-Indigenous population, for OCT was to be listed from 1 Sarah Davies the working group identified two key November 2016. Item 11219 will Policy and Advocacy Officer, Vision barriers to access to anti-VEGF therapy reimburse the use of OCT as an 2020 Australia for Aboriginal and Torres Strait Islander alternative diagnostic procedure to people and those in rural and remote FA to determine patient eligibility Australia: requirements for initial treatment 1. the diagnostic requirement of with anti-VEGF therapies, including fluorescein angiography (FA) for ranibizumab and aflibercept, in PBS approval; and age-related macular degeneration, 76 Ophthal News

Federal parliamentarians get their eyes checked to mark World Diabetes Day and the ‘Eyes on Diabetes’ campaign to prevent blindness

Over 25 federal MPs and Senators had their eyes checked at Parliament House on 23 November 2016 to enable early detection of diabetes- related damage to the eyes. The event was co-sponsored by two Parliamentary Friends Groups - the Diabetes Group, co-chaired by Rowan Ramsay MP and Graham Perrett MP; and the Eye Health and Vision Care Group, co-chaired by Hon Amanda Rishworth MP and Dr Andrew Laming MP. Minister for Health Hon Sussan Ley MP also spoke at the event. Diabetes Australia CEO, A/Prof Greg Johnson, congratulated Minister Ley on a new Medicare initiative that will increase the number of Australians with diabetes undergoing eye examinations. “At least 165,000 Australians with diabetes have damage to their retina in their eye (retinopathy) and many develop diabetic macular oedema which is the most common cause of Hon Judi Moylan AO, Diabetes Australia President, Dr Andrew Laming MP, Carla Northam, Hon Ken Wyatt AM MP and Greg Johnson, November 2016 vision loss and is on the increase,” A/Prof Johnson said. of non-Indigenous Australians are the number of people who go blind “Diabetes is a leading cause of not having an eye examination at unnecessarily. preventable eye damage and blindness the frequency recommended by the “A National Diabetes Blindness in Australia despite the fact that we are National Health and Medical Research Prevention Initiative would integrate a developed, wealthy nation. Council,” Mrs Northam said. the use of retinal photography for “The great opportunity is that more “New mobile technology and screening and better connect the systematic screening using retinal electronic health records provide easier capacity in general practice, optometry photos can detect eye damage much access to health services, particularly in and ophthalmology services in earlier, and early treatment is more rural and remote areas. Australia with Primary Health Networks effective in preventing vision loss and “98 per cent of severe loss of vision taking the lead in coordination,” he said. reducing the impact of diabetes on from diabetes can be avoided if “Lack of coordination continues to pose individuals and their families as well as detected early, however awareness a major barrier.” reducing health system costs.” of preventing diabetes-related The 2016 World Diabetes Day Vision 2020 Australia CEO Carla eye conditions such as diabetic (November 14) global campaign was Northam said substantial progress retinopathy is low. ‘Eyes on Diabetes’ highlighting the risk could be made by utilising new “Diabetes-related eye disease is of diabetes-related eye disease leading technology and encouraging regular often asymptomatic until it reaches an to blindness. eye examinations. advanced state and outcomes of late The International Diabetes Federation “One in three people with diabetes treatment are usually inferior to early estimates that worldwide 415 million have a diabetes-related eye disease intervention.” people have diabetes and 93 million of yet we know from the National A/Prof Johnson called for a these have diabetic retinopathy. Eye Health Survey that half of National Diabetes Blindness Indigenous Australians and a quarter Prevention Initiative to help reduce Eye2Eye Summer 2016 77

