EYE2EYE 2The Magazine of the Leaders in Collaborative Eye Care

Quarter 1 2020 VOLUME 23 ISSUE 1 EYE2EYE 2the magazine of the leaders in collaborative eye care

IN THIS Australia Day Honours Increased Physical Activity Triathlete Couple RANZCO Welcome Two pg.28 Keeps the Mind Healthy Conquers Ironman New Board Directors ISSUE: pg.32 pg.49 pg.52 Paired for Performance STELLARIS ELITE ™ + CAPSULE GUARD ®

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EYE2EYE 2the magazine of the leaders in collaborative eye care CapsuleGuard® Handpiece

Excellent in all Message from the President...... 6 Eye2Eye is published by The Royal Australian and New Zealand College Censor-in-Chief’s Update...... 8 of Ophthalmologists as information phases of I/A for its members. The views expressed CEO’s Corner...... 11 in the publication are those of the authors and not necessarily of the CEO Journal Update...... 14 College. The inclusion of advertising in this publication does not Branch Musings...... 17 constitute College endorsement of the products or services advertised.

Special Interest Groups...... 20 Publisher: Alex Arancibia Editor: Jen Miguel RANZCO Affiliates...... 22 Design and layout: Francine Dutton The aptly named CapsuleGuard is the best IA device Feature News...... 28 RANZCO Office “ The Royal Australian and New I have used to date. It provides more degrees of Australia Day Honours Zealand College of Ophthalmologists A.C.N 000 644 404 RANZCO Museum...... 31 94-98 Chalmers Street freedom than any other I/A device: the soft, smooth, Surry Hills NSW 2010 Australia Health and Wellbeing Ph: +61 2 9690 1001 relatively transparent silicon tip obviates metal on Fax: +61 2 9690 1321 Increased Physical Activity Keeps the Mind Healthy...... 32 E-mail: [email protected] capsule contact and three different tip angulations Motivation to Get Moving: RANZCO Fellows Share Website: www.ranzco.edu Cover photograph by István Laszák Built for the next generation. cater for various surgeon proclivities. The optimised Their Stories...... 35 purchased from Colourbox.com aspiration port allows safe, efficient cortical cleanup Mind Skills for Enhanced Performance But ready for this one. for Young Ophthalmologists...... 37 and polishing of both anterior and posterior capsule Health in Practice...... 38 I believe that the Stellaris Elite is one of the most and also, removal of epinucleus if required. The dual “ Feature Stories...... 39

advanced Phaco platforms on the market today, and irrigation ports allow uniform capsular irrigation and My Ophthalmic Adventures...... 40 one of the most efficient cataract surgical devices maintenance of capsular bag space. Overall this “ In the Bowels of Moorfields...... 44 I have ever worked with. For cortical cleanup, device adds a safety margin previously unattainable. From Wellington to Toronto...... 45 Of High Seas and Island Visions...... 47 CapsuleGuard is an excellent choice to combine with Prof Minas T Coroneo Triathlete Couple Conquers Ironman...... 49 the Elite platform. The one piece disposable silicone Member Profile

I/A comes in several diameters which allows for a RANZCO Welcomes Two New Board Directors...... 52 “ Women in Ophthalmology New Chair...... 55 water tight closure of the incision during I/A which In Practice...... 56 helps in reducing ﬂuid utilization. Healthcare Practice Management for Dr Mitch Shultz Patient Satisfaction...... 56 Effective Communication...... 58 Promoting Positive Mental Health...... 59 Call Today to Test Drive Stellaris Elite ™ with CapsuleGuard ® 1800 251 150 Obituaries...... 60 Calendar of Events...... 64 © 2019 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) Classifieds...... 66 New Zealand Distributor: Toomac Ophthalmic. 32D Poland Road, Glenﬁeld 0627 Auckland New Zealand (Ph 0508 443 5347) STE.0028.AU.19 4 Eye2Eye Quarter 1 2020 Contributors Ruth Hadfield Roderick O’Day Even Modest Increases in Physical In the Bowels of Moorfields – Activity Boost Mental Wellbeing – Feature Stories Health and Wellbeing Dr Rod O’Day, FRANZCO, is a recently grad- Ruth Hadfield, PhD, is a freelance medi- uated ophthalmologist with dual sub-spe- cal writer based in Sydney, Australia. Ruth cialty training in ocular oncology and medi- completed her PhD at the University of cal retina. He has returned to Victoria with his Oxford in genetics and epidemiology family after 12 months working in London at research. Following 10 years as an academic Moorfields Eye Hospital. researcher, she set up her freelance medical writing practice and now writes a wide range of material for clinical and academic audiences.

William Morgan Nicholas Andrew

My Ophthalmic Adventures in From Wellington to Toronto - Indonesia - Feature Stories Feature Stories Prof William “Bill” Morgan, MBBS, FRANZCO, Dr Nick Andrew is an ophthalmologist PhD, is Managing Director of the Lions Eye who recently relocated to the Gold Coast, Institute, Western Australia and a Professor of Australia. Areas of interest include glau- Ophthalmology at the University of Western coma, refractive cataract, and complex sur- Australia. Bill has a busy glaucoma practice in gery of the iris and lens (pupilloplasties, IOL Perth and actively studies pressure relation- exchanges, discloated lenses). He has pub- ships across the optic disk, as well as being lished over 40 scientific articles and is com- involved in exploring novel glaucoma sur- pleting a PhD. He was formerly a keen rower gical procedures. He has been working and but now spends most of his free time with teaching in Indonesia for over 15 years. his young family.

Colleen Sullivan Mark Walland

Healthcare Practice Management Obituary for Arthur David McGowan for Patient Satisfaction – In Steele Practice Dr Mark Walland is a Victorian glaucoma Mrs Colleen Sullivan OAM, specialises in the and anterior segment surgeon. He trained area of healthcare practice management. at the Royal Victorian Eye and Ear Hospital She is an author and regular contributor of and at the Moorfields Eye Hospital. He has articles to healthcare publications and a been a RACE Examiner, a Section Editor for presenter at conferences. In 2019, she was Clinical and Experimental Ophthalmology and awarded the RANZCO Distinguished Service RANZCO Victorian QEC Chair. Medal.

