Lions Eye Institute

Annual Report 2018 Annual Report 2018 Annual Report

www.lei.org.au E [email protected] ABN 48 106 521 439

Nedlands 2 Verdun Street, Nedlands WA 6009 Ph +61 8 9381 0777 Fax +61 9381 0700 Email [email protected]

Murdoch Level 1, Suite 24, Murdoch Medical Centre, 100 Murdoch Drive, Murdoch WA 6150 Ph +61 8 9381 0765 Email [email protected]

Midland Suite 11 53 The Crescent Midland, Midland WA 6056 Ph +61 8 6382 0599 Email [email protected]

Celebrating our past, looking to the future The Lions Eye Institute combines excellence in clinical care with world-leading research investigating the causes of eye disease and developing new treatments and cures.

Over 35 years, our doctors, nurses and allied health staff have served the Western Australian community, providing patients with the highest standard of care across all specialty areas. Meanwhile, our research teams have operated at the frontiers of science, working on the next generation and cures for eye disease. Founded in 1983, the Lions Eye Institute has become one of the world’s leading eye research institutes. As a not-for-profit organisation, we rely heavily on community support and thank our patients, study participants, donors and benefactors for partnering with us in our quest to save sight.

Lions Eye Institute 2 Verdun Street, Nedlands WA 6009 Phone +61 8 9381 0777 Fax +61 8 9381 0700 Email [email protected] ABN 48 106 521 439

Media Contact Francesca Robb Mobile 0409 102 556 [email protected] Thank you for

A digital version of this report partnering with is available on our website: us in our quest to www.lei.org.au save sight

Our front cover features paediatric ophthalmologist Dr Antony Clark and medical researcher Dr Livia Carvalho Lions Outback Vision McCusker Director Dr Angus Turner was one of four with Lions Eye Institute founder and outstanding Western Australian finalists in the 2019 Australian of the Patron Professor Ian Constable Year (WA) Awards announced by Governor Kim Beazley in October. Annual Report 2018 1 2018 at a Glance

91 research papers

226 94 Clinical Services staff corneal transplants employed to support 16 ophthalmologists

6,062 donations 4 valued at 19th annual Grateful Patient $1.46 million Ian Constable events Lecture 2,518 patients 14 bequests totalling in 21 communities $621,784 treated on the Lions Outback Vision Van

More than 40 36 grants valued at 60,000 1,315 active Clinical Trials $6.5 million eye consultations eye examinations - a new record by Lions Optics

4,771 patients seen by Lions 27 volunteers Outback Vision in the Concierge outreach services Program

7,900 21,441 kms 929 surgeries and minor travelled by the Vision metropolitan patients procedures - a Van over 353 seen by Lions new record driving hours Outback Vision

2 Lions Eye Institute Annual Report 2018 3 Our Values Our Vision Contents

To prevent and cure blindness and eye disease 2 2018 at a Glance 32 Clinical Services 4 Vision & Mission 36 Community 6 Chairman’s Report 38 Lions Outback Vision Our Mission 8 Managing Director’s Report 40 Development 10 Board of Directors 42 Publications Excellence To achieve leadership in scientific research and clinical practice 14 Celebrating our Past, Looking to the Future 46 Our Ophthalmologists We strive to achieve in the prevention of blindness and eye disease through: excellence in all we do. 16 Vision for the future 52 Lions Laser Vision - global leadership in scientific research 20 Genetics and Epidemiology 54 Lions Eye Bank - translation of research into community outcomes 22 Experimental Immunology 56 Acknowledgments - a commitment to growing the reach of our research capabilities and clinical services 24 Ocular Tissue Engineering 58 Lions Save-Sight Foundation - development and training of outstanding eye care professionals and researchers 26 Physiology and Pharmacology 60 Grants - community engagement and education to build awareness, maintain a high reputation and increase funding 28 Retinal Genomics 62 Financial Statements 30 Clinical Trials 66 Auditor’s Report

Integrity Working towards our vision, mission and organisational goals with respect and honesty.

Respect Recognition of the abilities and diversity of our colleagues, patients and collaborators.

Dedication Commitment and passion for achieving our vision and mission.

4 Lions Eye Institute Annual Report 2018 5 Chairman’s Report

contribution to the Board and I The Lions Eye Institute The year also saw Professor wish her every success. (LEI) celebrated its Constable celebrate his 50th year in ophthalmology: a truly All LEI Board members give freely 35th anniversary in remarkable achievement. of their time and energy and make 2018 - a year in which a significant contribution to the we reflected on past Toward the end of 2018, Managing good governance of the LEI. I thank Director Professor Mackey announced them all. achievements while his intention to formally step down setting our sights firmly from February 2019 to focus on five A personal highlight of the year was on our future potential. funded research projects into the an Appreciation Dinner hosted by genetics of eye disease. Appreciation Dinner, October 2018 the Board in October. The LEI was founded in 1983 by Professor Ian Constable AO, who On behalf of the Board, our Following a major strategic review - Supporting our staff in working It was a moment to reflect on the Peter Forbes created a cutting-edge research stakeholders and staff, I want conducted by Mainsheet Capital in in a safe environment and LEI’s achievements, with many institute to discover and develop to thank Professor Mackey for 2017, the Board continues to focus where career opportunities for LEI clinicians and researchers cures and treatments for blindness his almost 10 years at the helm, upon the future strategic priorities improvement and advancement in attendance, as well as former and eye disease, supported by a progressing the LEI’s standing and of the LEI to sustain its future. are achievable. Chairs Brian King and David Eiszele reputation as a world-renowned and Lions Save-Sight Foundation range of world-class clinical services. - Growing our eye health service medical research institute. In 2018, I am pleased to report we (LSSF) Chairman Ambrose Depiazzi outreach, particularly in Western He was the LEI’s first Managing have either completed or initiated (pictured). Director and in 2018, Professor Professor Mackey will continue his the key recommendations of the Australia’s rural, remote and Constable – our true “founding father” association with the LEI, leading Mainsheet Review. Indigenous communities. I particularly wish to acknowledge - became just the fourth Patron in the the Genetics and Epidemiology - Ensuring our stakeholders are the important, enduring and history of our organisation. research group and mentoring Our key priorities remain: kept fully engaged and form productive partnership between the students and early- and mid-career - Continual improvement to ensure an integral part of our LEI LSSF and the LEI Board. I am delighted that after such researchers. patients who utilise our clinics community. Finally, the LEI is fortunate to a long association, Professor experience excellent and safe In December, the Board announced be staffed by a dedicated and Constable remains passionate clinical treatment and service. In other Board news from 2018, about our vision to the appointment of senior LEI respiratory specialist Grant Waterer passionate team of people who prevent blindness ophthalmologist and researcher - Ensuring our research and was appointed as a non-executive are committed to our values of clinical trials are well supported We reflected on past and eye disease, Professor Bill Morgan as Acting director from May 2. excellence, integrity, respect and committed to the future Managing Director. within the LEI. dedication. I thank each and every achievements while sustainable growth of - Establishing a research Professor Waterer is a Professor of LEI employee. An integral member of the LEI team the LEI and dedicated advisory panel to develop Medicine at Royal Perth Hospital setting our sights for 25 years, Professor Morgan is to promoting the LEI to a comprehensive Research Unit and The University of Western also a member of the Board and firmly on our future our key stakeholders in Strategic Plan which will Australia (UWA). He is currently the brings great insight and institutional government, business prioritise research within the acting Director of Clinical Services potential. knowledge to the role. LEI and develop meaningful at Royal Perth Hospital. and the wider community. Peter Forbes measurements of outcomes. Diana Forsyth officially concluded Chairman - Ensuring our clinicians and her Board role in September patients are provided with following her appointment as the very best equipment and Chief Operating Officer at the consulting and operating Harry Perkins Institute of Medical facilities. Research. She made a wonderful

6 Lions Eye Institute Annual Report 2018 7 Managing Director’s Report

2018 was a year of clinical practice in the prevention of The Ocular Tissue Engineering In other news, the LEI was well- We also acknowledged the loss exciting achievements blindness and eye disease. group focused on generating patient represented at the Royal Australian of Emeritus Professor Bernard derived stem cells for future testing and New Zealand College of Catchpole in April. He was a key for the LEI, with one All LEI research groups reported of novel therapies to treat inherited Ophthalmology (RANZCO) Golden figure in promoting ophthalmology of our most significant significant accomplishments in retinal diseases. This group continues Jubilee Congress in Adelaide. as a speciality at The University of scientific research 2018. to collaborate widely across Australia Lions Outback Vision McCusker Western Australia and helped attract programs reaching Genetics and Epidemiology with the country’s best experts in Director Associate Professor Angus Ian Constable away from a promising fruition. secured a $2.5 million National novel medicine manufacturing, Turner delivered the Fred Hollows career in the United States to Health and Medical Research computer science, engineering, Lecture and a large number of LEI establish the inaugural Lions Chair After more than 20 years of Council (NHMRC) Centre of epidemiology and clinical trials researchers chaired sessions and of Ophthalmology in 1975. to bring the novel treatments and gave presentations. painstaking research and Research Excellence project grant to In November, acclaimed development, a new surgical take new discoveries in the genetics technology from the laboratory Professor David Mackey bench to the patient in clinic. Professor Andrew Dick from businessman Stan Perron AM also intervention for glaucoma, of eye disease and translate them University College London’s Institute passed away. Mr Perron has shown developed at the LEI by into improved patient care. The Retinal Genomics pioneered a of Ophthalmology delivered the great kindness and generosity to Professors Dao-Yi Yu and Bill five-year project includes teams study of the world’s first and only annual Ian Constable Lecture – A many charities and not-for-profits Morgan and the Physiology and from across Australia and involves mouse model of a rare retinal Tale of Two Diseases: Regulating (including the LEI) over many years Pharmacology research group and analysing blood and DNA from disease called Cone dystrophy Immune Responses in the Retina. and leaves a remarkable legacy to their international collaborators, people with eye diseases as well as with supernormal rod response Western Australian medical research. became commercially available for those with healthy eyes to provide (CDSRR), paving the way for new Professor Damien Harkin from the implantation in Australian patients. insight into how genes influence risk treatment pathways. The model Queensland University of Technology Finally toward the end of 2018, of eye disease. closely matches what is seen in gave the 2018 Miocevich Lecture I announced my decision to step The Xen® Gel Stent is a microfistula – The Silk Road: A 10-year Journey down as Managing Director after implant that reduces intraocular Experimental Immunology humans with CDSRR, allowing the researchers to validate treatment Evaluating the Potential Use of Silk almost 10 years in the role. This pressure in the eye. Raised published research demonstrating Proteins for Repairing the Human Eye. allows me to focus all my time on intraocular pressure is the biggest how a common virus triggers long- strategies, better understand the physiology of vision and the five fully funded research projects risk factor for glaucoma. Before it lasting inflammation in the eyes of In October, our Annual Open Day into the genetics of eye disease. was introduced in Australia in individuals with healthy immune pathophysiology of this disorder. attracted an enthusiastic crowd of March 2018, the stent systems. Professor Mariapia In collaboration with American people wishing to know more about It has been a privilege and pleasure was approved for use in Degli-Esposti, the group’s leader, research laboratories, the Retinal eye disease and LEI research. to guide the LEI through a period All LEI research the United States, Europe also announced a move to the Genomics research group is also of significant change and growth and other countries. Monash Biomedicine Discovery developing a gene therapy for a Throughout the year, we hosted and I wish Acting Managing Director groups reported Institute at Monash University while type of Usher syndrome. many dignitaries, including WA Professor Bill Morgan every success The enormous innovation retaining her links with the LEI, Governor Kim Beazley and WA in the role in 2019. significant of the Xen® Gel Stent Our Clinical Trials team was Education Minister Sue Ellery. opening up exciting opportunities extremely busy with more than 40 accomplishments highlights the challenges for collaborative research efforts. I especially want to acknowledge and timelines involved in active trials – giving patients with and thank the remarkable LEI team, in 2018. translating a new therapy Lions Outback Vision published specific eye disorders, or previously who bring passion and commitment from initial concept to research on the growth in telehealth untreatable eye conditions, access to their work each day. commercial reality. consultations and engagement with to new therapies well before they telehealth services – an evolution are available to the general public. With the Xen® Gel Stent, Professor that has reduced waiting times for The WA Atropine for the Treatment Yu and his team have greatly patients, provided continuity of care of Myopia (ATOM) Study, which contributed to our mission to achieve is testing the effect of low-dose and improved efficiency of outreach Professor David Mackey leadership in scientific research and ophthalmology trips. atropine eye drops on myopia in WA children, was expanded in 2018. Managing Director

8 Lions Eye Institute Annual Report 2018 9 Board of Directors

Rudolf Brunovs Dr Margaret Crowley

Mr Brunovs is a Fellow of the Institute of Chartered Dr Crowley is an experienced CEO and Board Director Accountants, CPA Australia and the Australian and a Graduate of the Australian Institute of Company Institute of Company Directors and holds a Masters Directors. She has held senior executive positions in of Business Administration. Mr Brunovs retired as state and national governments, universities and the a partner of the chartered accounting firm Ernst not-for-profit sector - most recently as CEO of the & Young after 27 years as a partner in a number Association for the Blind of WA Inc. for 15 years. Her of their offices. He is currently a Director and the Ph.D. focused on the perceived role of professional Principal of Mainstay Consulting Pty Ltd and a women in the United Nations Secretariat in New York. Director of Deep Yellow Limited. Mr Brunovs joined Dr Crowley joined the Board of the LEI in 2016. the Board of the LEI in 2005.