Innovative app brings support to those living with diabetic macular oedema A new app has been released “I hadn’t spoken to many people I hope it gets widely taken up and to support people with about my condition and I wanted to used,” said Prof Taylor. help others similar to me. The app is “Everyone with diabetes is at risk of diabetic macular oedema simple and down to earth. It has good losing vision and blindness. However, (DME). Diabetic Macular solid information just at your fingertips up to 98% of the severe vision loss can Oedema Xplained is a free, without searching on Dr Google,” said be prevented with timely treatment. innovative resource aimed Julia who wanted to be part of the app That is why people with diabetes need at explaining complicated as a way of coming to terms with vision to have regular eye tests, once every impairment. two years for most people and once disease information to Diabetic Macular Oedema Xplained every year for Indigenous Australians. patients and their families has been developed with input I am sure this app will help encourage through storytelling. It from patients, ophthalmologists, and reassure people about the issues.” follows the journey of a real researchers and nurses as well as the Dr Kim Chilman-Blair, Founder and patient and breaks down Macular Disease Foundation, Vision CEO of Medicine X, the organisation 2020 Australia, Optometry Australia, that worked with Julia to tell her story, what DME is and explains Diabetes Australia and The Australian believes that storytelling is the best way risk factors, treatment Centre for Behavioural Research in for patients to understand and retain options, side effects and Diabetes and is sponsored by Novartis information in order to make serious psychological issues. Australia. decisions about their treatment. Professor Hugh Taylor, “Around 80 per cent of medical Available online at RANZCO Fellow and President information provided by doctors is www.dmexplained.com.au, Google of the International Council of forgotten straight away. Diabetic Play and iTunes, Diabetic Macular Ophthalmology, reviewed the app and Macular Oedema Xplained is designed Oedema Xplained features the story of provided feedback on the content. to fill these gaps in a creative and Julia, a nurse and diabetic for over 30 "The app has done an excellent job in powerful way,” said Dr Chilman-Blair. years who was diagnosed with DME making a somewhat complex issue For further information, please visit two and a half years ago. both simple to understand and fun. www.dmexplained.com.au

Images from the Diabetic Macular Oedema Xplained app 78 Ophthal News

CERA researchers win $750,000 to help end endemic eye disease in remote and regional communities

from eye specialists and it has the healthcare settings, particularly in potential to help millions of people regional, remote and Indigenous not only in Australia but worldwide. communities. The Australian Institute “I also want to thank everyone who of Health and Welfare estimates over voted for our project and Google for 600,000 Australians live with vision their extraordinary generosity,” he said. impairment, a number projected to Researchers from the Centre CERA’s Project Lead and PhD increase to 1 million by 2024. for Eye Research Australia candidate, Dr William Yan, who CERA plans to first trial the (CERA) have won $750,000 presented the project to the Google technology with post-operative after competing in the finals judges and received the award, said patients from the Eye and Ear Hospital, he was “absolutely stoked” to win. “It with elderly and disability patients of the 2016 Google Impact is just sinking in,” he said immediately across Victoria, and in schools across Challenge held in Sydney. after hearing the results. Indigenous communities. The prize money will go towards “Now the goal is to create the research for the creation of Vision at solution and help those who can’t Home, an evidence-based software easily get to treatment,” Dr Yan said. algorithm that provides a method “94% of blindness or vision for patients to test their eyesight loss in Indigenous Australians is anywhere there is access to a webcam preventable or treatable and Vision and the Internet. at Home will bring testing to areas “I am thrilled our proposal received with poor access and benefit groups such a positive response from the with great potential for sight-saving competition judges and the general interventions, including children, the public,” said Professor Mingguang He, elderly and Indigenous Australians. It Principal Investigator at CERA and can also be used overseas in remote Professor of Ophthalmic Epidemiology locations.” at the University of Melbourne. The largest challenge to preventable “Our project is a simple hand-held eye disease is the lack of access solution for those who live far away to eye care services in primary Dr William Yan

contributing to social media Facebook Twitter LinkedIn RANZCOeyedoctor @RANZCOeyedoctor RANZCO Eye2Eye Summer 2016 79