Tempe Harvey

Obituary for Daniel Roberts Lloyd Hart Mrs Tempe Harvey, LLB, LLM, is a retired solic- itor. She worked for four years with her father, Dr Daniel Hart, as a research assistant and editor of his autobiography, Fido & Friends (2005). In recent years, Tempe has developed an inter- active history timeline of England and Australia to teach children about historic events, the origins of the English language, Western civili- sation, the rule of law and free speech. Eye2Eye Quarter 1 2020 5

Message From The President

Burnout in Australian and New Zealand Ophthalmologists

Burnout of medical practitioners, includ- Burnout in the medical profession ing ophthalmologists, is in epidemic pro- is attributed to both personal and portions worldwide. In this mental health work-related factors. Personal resilience and work/life balance issue of Eye2Eye, is helpful in reducing the risk of burn- I will discuss burnout and its conse- out; neuroticism personality trait diag- quences as well as approaches to its mit- nosis during medical school is thought igation for Australian and New Zealand to increase the risk. Most of the risk of ophthalmologists. burnout, however, is attributed to the Professional burnout, reported first by medical work environment. Risk of burn- Freudenberger, is a concept character- out in ophthalmology may be height- ised by a triad of a loss of enthusiasm for ened by rapid technological change in our specialty, which can further increase work (emotional exhaustion), feelings already unrealistic patient expectations. of cynicism (depersonalisation) and a low sense of personal accomplishment. Analysing the data Burnout is important to discuss because The best Australian data is the Beyond it impacts satisfaction with professional/ Blue National Mental Health Survey of personal work/life balance for individu- Doctors and Medical Students (response als. It appears to have adverse personal rate 27%, resulting in 12,252 responses consequences for doctors, including from doctors in 2011), which reported contributing to broken relationships, notable percentages of Australian problematic drug and alcohol use, and doctors with high levels of emotional early retirement. Burnout is not a diag- exhaustion (32%) and cynicism (35%). nosis in its own right but a risk factor Reported emotional exhaustion levels for mental illness including depression, were higher among female doctors anxiety and, in some cases, suicide. (38%) than males (27%). Those at greater Patients may also be affected through risk were young doctors. Twenty-one loss of empathy and possible impacts on percent of doctors reported ever been professionalism, quality of care and risk diagnosed with depression, with 6% of medical errors. having a current diagnosis (similar to the population but higher than other Australian professionals) and 3.7% a current diagnosis of anxiety disorder “Burnout is important (Australian population 2.7%). Studies in NZ demonstrate similar findings. A 2016 to discuss because it study of the public hospital senior medical workforce (1,487 respondents) found impacts satisfaction a 50% rate of personal burnout, with women aged <40 years having highest with professional/ prevalence (71%), and more recently a personal work/ study of an urban emergency department (380 surveyed with a response rate life balance for of 71% in 2019) similarly found 42% to have personal burnout. The reported individuals.” results are comparable to data from the USA, UK and India. There is no specific data on Australian or NZ ophthalmologists, however a recent study of US physicians (7,288 6 Message from the President

surveyed, 27% response rate) reported and a collegial attitude, valuing the doc- 46% had at least one symptom of tor/patient relationship, finding a men- burnout, with ophthalmologists faring tor and regularly debriefing. “…respondents to slightly better than the mean (43.4% RANZCO recognises burnout as an reporting burnout). The study found issue and the vulnerability of our train- the 2016 NZ survey that US doctors were most likely to be ees as a population of younger doctors. dissatisfied with their professional/per- We allocate mentors to all trainees rejected the assertion sonal life balance (40.2% versus 23.2% and have engaged Converge to offer a of adults in the population). However, free confidential telephone service for that patients were ophthalmologists fared relatively well trainees, Fellows and staff. Uptake of the source of burnout with 57% of ophthalmologists report- Converge consultations has been slowly ing satisfaction with their professional/ increasing. and instead noted personal life balance (physician popula- Burnout is increasingly recognised as tion 49%). an issue for trainees and Fellows alike. administration and The Beyond Blue survey confirmed Response of the health sector is frag- that general work experience for mented but RANZCO has proactively under-resourcing to be Australian doctors is stressful and established systems to assist those who contributors.” demanding, with stressors including are at risk or affected with burnout and the need to balance work and personal its consequences. responsibilities (27%), work overload (25%), huge amount of responsibility at Clinical A/Prof Heather Mack work (21%), long work hours (20%) and President fear of making mistakes (19%). Similarly, respondents to the 2016 NZ survey References available upon request. Please email RANZCO. rejected the assertion that patients were the source of burnout and instead noted administration and under-resourcing to be contributors. Reducing Burnout GET HELP AND Despite recognition of the problem, including that by the Medical Board of SUPPORT For the latest Australia and the Medical Council of NZ, RANZCO’s Employee Assistance there is no national approach to burnout updates on of medical practitioners in Australia or Program (EAP) offers confi- NZ. The problem is compounded by per- dential support provided by RANZCO’s ceived stigma of mental illness and fear qualified external counsel- of mandatory reporting. In Australia, lors – free to all members position on there are some state-based services (e.g. and their immediate families. Victorian Doctors Health Program, NSW COVID-19. Check To make an appointment or Doctors’ Health Advisory Service) and the news feed help may be offered by some via med- speak with an EAP provider, ical defence organisations and hospital contact: on the RANZCO employee assistance schemes. The NZ NZ – 0800 666 367 Medical Protection Society runs work- AU – 1300 687 327 website. shops on burnout management. Steps [email protected] individuals can take personally include regular rest, eating nutritious meals, www.ranzco.edu spending time with family, engaging in broad interests, socialising with non-medical friends and exercising regularly. Professional steps to reduce burnout include engaging in professional development, focusing on teamwork Eye2Eye Quarter 1 2020 7

For patients with wet AMD1 THEIR VISION IS A MASTERPIECE NOW TGA REGISTERED

In two head-to-head trials vs aflibercept, Beovu:2 • Demonstrated robust vision gains*2 • Demonstrated superior fluid resolution† 2 • Maintained a majority of patients on a q12w interval immediately after loading through Week 48 2 • Exhibited an overall safety profile comparable to aflibercept2 * Mean BCVA improvement of 6.6 letters (HAWK) and 6.9 letters (HARRIER) from baseline at Week 48. †Secondary endpoint in HAWK and HARRIER; p<0.001; confirmatory analysis in HAWK only (1-sided p values for superiority of Beovu)

Abbreviations: AMD: age-related macular degeneration; q12w: 12-weekly dosing; TGA: Therapeutic Goods Administration.