Chairman Peter Forbes Richard Alder Tony Joyner Professor Ian McAllister

Mr Forbes was a founding partner and former managing partner Mr Alder has worked in the securities industry Mr Joyner has over 25 years’ experience as a Professor McAllister trained in WA with additional sub-specialty of the WA branch of HLB Mann Judd, chartered accountants. He since 1965. He was employed by JB Were for commercial and corporate lawyer and is currently training in vitreoretinal disorders in the USA. He is Director of is the former CEO of specialist medical indemnity mutual MDA 31 years, consulted to Australia’s largest ASX the Managing Partner of the Perth office of Clinical Services at LEI and a consultant ophthalmologist at National and Managing Director of MDA National Insurance. listed investment company, Australian Foundation international law firm Herbert Smith Freehills. Royal Perth Hospital (RPH) and Sir Charles Gairdner Hospital Previous non-executive director roles include Chair of the Investment Company, and was Employer Director Mr Joyner sits on the global board of the firm, (SCGH). Professor McAllister is actively involved in research Victorian health fund provider Transport Health and Law Cover on the Board of the Government Employees and chairs its Risk Management and Audit for cures for vitreoretinal disorders, especially retinal vascular Insurance, the NSW statutory insurer for NSW solicitors. His Superannuation Board. He was a Board Director Committee. He is also Chair of Scitech and a disorders, and has held 10 NHMRC grants in this area as well current non-executive director roles are: Honorary Chair of the of the Royal Flying Doctor Service (Western board member of the WA Chamber of Commerce as numerous minor grants. He has been involved for many years LEI; Board Member of the East Metropolitan Health Service; Operations) and WA representative to the Federal and the LEI. Mr Joyner joined the Board of the LEI in Statewide diabetic retinopathy screening and treatment and Board Member of Farmers Mutual Limited; Board Member of Board and is involved with the Scotch College in 2013. was Vice-Chairman of the Ophthalmic Research Institute of the Local Government Insurance Scheme-WA and; External Foundation. He joined the Board in 2017. Australia and Chairman of the Research Board. He is widely Member of the Law Society of WA’s Professional Indemnity published in scientific journals and received an achievement Insurance Management Committee. award from the American Academy of Ophthalmology. He joined the Board in 2010.

10 Lions Eye Institute Annual Report 2018 11 Staff A block circa 1988

Professor David A Mackey Professor William Morgan

Professor Mackey was appointed Managing Professor Morgan is a consultant ophthalmologist at RPH, Director of the LEI, Professor of Ophthalmology/ consultant ophthalmologist at Perth Children’s Hospital, Director of the Centre for Ophthalmology and Professor at UWA and Co-Director of the LEI’s McCusker Visual Science (COVS) at UWA and Board Glaucoma Centre. He has completed a doctorate in member in March 2009. Professor Mackey has philosophy studying the response of the optic nerve to achieved international recognition as a genetic pressure, particularly in relation to glaucoma. He sees ophthalmologist/scientist. His original research patients with glaucoma and other ocular conditions over more than 25 years into the genetics of such as cataracts. Professor Morgan maintains an glaucoma and in the fields of optic atrophy active research interest in glaucoma as well as in the and congenital cataract has received continued epidemiology of blinding eye disease. He joined the research funding support. Board of the LEI in 2018 and assumed the role of Acting Managing Director in December, 2018.

Thank you to former Director Diana Forsyth Celebrating our past looking to Professor Grant Waterer Diana Forsyth the future Lions Eye Institute today Professor Waterer serves as a Professor of Ms Forsyth is a business leader and management Medicine at the RPH Unit and UWA as well as consultant and has worked internationally across a adjunct Professor of Medicine at Northwestern range of sectors, industries and organisations. She University, Chicago, and adjunct Professor of joined the Board of the LEI in 2017 and resigned in “The Lions Eye Institute is in the business of solving Medicine at Curtin University. Professor Waterer October, 2018. We thank Ms Forsyth for her contribution. problems, namely vision threatening disease, through our is a respiratory specialist but with a particular clinical skills and our research. We have a great team interest in pulmonary infectious diseases. He is currently the acting Director of Clinical Services of people who are passionate, dedicated and skilled and at RPH. He joined the LEI Board in 2018. we have reached a size where our clinical, research and community streams can pursue exciting new opportunities.”

Acting Managing Director Professor Bill Morgan

12 Lions Eye Institute Annual Report 2018 13 In 2018, the LEI paid homage to the many important Also in 2018, the LEI celebrated the hard work and Celebrating figures that have helped shape the institute and the success of a new generation of eye health champions. Looking to cause of saving sight over 35 years. our past the future Planning

The Lions Eye Institute Board talent Vale Stan Perron continued to progress planning for the Ian Constable Chair in Discovery New research The LEI continued to Respected businessman and and Translational Ophthalmic strengthen the composition of its Board with new philanthropist Stan Perron Science. The science-based Young LEI researchers appointments in Grant AM passed away in November. Chair and affiliated research Dr Carla Mellough and Waterer, Professor of team will honour Professor Dr Livia Carvalho were He was a generous donor and Medicine at the RPH Constable’s outstanding awarded a Telethon-Perth supporter of the LEI, with his Unit, and renowned LEI contribution to ophthalmic Children’s Hospital Research financial backing facilitating ophthalmologist Professor Bill science and clinical Fund grant to investigate Patron vital research and treatment of Morgan, who also assumed practice over the past five genetic and environmental the role of Acting Managing blindness and eye disease. decades. This initiative is a factors involved in early Director of the LEI. LEI founding father Professor Ian Constable became collaboration between the onset myopia. LEI and UWA, and has Patron in 2018 to foster support in the community attracted funding from a and promote the achievements of the LEI. Professor range of generous individuals Constable also celebrated a remarkable 50 years in and foundations. ophthalmology in 2018 and remains active today as a clinician and researcher. Among many honours, he was inducted into the WA Science Hall of Fame in 2009. Strong Photo finish partnerships Major first Teaching tools Dr Hessom Razavi has Quadrant Energy and Santos, LEI celebrated a major Chris Barry, considered developed and released Joint Venture Partners in first with Dr Kristopher a new video resource for one of the best A piece of history the Devil Creek Gas Plant, Rallah-Baker becoming ophthalmic photographers medical students seeking reached an agreement to Australia’s first Indigenous further information on the in the world, retired from ophthalmologist. Dr Rallah- The LEI’s Linton Library was the continue supporting eye eyes. Eyeballs Made Easy is the LEI in 2018. He was health services in the Pilbara Baker was based with Lions recipient of a piece of Western a joint collaboration between one of the original staff region, especially diabetic eye Outback Vision in 2018 Australian ophthalmic history the LEI and UWA. Dr Razavi members, starting at Royal health information, provided and formally completed the has also helped develop with the donation of a slit lamp Perth Hospital in 1975. by Lions Outback Vision’s RANZCO Vocational Training virtual reality software that owned by Dame Ida Mann. Outreach Eye Health program. Program in June. takes viewers inside the eye.

Ophthalmic pioneer Eye safety

Emeritus Professor Bernard Catchpole passed away in Perth in April. He was just the second The LEI’s Annette Hoskin is a leader in eye injury prevention. She is a member of Professor of Surgery appointed at UWA medical school and a key figure in promoting ophthalmology the Asia Pacific Ocular Trauma Society and was a guest speaker at the 2018 Ocular as a speciality at UWA. He helped attract Professor Constable from the United States to establish TraumaCON in India. She also spoke at the National University Hospital in Singapore the inaugural Lions Chair of Ophthalmology at UWA in 1975. as part of their continuing medical education for ophthalmologists and optometrists.

14 Lions Eye Institute Annual Report 2018 15 Vision for the future

Professor Morgan is a renowned ophthalmologist and medical researcher who has worked at the LEI for 25 years. He was appointed Acting Managing Director in late 2018. Here, he outlines his bold vision for the future of the Institute.

I was very honoured The big advantages of this are Our clinical services are We are establishing a series of with whom we are beginning This would greatly increase the when the LEI Board that it encourages greater staff internationally recognised and fundamentally important seminars research collaboration as well as service provision to patients input into the management and this is perhaps best exemplified to link the clinical problems with the University of Udayana in Bali. residing in the Northwest and also asked me to take on also brings up people within the by the fact that Allergan, the the research staff, their techniques provide a centre for learning and the role as Acting Institute who have a good working large pharmaceutical and device and methodologies to drive forwards We see this work as fundamentally teaching excellence in that area. Managing Director in knowledge of the amazing but also manufacturer has asked us to be linking fundamental clinical questions important to our long-term clinical mid-December 2018. complex nature of our own clinical one of only two surgical excellence to research techniques which should and research expertise as Indonesia So in short it is an incredible and research cultures. training centres in the world for the deliver results into the future. grows economically and intellectually. privilege to be asked to lead the Institute. Upon accepting the position, I was Xen® Gel Stent. One outcome of our collaborative very fortunate to have the immediate There simply is no other Institute Our core vision is to prevent in Australia with such a strong The Xen® Gel Stent was invented blindness and to treat disabling research has been the successful We are witnessing a turnaround and total support of all the staff and design of a glaucoma drainage in our clinical fortunes and this I the Board members. combined clinical, research and and largely developed here at the and painful eye diseases. We community ophthalmic focus. Most LEI by Professor Dao-Yi Yu and now have enough research device specifically built for believe is driven by fundamental My immediate focus was upon other Institutes are very strong in his team and there have been funds from generous donors to Indonesian patients to be changes in our management the continued restructure of the one of these areas but not strong in 75,000 XEN procedures performed the Ian Constable Chair fund to manufactured in Indonesia at structure. one tenth of the cost of such clinical management systems and all three. worldwide in the last five years. establish a Research Professor of We have also witnessed incredible to work towards the restructure and The fact that Allergan wants us to Ophthalmology at the Institute. current devices. This device should The management of an Institute be released nationally across outcomes from the very active reinvigoration of the research side of be a worldwide centre of surgical translation of our research focused the Institute. like this with such complexity - excellence for Xen is testament to A significant outcome in the next Indonesia in mid-2019. particularly as it has grown - has year will be towards deciding how into clinically fundamental our overall clinical surgical skills Already some 250 devices have questions now delivering improved Restructuring of the clinic had begun formed its own problems over time and infrastructure. best to fund and employ the best in March, 2018, with the formation but I am extremely confident that quality scientist for this position. been inserted into patients with glaucoma care to more than of the Clinical Leadership Committee we are now on track for continued The Xen® Gel Stent is another This will be a very important severe forms of glaucoma in 75,000 patients internationally. Indonesia under the supervision (CLC) - a core group of senior growth, efficiency and great patient example of how our basic research decision for our research base This philosophy will no doubt clinicians who were given more outcomes. in terms of studying a fundamental going forward. of myself and Dr Virna Octariana, Head of Glaucoma at the University underpin the future development of power to make decisions within the pathophysiological problem has research across the Institute and clinical space. An example of the expansion led to direct clinical outcomes Regarding community and teaching, of Indonesia. and increased efficiencies that our community outreach work allow its expansion. benefiting thousands of patients not The other very important We had employed several external have occurred within the Institute only at our Institute but worldwide. extends to local rural and remote We also have tremendous practice managers during the includes the fact that we have communities as well as overseas. development in the community space involves Lions Outback opportunities and developments preceding years and for various set up a new clinic at Midland We are just embarking upon a Overseas, clinicians have been occurring in the community space reasons, including the unique with Dr Hessom Razavi servicing research renewal program and have teaching surgical and other skills Vision, which services many thousands of patients per year both locally and abroad. I very complexity and structure of our disadvantaged and other patients established a research advisory in Indonesia for many years and much look forward to reporting to Institute, this position had proven in that sector. Long-term we see panel with two external scientists, we have more recently begun across the rural and remote communities of our state. you all the developments that occur difficult for any one person to manage. efficient service delivery particularly two senior internal scientists, the collaborating in research with the over the next 12 months. to disadvantaged patients as one of Managing Director, two Board University of Indonesia based in Dr Angus Turner and Dr Hessom Mr Rob Bacon led the transition for our core aims. members and a leading clinician. Jakarta. a period of four months before the Razavi are very active in this space CLC could implement a new more Clinic efficiency is turning, making This creates a small, cohesive and We are developing a Memorandum and have been able to negotiate horizontally-layered structure. This in excess of $1 million dollars more transparent research advisory and of Understanding with that preliminary agreements with structure is allowing and fostering for research and administration assessment panel to drive research University and already have various industry governmental Professor Bill Morgan local feedback and to build up in the 12 month period to March further into the future here at the two others in existence with the bodies towards the formation of a Managing Director (Acting) leadership skills within our own staff 2019 compared with the previous Institute. University of Brawijaya at Malang Northwest Clinical Ophthalmic Hub. members in the clinical sector. 12 months.

16 Lions Eye Institute Annual Report 2018 17 Rod photoreceptors (red) in an adult human retina (retinal cell nuclei can be seen in blue). Rods are responsible for our vision under low light conditions.​ Image by Dr Carla Mellough.