Orthoptists develop stroke tool for non-eye care practitioners

Stroke is the third most stroke are elderly, even though it can further improvement of the vision common cause of death and affect any age group. screening tool outcomes. the leading cause of disability “Older people generally have other “If we can improve non-eye care age-related ocular problems that often health practitioners’ ability to assess in adults in Australia. To date, get forgotten, all of which can lead to and understand eye function through rehabilitation and treatment poor visual function, affecting their the screening tool and education have largely been focused on rehabilitation process. package, then their over-referral rate mobility and speech. “If there are disturbances along will come down. the visual pathway, or the cranial However, a number of ocular “This will make a real difference to nerve pathways, there can be ocular conditions can result from stroke, as the outcomes and speed of treatment implications and patients can suffer the brain and eyes are interconnected. in regional NSW, as currently there is from things like double vision, visual In addition, non-eye care health an overburden due to the limitation of neglect, and visual field loss. This practitioners are not always able to ophthalmological services available.” will impact their rehabilitation and distinguish between pre-existing and The validated vision screening tool possibly their ability to drive and have newly acquired eye conditions. This will be introduced into NSW hospitals normal mobility in the long term.” can result in misinterpretation and this year as part of the acute stroke The screening tool’s main over-referrals to already stretched pathway. Ms Courtney-Harris works objective is to help non-eye care ophthalmology services, especially in in partnership with NSW ACI on the health professionals identify both regional areas. validation of the tool and the design of pre-existing and newly acquired eye To improve detection and the education package. conditions in patients diagnosed with recognition of visual and ocular stroke. changes in patients diagnosed with “The tool has the ability to identify stroke, orthoptist and UTS PhD an existing visual problem as well candidate Michelle Courtney-Harris as new ones. If the visual problem is has completed validation processes significant then health practitioners which led to refinement of a vision can adapt their rehabilitative screening tool developed by Neryla processes more appropriately. Jolly from Ryde Rehabilitation Hospital “It is simple enough that busy in conjunction with the NSW Health health professionals such as Agency for Clinical Innovation (ACI). registrars, occupational therapists, An education package allowing physiotherapists or nurses can clinicians to easily adopt the tool when easily incorporate it in to a routine assessing stroke patients is now under examination of the patient.” development. At the Stroke 2016 conference in Ms Courtney-Harris says the elderly Canberra, Ms Courtney-Harris and her are more likely to have on-going supervisor, Professor Kathryn Rose, eye conditions. As such, health Head of Discipline (orthoptics) at UTS, practitioners need to be able to led a workshop for health practitioners decipher between a stroke-related or specialising in stroke to gain feedback pre-existing eye condition. on specific areas of eye health that “One of the main problems is that should be included in the education many of the patients who experience package. This will be developed for Michelle Courtney-Harris 80 Ophthal News

Ongoing support for anyone with low vision or blindness? In an age of technology, it’s still personal connection that matters most

We live in a fast changing world. There are new advances in technology every day. The healthcare space is transforming from the ‘not so futuristic now’ science of personalised stem cell treatments, through to digitally mediated access to online health consultations. A great deal of technological innovation is at work in the low vision and ophthalmological space – much of it on show at the 2016 RANZCO Annual Scientific Congress in Melbourne. Yet amongst all the advanced lenses, amazingly engineered precision surgical provide a holistic support package that the people around the patient so that devices and computers, one piece of helps an individual reach their potential. uniquely sophisticated technology drew they can help promote that person’s As much as we love our dogs, they repeated crowd, to be played with and confidence and independence. patted! aren’t for everyone, and many patients Without a doubt the technology This was of course Maxwell, the need other services instead of, or in on offer has eased the lives of people beautiful black Guide Dog, bought addition to, a Guide Dog. We provide with low vision and blindness. From along by exhibitors Guide Dogs Victoria, orientation and mobility training to help text scanners to smartphones, GPS representing Guide Dogs Australia at people navigate and get around, with technology in long canes, drink level the RANZCO Congress. Beneath the or without a dog, as well as providing metres to help make a cup of tea, occupational therapy to help people live charming exterior of Maxwell lies an implantable magnifiers and the bionic well at home – from making a cup of tea incredible story of innovative genetics eye – the world of low vision support to ensuring they can choose the clothes and training spanning 60 years. He is an is very different from when the first they want, or do their garden safely. example of the ultimate in orientation orientation and mobility training started and mobility technology for hundreds Of course, there are many different types of vision loss. Permanent nationally with Guide Dogs Australia 60 of Australians. For all of these people years ago. nothing matches the fluidity, safety or temporary, gradual or sudden, It is still the personal one-to-one and social lubrication of an intelligent ophthalmological or neurological, support and understanding of our partner in getting them from A to B, and complete loss, recoverable, unknown… connecting them with the community. all needing a highly personalised practitioners, with individually designed A Guide Dog is not a last resort, but an approach. Patients often have programs built around individual elite form of support. accompanying concerns like depression, goals, that really make the difference to Understanding and measuring the mobility or speech issues. No patient’s people’s lives as they learn to live well real outcomes that people achieve with support plan is ever the same. with their vision loss. It’s the human their Guide Dogs is just one of the ways People with low vision or blindness touch that makes them feel part of a that Guide Dogs Australia is responding are part of a community – a network community, giving them the confidence to the changing needs of the low vision of friends, family and community. to get out and about. And, of course, for and blind community. Often this network needs assistance many of them, the canine touch as well. A diversified range of services so that they can understand better If you want to know more visit accessible through one point is also how to live with, support or work with http://www.guidedogsaustralia.com/ increasingly essential. Just as complex a person with low vision or blindness. to click through to the Guide Dogs healthcare situations in the acute We live in such a visual world, it’s almost organisation in your state. environment are being looked at more impossible to comprehend what it’s through a multi-disciplinary lens, like to lose your vision and what level of Sophie Wild ongoing support services need to assistance is appropriate. A large part Marketing Manager, Guide Dogs bring in experts of many disciplines to of our practitioners’ jobs is to support Victoria Eye2Eye Summer 2016 81