PBS Information: This product is not listed on the PBS. Please review the Approved Product Information before prescribing. Full Product Information can be accessed via www.novartis.com.au/products/healthcare-professionals or from Novartis Medical Information: 1800 671 203. Beovu® (brolucizumab [rbe]) Indication: Treatment of neovascular (wet) age-related macular degeneration (AMD). Contraindications: Hypersensitivity to brolucizumab or to any of the excipients. Patients with active or suspected ocular or periocular infections. Patients with active intraocular inflammation.Dosage and administration: Single-use pre-filled syringe for intravitreal (IVT) use only.Beovu must be administered by a qualified ophthalmologist experienced in administering IVT injections. The recommended dose is 6 mg brolucizumab (0.05 mL solution). Complex dosage and administration – see full PI before prescribing. Precautions: IVT injections have been associated with endophthalmitis and retinal detachment. Proper aseptic injection techniques must always be used. Patients should be instructed to report any symptoms suggestive of the above mentioned events without delay. Transient increases in intraocular pressure have been seen within 30 minutes of injection, similar to those observed with IVT administration of other VEGF inhibitors. Sustained intraocular pressure increases have also been reported. Both intraocular pressure and perfusion of the optic nerve head must be monitored and managed appropriately. Special precaution is needed in patients with poorly controlled glaucoma. ♦ Arterial thromboembolic events (ATE): There is a potential risk of ATE following IVT use of VEGF inhibitors. ♦ Immunogenicity: Patients should be instructed to inform their physician if they develop symptoms such as eye pain or increased discomfort, worsening eye redness, blurred or decreased vision, an increased number of small particles in their vision, or increased sensitivity to light. ♦ Beovu should not be administered concurrently with other anti-VEGF medicinal products. ♦ Treatment should be withheld and not be resumed earlier than the next scheduled treatment in the event of a decrease in BCVA of ≥ 30 letters compared with the last assessment of visual acuity; a retinal break; a subretinal haemorrhage involving the centre of the fovea, or, if the size of the haemorrhage is ≥ 50% of the total lesion area; performed or planned intraocular surgery within the previous or next 28 days. ♦ Risk factors associated with the development of a retinal pigment epithelial tear after anti-VEGF therapy for wet AMD include a large and/or high pigment epithelial retinal detachment. Caution should be used in patients with these risk factors for retinal pigment epithelial tears. ♦ Treatment should be discontinued in subjects with rhegmatogenous retinal detachment or stage 3 or 4 macular holes. ♦ Caution should be exercised when treating patients with a history of stroke, transient ischaemic attacks or myocardial infarction within the last 3 months. Beovu should not be administered concurrently with other anti-VEGF medicinal products (systemic or ocular). ♦ Use in Pregnancy: Category D. Based on the anti-VEGF mechanism of action, Beovu must be regarded as potentially teratogenic and embryo/fetotoxic. Therefore, Beovu should not be used during pregnancy unless the expected benefits outweighs the potential risks to the foetus. ♦ Lactation: Breast-feeding is not recommended during treatment and for at least one month after the last dose when stopping treatment. ♦ Women of reproductive potential should use effective contraception (methods that result in < 1% pregnancy rates) during treatment and for at least one month after the last dose when stopping treatment. ♦ Patients may experience temporary visual disturbances after an IVT injection and the associated eye examination. Patients should be advised not to drive or use machinery until visual function has recovered sufficiently. Adverse effects: ♦ Common (1 to 10%): Visual acuity reduced, retinal haemorrhage, uveitis, iritis, vitreous detachment, retinal tear, cataract, conjunctival haemorrhage, vitreous floaters, eye pain, intraocular pressure increase, conjunctivitis, retinal pigment epithelial tear, vision blurred, corneal abrasion, punctate keratitis, hypersensitivity. ♦ Uncommon (0.1 to 1%): Endophthalmitis, blindness, retinal artery occlusion, retinal detachment, conjunctival hyperaemia, lacrimation increased, abnormal sensation in eye, detachment of retinal pigment epithelium, vitritis, anterior chamber inflammation, irirodyclitis, anterior chamber flare, corneal oedema, vitreous haemorrhage. Based on TGA approved Product Information dated January 2020 (beo150120m). REFERENCES: 1. Beovu Product Information. 2. Dugel PU et al. Phase 3, Multicenter, Randomized, Double-Masked Trials of Brolucizumab for Neovascular Age-Related Macular Degeneration. Ophthalmology 2019;pii:S0161–6420(18)33018–5. Novartis Pharmaceuticals Australia Pty Limited ABN 18 004 244 160. 54 Waterloo Road, Macquarie Park NSW 2113. Ph (02) 9805 3555. ® Registered trademark. February 2020. AU-11624. NOBR17909W EF. Ward6.

NOBR17909W TGA Eye2Eye A4 210x297 v1a.indd 1 5/2/20 5:17 pm 8 Censor-in-Chief Update

Censor-In-Chief’s Update

Shifting Service Towards Education The Asia Pacific region RANZCO Fellows have always taken this mission statement to heart by getting has about one-third of the involved with training and education world’s blind and visually not only in Australia and New Zealand impaired so it is appropriate but also in the whole Asia Pacific region. Often this is delivered by Fellows work- that our College has in its ing as individuals but also through 2017-2020 Strategic Plan programs developed with the RANZCO the mission statement: education team. We have a long history in this space. Improving eye healthcare through Our Fellows’ involvement in overseas education, communication, collabo- training goes back beyond Fred Hollows ration and advocacy, nationally and and his work in Eritrea and Nepal with internationally. many notable achievements since then. In 2006, Fred Hollows New Zealand established the Pacific Eye Institute And further within the plan: (PEI) in Suva, Fiji, a project strongly sup- …we will focus our efforts on South ported by RANZCO Fellows. Its aim was East Asia and the Pacific. We will to improve access to ophthalmic care in work on capacity building, support- the Pacific by training Pacific people to ing the enhancement of educational provide care in their own communities. and professional standards, sup- This has been hugely successful having porting/increasing the effectiveness trained 174 eye doctors, nurses and of our partnerships and improving technicians across 15 Pacific nations over the last 13 years. In 1986, I did my three- communication. month medical elective in the Solomon Islands and I learned that the ophthalmic service delivery was provided by a generous Australian for one week per year. While the community was very grateful for that at the time, how much better off are they now with three PEI-trained Solomon Island ophthalmologists working in Honiara. Coincidentally, one of those is the daughter of the surgeon I worked with as a student. The PEI has always relied on and will continue to benefit from the teaching provided by RANZCO Fellows. Many of you have been involved in subspecialty weeks or as external observers for the PEI exams. Many of you also contributed to the development of the Cambodian, Fijian and PNG ophthalmology cur- ricula. Since 2006, RANZCO has assisted the Fred Hollows Foundation and University of Health Sciences to establish an ophthalmology training Eye2Eye Quarter 1 2020 9