Research Our vision is to prevent and cure blindness and eye disease

18 Lions Eye Institute Annual Report 2018 19 Genetics and Epidemiology

Discovering new genes five Australian centres, with the LEI The project brings together experts responsible for major sharing in this work. in genetic eye disease and clinical trials from around Australia covering eye diseases causing The Genetics and Epidemiology all the critical aspects required to blindness and vision group is a major contributor to this deliver novel therapies to Australian loss remained a major collaborative research program, patients. which is aiming for a future free of focus for the Genetics most blindness. The researchers will also work and Epidemiology towards improving diagnosis and research group in 2018. Modern ophthalmology has made treatment outcomes for familial such great inroads into preventing and non-familial retinoblastoma (a Group Leader Professor David and treating blinding disorders cancer of the eye that affects young Mackey was awarded a highly over the last century that most children), establishing genetic coveted Practitioner Fellowship from remaining “untreatable blindness” testing for developmental and the NHMRC worth almost $600,000 is due to genetic causes. congenital diseases, developing to discover new genes responsible The four primary research aims of accredited genetic testing for risk for glaucoma and myopia. the project are to: prediction in complex diseases and developing protocols for feedback Glaucoma is the second leading • Define the natural history of of results to patients and their cause of blindness while myopia blinding eye diseases with families. is a risk factor for glaucoma, with rigorous phenotyping and rates rising across the world. genetic information. The research aims to identify new • Facilitate and initiate treatment treatments for both diseases and trials for inherited ophthalmic develop family-screening strategies conditions. to identify undiagnosed cases of • Identify genes and mutations glaucoma before it affects sight. leading to blindness in children The $9.4 million grant and adults. The research project builds on was recognised as the a nationwide NHMRC Centres of • Develop world-leading models Excellence, Partnership, Project and for genetic risk prediction and “Top Ranked Program for the feedback of genetic Program grants – From Discovery to Grant” in the country Therapy in Genetic Eye Diseases. results for Mendelian and complex eye diseases. The $9.4 million Program grant was recognised as the “Top Ranked Program Grant” in the country and the largest ever NHMRC grant awarded for eye research. It is distributed across

Researchers are focused on discovering new genes responsible for common inherited eye diseases such Members of the Genetics and Epidemiology research group as myopia

20 Lions Eye Institute Annual Report 2018 21 Experimental Immunology

Monash Biomedicine Discovery Institute

The Experimental been thought not to trigger an While more research is needed to Move boosts Immunology group inflammatory response. determine whether these unexpected findings extend to humans, they published important LEI researchers conducted a suggest that researchers and doctors collaborative new research in series of experiments using a may need to rethink the effect of power 2018 on the role a mouse version of the common CMV – and, potentially, other viruses virus cytomegalovirus (CMV) and – on the eyes. common virus plays examined the effects of systemic in triggering long- infection on the eye of healthy hosts. Some eye problems caused by Professor Mariapia Degli-Esposti announced lasting inflammation dormant or reactivated CMV in in late 2018 she would take up a professorial in the eyes of hosts They found that this common virus people with healthy immune Under her supervision, the targets the eye much more frequently appointment at the Monash Biomedicine with healthy immune systems may be misdiagnosed, Discovery Institute while retaining strong links than appreciated, and that healthy leading to improper treatment that Experimental Immunology systems. with the LEI. eyes become an unexpected could damage vision. group at LEI will continue reservoir for the CMV virus. Published in the medical journal The research was funded by the Professor Degli-Esposti, the LEI’s Director of Research and Head of the its leading work in a PLOS Pathogens, the research CMV infections are common, Immunology Division, is using the move to expand her internationally- Hardie Foundation, the Stan Perron number of important areas reported on the work of Dr Valentina with more than half of the adult Charitable Trust and the NHMRC. recognised research programs and build collaborative research Voigt, Professor Mariapia Degli- population infected, but clinical partnerships between the two Institutes. Esposti and the Experimental symptoms are usually seen only in Immunology group. patients with compromised immune Under her supervision, the Experimental Immunology group at the LEI systems. Dr Valentina Voigt’s research into will continue its leading work in a number of important areas, including: Healthy eyes have been considered the impact of viruses on the eye is the impact of viral infection on the functionality of the eye; the impact largely inaccessible to viruses, The research highlighted that challenging long-held assumptions of viral infection on neurological tissues including the retina and brain; as well as “immune privileged”, CMV infection triggers sustained improving the outcome of bone marrow transplantation and avoiding meaning that exposure to foreign inflammatory responses in healthy complications that affect the eye; investigations of novel therapeutics Professor Mariapia Degli-Esposti is agents, such as viruses, had eyes, including the neural retina. for dry eye disease; and understanding the cause of uveitis and the building cross country research links processes that need to be targeted therapeutically.

22 Lions Eye Institute Annual Report 2018 23 Ocular Tissue Engineering

In 2018, the Ocular recruitment and assessment Tissue Engineering of many more participants with group focused on inherited retinal diseases to prepare them for future therapies. generating patient derived stem cells For many of these individuals, a for future testing of genetic diagnosis is the beginning of new research projects and novel therapies to collaborations to develop treat inherited retinal personalised treatment and diseases. detailed monitoring of disease progression prior to future treatment Led by Dr Fred Chen, this group is essential. continues to collaborate widely across Australia with the country’s Several trials in geographic best experts in novel medicine atrophy, led by Dr Chen, were also manufacturing, computer science, completed in 2018. engineering, epidemiology and Two of the three drugs tested clinical trials to bring the novel showed promising results, which treatments and technology from will be announced at international the laboratory bench to the patient conferences in 2019. in clinic. Encouraging results from the Scientists in the group have LEAD trial (nanosecond laser) for focused on growing stem cells from drusen treatment was announced patients with retinitis pigmentosa The Ocular Tissue Engineering team is focused on developing personalised therapies for patients with inherited retinal diseases in 2018 with further analysis and and Stargardt disease. Potential publications planned for 2019. medicines to restore faulty genes are currently being tested in patient New clinical trials are due to affects one in every 5000 children disease monitoring, modelling cells by the group and the six Ph.D. commence in 2019, including Major cause and adolescents with profound of disease in the petri dish and students co-supervised by Dr Chen. therapies for geographic educational, personal development personalised medicine development. atrophy and newer generation of childhood During 2018, many patients with and economic impacts. of injections medicine for wet inherited retinal disease finally macular degeneration and diabetic blindness in Inherited retinal diseases account received a genetic diagnosis after retinopathy. for 44 per cent of blindness in waiting for many years or decades the spotlight children and adolescents in WA thanks to the boost in research Dr Chen’s clinical trials team and the most common form is funding from the McCusker appreciates the continued support juvenile macular degeneration. Foundation. and referrals from ophthalmologists The Ocular Tissue Engineering and optometrists of patients group announced in 2018 the The Centre of Research Excellence The 2018 Miocevich Retina who might be suitable for these creation of a Centre of Research is being funded with a $250,000 Fellow, Dr Sukanya Arunachalam, clinical trials. Excellence in Juvenile Macular Telethon Perth Children’s Hospital contributed significantly to the Disease to highlight an important Research Fund grant. cause of childhood blindness. It will focus on early clinical Juvenile macular degeneration is recognition of juvenile macular Dr Fred Chen with a young patient who one of the most common causes degeneration, accurate genetic has Stargardt disease - the most common of legal blindness in Australian diagnosis, clinical protocol for form of inherited juvenile macular children. Childhood blindness degeneration.

24 Lions Eye Institute Annual Report 2018 25 Physiology and Pharmacology

The use of the Xen® Gel The concepts have been proven Retinal vascular diseases such as Stent, invented at the experimentally. We are currently diabetic retinopathy and retinal attempting to improve the efficiency vein occlusion are common vision LEI, has been increasing and reliability of the optical fibre threatening diseases. rapidly around the world delivery system. This approach could - particularly in the be an ideal glaucoma surgery to The Physiology and Pharmacology achieve the best surgical outcome. group is focused on early functional USA, United Kingdom, diagnosis and early therapeutic Germany, Switzerland In addition, such ultraviolet laser interventions. One of our new and Australia. surgery also can be used for other techniques for the diagnosis of high precision intraocular surgeries diabetic retinopathy is to non- The Xen® Gel Stent, a surgical at the micron level. invasively detect spatial and treatment for glaucoma, was temporal variations of retinal approved for use in Australia in Increased intraocular pressure is a capillary perfusion clinically. March, 2018. major risk factor for glaucomatous optical nerve damage. We recently published a paper The Physiology and Pharmacology in the highest ranked journal Group continue to provide their The Goldmann Applanation in ophthalmology specifically knowledge and experience with this Tonometer has been the gold describing our progress in this field. procedure gained from more than 20 standard for intraocular pressure years of research and development measurement for decades. Researchers and clinicians are and clinical applications. working with highly talented image The Physiology and Pharmacology analysis specialists and engineers LEI glaucoma specialists, Dr Antonio group is developing a new performing both experimental and Giubilato and Dr Antony Clark, Applanation Tonometer which could clinical studies. have also contributed to further avoid the possible errors associated improving surgical outcomes from a with the Goldmann Applanation For therapeutics of retinal vascular clinical perspective. Tonometer. More than 200 diseases, we are developing At a glance: the Xen® Gel Stent experimental studies have been specific interventions to target the Conjunctival lymphatic drainage performed to identify the errors and causes of the diseases rather than plays a critical role in outcomes improve the prototype device. the complications. For example, of any glaucoma filtration surgery in branch retinal vein occlusion, including the Xen® Gel Stent We have extensively studied we are developing a site-specific procedure. However, there is no retinal vein pulsation pressure technique to release the occlusion commercially available device and are developing a non-invasive site and reduce endothelium which can non-invasively image the intracranial pressure measuring hemodynamic stress. conjunctival lymphatics. technique both experimentally and clinically. The Physiology and Pharmacology group has been working with A new field of orbital pressure leading engineering teams to measurement will be expanded and develop a non-invasive and label cover three critical and interlinked free lymphangiography to image pressure compartments. The Invented at the LEI, the Xen® Gel Stent is a microfistula Surgeons implant the microfistula tube using a needle- lymphatic capillaries before and knowledge gained will help us to tube that successfully reduces intraocular pressure. type implanter in the space between the eye’s anterior after glaucoma surgery. understand the pathogenesis of The tube is about the size of an eyelash, thinner than a chamber and the conjunctiva, the tissue covering the glaucoma, orbital and cerebral human hair and almost transparent. white part of the eye. This creates a bleb, allowing excess The Physiology and Pharmacology diseases and their interactions and group has also worked on fluid to drain from the eye, thereby lowering intraocular provide new strategies for developing pressure – the biggest risk factor in glaucoma. developing a novel glaucoma new diagnostics and therapeutics for surgical approach using ultraviolet these important diseases. laser ablation.

26 Lions Eye Institute Annual Report 2018 27 Retinal Genomics

The Retinal Genomics This testing measures the electrical With a prevalence of less than As the only group in the world that team is working to responses of various cell types one in a million, CDSRR is a owns the Kv8.2 KO, the Retinal in the retina. People affected very rare autosomal recessive Genomics and Therapy Group better understand by CDSRR show very depressed retinal disorder. Patients have a is in a prime position to further and provide possible rod and cone cell activity which progressive deterioration of visual study the disease mechanism treatment pathways for switches to a supernormal rod acuity and colour vision and most behind CDSRR. They also believe response when presented with a of them also present with myopia. that CDSRR would be an ideal a rare retinal disease very bright flash of light. Symptoms of visual loss begin in candidate for a gene therapy based which affects children early childhood and deteriorate treatment as their Kv8.2 mouse This makes the ERG testing an easy and causes life-long rapidly by the second decade provides the ideal pre-clinical diagnostic tool, which is unique to of life. Unfortunately, there is no model to test the treatment. visual loss. this disorder. The abnormal ERG treatment for CDSRR and the phenotype at high light intensities small number of studies about The research team, led by Emeritus suggests a dysfunction affecting the mechanism and cause of this Professor David Hunt and Dr Livia the first stage of photoreception in rare disease has limited progress Carvalho, have pioneered a study the retina. towards a cure. of the world’s first and only mouse model of cone dystrophy with supernormal rod response (CDSRR). The model was developed by the Welcome Trust Sanger Institute and brought to Western Australia from the United Kingdom by Professor Hunt in 2013. Whilst still in the United Kingdom, Professor Hunt led the first study LOOKING TO OUR FUTURE that linked the genetic cause of CDSRR to mutations in a gene called KCNV2. The gene specifies Little fish is a big lure for a channel responsible for the movement of potassium ions across childhood myopia researchers cell membranes in the retina. The retina is unique in the number LEI scientists are using zebrafish techniques and a zebrafish model to time. They are also transparent so of different mutations that cause – a relative of the minnow – specifically target the mechanisms we are able to observe their growth vision loss, with 240 different to study how environmental behind early-onset myopia. under the microscope from fertilised disease genes now identified. factors and genetics interact in egg to fully formed fish in just a Myopia, or short-sightedness, starts matter of days.” As phenotypes do not always the development of childhood in childhood and involves axial correlate with the respective myopia. growth of the eye ball so that it The researchers are hoping to answer genotypes, molecular analysis becomes more egg-shaped. how genes and environmental factors Dr Livia Carvalho and Dr Carla is the only way to detect the influence the development of myopia Mellough have secured a $250,000 causative gene. However, CDSRR “We chose a zebrafish model rather in children. is the exception because it can be grant from the Telethon-Perth than a mouse model because diagnosed via electrophysiology Children’s Hospital Research Fund for zebrafish are easier to manipulate The zebrafish may contribute testing. the project. and study eye development from a very early stage,” Dr Carvalho said. to better understanding of Their research is, for the first time, childhood myopia combining genome-wide association “Zebrafish breed every 10 days and Dr Livia Carvalho is part of the studies, cutting-edge gene editing can produce hundreds of eggs each Retinal Genomics research team studying a rare eye disorder

28 Lions Eye Institute Annual Report 2018 29 Clinical Trials Renowned scientist continues association with the LEI

Award-winning scientist Professor Elizabeth Rakoczy was awarded Emeritus Professorship and Senior Honorary Research Fellow appointments at UWA in 2018 in recognition of a 32-year contribution to research. Active people who spend a lot of time outdoors are more prone to developing pterygium – or surfer’s eye. The aptly named “SURPH” Trial is examining whether eye drops can reduce eye redness associated with the condition Professor Rakoczy was a key driver of the and even reduce the need for surgery pioneering research at the LEI that led to the development of a new gene therapy for wet age-related macular degeneration.