Scholarship Report A Very Worthwhile Time Paediatric Ophthalmology and Strabismus fellowship in Toronto

I have gained a great deal of clinical and surgical skills during my Paediatric Ophthalmology and Strabismus fellowship at the Hospital for Sick Children in Toronto. These skills are very complementary to those I developed through my general ophthalmology training and the previous paediatric ophthalmology fellowship I completed in Western Australia in 2014. I look forward to returning home to New Zealand and using all of these skills to deal with the clinical challenges ahead. The Hospital for Sick Children provides secondary and tertiary level care for a very large population both locally and internationally. I was able to further develop my paediatric intraocular surgical skills with both straightforward and complex cataract, glaucoma, anterior segment dysgenesis and trauma cases. I have learnt a great deal from being involved in the care of these patients both in the immediate and longer term post-operative period. I have gained confidence in my ability Allez, allez, allez! Family dog sledding in Quebec with commands only being useful if they were to counsel these patients and their in French families with respect to prognosis, opinions regarding treatment. This One of my objectives for my complications and day-to-day logistics allowed me to develop a more time in Toronto was to increase my of management. robust understanding of how this exposure to adult strabismus. This was I have also gained more experience disease behaves, and times when achieved with a three-month rotation of retinopathy of prematurity (ROP) where adult strabismus was the it is safe to watch rather than screening and treatment. Again, primary focus. I had opportunities treat. During this fellowship I have because of the nature of the hospital, to be involved both clinically and there are a large number of babies had the opportunity to give both surgically with complex adult and needing screening within the intravitreal Avastin injections and paediatric strabismus cases. I saw hospital, as well as babies referred laser treatments for retinopathy of different techniques for adjustable from other neonatal units for second prematurity. sutures, a variety of methods for 82 Scholarship Report

oblique surgery and approaches to My family and I enjoyed our time of my fellowship for being the most managing challenging complications in Toronto. It is a wonderfully diverse outstanding ophthalmology fellow referred for expert opinions. city and we valued learning about at Sick Kids. Other areas where I gained and experiencing a number of I am very grateful for the new clinical experience include cultures different to our own. We also opportunities I have been given, and the field of retinoblastoma. I was enjoyed learning to ice skate and my family and I are very thankful for exposed to different imaging and how to dress to avoid freezing when the support from the RANZCO/Bayer treatment modalities than I had seen the temperature dropped below scholarship I received. I look forward previously, and it reinforced to me minus 20 degrees Celsius. to returning home and positively the importance of multidisciplinary Overall this extra fellowship year contributing to paediatric ocular teams to provide the best possible has allowed me to develop my health in New Zealand, registrar care for children in these situations. clinical and surgical skills to a level training and to the College to the One of the greatest learning where I am confident and excited to very best of my abilities. opportunities were the be returning home. I have been able Dr Anne-Marie Yardley oculogenetics clinics. The large to form relationships with a large population of Toronto and its number of colleagues with a great surrounding areas, along with deal of experience who I will be able the complex and varied ethnic to look to for guidance and advice backgrounds meant I saw a number in the future. I believe I have made of diseases I had previously only had the most of this opportunity and academic knowledge of. Learning was very humbled to be awarded how to investigate these diseases the Morin Award at the completion both clinically and molecularly in a rational way was very worthwhile. It also gave me a great appreciation of the vital role genetic counsellors can play in disclosing and discussing diagnoses with patients and their families. During my previous fellowship in Perth I had developed a research interest in paediatric ocular trauma. I was able to further concentrate on this area during my time in Toronto. The main focus of my research was investigating the visual and refractive outcomes of children undergoing surgery for traumatic cataract and the factors that influenced success. I valued this opportunity and believe I have increased both my overall research skill base and my interest in this area and other aspects of paediatric ophthalmology. Being exposed to different health systems has also been a very worthwhile part of my fellowship experiences. The objective of having the best health system possible is very honourable. My time working in different systems has reinforced that there is no perfect system, however all systems I have worked in have their strengths, and are different in their weaknesses. Out and about in Toronto — making the most of freshly groomed ice and -26 degrees Eye2Eye Summer 2016 83