program in Cambodia with the first PNG ophthalmologists Drs Jambi Garap, has focused on training ophthalmologists ophthalmologists graduating in 2009. Robert Ko, David Pahau, Simon Melengas in Myanmar, Laos, Cambodia and Vietnam Following an injection of funding from and (former) UPNG Senior Lecturer at the subspecialty level. The SFA fellow- the Australian government, RANZCO’s Geoffrey Wabulembo. As the people ships aim to create a group of local experts contribution to capacity building in who have to institute the program, the who can pass their knowledge and skills Cambodia increased. In 2013, RANZCO Geoffrey Wabulembo’s and many others’ on to the next generation of doctors. signed a memorandum of under- support have been vital and I am pleased Of course, not all education is purely standing with the University of Health to say that, while in its gestational stage, clinical, a fact recognised by Dr Cathy Sciences in Cambodia. My predecessor the PNG training program is going well. Green AO when she established the as CiC, Dr Mark Renehan, along with RANZCO has links with other countries Leadership Development Program. This Gerhard Schlenther (GM Policy and in the region with educational MOUs has proven to be hugely beneficial in Programs) and the RANZCO education with Singapore, Malaysia and Indonesia. encouraging younger ophthalmologists and international development teams For Malaysia and Indonesia, we provide to challenge themselves and prepare designed and implemented a bespoke external examiners and host their exam- to lead their respective countries in the curriculum suited to the particular chal- iners at RACE in return. These symbiotic decades ahead. lenges facing that country. relationships are wonderful for all par- RANZCO’s International Development ties. They improve the quality of care Committee, led until recently by and we all benefit from the relationships Anthony Bennett Hall and now by Garry generated through these contacts. Brian, knows full well that education is The focus of international ophthalmic the key to improving ophthalmic care “The focus of efforts has quite rightly shifted away in the Asia Pacific and they work closely international from service towards education. Those with the education team at RANZCO to of you who have worked in the develop- ensure that all the work done by our ophthalmic efforts has ing world understand the resource limi- Fellows achieves the best outcomes. tations they face. Teaching an Australian Any of you who have not been quite rightly shifted or New Zealand model of care is not nec- involved in an overseas education, essarily appropriate. While the same out- whether it is a RANZCO one or another away from service comes must be sought, it is important to Australian or NZ run program, have yet towards education.” appreciate the context or environment to experience the satisfaction of sharing we are teaching in; and in-country pro- your knowledge and experience in a way grams that train the local doctors to that makes a unique difference. teach are the most effective. When you are at an appropriate stage Following the signing of a letter of in your career, recognising that we all agreement in 2017 with the University have other commitments to our families of Papua New Guinea (UPNG), using the and our day-to-day work, I encourage information gained from an in-country you to get involved. And for those who assessment of the causes of blindness, “…education is the think they might be ready now, please the UPNG curriculum was reviewed key to improving consider putting your hand up for teach- focusing on community-specific needs. ing visits to PEI or PNG. For information It was very valuable to have Dr Harris ophthalmic care in the about opportunities to get involved Ansari from the PEI and RANZCO Fellow please refer to the RANZCO E-News. Dr Neil Murray lend their considerable Asia Pacific” developing world experience to the pro- Dr Justin Mora cess but, as with Cambodia, the desired Censor-in-Chief outcome would not have been achieved That model is exemplified by RANZCO’s without the assistance of many RANZCO work in Cambodia and PNG, FHFNZ work Fellows such as Dr Cathy Green AO, A/Prof with PEI but also by others. Fifteen years Anthony Bennett Hall, Dr Brian Sloan, ago, 2020 Australian of the Year Dr James Dr Garry Brian and in particular the Muecke AM established Sight for All and 10

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1. Craig, J.P., Chen, Y.H., Turnbull, P.R. Prospective trial of intense pulsed light for the treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 56 (3), 1965 - 1970 (2015). 2. Jiang, X., et al. Evaluation of the Safety and Effectiveness of Intense Pulsed Light in the Treatment of Meibomian Gland Dysfunction. J Ophthalmol. (2016). 3. Albietz, J.M., Schmid, K.L. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 101 (1), 23 - 33 (2018).

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CEO’S Corner

In the Service of Care

As highlighted in other articles in this the expectation that this will result in magazine, stress on doctors at all stages a trainee rushing off to learn more, or of their career and mental health is not ignoring trainees in difficulty because new. It’s just being talked about more. they are ‘unteachable’. At the same time, This is a critical step in addressing the trainees can misunderstand the differ- factors that lead to stress and mental ence between the need to take instruc- health problems. There is no doubt that tion quickly and accurately for the safety workplace culture is one key factor. of a patient and bullying. There is no Another is the growing competition doubt that in the last few years in par- between doctors, at the expense of col- ticular, but probably over the last 10 legiality and care. years, there has been a shift in social You are probably aware that RANZCO attitudes and work culture that requires has undertaken two surveys on bullying some people to think differently about and harassment. We also regularly sur- how they interact with those in more vey trainees and supervisors about their junior positions. It’s a two-way street but experiences in the training program. As it is clear that teaching by intimidation part of our accreditation process, we ask belongs firmly in the past and clear com- trainees, supervisors and administrators munication around expectations will go various questions relating to work cul- a long way to stopping issues before ture, bullying and harassment. For the they arise. This will not only result in first time in 2019, the Medical Board of trainees being less stressed, having less Australia ran a survey of all doctors in mental health issues and being more training, from those just out of university productive, but it will also mean super- to those completing college programs. visors are not taking on the burden of All surveys were anonymous. The results dealing with trainees in difficulty and all of a number of these have been shown the extra work and stress that can come in previous editions of Eye2Eye, and with it. the Australian National Training Survey results are publicly available through AHPRA/MBA websites. There is no doubt that there remains a problem of bullying at all levels within ophthalmology. But “…it’s up to everyone this is not unique to ophthalmology. Unfortunately, all the surveys show to think about the way that over the last five years, there really hasn’t been much of a shift in trainees people behave, call out observing or experiencing what they perceive to be bullying or harassment. bad behaviour when It is not up to the trainees to change it happens and help their attitude, it’s up to everyone else to think about the way people behave, change the culture call out bad behaviour when it happens and help change the culture across the across the whole of whole of medicine. As I look back at specific issues, the medicine.” most common factor is poor communication. Some supervisors tend to bark orders, ‘teach’ by using belittling com- ments about lack of knowledge with 12 CEO’s Corner