In 2018, the Clinical Trials A combination of genetics and The LEI’s Clinical Trials team is one The new gene therapy, which is proving to be safe and well-tolerated in human trials, team began recruiting environmental factors - including of the largest ophthalmological excessive exposure to sun, dust or research centres in the world, with promises to replace monthly injections with a people with a pterygium wind - are believed to be factors in more than 40 active trials. one-off treatment. to test whether a new developing the condition. The team tests new drugs or The science behind the new treatment began medication given as more than 20 years ago. It was the first eye drops can reduce The SURPH (StUdy of the Response devices, collects information from to AG-86893 in patients with patients to better understand a research in Australia using gene therapy in eye redness associated Pterygium Hyperemia) Trial, led by particular ophthalmic condition ophthalmology or any other medical field and with the condition and the LEI’s Dr Jean-Louis deSousa, and audits patient medical notes to was named by the NHMRC in its 10 of the Professor Rakoczy potentially replace surgery forms part of a multi-centre study to establish treatment outcomes and best national research projects in 2005. as a treatment option. ascertain the safety, tolerability and ways in which patient outcomes In 2017, Professor Rakoczy won the was a key driver of the effectiveness of eye drops in the may be improved. prestigious Australian Institute of Policy and pioneering research at Pterygium – also known as surfer’s treatment of pterygia. Patients with specific eye disorders, Science Florey Medal, which recognises eye - is a fleshy growth on the the LEI that led to the Researchers believe AG-86893, or previously untreatable eye significant lifetime achievement in biomedical surface of the eye. As its growth given as eye drops, has the potential conditions, gain access to new science and /or human health advancement. development of a new progresses, it can obscure the to reduce conjunctival hyperemia treatments and therapeutic optical centre of the cornea, Professor Rakoczy’s Molecular Ophthalmology gene therapy (red eye) with short-term use as well approaches well before they are causing visual impairment. research group was wound up in late 2017. as reduce new blood vessel growth available to the general public. However she is continuing to mentor junior Currently, surgery is the only option and fibrosis that may contribute to scientists and contribute to research activities for people with a pterygium that the growth of pterygium. at both UWA and the LEI. affects their vision. The SURPH Trial represents a move Australia has one of the highest by the Clinical Trials team into rates of pterygia in the world. It’s testing new treatments for eye disease that affect the front of the estimated that 1.1 per cent of Florey Medal winner Professor Elizabeth Rakoczy is mentoring a new generation of medical researchers Australians are affected, rising to 12 eye, as well as continuing studies per cent in men over the age of 60. on the back of the eye. Example of a pterygium

30 Lions Eye Institute Annual Report 2018 31 Clinical Services The 2018 year saw a During 2018, an LEI clinic opened A new intracranial pressure significant strategic in Midland, and in January 2019 assessment clinic was established moved to share premises there in collaboration with neurology shift in the LEI’s with a small group of other highly and neurosurgery to assist with approach to managing respected eye specialists. some complicated neurological its Clinical Services. disorders using techniques derived We also worked closely with the from our research. Recognising and building on the newly opened Perth Children’s enormous contribution its highly Hospital to set up and begin 2018 also saw the increased use of experienced clinicians make to to deliver excellent dedicated refined corneal grafting techniques delivering on the mission and vision paediatric eye care. using thin tissue sections and novel of the LEI, the Institute has formally retinal techniques imaging blood flow. Ophthalmology increasingly appointed glaucoma specialist relies on the use of sophisticated The result has been a solid and chair of its Medical Advisory specialised medical equipment. improvement in the performance of Committee Dr Antonio Giubilato the Clinical Services function, which as Director Clinic, supported by a During 2018, the LEI acquired an is well placed to improve further in key group of sub-specialists and a Endocyclodiode machine to assist the coming years. new management team focused on in the treatment of glaucoma – service and patient care. currently the only one in Western Eye consultations including Australia, and the capability of the injections reached a new high of Dr Giubilato has begun instituting Day Surgery was expanded through 60,000 patient visits for the year, wide ranging reforms to devolve the acquisition of a vitrectomy with surgeries and minor procedures management decisions to the machine, which was commissioned performed by the Institute’s clinical units in order to improve in early 2019. clinicians also approaching a new efficiency, flexibility and staff peak of 7900. engagement. A vitrectomy is an operation to remove the vitreous gel from the At December 31, 2018, the Investments of time and inside of the eye. Institute’s Clinical Services resources continue to be made employed 94 people supporting our in continuously improving patient This is necessary in order to carry out 16 exceptional ophthalmologists. safety, quality of care and matters procedures that cannot be performed such as patient waiting times. with the fluid in its place, and this Thank you to all of them for their will enable our ophthalmologists to hard work and commitment to A new quality management system, offer a more comprehensive surgical helping people at risk of vision loss. learning management system and service and perform more sight- patient satisfaction survey system saving operations. were implemented in the year.

Rate of growth in LEI’s Clinical Services over the past decade 80,000 70,000 60,000

50,000 Surgeries 40,000 Minor Procedures 30,000 Injections Consultations 20,000 10,000 Dr Chandra Balaratnasingam performs the first vitrectomy operation at the LEI following the 0 acquisition of a vitrectomy machine. 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

32 Lions Eye Institute Annual Report 2018 33 Clinical Services

The Clinic Leadership Committee (CLC), formed in March 2018, is composed of senior clinicians and one senior manager to guide decisions within the LEI clinic. The new structure aims to improve and foster local feedback and build the leadership skills of clinical staff. Dr Chandra In March, 2018, the It draws on many years’ work by the This work also aids our research Balaratnasingam LEI introduced a new LEI’s Physiology and Pharmacology to further improve and modify our Dr Antonio Giubilato (Chair) research group, which invented existing ICP estimation techniques. clinical service called a new system for measuring the ICP Assessment retinal venous pulsation and The LEI is very excited to have Clinic – Ophthalmology. novel mathematical algorithms for developed this new clinic and it analysing video footage taken from would not have been possible Mr Chris Whitelock, ICP stands for intracranial special retinal photographs in such without the total support from Chief Operating pressure, which is also known as patients. neurosurgery and neurology at Officer cerebrospinal fluid pressure (CSF Sir Charles Gairdner Hospital and pressure). This is the fluid pressure The other novel part of this work is NIISwa. surrounding the brain which passes the use of devices built at the LEI to Dr Jo Khoo, a young doctor, has up around the optic nerve to alter ICP whilst taking high quality been fundamentally important in the back of the eyeball and is a images from the retinal circulation. supporting and liaising with these fundamental pressure in diseases The mathematics and research departments and helping to build affecting the optic nerve, in concepts are complex but the the clinic. particular glaucoma. Other diseases outcome is very simple in allowing where high ICP is a feature include patients to potentially have ICP The LEI has also had fantastic idiopathic intracranial hypertension, measurements without the need for support from external brain tumours, traumatic head a hole being drilled into their head ophthalmologists, in particular injuries and numerous other or needles inserted in the back (via Dr Steven Colley, a well-known neurological and neurosurgical a lumbar puncture). and very well respected neuro- disorders. ophthalmologist in Perth. The latter two techniques were the This clinic is a collaborative service only methods previously available The LEI looks forward to continuing developed in concert with the to measure ICP and were obviously this service and modifying it to departments of neurosurgery and invasive and prone to complications best meet the needs of our clinical neurology at Sir Charles Gairdner and problems. colleagues and our patients. Hospital and the Neurological Intervention and Imaging Services The LEI began this new clinic of Western Australia (NIISwa). to help neurologists and neurosurgeons manage various The clinic was initiated as a result disorders. This is already saving of the LEI developing a system patients the need for some invasive for non-invasively measuring and measurements and is providing vital estimating ICP in patients. information to neurosurgery and Our technique specifically allows neurology concerning optic nerve clinicians to identify patients with function and parameters related elevated ICP – and therefore most to their ICP. With this, we can also likely to be suffering disorders advise on the management of related to the condition. ICP-related disorders. Professor Steve Wiffen (Acting)

An example of end-stage glaucoma in the eye. The LEI has developed a system for non-invasively measuring and estimating intracranial pressure (ICP) in patients. ICP is implicated in many diseases, including glaucoma, brain tumours and neurological disorders. Associate Professor Mei-Ling Tay-Kearney 34 Lions Eye Institute Annual Report 2018 35 Community

Professor Bill Morgan, Dr Danti Ayu and the LEI’s Anna Sheehan

The LEI continued Glaucoma is the second commonest The LEI’s overseas standard its long history of cause of blindness in Indonesia model of teaching generally following cataract blindness. involves young ophthalmologists supporting, training Unfortunately it presents very late, undertaking observations at the and upskilling overseas usually when a patient has gone LEI, with follow-up visits from some ophthalmologists in blind in one eye already and has of our senior consultant staff to 2018, with Indonesia’s severe disease in the other eye. help supervise and teach live surgery and clinical skills. Dr Danti Ayu spending It frequently requires surgery three months with the given the severity at presentation. We anticipate this will occur with glaucoma team. An additional consideration for Dr Ayu’s home hospital in Surabaya, glaucoma sufferers in Indonesia is as has occurred in Jakarta and Dr Ayu, from Surabaya, was the cost of eye drops which tends Denpasar. supervised during her stay by Dr to be well in excess of the cost Antonio Giubilato, Dr Antony Clark of surgery long term. This tends In 2019, the LEI will host three and Professor Bill Morgan as part to drive the treatment paradigm observers from the University of of the LEI-Indonesian overseas towards earlier surgery. Udayana, Denpasar, with whom teaching program. She also spent the LEI has a Memorandum time at Royal Perth and Sir Charles Dr Ayu returned to Indonesia after of Understanding as well as a Gairdner hospitals. her stint with the LEI, taking back separate observer from Jakarta. Professor Ian McAllister treating a Balinese girl who new skills and a determination was injured in the 2002 Bali bombing. She had a Dr Ayu attended theatre and saw to build a glaucoma department A Nigerian doctor will also spend large piece of glass embedded in her eye requiring a range of glaucoma surgeries in Surabaya and train young time with Professor Morgan at the an operation to remove. Her care was arranged by including trabeculectomies, Xen® Gel ophthalmologists. LEI and RPH in 2019. the John Fawcett Foundation, and part of the LEI’s Stent and glaucoma drainage device long-standing commitment to Bali and Indonesia. implants, as well as laser treatments for angle closure glaucoma.

36 Lions Eye Institute Annual Report 2018 37 The Lions Outback Vision Van on the road Lions Outback Vision

The Lions Outback Staffed by ophthalmologists, the the government $1.6 million. Vision Van (LOVV) is van consists of in-built consulting The observed value for PATS rooms with specialist equipment expenditure of $1.6 million proving effective in on board. It augments existing was significantly lower than boosting attendance outreach services provided by LOV the predicted interval of rates and access to that includes outreach specialist $1.8-$2.26 million expected sight-saving treatment and optometry clinics, diabetic from the trend of the previous among regional and retinopathy screening and telehealth three years, but no significant consultations. change was observed in the remote patients. number of ophthalmological PATS The report compared service claims and distance travelled. A report published by Lions Outback provision before and after the Vision (LOV) in 2018 evaluated the introduction of the LOVV and found: The report included a case study results of an audit from the first year - Outreach clinic days increased of Derby comparing the previous of the van’s operation. from 107 to 152 (up 42 per cent). year’s records. The introduction of the Vision Van saw statistically significant The LOVV was launched in 2016 to - Outreach ophthalmology consults odds ratio of attendance double and provide comprehensive mobile eye increased from 2341 to 2837 the odds ratio of being transferred health services to rural and remote (up 21.2 per cent). out of town reduced four-fold. communities throughout Western - Of the 14 pieces of specialist Australia, where residents suffer ophthalmological equipment The report concluded that the LOVV poorer visual outcomes compared carried on-board the LOVV, seven has improved regional WA service to their urban counterparts. were previously not available at delivery by increasing specialist outreach availability and access to Starting with 16 communities in any of the 16 regional locations. equipment while saving government 2016 and increasing to 20 in 2018, - In 2016, 7086 ophthalmological- expenditure on patient travel. the Vision Van visits sites from related Patient Assisted Transfer Albany in the south to Kununurra Scheme (PATS) claims were The service has also demonstrated in the north at least twice a year, made across WA travelling 3.38 high accessibility, acceptance and travelling up to 25,000kms. million kilometres and costing integration from the community. CELEBRATING OUR PAST Early work in 2018 Highlights Indigenous eye health