RANZCO Office

recommendations and requirements My relevant qualifications are Master RANZCO office of accreditation report as well as of Adult Education and Training (UTS welcomes new maintain and enhance the existing 1999) and Master of Business (UTS practices commended by the 2005). I am currently (apprehensively) staff member Australian Medical Council. waiting a viva voce from Middlesex University in the UK in a Doctorate of A bit about my background…I The College office in Sydney Public Works after having submitted have over 15 years’ experience in welcomes new staff member, my thesis in June 2016. The area on professional association executive which I presented my thesis was Ruth Ferraro, who officially management in both education and emerging a profession. took on her role as Deputy professional standards domains. I CEO and Head of Education in feel I have found my niche in helping late 2016. professional bodies deliver applied Ruth Ferraro education. Nowhere more than in Deputy CEO and Head of the professions is applied education Education and skill more prized. I am excited to bring this to my role at RANZCO. I joined RANZCO in October 2016 in a newly created position which has I pride myself on my ability to work responsibility for the whole lifecycle consultatively with subject matter of Education - both Vocational experts to help them create the best Training Program and Post-Vocational education outcomes for trainees. Education and Standards and with IT In doing so those trainees can be and HR in my portfolio. inspired by experts. I therefore At this key point in RANZCO’s look forward to meeting the many accreditation cycle it is important dedicated leaders who contribute to underline our commitment to so generously to RANZCO and to continuous improvement and the trainees who aspire to Fellow to work towards fulfilling the membership. Ruth Ferraro

RANZCO staff get lesson in ‘eye-natomy’ Recently RANZCO Fellow and Vice President Dr Diana Semmonds kindly volunteered to provide RANZCO staff with an overview of ophthalmology at the College offices in Surry Hills. It was an excellent opportunity for staff to get a better understanding of the day-to-day work of ophthalmologists and the various eye conditions they treat. Dr Semmonds also delivered a brief introduction to ‘eye-natomy’ and provided tips on how to maintain healthy vision. The session was incredibly worthwhile and we thank Dr Semmonds for this opportunity. RANZCO staff receive an introduction to ‘eye-natomy’ 84 RANZCO Office

World Sight Day 2016 activities World Sight Day is held annually on the second Thursday of October, raising awareness about the global issues of avoidable blindness and vision impairment. The theme for last year’s World Side Day was ‘Stronger Together’ and RANZCO staff gathered for a healthy breakfast to celebrate this important event and help raise awareness about eye health and vision care.

RANZCO staff gather for a healthy breakfast to celebrate World Sight Day 2016

RANZCO staff also participated in Vision 2020 Australia’s #snapfforsight social media campaign to help raise awareness of eye health and the importance of having regular eye examinations.

A collection of images submitted by RANZCO staff for the #snapforsight social media campaign Eye2Eye Summer 2016 85