Although not unique to ophthalmol- competitors has been greatly expanded RANZCO, the Medical Board of Australia ogy, the commercialisation of private and they are very willing to tackle these or the Medical Council of New Zealand, medicine is another area that results in issues. I am not saying that advertising your medical indemnity insurer, your significant stress for some people. Some is wrong. Rather that sometimes peo- hospital or place of employment, the areas of ophthalmology are clearly more ple can get carried away which almost AMA or NZMA or various mental health competitive than others. The race to have certainly has a negative effect on a organisations. Please do not bear the the best looking practice with the latest colleague’s mental health, if not their burden alone. Seek help. equipment to attract the most patients practice, and may lead to action from Dr David Andrews is expensive. The outlay needs to be the regulator. Consider what you reason- CEO recouped and unfortunately, not infre- ably need to do to best serve patients, quently, it turns to making overblown not what you could do to have the most claims about the skills or experience business. By all accounts there are more of practice owners or unsubstantiated than enough patients needing ophthal- claims about local competitors’ standard mology services. of care. While it is true that many Fellows Over 50 years ago, RANZCO was “…thinking about in Australia and New Zealand have established to provide high quality, taking care of not only undertaken considerable extra training standardised training and education and in sub-specialty areas, it is also true that collegiality for ophthalmologists. The patients but trainees almost all Fellows have been trained to world has changed a lot since then but some of the highest standards in the I believe these two founding principles and colleagues and world and are extremely competent should still underpin all our activities ophthalmologists. To suggest, for exam- today and in the future. Bearing these giving back to the ple, that the purchase of the latest phaco in mind, thinking about taking care of college and your machine somehow makes you the best not only patients but trainees and col- cataract surgeon in town is wrong, nor leagues and giving back to the college community will should new premises imply the service and your community, will undoubtedly will be better than an existing practice. make everyone feel a bit happier and a undoubtedly make In my discussion with the Medical Board lot less stressed. of Australia late last year, they have For those continuing to experience everyone feel a bit said that their team examining cases of bullying, harassment or other stressful happier and a lot less ‘overzealous’ advertising and claims by situations, there are multiple organisa- doctors to differentiate themselves from tions that may be able to help including stressed.”

CRMUPDATE YOUR INFORMATION Fellows are highly encouraged to update their details including practice locations in the portal. Click Log In from the RANZCO website to update or scan the QR code using your phone camera app for support.

CRM strip ad E2E.indd 1 06/02/2020 2:19:38 PM Eye2Eye Quarter 1 2020 13

AVANT Advertorial

as normal within a few days of an attack. However, when backup Guarding Against a Cyber-attack files cannot be accessed, the practice will have to gather patient on Your Practice information from other sources. You may also be able to access information from a patient’s My Health Record. A cyber-attack can have a devastating impact on your practice, potentially locking out systems for weeks and Lack of access to electronic medical records will make patient care difficult, but in most cases, you should continue to see patients breaching patient privacy. unless you are unable to provide adequate healthcare. However, practice owners and managers can be prepared In Mary’s case, the practice appointments were in the IT system for and minimise the risks of a cyber incident by having that could not be accessed. When a patient arrived for an appoint- clear IT security policies and procedures for all staff. ment, the practice took demographic details and contacted the A hard cyber lesson patient’s GP, other specialists and pharmacists etc. to provide clinical data for the patient. Avant member Mary (a pseudonym) recently spoke to Avant about the devastating impact of a ransomware attack on her practice. The most concerning aspect for Mary was not knowing if patients had failed to attend an appointment. It was a hard lesson on why cyber security policies and procedures are essential in every practice, particularly ensuring your backup Patient privacy is secure. Mary was also concerned about privacy obligations. The OAIC did Mary described the cyber-attack at her practice as a catastrophe. ask the practice for information about the incident. It was ulti- Like many practices, it had relied on its IT provider to deal with mately agreed that as the firewall had not been breached, there cyber security and IT systems. The practice did not have a sepa- was no reasonable chance data had been accessed by unauthor- rate cyber response plan and staff felt unprepared to respond to ised people or exported. Therefore, there was no obligation to a cyber incident. report the incident to the OAIC under the Notifiable Data Breach When the attack happened, the paperless practice suddenly found scheme. it had no information on any patients. It discovered its backup was However, this may not always be the case. Whenever there is not sufficiently secure and had been infected as well. Ultimately, a cyber incident, the practice should check if the incident is a all systems, data and backup files were inaccessible, from appoint- notifiable data breach that needs to be reported to the OAIC ment books to patient records. It was five weeks before all patient and patients, and keep good records of its investigation in case a information was recovered. report is required. Recognising a cyber-attack Kate Gillman It can be difficult to recognise a cyber incident which may appear BA, LLB, Head of the Medico-legal Advisory Service, Avant, NSW to be an internet connection or service provider problem.

Minimise the damage Key lessons If your practice experiences IT problems, assume the worst and shut down all computers. • Ensure your backup is safe, secure and impenetrable. • Have strong cyber security policies and procedures Be aware that if you try to restore your files from your backups in place and ensure all practitioners and staff adhere while your system is still exposed to the attack, you may infect to these, especially password security. your backup. Do not connect the backup data or any portable • Conduct a cyber audit. Mary said she would now devices to the network. Contact your IT provider immediately. recommend getting a second opinion on IT security Don’t rely on paying to restore your data from another provider or consultant to ensure there Seek advice from your insurance provider and IT experts if you are no weaknesses in the system rather than relying receive a ransomware demand. on one provider. Mary’s practice received a random demand about 24 hours after the cyber-attack. After four weeks of being unable to access data More information: and backup files, the practice owners decided to pay the ransom. • Avant: Cyber security - What you need to know CRM However, even if you receive a decryption code, this is no guaran- (https://www.avant.org.au/Resources/Public/ UPDATE YOUR INFORMATION tee you will get all your data back. In Mary’s case, it took another Cyber-security-what-you-need-to-know/) week before the decryption code worked. • Avant: Podcast - It happened to me Fellows are highly encouraged to update their details The Australian Cyber Security Centre advises against paying (https://www.avant.org.au/Resources/Public/ Podcast--It-happened-to-me--Cyber-attack/) including practice locations in the portal. ransoms. • Office of the Australian Information Commissioner: What is a Recreating patient records notifiable breach? Click Log In from the RANZCO website to update or scan While trying to get data restored, Mary’s practice had to rebuild its (https://www.oaic.gov.au/privacy/data-breaches/ the QR code using your phone camera app for support. data systems, including medical records, because the backup files what-is-a-notifiable-data-breach/) • RACGP: Information security were also inaccessible. (https://www.racgp.org.au/running-a-practice/security) If a practice has separate and secure backups, it may be able to • Avant: Cyber insurance retrieve clinical and administrative information and be operating (https://www.avant.org.au/cyber-insurance/) CRM strip ad E2E.indd 1 06/02/2020 2:19:38 PM 14 CEO Journal Update