LOV McCusker Director Lions Outback Dr Kristopher Rallah-Baker From 1964, the Australian Foundation for the Vision Dr Angus Turner was awarded the formally completed the RANZCO Prevention of Blindness began glaucoma screenings inaugural 2018 Leaky Pipe Award for Vocational Training Program, of Western Australians from a mobile caravan. Service Delivery. The award recognised becoming Australia’s first significant contribution towards Closing Indigenous ophthalmologist. After its formation, the Lions Save-Sight Foundation the Gap for Vision and was presented Dr Rallah-Baker was a member expanded these programs to include amblyopia in children at the Vison2020 Indigenous Eye of the LOV team for six months and diabetic retinopathy. At the peak of the mobile eye Health Conference in Melbourne. in 2018. program, screenings were offered out of 69 regional locations, ensuring many people received early treatment During 2018, LOV Aboriginal Eye and diagnosis, as well as raising public awareness of eye Health Coordinator Kerry Wood met disease and preventable blindness. The LEI continued its with Indigenous Health Minister Dr Turner was one of four Western Dr Turner delivered the Fred commitment to outreach work in South-East Asia, through Ken Wyatt at the Parliamentary Australians shortlisted for the 2019 Hollows Lecture at the RANZCO early research into the potential of tele-ophthalmology and Friends Group Dinner for Eye Australian of the Year (WA) Awards, Golden Jubilee Congress in in 2016, in launching Lions Outback Vision. Health and Vision Care in Canberra announced by WA Governor Kim Beazley. Adelaide. The original glaucoma caravan 1964 38 Lions Eye Institute Annual Report 2018 39 Development

A profile on Ian Constable featured in The West Magazine

Professor Andrew Dick (centre) is pictured with Professor Ian Constable and Professor David Mackey at the 2018 Ian Constable Lecture

The annual Open Day showcased the LEI to the community with a Dr Fred Chen speaks at the 2018 Visionaries Luncheon at The UWA Club range of fun, interactive events Volunteers provide much-needed assistance to visually-impaired patients

At the LEI, we know that a man who was highly respected by Our annual Visionaries luncheon was a good reputation is hard all who knew him. once again a popular event, and in Our Volunteers 2018 featured presentations by LEI’s won and easily lost. During 2018 we undertook a Dr Fred Chen and Dr Carla Mellough. range of fundraising and donor The LEI takes huge pride in our Volunteer The Development and stewardship activities, including The LEI is fortunate to regularly Concierge Program, established in 2010 to assist Communications team aims to campaigns through direct mail and receive gifts in wills, and we are patients attending the LEI for medical treatment. build LEI’s reputation through online platforms, clinician-patient deeply appreciative of people’s engaging constructively with a events, research tours and lectures. generosity in thinking of the LEI LEI volunteers give friendly and informed assistance to patients and wide range of stakeholders. This when organising their affairs. visitors and help provide a positive and welcoming environment. Duties means bringing people along on The annual Ian Constable Lecture consist of escorting the elderly and vision impaired to their appointments, our journey as we find cures and featured Professor Andrew Dick, One of our ophthalmologists, collecting prescriptions, conveying patients from treatment areas, treatments for eye disease, through Director of the University College Dr Andrea Ang, featured in the arranging transport and making tea or coffee while they wait in the clinic. telling our stories in a meaningful London Institute of Ophthalmology, compelling documentary, ‘Dying to and compelling way. while Dr Damien Harkin, Professor in Live’, along with Henry, a patient During 2018, volunteer numbers remained stable at 27. They are rostered the School of Biomedical Sciences of Lions Outback Vision. The WA on morning and afternoon shifts from Monday to Friday. Philanthropy accounts for almost at the Queensland University of premiere of ‘Dying to Live’ was half of the funds we are able to Technology and Director of Ocular part of the Cinefest Oz event A highlight was a lunch hosted in May to celebrate Volunteer Week. The invest in research, and we are Cell Therapies at the Queensland Eye in Busselton, while LEI hosted LEI thanks all our volunteers for doing so much to support our patients. extremely grateful to our generous Institute, was the 2018 Miocevich a community screening at the and committed donors, including Lecture guest speaker. Windsor Cinema in Perth. individuals, foundations, families, civic groups and corporations. They LEI hosted important guests such More than 100 stories about LEI share our goal for a world without as Western Australia’s Governor, appeared across print, electronic blindness and help to sustain the LEI. the Honourable Kim Beazley AC and online media outlets, with a and the Hon Sue Ellery, Minister for particular highlight a profile piece On this note, we were saddened Education and Training for tours of in the Weekend West magazine to learn of the passing of our research facilities, as well as about our new Patron, founding businessman and philanthropist Mr many members of the community at Managing Director of LEI Professor Stan Perron AM, a long-term and our Open Day. Ian Constable. committed supporter of the LEI and Volunteers Christabel Lee and Robin Miller at the Volunteers desk in the LEI foyer

40 Lions Eye Institute Annual Report 2018 41 Publications Top publications with a Journal Impact Factor of five or above

Clinical Trials Genetics and Guymer RH, Markey CM, McAllister Epidemiology IL, Gillies MC, Hunyor AP, Arnold Duffy DL, Zhu G, Li X, Sanna M, JJ; FLUID Investigators. Tolerating Iles MM, Jacobs LC, Evans DM, Subretinal Fluid in Neovascular Yazar S, Beesley J, Law MH, Kraft Age-Related Macular Degeneration P, Visconti A, Taylor JC, Lui F, Wright Treated With Ranibizumab Using MJ, Henders AK, Bowdler L, Glass D, a Treat and Extend Regimen: Ikram AM, Uitterlinden AG, Madden FLUID Study 24 Month Results. PA, Heath AC, Nelson EC, Green AC, Ophthalmology. 2018 Nov 28. pii: Chanock S, Barrett JH, Brown MA, S0161-6420(18)32316-9. doi: Hayward NK, MacGregor S, Sturm 10.1016/j.ophtha.2018.11.025. RA, Hewitt AW; Melanoma GWAS [Epub ahead of print] PMID: Consortium, Kayser M, Hunter DJ, 30502372 [IF: 7.479] Newton Bishop JA, Spector TD, Montgomery GW, Mackey DA, Smith Guymer RH, Wu Z, Hodgson LA, GD, Nijsten TE, Bishop DT, Bataille Caruso E, Brassington KH, Tindill N, V, Falchi M, Han J, Martin NG. Novel Aung KZ, McGuinness MB, Fletcher pleiotropic risk loci for melanoma EL, Chen FK, Chakravarthy U, Arnold and nevus density implicate JJ, Heriot WJ, Durkin SR, Lek JJ, multiple biological pathways. Nat Harper CA, Wickremasinghe SS, Commun. 2018 Nov 14;9(1):4774. Sandhu SS, Baglin EK, Sharangan doi: 10.1038/s41467-018- P, Braat S, Luu CD; LEAD Study 06649-5. PMID: 30429480 [IF: Group. Sub-Threshold Nanosecond 12.353] Laser Intervention in Age-Related Macular Degeneration: The LEAD Han X, Souzeau E, Ong JS, An Randomized Controlled Clinical J, Siggs OM, Burdon KP, Best S, Trial. Ophthalmology. 2018 Sep 19. Goldberg I, Healey PR, Graham pii: S0161-6420(18)32135-3. doi: SL, Ruddle JB, Mills RA, Landers 10.1016/j.ophtha.2018.09.015. J, Galanopoulos A, White AJR, [Epub ahead of print] PMID: Casson R, Mackey DA, Hewitt 30244144 [IF: 7.479] AW, Gharahkhani P, Craig JE, MacGregor S. Myocilin Gene McAllister IL, Smithies LA, Chen Gln368Ter Variant Penetrance and FK, Mackey DA, Sanfilippo PG. Association With Glaucoma in Two-Year Efficacy of Ranibizumab Population-Based and Registry- Plus Laser-Induced Chorioretinal Based Studies. JAMA Ophthalmol. Anastomosis vs Ranibizumab 2018 Sep 27. doi: 10.1001/ Monotherapy for Central Retinal jamaophthalmol.2018.4477. [Epub Vein Occlusion: A Randomized ahead of print] PMID:30267046 Clinical Trial. JAMA Ophthalmol. [IF: 6.669] 2018 Dec 1;136(12):1391- 1397. doi: 10.1001/ Hysi PG, Valdes AM, Liu F, Furlotte jamaophthalmol.2018.4973. PMID: NA, Evans DM, Bataille V, Visconti 30347030 [IF: 6.669] A, Hemani G, McMahon G, Ring SM, Smith GD, Duffy DL, Zhu G, Gordon SD, Medland SE, Lin BD, Willemsen G, Jan Hottenga J,