Calendar of Events 2017

EVENT DETAILS WEBSITE 2017 ANZ Cornea Society & Eye Bank 4 February 2017 W: http://anz-cornea-society.org/ Meeting Queensland Gallery of Modern Art Stanley Place South Brisbane QLD Australia ANZGIG Scientific Meeting 2017 4-5 February 2017 W: www.anzgig2017.com Stamford Plaza Brisbane 39 Edward Street Brisbane QLD Australia ARVO Asia 5-8 February 2017 W: www.ranzco.edu and go to the Brisbane Convention and Exhibition calendar of events Centre 3rd Asia - Australia Congress on 9-12 February 2017 W: http://www.comtecmed.com/ Controversies Ophthalmology JW Marriott Seoul cophy/aa/2017/general.aspx (COPHy AA) 176 Sinbanpo-ro, Seocho-gu, Seoul, T: +82 (0)2 6282 6214 137-040, South Korea Australia & New Zealand Strabismus 24-25 February 2017 W: www.ranzco.edu and go to the Society (ANZSS) – Squint Club, Annual Fisher Paykel Education Center calendar of events Meeting 2 Park Rd Graft, New Zealand Asia-Pacific Academy of Ophthalmology 1-5 March 2017 W: http://2017.apaophth.org/ (APAO) 2017 Suntec Singapore Convention and Exhibition Centre Raffles Boulevard Suntec City, Republic of Singapore Victorian Branch Annual Scientific 4 March 2017 W: www.ranzco.edu and go to the Meeting Woodward Conference Centre calendar of events 10th floor, Melbourne Law (Building 106) 185 Pelham St Carlton VIC Australia 3rd OCT San Raffaele Forum 17-18 March 2017 W: www.ranzco.edu and go to the San Raffaele Congress Center calendar of events Via Olgettina, 58 Milan, Italy Cornea & Contact Lens Society annual 23-25 March 2017 W: www.contactlens.org.nz conference Rutherford Hotel Nelson 27 Nile St W Nelson, New Zealand International Society of Ocular 24 – 28 March 2017 W: http://isoo2017.com/ Oncology (ISOO) Biennial Conference Convention Centre together with the RANZCO-NSW ASM Darling Harbour (24 -25 March 2017) Australia 8th World Congress on Controversies in 30 March to 1 April 2017 W: http://www.comtecmed.com/ Ophthalmology (COPHy) Madrid Spain cophy/2017/welcomeN.aspx SA RANZCO Biennial Scientific Meeting 8-9 April 2017 W: www.ranzco.edu and go to the The Sanctuary, Adelaide Zoo calendar of events 1 Plane Tree Drive Adelaide, SA, Australia 86 Classifieds

Classifieds

Positions vacant OPHTHALMOLOGIST PRIVATE Equipment for sale PRACTICE OPPORTUNITY IN ASSOCIATE OPHTHALMOLOGIST QUEENSLAND ORBSCAN IIZ & ALLEGRO NORTH QUEENSLAND Seeking an ophthalmologist OCULYSER FOR SALE An established practice in North to work in a long established Two corneal topographers for sale, Queensland in a stand-alone Queensland practice with an older Orbscan IIz and Allegro Oculyser. facility is seeking an Associate general ophthalmologist. The Regularly serviced and well Ophthalmologist to become part of practice is located in new premises maintained. Can be sold separately. their dynamic team. with up-to-date equipment. C: Shih Shih The practice has all the latest E: [email protected] P: +61 2 9424 9999 equipment & access to surgical caseload. OPHTHALMOLOGISTS TO JOIN You will enjoy: GROWING PRACTICE IN SYDNEY IOL MASTER • an interesting & varied caseload We are looking for motivated IOL Master 500, with reference • support from a fully trained ophthalmologists to join our image camera. Administrative, Nursing Assistant growing practice near Sydney C: Lisa Seierup Team & Senior Ophthalmologist. CBD. Sessional work available, E: [email protected] Attractive package negotiable. initially on a fortnightly or monthly basis. Subspecialty interest is an C: Tanya Hutley OPTOS OCT SLO SPECTRAL advantage, especially cornea/ P: 0409 760 235 DOMAIN refractive, oculoplastics or Only 28 months old and excellent paediatrics. LOCUM PAEDIATRIC for high-quality retinal images. Now Email your expression of interest OPHTHALMOLOGIST surplus to requirements. and recent CV. 7 June 2017 - 5 January 2018 C: [email protected] (7 months) E: [email protected] Wednesday and Friday mornings. All consultations are conducted after Positions wanted a preliminary paediatric orthoptist assessment. SENIOR OPHTHALMOLOGIST To work in a group sub-specialist AVAILABLE FOR LOCUM WORK ophthalmology practice. Australia/New Zealand Well established and busy paediatric Senior Adelaide-based practice. ophthalmologist available for May be the opportunity to locum at locum work anywhere in Australia the nearby Children’s Hospital for the and New Zealand. same period. C: Dr Alec Jordan C: Dr Joanna Black P: +61 8 8267 2192 P: +61 8 8267 3211 POSITION WANTED SYDNEY RURAL LOCUM POSITION General medical ophthalmologist, AVAILABLE NSW who has been working part-time, Short term or long term. Well with 20+ years experience, is equipped for medical retina, cataract, looking for an extra full day’s work general ophthalmology and plastics. on a Tuesday. Sydney location. C: Ros C: Diana P: 0411 254 282 M: 0411243589