CEO Journal Update

Clinical and Experimental Ophthalmology appoints first female Editor-in-Chief

Justine is a Matthew Flinders President of the American Uveitis Society, Distinguished Professor at the Flinders and serves on Boards of the International University College of Medicine and Public Council of Ophthalmology, the Health in South Australia. International Ocular Inflammation Society She is an internationally recognised and the Global Ocular Inflammation expert in the causes, effects and treatment Workshops. of uveitis. Her work extends to infection by In 2017, Justine was named a Superstar parasites and viruses, and ocular cancers. of STEM by Science and Technology Through her research, important discov- Australia and is a passionate advocate for eries on the mechanisms of infectious uve- supporting girls and women to pursue itis have been made, while her laboratory careers in science. research and the associated clinical trials Justine aims to build on the excellent have supported the use of biologic drugs work achieved by Prof Robert Casson and to reduce vision loss from non-infectious A/Prof Salmaan Al-Qureshi, maintaining uveitis. the high Journal Impact Factor (JIF) and Justine is a Research Strategic Professor position in the ophthalmology JIF table, at Flinders University, Fellow of the while making her mark by developing the Australian Academy of Health and Medical journal in other strategic areas. I would like to take this opportunity The CEO Editorial team are Sciences, and Chair of the Academia to welcome Justine to CEO. The Editorial Ophthalmologica Internationalis. delighted to announce the Board members and I look forward to She is Executive Vice-President of the appointment of Prof Justine working with her in the coming years. Association for Research in Vision and Smith as the new CEO Ophthalmology, the world’s largest eye Victoria Cartwright Editor-in-Chief. and vision research organisation, a past Managing Editor, CEO Journal Top Team Retire from Editor-In-Chief Positions After 10 years at the helm of Clinical and Experimental Ophthalmology, Editors- in-Chief Prof Robert “Bob” Casson and A/Prof Salmaan Al-Qureshi have retired from the Board to allow a new EIC to make their mark on the journal. Bob and Salmaan took over from the previous EIC, Prof Charles McGhee, in early 2010 and continued on from his legacy of evolving CEO from a regional journal into an internationally recog- Prof Bob Casson, Ms Victoria Cartwright and A/Prof Salmaan Al-Qureshi at the CEO Journal nised publication, attracting readers and Editorial Board Meeting November 2019 authors of quality research from the top Eye2Eye Quarter 1 2020 15

institutions around the world. In the last app, and the result was that CEO was the 2015 to manage the role that CEO plays 10 years, they have taken this to a new first ophthalmology journal in the world in the RANZCO CPD process, and to level by expertly managing the difficult to be launched on the App Store back in encourage RANZCO Fellows to read the task of identifying papers of interest and 2011. journal and have this recognised with reducing the acceptance rate to further In the last 10 years, CEO has run well-re- CPD accreditation. improve the quality of the articles pub- ceived research courses for trainees, doc- Throughout their 10 years in charge of lished in CEO. tors and scientists interested in under- CEO, Bob and Salmaan have worked as a The success of their leadership is clearly taking research at several Australasian perfectly complementary team, and they evident in the outstanding improvement RANZCO congresses and international have maintained the high ethical stand- in Journal Impact Factor (JIF) score and APAO congresses. ard expected from the RANZCO journal. rank. In 2009, CEO was placed 23rd in the Every year since 2012, Bob and Salmaan They hand over a thriving and highly suc- ophthalmology JIF table with a score have persuaded world-renowned experts cessful journal to the new Editor-in-Chief, of 1.76. In July last year, we were all into contributing to the annual themed Prof Justine Smith. delighted to see CEO reach an impres- special issue. Many of the review articles From a personal point of view, it sive 11th place in the table with a JIF of that have been published in these issues has been an absolute pleasure to work 3.41. This figure suggests that recent CEO remain the most highly downloaded and with Bob and Salmaan over the years. articles are cited 3.41 times per year on cited articles in CEO. On behalf of the RANZCO Fellows and average. During their tenure, Bob and Salmaan CEO Editorial Board, we thank them for In 2020, CEO is now recognised as one have enabled the journal to link in their service to the RANZCO journal and of the top ophthalmic journals with an with Publons, a platform that enables hope that they are now able to enjoy a excellent international profile. The read- reviewers to record and showcase their few extra hours downtime in their busy ership has expanded such that CEO arti- reviewing contributions. CEO has also weekly schedules. cles are downloaded more than 200,000 partnered with iThenticate, to allow times every year and submissions have for the easy identification of plagiarised Victoria Cartwright increased from 70 per month back in submissions. Managing Editor, CEO Journal 2010 to 106 per month for 2019. The Editorial Board has been stream- The achievements of the outgoing lined and now all the members play an Editors are not only limited to improve- active role in managing the reviewing ment in the JIF. Salmaan was instrumental process for submitted papers. A CPD in pushing for CEO to be available via an Section Editor position was created in

CEO Journal is now on Twitter Follow @ClinExpOphthal on Twitter for updates on the journal

CEO Impact Factor scores and rank, 2009-2018 RANZCO20 BRISBANE20 9-13 October 2020

Local & International INVITED SPEAKERS

Dame Ida Mann Memorial Lecture Prof Alex Hewitt Sir Norman Gregg Lecture Prof Graham Barrett Fred Hollows Lecture Dr Catherine Green Council Lecture Dr Clare Fraser Neuro-ophthalmology Update Lecture Dr Lynn K Gordon MD Cataract Update Lecture Mr David Lockington Retina Update Lecture Dr Anita Agarwal MD Glaucoma Update Lecture Dr Pradeep Ramulu MD Refractive Update Lecture Dr Damien Gatinel MD