42 Lions Eye Institute Annual Report 2018 43 Vuckovic D, Girotto G, Gandin I, Sala MacGregor S, Ong JS, An J, Han Hammond CJ, Klaver CCW. Genome- Belz GT, Brocker T, Degli-Esposti Lions Outback Vision C, Concas MP, Brumat M, Gasparini X, Zhou T, Siggs OM, Law MH, wide association meta-analysis MA, Lane SW, Hill GR. Flt-3L Drinkwater JJ, Davis TME, Turner P, Toniolo D, Cocca M, Robino A, Souzeau E, Sharma S, Lynn DJ, highlights light-induced signaling Expansion of Recipient CD8α+ Yazar S, Hewitt AW, Chen Y, Zeng C, Beesley J, Sheldrick B, Mills RA, as a driver for refractive error. Nat Dendritic Cells Deletes Alloreactive AW, Bruce DG, Davis WA. Incidence Uitterlinden AG, Ikram MA, Hamer Landers J, Ruddle JB, Graham Genet. 2018 Jun;50(6):834-848. Donor T Cells and Represents and Determinants of Intraocular MA, van Duijn CM, Nijsten T, Mackey SL, Healey PR, White AJR, Casson doi: 10.1038/s41588-018-0127- an Alternative to Posttransplant Lens Implantation in Type 2 DA, Falchi M, Boomsma DI, Martin RJ, Best S, Grigg JR, Goldberg I, 7. Epub 2018 May 28. PMID: Cyclophosphamide for the Diabetes: The Fremantle Diabetes NG, Hinds DA, Kayser M, Spector Powell JE, Whiteman DC, Radford- 29808027 [IF: 27.125] Prevention of GVHD. Clin Cancer Study Phase II. Diabetes Care. TD; International Visible Trait Smith GL, Martin NG, Montgomery Res. 2018 Apr 1;24(7):1604-1616. 2018 Dec 6. pii: dc181556. doi: Genetics Consortium; International GW, Burdon KP, Mackey DA, doi: 10.1158/1078-0432.CCR-17- 10.2337/dc18-1556. [Epub ahead Visible Trait Genetics Consortium. Gharahkhani P, Craig JE, Hewitt AW. Experimental 2148. Epub 2018 Jan 24. PMID: of print] PMID: 30523034 [IF: Genome-wide association meta- Genome-wide association study Immunology 29367429 [IF: 10.199] 13.397] analysis of individuals of European of intraocular pressure uncovers Dorgau B, Felemban M, Sharpe ancestry identifies new loci new pathways to glaucoma. Nat A, Bauer R, Hallam D, Steel DH, Sheppard S, Schuster IS, Andoniou Physiology and explaining a substantial fraction of Genet. 2018 Aug;50(8):1067- Lindsay S, Mellough C, Lako M. CE, Cocita C, Adejumo T, Kung SKP, hair color variation and heritability. 1071. doi: 10.1038/s41588-018- Sun JC, Degli-Esposti MA, Guerra Pharmacology Laminin γ3 plays an important role Nat Genet. 2018 May;50(5):652- 0176-y. Epub 2018 Jul 27. PMID: in retinal lamination, photoreceptor N. The Murine Natural Cytotoxic Balaratnasingam C, Yannuzzi 656. doi: 10.1038/s41588-018- 30054594 [IF: 27.125] organisation and ganglion cell Receptor NKp46/NCR1 Controls LA, Franchina M, Freund KB. 0100-5. Epub 2018 Apr 16. PMID: differentiation. Cell Death Dis. 2018 TRAIL Protein Expression in NK Idiopathic Retinal Vasculitis, 29662168 [IF: 27.125] Tedja MS, Wojciechowski R, Hysi PG, May 23;9(6):615. doi: 10.1038/ Cells and ILC1s. Cell Rep. 2018 Aneurysms, and Neuroretinitis Eriksson N, Furlotte NA, Verhoeven s41419-018-0648-0. PMID: Mar 27;22(13):3385-3392. doi: (IRVAN) in a Patient Without Iglesias AI, Mishra A, Vitart VJM, Iglesias AI, Meester-Smoor 29795281 [IF: 5.638] 10.1016/j.celrep.2018.03.023. IRVAN History. JAMA Ophthalmol. V, Bykhovskaya Y, Höhn R, MA, Tompson SW, Fan Q, Khawaja PMID: 29590608 [IF: 8.032] 2018 Nov 8. doi: 10.1001/ Springelkamp H, Cuellar-Partida AP, Cheng CY, Höhn R, Yamashiro jamaophthalmol.2018.5247. [Epub Felemban M, Dorgau B, Hunt NC, G, Gharahkhani P, Bailey JNC, K, Wenocur A, Grazal C, Haller T, ahead of print] No abstract available. Hallam D, Zerti D, Bauer R, Ding Voigt V, Andoniou CE, Schuster Willoughby CE, Li X, Yazar S, Nag A, Metspalu A, Wedenoja J, Jonas JB, PMID: 30419083 [IF: 6.669] Y, Collin J, Steel D, Krasnogor N, IS, Oszmiana A, Ong ML, Fleming Khawaja AP, Polašek O, Siscovick Wang YX, Xie J, Mitchell P, Foster PJ, Al-Aama J, Lindsay S, Mellough P, Forrester JV, Degli-Esposti D, Mitchell P, Tham YC, Haines Klein BEK, Klein R, Paterson AD, C, Lako M. Extracellular matrix MA. Cytomegalovirus establishes Balaratnasingam C, Cherepanoff JL, Kearns LS, Hayward C, Shi Y, Hosseini SM, Shah RL, Williams component expression in human a latent reservoir and triggers S, Dolz-Marco R, Killingsworth M, van Leeuwen EM, Taylor KD; Blue C, Teo YY, Tham YC, Gupta P, Zhao pluripotent stem cell-derived retinal long-lasting inflammation in Chen FK, Mendis R, Mrejen S, Too Mountains Eye Study—GWAS group, W, Shi Y, Saw WY, Tai ES, Sim XL, organoids recapitulates retinogenesis the eye. PLoS Pathog. 2018 LK, Gal-Or O, Curcio CA, Freund Bonnemaijer P, Rotter JI, Martin NG, Huffman JE, Polašek O, Hayward C, in vivo and reveals an important May 31;14(5):e1007040. doi: KB, Yannuzzi LA. Cuticular Drusen: Zeller T, Mills RA, Staffieri SE, Jonas Bencic G, Rudan I, Wilson JF; CREAM role for IMPG1 and CD44 in the 10.1371/journal.ppat.1007040. Clinical Phenotypes and Natural JB, Schmidtmann I, Boutin T, Kang Consortium; 23andMe Research development of photoreceptors eCollection 2018 May. PMID: History Defined Using Multimodal JH, Lucas SEM, Wong TY, Beutel Team; UK Biobank Eye and Vision and interphotoreceptor matrix. Acta 29852019 [IF: 6.158] Imaging. Ophthalmology. 2018 ME, Wilson JF; NEIGHBORHOOD Consortium, Joshi PK, Tsujikawa A, Biomater. 2018 Jul 1;74:207-221. Jan;125(1):100-118. doi: Consortium; Wellcome Trust Case Matsuda F, Whisenhunt KN, Zeller T, doi: 10.1016/j.actbio.2018.05.023. Young A, Ngiow SF, Gao Y, Patch 10.1016/j.ophtha.2017.08.033. Control Consortium 2 (WTCCC2), van der Spek PJ, Haak R, Meijers- Epub 2018 May 17. PMID: AM, Barkauskas DS, Messaoudene Epub 2017 Sep 28. PMID: Uitterlinden AG, Vithana EN, Heijboer H, van Leeuwen EM, Iyengar 29777959 [IF: 6.383] M, Lin G, Coudert JD, Stannard KA, 28964580 [IF: 7.479] Foster PJ, Hysi PG, Hewitt AW, Khor SK, Lass JH, Hofman A, Rivadeneira Zitvogel L, Degli-Esposti MA, Vivier CC, Pasquale LR, Montgomery F, Uitterlinden AG, Vingerling JR, Forrester JV, McMenamin PG, E, Waddell N, Linden J, Huntington Morgan WH, Quill B, Cringle GW, Klaver CCW, Aung T, Pfeiffer Lehtimäki T, Raitakari OT, Biino G, Dando SJ. CNS infection and ND, Souza-Fonseca-Guimaraes SJ, House PH, Yu DY. Long-Term N, Mackey DA, Hammond CJ, Concas MP, Schwantes-An TH, Igo RP immune privilege. Nat Rev Neurosci. F, Smyth MJ. A2AR Adenosine Results Using Gelatin Microfistulae Cheng CY, Craig JE, Rabinowitz YS, Jr, Cuellar-Partida G, Martin NG, Craig 2018 Nov;19(11):655-671. doi: Signaling Suppresses Natural Implantation without Antimetabolite. Wiggs JL, Burdon KP, van Duijn JE, Gharahkhani P, Williams KM, Nag 10.1038/s41583-018-0070-8. Killer Cell Maturation in the Tumor Ophthalmology. 2018 Jun 16. pii: CM, MacGregor S. Cross-ancestry A, Rahi JS, Cumberland PM, Delcourt Review. PMID: 30310148 [IF: Microenvironment. Cancer Res. S0161-6420(18)30917-5. doi: genome-wide association analysis C, Bellenguez C, Ried JS, Bergen AA, 32.365] 2018 Feb 15;78(4):1003-1016. 10.1016/j.ophtha.2018.05.024. of corneal thickness strengthens link Meitinger T, Gieger C, Wong TY, Hewitt doi: 10.1158/0008-5472.CAN-17- [Epub ahead of print] No abstract between complex and Mendelian AW, Mackey DA, Simpson CL, Pfeiffer 2826. Epub 2017 Dec 11. PMID: available. PMID: 29921455 Markey KA, Kuns RD, Browne DJ, eye diseases. Nat Commun. 2018 N, Pärssinen O, Baird PN, Vitart V, 29229601 [IF: 9.13] [IF: 7.479] May 14;9(1):1864. doi: 10.1038/ Amin N, van Duijn CM, Bailey-Wilson Gartlan KH, Robb RJ, Martins JP, s41467-018-03646-6. PMID: JE, Young TL, Saw SM, Stambolian D, Henden AS, Minnie SA, Cheong M, 29760442 [IF: 12.353] MacGregor S, Guggenheim JA, Tung JY, Koyama M, Smyth MJ, Steptoe RJ, For a full list of 2018 publications by LEI researchers visit Experimental Immunology group www.lei.org.au/research/publications/#accordion-2018-sa-1 researcher Peter Fleming

44 Lions Eye Institute Annual Report 2018 45 Our Ophthalmologists

Dr Andrea Ang Dr Chandra Professor Graham Dr Fred Chen Dr Antony Clark Professor Ian Balaratnasingam Barrett Constable AO

Dr Andrea Ang is a consultant Dr Balaratnasingam undertook Dr Barrett trained in Dr Chen studied medicine at UWA. Dr Clark completed his Professor Constable trained ophthalmologist at the LEI ophthalmology training in ophthalmology in Perth, After completion of ophthalmology ophthalmology training in in ophthalmology in New (Nedlands and Murdoch) Perth, Western Australia, Western Australia, and training at Royal Perth Hospital Western Australia before South Wales before being and Royal Perth Hospital. She after which he completed undertook specialty training in 2006, he moved to London undertaking two years of appointed as Clinical Retinal graduated with the gold medal subspecialty training in in the USA. He is a consultant for advanced training in medical sub-speciality fellowship Fellow at the Massachusetts in medicine from UWA and vitreoretinal disorders in ophthalmic surgeon and Head and surgical retina at Moorfields training at the University of Eye and Ear Infirmary. He also completed a Masters Vancouver, Canada, and New of Department at Sir Charles Eye Hospital. He also completed Toronto in Canada. His first later became a consultant of Public Health at Harvard York City, USA. Following Gardiner Hospital. Professor a Doctorate of Philosophy (PhD) fellowship was in glaucoma surgeon and Lecturer at University. She has undertaken this, he was appointed to Barrett is founding and current in surgical techniques of retinal and anterior segment surgery, Harvard University. He was fellowships in cornea, anterior the clinical faculty at New president of the Australasian pigment epithelium transplantation and the second in paediatric appointed the foundation segment and external diseases York University School of Society of Cataract & Refractive for treatment of dry and wet macular ophthalmology and strabismus professor of ophthalmology at the Cincinnati Eye Institute Medicine and worked as Surgeons and president of degenerations at the University College at The Hospital for Sick and retinal surgeon at Royal and the Singapore National a vitreoretinal surgeon in the Asia Pacific Association of London Institute of Ophthalmology. Children. Dr Clark has a PhD in Perth Hospital in 1975 before Eye Centre. She specialises Manhattan for a year before of Cataract and Refractive Dr Chen returned to Perth in 2010 as public health and continues his establishing the LEI in 1983. in corneal and refractive joining the LEI. He is also a Surgeons. He is the recipient a senior lecturer at the UWA Centre for interests in epidemiology and He continues to practice as surgery including corneal consultant ophthalmologist of major international awards Ophthalmology and Visual Science. clinical ophthalmic research. a consultant ophthalmologist transplantation, cataract and at Sir Charles Gairdner including the Ridley Medal His research teams are involved In addition to consulting at the at the LEI and at Sir Charles laser refractive surgery. Dr Hospital. Dr Balaratnasingam (European Society of Cataract in testing of new treatments in dry LEI, Dr Clark is a consultant Gairdner Hospital with a Ang is the director of training has completed a PhD and & Refractive Surgeons), the age-related macular degeneration, ophthalmologist at Sir Charles special interest in diabetic for the WA RANZCO training continues clinical and Binkhorst Medal (American monitoring of inherited retinal disease Gairdner Hospital and Perth retinopathy, macular program, OBCK examiner laboratory-based research in Society of Cataract & Refractive progression and application of Children’s Hospital. degeneration and second and is on the RANZCO CPD diabetic retinopathy and other Surgeons) and the Ridley stem cell technology in developing opinions for complex eye committee and RANZCO retinal vascular diseases. Medal (Congress of German personalised medicine for rare retinal problems. He was Managing Surgical Taskforce committee. He has published over 80 Ophthalmic Surgeons). diseases. His research group is funded Director at the LEI from 1983 She is currently a participant papers in ophthalmic and by philanthropic donations, NHMRC to February 2009 and was of the RANZCO leadership neuroscience journals, written grants, Macular Disease Foundation, appointed Patron of the LEI in development program. She is book chapters for key retina McCusker Foundation, Retina Australia 2018. an active volunteer with the texts and has been an invited and Telethon Institute. He consults Myanmar Eye Care Project. speaker at a number of and operates at the LEI, Royal Perth international meetings. Hospital and Perth Children’s Hospital. His special clinical interest is in macular degenerations and inherited retinal diseases.

46 Lions Eye Institute Annual Report 2018 47 Professor Geoffrey Dr Jean-Louis Dr Adam Gajdatsy Dr Antonio Giubilato Professor David A Professor Ian Crawford deSousa Mackey McAllister

Professor Crawford completed his Dr deSousa trained Dr Adam Gajdatsy trained in Dr Giubilato underwent Professor Mackey was Professor McAllister undertook ophthalmic training in Western in ophthalmology in ophthalmology in Western specialty fellowship training appointed Managing Director training in Western Australia Australia and is a Fellow of the Royal Perth before completing Australia before undertaking in glaucoma at the Royal of the LEI and Professor of with additional sub-specialty Australian and New Zealand College of fellowships in ophthalmic fellowship training at the Victorian Eye and Ear Hospital Ophthalmology/Director of training in vitreoretinal disorders Ophthalmologists and a Fellow of the plastic and reconstructive University Hospital of Wales after training in ophthalmology the Centre for Ophthalmology in the USA. He is a consultant Royal Australasian College of Surgeons. surgery in Oxford and East in Cardiff and at Moorfields in Perth, Western Australia. and Visual Science at UWA in ophthalmologist and a member He completed further sub-specialty Grinstead in the UK. He is Eye Hospital in London in This included both clinical March 2009. Professor Mackey of the board of directors at the training in oculoplastic surgery at the Head of Department oculoplastic, lacrimal and and surgical management of has achieved international LEI and is also a consultant Moorfields Eye Hospital in London and of Ophthalmology and orbital surgery. Dr Gajdatsy glaucoma as well as research recognition as a genetic ophthalmologist at RPH. Professor then cornea and refractive surgery at consultant ophthalmologist is currently operating as an into new therapies for the ophthalmologist/scientist. McAllister has a doctorate in Emory University in Atlanta, Georgia, USA. at Royal Perth Hospital and ophthalmic surgeon consultant condition. He is presently His original research over medicine which is the highest He is the Director of Surgical Services is a member of the Australian at Sir Charles Gairdner Hospital, consultant ophthalmologist in more than 25 years into the post-graduate degree at UWA and and the Director of the Laser Vision and New Zealand Society of LEI, Osborne Park Hospital the Glaucoma Clinic at Royal genetics of glaucoma and is actively involved in research for Centre at the LEI. He is a co-inventor Ophthalmic Plastic Surgeons. and Murdoch Surgicentre. Perth Hospital and operates in the fields of optic atrophy cures for vitreoretinal disorders, of the AlphaCor™ artificial cornea and He also provides ophthalmic He also acts as an honorary at Bentley Hospital for public and congenital cataract has especially retinal vascular AlphaSphere™ orbital implant and services to the central ophthalmologist consultant at patients. He consults at both received continued research disorders, and has held 10 developed the techniques for insertion of Wheatbelt from Merredin. Dr Perth Children’s Hospital. Dr the Nedlands and Murdoch funding support. Dr Mackey NHMRC grants in this area as well these devices. He also introduced LASIK deSousa is a consultant and Gajdatsy sits on the Curriculum LEI clinics. He is also a WA announced that he was as numerous minor grants. He has surgery into Western Australia. He serves visiting surgeon and lecturer Review Committee of the Royal committee member of the stepping down from the role of been involved for many years in on the committees of the Australian and for humanitarian eye projects Australian and New Zealand Australia and New Zealand Managing Director of the LEI in State-wide diabetic retinopathy New Zealand Cornea Society and the in Bali and East Timor. College of Ophthalmologists, Glaucoma Interest Group late 2018 to focus on several screening and treatment and Australasian Society of Cataract and as well as holding the position and is on numerous advisory major research projects. was vice-chairman of the Refractive Surgeons. Professor Crawford of State Councillor. He also sits boards, both medical and Ophthalmic Research Institute specialises in all forms of refractive on the Executive Committee surgical. of Australia and chairman of the surgery including LASIK, PRK and of the Australian and New Research Board for many years. insertion of phakic intraocular lenses. He Zealand Society of Ophthalmic He has published more than performs lens surgery for cataracts and Plastic Surgeons (ANZSOPS). Dr 140 papers in scientific journals for refractive errors. He also specialises Gajdatsy is the coordinator of and has given over 180 papers in corneal and conjunctival diseases of ophthalmology teaching at UWA. at meetings as an invited guest the eye and performs all surgeries related speaker. Professor McAllister to these conditions including all types recently received an achievement of corneal transplantation, pterygium award for distinguished service to removal, tumour removal and correction ophthalmology from the American of keratoconus with intracorneal ring Academy of Ophthalmology. segments (Kerarings) and corneal collagen cross-linking. He is a pioneer in many of these techniques in Western Australia.

48 Lions Eye Institute Annual Report 2018 49 Professor William Dr Hessom Razavi Associate Professor Associate Professor Dr Steven Wiffen Morgan Mei-Ling Tay-Kearney Angus Turner, McCusker Director Professor Morgan joined the Dr Razavi completed his Associate Professor Tay-Kearney Lions Outback Vision Dr Wiffen is a graduate of LEI Board in 2018 and in ophthalmology training in completed her ophthalmology the University of Queensland December, was appointed Western Australia before training in WA completing Associate Professor Turner Medical School and trained in Acting Managing Director. He is undertaking two fellowships. postgraduate studies in ocular completed medical training at ophthalmology in Western Australia a consultant ophthalmologist He was the inaugural Lions immunology and infections at the UWA before studying at Oxford before undertaking two-year at Royal Perth Hospital, Outback Fellow, providing Wilmer Eye Institute in the Johns University and completing a fellowships in cornea and refractive consultant ophthalmologist outreach services to remote Hopkins Hospital, Baltimore, USA. Masters of Evidence Based surgery at both the Corneo- at Perth Children’s Hospital, and Indigenous communities Plastic Unit, East Grinstead, UK, She has held various Medicine. Ophthalmology Professor at UWA and Co- in WA. This was followed by a training was undertaken in and the Mayo Clinic, Rochester, Director of the Lions Eye medical retina fellowship at positions including Head of Minnesota, USA. He was Director Department at Royal Perth Melbourne. As Director of Lions Institute McCusker Glaucoma the Royal Victorian Eye and Outback Vision, Associate of the Corneo-Plastic Unit and Centre. He has completed Ear Hospital and the Centre for Hospital, RACE examiner and Eye Bank in East Grinstead from QEC Chair responsible for the Professor Turner is actively a doctorate in philosophy Eye Research Australia. Prior involved in the delivery of 1993-1994. He has been a studying the response of to this, Dr Razavi completed a ophthalmological training program Consultant Ophthalmologist at in WA. specialist outreach services the optic nerve to pressure, Masters of Public Health in Eye to remote and Indigenous Fremantle Hospital since 1997 particularly in relation to Care at the London School of She is very active in the Royal communities in the Kimberley, and was Associate Professor in glaucoma. He sees patients Hygiene and Tropical Medicine. Australian and New Zealand Pilbara, Goldfields, Midwest the Centre for Ophthalmology and with glaucoma and other He consults at the Midland College of Ophthalmology and and Great Southern regions. As Visual Science, UWA, from 1997- ocular conditions such as Eye Clinic and is the unit is presently a Selection Board an Associate Professor at UWA, 2014. He has been Director of cataracts. Professor Morgan coordinator for ophthalmology member, Training Progression Dr Turner is actively engaged the Lions Eye Bank of Western maintains an active research teaching at UWA. Committee member and a Training in a number of research Australia since 1997. Dr Wiffen interest in glaucoma as well as Hospital Inspector. She is also a projects at the LEI, focusing on has held numerous other positions, in the epidemiology of blinding member of The MAC at Royal Perth service delivery for remote and including Head of Department of eye disease. Hospital and is part of the LEI’s Indigenous people. He is also Ophthalmology Fremantle Hospital, Clinical Leadership Committee. a clinical lecturer for the Rural Chair of the Qualifications and Clinical School at UWA and Education Committee of the WA She consults at Royal Perth Notre Dame. Branch of RANZCO, Chair of Eye Hospital and the LEI and is active Banks Australia and New Zealand in Clinical Trials, focused on new and Chair of the Cornea Standing drug treatments for infectious and Committee of the Transplantation non-infectious ocular inflammation Society of Australia and New and continues to participate in Zealand. He has special expertise tele-ophthalmology research. in corneal transplantation, pterygium and cataract surgery as well as refractive surgery.

50 Lions Eye Institute Annual Report 2018 51 Lions Laser Vision

Lions Laser Vision was Lions Laser Vision provides a full in optimum vision quality in the first laser vision range of refractive procedures that the early post-operative phase can eliminate the need for glasses and significantly faster healing. centre established or contact lenses in patients with The result is clear vision without in Western Australia short-sightedness, long-sightedness compromise. and continues to be and astigmatism to produce excellent unaided vision. Lions Laser Vision also provides the first for patient a comprehensive service to treat safety, technology and These include LASIK – the gold Keratoconus (conical cornea), excellent outcomes. standard of all laser refractive which affects one in 1000 procedures, photoreactive Western Australians. Despite its During 2018, Lions Laser Vision keratectomy (laser surface increasing prevalence, the cause of consolidated its position as the first ablation), phakic IOLs (implantable Keratoconus is not well understood. centre for laser vision correction contact lens) and all types of in Western Australia. In November refractive lens surgery. We perform corneal collagen 2018, the laser vision centre held cross-linking (CXL), insertion a dinner that attracted more than Lions Laser Vision takes pride in of intracorneal ring segments 115 local optometrists to hear having the most advanced laser (kerarings) and all forms of corneal common myths about corneal equipment – including the world’s transplantation for Keratoconus and refractive surgery. We expect fastest, safest and most effective with the latest equipment. in 2019 we will continue to grow excimer laser, the Schwind AMARIS As part of our future efforts to our position as market leader for 1050RS laser. help people with Keratoconus technology, safety and results for With the Schwind laser we are we are one of the major centres laser vision correction. able to perform TransPRK which is around the world participating With the most experienced a touch-free laser eye correction in the Keratoconus International refractive surgeons in Western method. The Schwind Amaris laser Consortium (KIC). KIC will Australia whose experience removes the epithelium, without consolidate all research within the stretches to the very beginnings of suction, flap or blade. This touch- field and generates collaborative the procedure, Lions Laser Vision free procedure is non-invasive, safe opportunities to address key issues and gentle to the eye in a one-step faced by Keratoconus patients. As is able to celebrate the genesis of LOOKING TO OUR FUTURE refractive surgery in Australia and to procedure. part of the consortium there will be lead the field into the future. opportunities to conduct big data The Schwind laser also integrates analysis and research in this area. Laser vision correction is about our patients seeing well into the future. It was here at the LEI that the first SmartSurfACE technology that New laser, excimer laser PRK (photorefractive combines the advantages of There are four refractive surgeons Lions Laser Vision is about to add another first. In 2019, we will be the keratectomy) surgery in Australia SCHWIND’s proven TransPRK at Lions Laser Vision: Professor new vision first clinic in Australia to offer laser vision correction with the Schwind Titan was performed in 1991 and surface ablation method and Geoffrey Crawford, Professor femtosecond laser. revolutionary SmartPulse Graham Barrett, Associate Professor the first LASIK (laser in-situ The Schwind Titan represents the latest generation of femtosecond lasers technology that gives the cornea a Steven Wiffen and Dr Andrea Ang keratomileusis) in Western Australia that are used to create the corneal flap during LASIK procedure as well as very smooth surface. - all of whom have had specialist in 1996. implantation of corneal ring segments and some corneal graft treatments. The fellowship training in refractive Schwind Titan also offers SMILE (SMall Incision Lenticule Extraction) which Lions Laser Vision was the first and SmartPulse uses a three- and corneal surgery in the United expands the range of treatment options for patients at Lions Laser Vision. still is the only accredited laser dimensional geometric model with States. Two of these surgeons fullerene structure that describes vision correction centre in WA. The were the initial pioneers of laser The first generation of SMILE capable lasers has many shortcomings that are the curvature of the cornea very centre has achieved accreditation refractive surgery in WA. overcome with this new technology, including the compensation of rotational realistically. This sophisticated each year since 2006 with ISO9001 (cyclotorsional) eye movements, autocentration and also the ability to actively method allows better, closer and For more information about – an internationally recognised adjust the treatment zone. quality management system more even spacing of the laser Lions Laser Vision, visit indicating standards of excellence. pulses on the cornea resulting www.lionslaservision.com.au The continual investment in the latest technology keeps Lions Laser Vision the first in Perth for laser vision correction.

Lions Laser Vision refractive surgeons – Professor Geoffrey Crawford, Professor Graham Barrett, Dr Andrea Ang and The Schwind Titan femtosecond laser Associate Professor Steven Wiffen - are the most experienced in Western Australia

52 Lions Eye Institute Annual Report 2018 53 Lions Eye Bank

The Lions Eye Bank was A total of 11 surgeons, including established in 1986 by LEI clinicians Professor Graham Barrett, Professor Geoffrey Crawford, the LEI and Lions Save- Dr Andrea Ang and Lions Eye Bank Sight Foundation and Director Dr Steven Wiffen, performed over its lifetime, has corneal grafts for both public and completed more than private patients during 2018. 5000 procedures. LEI glaucoma surgeons Professor William Morgan, Dr Antonio During 2018, a total of 226 corneal Giubilato and Dr Antony Clark also transplants were performed (103 use scleral grafts in surgery to penetrating and 123 pre-cut) with reduce intraocular pressure. a further 169 procedures involving sclera (the white part of the eye). All donor tissue is used either for There were no waiting lists and the transplantation or, if unsuitable, Lions Eye Bank was always able to for ethically approved research or meet demand. surgical training with the consent of the donor’s family. This tissue is In January 2018, a new crucial to advancing research and microkeratome designed for use developing surgical techniques. by eye bankers was introduced, resulting in improved preparation of As an independent organisation, the pre-cut endothelial tissue. Lions Eye Bank of Western Australia is self-funded through cost recovery. In May, the Lions Eye Bank became the first eye bank in Australia to implement the national Electronic The key goals of the Lions Eye Donor register (EDR), which was Bank are to: originally used only for organ donation, and allows for the - Prevent blindness and improve operation of a completely paperless the outcome of eye disease by donor environment. providing corneal and sclera tissue for transplantation. Also in 2018, the Eye Bank Association of Australia and New - Raise the profile of the LEI in LOOKING TO OUR FUTURE Zealand (EBAANZ) established the community, both locally a Specialist Certificate in Eye and nationally, by educating the New standards for the ethical use of eye tissue Banking through the University of public and medical providers Melbourne’s School of Medicine about the critical role of the – the world’s first formal university Lions Eye Bank in sight-saving In June 2018, Lions Eye Bank Manager Lisa Buckland procedures. qualification for eye banking as represented EBAANZ at the signing of the Barcelona a vocation. All Lions Eye Bank - Continue to remain a sustainable Principles – the first ever global agreement on the staff successfully completed this unit within the LEI by generating use of human tissue for ocular transplantation, postgraduate course. sufficient proceeds through medical research and future technologies. As a member of EBAANZ, the Lions the provision of eye tissues for The principles are designed to lift eye banking standards Eye Bank works collaboratively transplantation. globally, encourage ethical practices and improve with other eye banks to maintain equitable access to the millions awaiting corneal surgery consistently high levels of quality, around the world. safety, proficiency and ethics. Excess Lions Eye Bank Manager Lisa tissue is shared when appropriate Buckland with Transplant Eye following corneal graft and emergency requests for tissue Coordinators Ben Foreman and are always supported. Natalie Duncalf

54 Lions Eye Institute Annual Report 2018 55 Acknowledgments

Special Gifts Trusts and Bequests Anonymous Foundations Estate of the Late Catherine Hardy Dr Ching Howe Chan Constantine Family Foundation Pty Ltd Estate of the Late Doreen Margaret Professor Geoffrey Crawford Fred Hollows Foundation Letcher Mr Vernon Fountain H&H Cohney Foundation Estate of the Late Ian Bickle Genetic Cures Australia Hardie Foundation Pty Ltd Estate of the Late Vera Lawrence Mr and Mrs Norm and Freda Hogg Lions Save-Sight Foundation Estate of the Late Walter Reginald Johnson Mr Stefan Jordanoff McCusker Charitable Foundation Harry & Margaret Kerman Trust Fund Mrs Louise Law Raine Foundation Stallard Family Trust Lions Club of Nannup Stan Perron Charitable Foundation Ltd The Alan and Lilian Cameron Mrs Maggie Low and Mr Donald Lee The Lindsay and Heather Payne Charitable Endowment Medical Research Charitable Mandurah Murray Mayday Inc. Foundation Estate of the Late Sheila Peet Mr Walter Millsteed The Patrick Foundation Mrs Carolyn Miocevich Usher 1F Collaborative Pride of LEI Pledges Mr Carlo Orlando of Support from Wheatley Family Foundation Oxford Compounding WA Lions Clubs Mrs Lynette Purser Major Institutional Lions Club of Perth Mrs Gwynneth Roberts Support Lions Club of Ballajura Lions Club of Busselton Mr and Mrs John and Lee Saleeba Australian Government – Department Mr Keith Spence of Education and Training Lions Club of Claremont/Nedlands Mrs Nora Susac Australian Government – Lions Club of Dardanup Department of Health Mrs Helen Sweet Lions Club of Dunsborough Gold Fields Australian Foundation Inc. Dr Angus Turner Lions Club of Kojonup Lotterywest Lions Club of Margaret River Macular Degeneration Foundation Lions Club of Moora National Health and Medical Lions Club of Morley Research Council Ophthalmic Research Institute of Australia PJ Architecture Retina Australia Rural Health West Santos Limited Specsavers Carolyn and Brad Miocevich are Telstra important supporters of Dr Fred Chen’s research into rare retinal The University of Western Australia diseases. The LEI thanks and WA Child Research Fund acknowledges all the individuals, businesses, government entities WA Country Health Service and institutions that help fund our WA Department of Health sight-saving medical research.