For all Congress details visit www.ranzco2020.com Eye2Eye Quarter 1 2020 17

Branch Musings RANZCO20 BRISBANE20 New Zealand Victoria Queensland 9-13 October 2020 CHAIR: COUNTRY VICE CHAIR: CHAIR: Peter Hadden David Van der Straaten Stephen Godfrey HON SECRETARY & TREASURER: HON SECRETARY: VICE CHAIR: Kenneth Chan Xavier Fagan Mark Chiang HON TREASURER: HON SECRETARY: It has been another busy few months in Lewis Levitz Alison Chiu New Zealand. We have had good, posi- HON TREASURER: tive engagement with the Ministry of The Victorian Branch continued to sup- Oben Candemir Health regarding the Dunedin Hospital port registrar involvement in Indigenous redevelopment and are continuing to health with funded trips to work with Hoping that the Christmas to New liaise with them regarding overdue fol- the Lions Outback Vision van during Year break was a restful and reward- Local & International low ups and the funding of a new train- 2019. We have also sponsored some ing family time for all of the College ing post in Tauranga. By the time this small local research projects that may Fellows. The extremes of weather have INVITED SPEAKERS article is published, David Andrews and I not have easily attracted financial sup- had a major impact on all Australians. will have met with the Minister of Health port including: We particularly remember the areas Dame Ida Mann Memorial regarding these and other matters. • The sensitivity and specificity affected by the fires and extreme con- One of these matters is the potential of bridge thyroid stimulating ditions in the more rural areas of New Lecture to negotiate with the UK regarding eas- immunoglobulin (TSI) immunoassay South Wales, Victoria and Queensland. Prof Alex Hewitt ier access for our trainees for fellowship in detecting thyroid eye disease (Dr As I write this article, the weather has posts in the UK post-Brexit. This has JJ Khong); improved substantially and gentle rain Sir Norman Gregg Lecture already been an ongoing discussion • The prize-winning poster at the is falling across the whole of South East Queensland helping to relieve Prof Graham Barrett with the Ministry of Health in New RANZCO 2019 congress by Ms drought-stricken areas. Zealand which is also of interest to our Monica Hu with Dr Tom Edwards’ In late 2019, Queensland ophthal- Fred Hollows Lecture Australian Fellows. The UK government group, “Looking towards gene mology lost two of its most senior Dr Catherine Green has expressed an interest in making such therapy: Characterisation of ex Fellows. Dr Daniel Hart passed away in access easier for both New Zealanders vivo AAV2.CYP4V2 gene therapy in his hundredth year in late December Council Lecture and Australians. The New Zealand gov- human retinal explants.“ ernment and their Australian counter- and will not only be remembered as Dr Clare Fraser Dr David Van der Straaten parts are wary in allowing this in case the second President of the College Neuro-ophthalmology New Zealanders move to the UK en of Ophthalmology, but more as a Update Lecture masse after Brexit where there is a pos- respected and revered ophthalmolo- sibility of losing EU doctors. We have gist. Dan was admired by all levels of Dr Lynn K Gordon MD presented to them the numbers that our Fellowship in Queensland and will be greatly missed. There will be much Cataract Update Lecture College has which indicates that we gain far more UK ophthalmologists than we more said in this magazine regarding Mr David Lockington lose. We would like for this to be pointed his life and legacy with regards to out to the Australian government. I have Australian ophthalmology. Retina Update Lecture also been told that the caution regard- Similarly, we note the passing of Dr Anita Agarwal MD ing such an agreement originated in Dr Tim Forster who has been a VMO Australia. and registrar mentor over decades of Glaucoma Update Lecture We continue to meet with the ophthalmic care to the Brisbane north- Dr Pradeep Ramulu MD Optometrists and Dispensing Opticians side. Tim had a unique approach to his Board, their regulatory body, to discuss work at the Royal Brisbane Hospital Refractive Update Lecture their scope of practice. We have reiter- and private practice and will be greatly missed. ated that the College thinks that oph- Dr Damien Gatinel MD Once again, the National Congress thalmologists are the only people who was a resounding success and packed should be injecting into eyes and that full of clinical and social gems for the we would not support optometrists per- delegates. From a Queensland performing intravitreal injections. spective, our wholehearted congrat- For all Congress details visit www.ranzco2020.com Dr Peter Hadden ulations go to Mrs Colleen Sullivan 18 Branch Musings

who received the Distinguished Service Medal for her untiring and pioneering New South Wales Western Australia work in practice management. Colleen has guided a generation of practice CHAIR: CHAIR: managers and continues to do so. It Diana Farlow Nigel Morlet is no wonder that her late husband, VICE CHAIR: HON SECRETARY: Frank, and son, Tim, have two of the best Alina Zeldovich David Delahunty ophthalmic practices that Queensland HON SECRETARY: HON TREASURER: has produced. Congratulations again, Alison Chiu Tom Cunneen Colleen. HON TREASURER: Apart from a number of Branch activ- Dr Matt Cranstoun has been given Nisha Sachdev ities in the last six months, many from the responsibility of Queensland COUNTRY VICE CHAIR: th Representative to the Remote and WA also attended the 50 RANZCO Rural Training Network. Matt has an Neale Mulligan Congress in Sydney which was the largest one held to date. The Congress excellent grounding in Queensland Our thoughts are with those in NSW, program has evolved over the years ophthalmology, certainly knows all of Victoria and other states that have the younger Fellows and will suit this and the plenary sessions had a consist- suffered from the bushfires. I’m sure ently large audience, even for the final role perfectly. We wish him well in this everyone knows someone affected. regard. one on Tuesday. We were proud to see Congratulations to Dr James Muecke Queensland had its first alumni the presentation of the WA collective AM, Australian of the Year. A fitting recip- weekend on 16–17 November 2019. audit on OCT gain the Audit Award – This has been the brainchild of Drs ient in the year 2020! Congratulations well done Drs Ella Suo and Jo Richards. Ken Hutchinson and Andrew Apel to other ophthalmology colleagues It is a certainly a tribute to the fine and was a really magnificent week- who have also received Australia Day efforts Jo has put into developing this end for both registrars and the Honours Awards in 2020. resource for branch Fellows over the Queensland ophthalmic alumni. Following up on Dr Robert Griffits’ last few years. There were excellent practical/surgi- newsletters, the Branch is keen to The Medical Board has further mod- cal skills gained, along with a day of promote and support rural, regional ified the requirements and this year excellent academic presentation. We and remote ophthalmology services in you will need to complete a CPD plan thank the conveners and certainly NSW. We have established a subcom- at the outset of the year. This will be required each year ongoing. Another all the speakers wholeheartedly. We mittee consisting of Drs Ashish Agar, change to be implemented soon is the would encourage more representa- Robert Griffits and Christine Younan. need for a yearly Performance Review tion from the Queensland alumni in Another objective of our committee and that will require 12.5 hours of 2020 as this will only grow in stature is to formalise and oversee a system as a Queensland ophthalmic event. activity in addition to the required of referral to Fellows for medicolegal As I am sure everyone is aware, the activity for Outcomes Review (audit). matters involving ophthalmology. This National Congress in 2020 will be held For your part, some thought is needed in Brisbane. The conference organis- includes litigation cases, Motor Vehicle as to how to meet the new require- ers are fine-tuning a very elaborate Accident and Worker’s Compensation ment as there may not be much time and wide-ranging academic program. claims. Dr Michael Delaney has been to adjust to this new process. We encourage all Fellows to join us heading up the existing structure for Congress is heading back to Perth in October for what looks to be once many years. However, he has made the again in 2021. The RANZCO Board again an amazing academic and social decision to pass the baton to someone recently decided to change the venue event. else at the end of this year. as the Auckland Convention Centre A decision regarding a name for will not be available for us to use that Dr Stephen Godfrey this panel will be made in due course. year. The panel will consists of Fellows with The pathology-imaging meeting qualifications and experience in this discussed many aspects around iris problems and Dr Mike Bynevelt field along with Fellows who have gave a fine update on the latest expressed an interest. Following this, in MRI imaging as the Eye Surgery a Chairperson will be appointed. It Foundation Lecturer. The day finished has been suggested that a member with more didactic on OCT use as of the Branch Executive Committee part of the collective audit process. act as Vice Chair. Expressions of inter- We are lucky to have such a wide est for the panel will be invited from range of talent for our local meeting NSW Fellows. It is hoped that existing in WA. Our next meeting is the Inter- Fellows who routinely undertake work Hospitals Meeting hosted by RPH on will stay on to guide the new recruits. neuro-ophthalmology scheduled for 3 April at the Perkins. Dr Diana Farlow Dr Angus Turner had success with a generous donation of space in Broome 20 to set up a permanent hub for remote RANZCO ophthalmology services – he plans to BRISBANE20 move there next year. This will provide 9-13 October 2020 a cornerstone in the development of a rural training scheme in WA, which www.ranzco2020.com in time will provide four full-time Eye2Eye Quarter 1 2020 19