56 Lions Eye Institute Annual Report 2018 57 Lions Save-Sight Foundation

It is now approaching Firstly I would like to acknowledge The link between our two Boards 50 years since the the considerable contribution and has never been stronger and I look assistance provided to our Board by forward to this situation continuing. Lions Save-Sight Professor David Mackey over the last Foundation (LSSF) was 10 years. Our Board is grateful for In concluding, may I congratulate all incorporated in January his support and we wish him well in involved with the LEI and recognise his future endeavours. We welcomed the many great things that have 1971. From humble been achieved in the research and beginnings it grew quite Professor Bill Morgan to our Board in December and look forward to medical consulting areas. LSSF will rapidly necessitating having this continuous link to the continue to support you wherever the spawning of the LEI through Professor Morgan. possible and ensure that the LEI in 1983 to better strong link between the two bodies The news that, as a result of continues as we work to ensure our protect and develop the David’s role, the Lions UWA Chair of joint goal of eradicating preventable medical and research Ophthalmology will cease to exist blindness marches on. area of ophthalmology was received with some sadness. in Western Australia. The Chair came into existence through the efforts and funding by CELEBRATING OUR PAST This all occurred with the support Lions in 1974, and to see the name and blessing of the LSSF; that of Lions no longer part of the Faculty support continuing (and increasing) of Medicine at UWA is disappointing. Ambrose Depiazzi OAM Lions Save-Sight Foundation created over the years through to the We trust another opportunity arises Chairman, Lions Save-Sight present day. In dollar terms for in the near future that will again Foundation (WA) Inc. this year the various salaries see our Lions name re-aligned with Lions Club members voted to create the Lions Save-Sight Foundation at and research funding to LEI has medical education in WA. their 1970 convention in Albany. amounted to some $350,000. Whilst still on change, I wish also The LSSF went on to expand the screening programs already begun by Dr Robert Whilst this is a considerable to acknowledge the efforts of one Linton and the Australian Foundation for the Prevention of Blindness (AFPB) contribution from the Lions Clubs of of our great supporters in Professor with considerable success. A research study analysing trends in blindness over WA, it is with some sadness that I Mariapia Degli-Esposti. We wish her 19 years in WA found blindness from glaucoma falling 75 per cent – partly due report that the membership of our well in her future role at Monash to earlier diagnosis and commencement of treatment. Clubs is declining at a rapid rate, University. But the LSSF’s contribution to saving sight did not end with the mass screening which in time will see less and less financial support to LSSF. This will I would also like to acknowledge the programs and in 1973, it helped establish the Lions Chair of Ophthalmology at support received from LEI Chairman UWA with Professor Ian Constable at the helm. not create a problem in the next decade but could be a matter of Peter Forbes. The increased level Over the years, the LSSF has also supported: community-based education concern beyond then. of communication from Peter since programs aimed at preventing eye disease; the creation of the LEI and its ongoing taking on this role at the LEI is 1970 research programs, the Lions Eye Bank and the PDG Brian King Post-Doctoral and The latter part of 2018 has seen much appreciated especially with Jack Hoffman fellowships. considerable changes within the the many changes that have been LEI, some of which will impact on envisaged during 2018. The success of the AFPB screening programs, initiated by Dr Robert Linton - the LSSF. “the father of modern ophthalmology” in WA, led to the creation of the LSSF

58 Lions Eye Institute Annual Report 2018 59 The Retinal Genomics team won grants in 2018 to further their Grants research into rare retinal diseases

Australian NHMRC Project Macular Disease Other Grants Competitive Grants Effective therapies to treat viral Foundation Australia infections and their complications Stargardt macular degeneration Genetic Cures Australia NHMRC Program Grant in transplantation finding new genetic mutations Usher 1F Syndrome Immunological therapies for cancer, Chief Investigators – Degli-Esposti Chief Investigator – Chen F Carvalho L chronic infection and autoimmunity M, Andoniou C Chief Investigator – Degli-Esposti M RANZCO Perpetual Impact – L&H NHMRC Project Turner A Payne Medical Research NHMRC Centre of Young adult myopia; genetic and Charitable Foundation Research Excellence environmental associations Government Grants Defining cone cell death From discovery to therapy in genetic Chief Investigators – Mackey D, mechanisms in inherited retinal eye diseases Chen F, Milne E Australian Government degeneration Chief Investigators – Mackey D et al Department of Health Chief Investigator – Carvalho L NHMRC Project Lions Outback Vision The University of Western Australia NHMRC Development The interplay between IL-6 and Turner A Fred Hollows Foundation Research collaboration award Developing a novel glaucoma GVHD on anti-viral and anti- Turner A surgery for clinical use and leukaemic immunity Government of Yazar S commercialisation Chief Investigators – Tey S, Andoniou C Western Australia Gold Fields Australian Chief Investigators – Yu D, Cringle S, Department of Health Foundation The University of International Morgan B Ophthalmic Research Telethon Perth Children’s Research Diabetic retinopathy screening Western Australia grants Institute of Australia Fund Goldfields Healy Award NHMRC Partnership Liquid biopsy for prognosis uveal Mackey D Turner A Lee S National Institutes melanoma of Health Glaucoma TARRGET Chief Investigator – Gray E A novel treatment for retinal Chief Investigator – Mackey D Government of McCusker Charitable The University of Western Australia Foundation Western Australia ischemia Chief Investigator – Yu D NHMRC Principal Ophthalmic Research Department of Health Ocular Tissue Engineering Early Career Research Award Institute of Australia Research Fellowship WACHS NHMRC partnership Chen F Lee S WA ATOM Myopia (1132454) Usher 1F Degli-Esposti M Collaborative Inc. Chief Investigator – Clark A McCusker Charitable The University of Mackey D NHMRC MRFF Career Foundation Western Australia Treatment for Usher 1F Development Fellowship Ophthalmic Research Lions Outback Vision Centre for Ophthalmology and Chief Investigator – Carvalho L Institute of Australia Government of Developing personalised treatment Western Australia Turner A Visual Science infrastructure for retinal degeneration Establishing risk of vision loss in funding Leber’s hereditary optic neuropathy Department of Health Chen F Lions Save-Sight families Round 21 MHRIF Foundation Chief Investigator – Mackey D NHMRC Early Career Research support Fellowship Government of Retina Australia Western Australia CJ Martin Overseas Biomedical The University of Department of Health Fellowship Utilising patient-specific retinal Western Australia organoids in vitro to investigate Research Institute Support (RIS) Yazar S Raine Foundation Total grants 2018 the effects of an SNRNP mutation Balaratnasingam C causing early onset of retinitis WA Country pigmentosa Health Service $6,546,791 Chief Investigator – Mellough C Turner A

60 Lions Eye Institute Annual Report 2018 61 Profit or Loss and Statement of Other 2018 2017 Comprehensive Income Year ended 31 December 2018 $ $ Financial Revenue 24,612,040 22,495,138 Statements Materials, supplies and consumables (3,239,549) (2,670,254) Other direct operating expenses (10,405,613) (10,679,850)

Gross surplus 10,966,878 9,145,034

Other non-operating income 936,789 1,527,000 Net fair value (loss)/gains on financial assets at fair value through (687,046) 787,717 profit or loss Marketing expenses (1,637,002) (1,372,696)

Research and development (4,737,398) (5,094,850)

Occupancy costs (561,706) (613,016)

Administrative employee expenses (2,403,217) (2,346,847)

Administration expenses (2,133,958) (2,973,320)

Deficit before income tax (256,660) (940,978)

Income tax expense - -

Deficit after tax (256,660) (940,978)

Other Comprehensive Income - 89,954

Total Comprehensive Loss (256,660) (851,024)

Revaluation of Statement of Available for Sale Retained Changes in Equity Financial Assets Earnings Total Year ended 31 December 2018 $ $ $

Balance at 1 January 2017 668,300 39,167,774 39,836,074

Surplus After Tax for the year - (940,978) (940,978)

Other Comprehensive Income for the year 89,954 - 89,954

Balance at 1 January 2018 758,254 38,226,796 38,985,050 Adjustment from adoption of AASB 9 (758,254) 758,254 - (refer to Note 8) Deficit After Tax for the year - (256,662) (256,662)

Other Comprehensive Income for the year - - -

Balance at 31 December 2018 - 38,728,388 38,728,388

62 Lions Eye Institute Annual Report 2018 63 Statement of Financial Position 2018 2017 Statement of Cash Flows 2018 2017

As at 31 December 2018 $ $ Year ended 31 December 2018 $ $

Current Assets Cash flows from operating activities

Cash and cash equivalents 13,261,990 10,773,083 Receipts from customers 25,976,705 21,388,181 Financial assets - 985,312 Payments to suppliers and employees (24,459,462) (24,310,513) Financial Assets at fair value through profit and loss 980,777 - Net cash provided by operating activities 1,517,243 (2,922,332) Trade and other receivables 2,801,994 3,060,277 Inventories 44,452 38,479 Cash flows from investing activities Other current assets 490,118 188,138 Total Current Assets 17,579,331 15,045,289 Interest received 96,517 117,570 Dividends received 865,699 1,327,336

Non-Current Assets Proceeds from sale of investment securities 4,140,000 8,544,787

Financial assets 25,769,018 26,947,485 Proceeds from sale of capital assets - -

Property, plant and equipment 10,514,235 11,775,823 Payments for investment securities (4,423,113) (11,454,817) Total Non-Current Assets 36,283,253 38,723,308 Payments for property, plant and equipment (485,828) (1,040,258)

Net cash (used in) investing activities 193,275 (2,505,382) Total Assets 53,862,584 53,768,597

Net increase/(decrease) in cash held 1,710,518 (5,427,714) Current Liabilities Trade and other payables 13,034,943 12,854,739 Short-term provisions 1,609,253 1,422,808 Cash and cash equivalents at the beginning of the financial year 12,065,506 17,493,220 Total Current Liabilities 14,644,196 14,277,547 Cash and cash equivalents at the end of the financial year 13,776,024 12,065,506

Non-Current Liabilities Cash and cash equivalents comprise Long-term provisions 490,000 506,000 - Current cash at bank, on hand and deposits 10,411,842 7,769,072 Total Non-Current Liabilities 490,000 506,000 - Current restricted cash 2,850,148 3,004,011

13,261,990 10,773,083 Total Liabilities 15,134,196 14,783,547 - Non-current term deposits 514,034 1,292,423

Net Assets 38,728,388 38,985,050 13,776,024 12,065,506

Equity Revaluation of Available for Sale Financial Assets - 758,254 Retained Earnings 38,728,388 38,226,796 Total Equity 38,728,388 38,985,050

64 Lions Eye Institute Annual Report 2018 65 Auditor’s Report

66 Lions Eye Institute Annual Report 2018 67 DID YOU KNOW

IS A NOT-FOR-PROFIT ORGANISATION

PATIENTS

Patients see their doctor in the clinic. Part of each bill Patients benefit, helps fund our research. D and the story O

S goes on… N

T A L T U I S 1 O

E N

R 5 S HOW WE 2 Donations and Gifts in Wills help fund WORK our research.

Research leads to new Research and Clinical treatments and cures. Trials are conducted. 4DID YOU KNOW3 DID YOU KNOW H

IS A C NOT-FOR-PROFIT ORGANISATION R N A E PATIENTS E S W E Patients see their doctor in the clinic. Part of each bill Patients benefit, R D helps fund our research. T and the story O S goes on… N

T A L R T U I S 1 O

E E N R A 5 S T HOW WE 2 Donations and Gifts in Wills help fund M WORKIS A our research. E Research leads to new Research and Clinical treatments andN cures. T 4 3 Trials are conducted. H S C NOT-FOR-PROFIT R N A E E S W E T R R ORGANISATION E A TM EN TS

68 Lions Eye Institute PATIENTS

Patients see their doctor in the clinic. Part of each bill Patients benefit, helps fund our research. D and the story O

S goes on… N

T A L T U I S 1 O

E N

R 5 S HOW WE 2 Donations and Gifts in Wills help fund WORK our research.

Research leads to new Research and Clinical treatments and cures. 4 3 Trials are conducted. H C R N A E E S W E T R R E A TM EN TS