non-metropolitan registrar training posts. We are hopeful that Bunbury will take on a second trainee to enable the scheme to be fully implemented in WA. Although The National Safety and Quality of Care Commission proposed to limit the visual acuity indication for the Cataract Surgery Clinical Standard to 6/12 (which would have provided health funds and Medicare a ‘big ee ca stick’), successful lobbying by RANZCO re o and others has removed that from the re document being developed. Currently the next challenge is the Medicare t Review Task Force proposal to reduce the rebate for intravitreal injections to the same as that of retro-bulbar anaes- thetic injections. Notwithstanding the fact that the OCT examination and consultation is not rebated with each intravitreal injection, overhead and disposable costs would exceed the proposed rebate by 50% or more. This would create an even larger gap for the patient and a number of whom would then seek care in the public sector; with the risk of vision loss while waiting for review and treatment. RANZCO Tasmania Dr Nigel Morlet Branch Annual Scientific Meeting 12-14 June 2020

RANZCO is developing the “Future of Eye Care 2050” A Vision of Eye Health. Using complex statistical analysis, population data, expert insights into technological developments and our recognised position as the leaders of eye care, the vision will articulate and predict what the future may bring. We need to draw on an even broader government, industry and expert knowledge base to produce an all- encompassing vision. We seek to do this through a weekend forum. This will take place at the RANZCO Tasmanian Branch Meeting on 12-14 June 2020 where the weekend will bring a diverse range of stakeholders together for an unprecedented opportunity to predict and effect meaningful outcomes. We already have a strong interest from many experts from different fields of eye care and the forum promises to be an important step in completing our vision. Please put these dates into your calendar and stay tuned for further information. We look forward to working with you on this important initiative. 20 Special Interest Groups

Special Interest Groups

ANZSRS ANZCS Australian ophthalmologists are doubt- date of 31 October 2020 or until supply is The Australian and New Zealand Cornea less aware of the recommendations of exhausted. Thereafter it can be obtained Society (ANZCS) and the RANZCO Cornea the recent MBS review, which particularly as an unregistered product via the Special Special Interest Group (SIG) have now stand to affect our patients being treated Access Scheme Category C. Approval will been formally merged. This merger for blinding retinal diseases. There is a not be required for each patient, but TGA should serve to reduce confusion and proposal to dramatically decrease the must be notified of each treatment. To increase productivity as we strive to Medicare rebate for intravitreal injections obtain a copy of the SAS Category C form, uphold our values of excellence, inno- and a suggestion that non-medical per- please email RANZCO at ranzco@ranzco. vation and collaboration within our sonnel perform these treatments. The edu. field. Membership of ANZCS includes all Australian and New Zealand Society of In 2018, ANZSRS established a grant, recent attendees of the annual meet- Retinal Specialists (ANZSRS) has assisted administered through ORIA, to support ing. Membership is free and open to all both ASO and RANZCO in preparing an retinal research. The grant was awarded ophthalmologists, eye bank scientists, evidence-based response. The process is in 2019 to A/Prof Fred Chen for his pro- ophthalmic researchers or others with an still ongoing. ject ‘Optimising a pipeline for developing interest in cornea. If you would like to join, please contact [email protected]. Patient access to photodynamic treatment for CRB1-related inherited reti- ANZCS, combined with the US Cornea therapy (PDT) with verteporfin has nal diseases’. Society, once again delivered a joint sym- also become more complex with the Euretina (European Society of Retina posium at 2019 RANZCO Congress. The recent announcement that Visudyne Specialists) has offered 20% reduction on session on cataract surgery and the cornea was removed from the PBS on 1 January membership fees for ANZSRS members. – pre-operative, operative and post-op- 2020. This follows the sale of the global To obtain a certificate of ANZSRS mem- erative considerations was intended for rights for Visudyne by Novartis to a new bership, please contact Francine Dutton at [email protected]. all those involved in cataract surgery. pharmaceutical company who will con- Dr Peter Zloty, A/Prof Mike Lawless, Prof Dr Jennifer Arnold tinue to manufacture the drug. However, Michael Belin, Prof Gerard Sutton and Dr their product will not be TGA registered. Chair, ANZSRS Jacqueline Beltz delivered presentations Link Healthcare is the new distributor for during this well-attended session. Visudyne in Australia. Current Novartis The ANZCS and Eye Bank Meeting was stock in Australia can still be obtained by held in Auckland on 28–29 February. The private prescription until the stock expiry World Cornea Congress will be on 14–15 May in Boston. Dr Jacqueline Beltz Chair, ANZCS ANZSRS Australian and New Zealand Society of Retinal Specialists

The ANZCS Executive has recently been finalised: Membership of ANZSRS is open to all RANZCO Chair - Dr Jacqueline Beltz Fellows with an interest in retina. Young Fellow - Dr Nick Toalster Full details of membership categories can be VIC - Dr Elaine Chong found at www.ranzco.edu/anzsrs. WA - Dr Steve Wiffen SA - Dr Aanchal Gupta NSW - Dr John Males QLD - Dr Peter Beckingsale Eye2Eye Quarter 1 2020 21

NOSA 2019 The last Neuro-Ophthalmology Society of Australia (NOSA) Neuro-Vision (Efferent Pathways) was held last year on 5–8 September at the Mariott Hotel in Brisbane. Organised by Dr Mark Paine FRACP and Dr Ioanne Anderson, NOSA NEURO-OPHTHALMOLOGY SOCIETY the guest lecturers were Prof Steven Galetta from NYI, Langone and A/ OF AUSTRALIA Prof Aki Kawasaki from University of Lausanne, Switzerland. 36th Annual Clinical & Scientific Meeting New Officers & NeuroVision Training Weekend Prof John Crompton, who has served for two years as NOSA President, has 10 – 13 SEPTEMBER 2020 now finished his term. The incom- ing President is Prof Christian Lueck Hyatt Hotel, Canberra FRACP, Canberra. A/Prof Celia Chen is the President-elect alongside Vice President A/Prof Clare Fraser. Save the Date This year’s NOSA/Neuro Vision (Efferent Pathways) will be held at the Hyatt SAVE Hotel, Canberra on 10–13 September. the The invited guests are A/Prof Fiona Costella from Calgary, Canada and Dr Konrad Weber from Zurich, Switzerland. GUEST SPEAKERS DATE Prof John Crompton Dr Fiona Costello, MD, FRCPC President, NOSA Associate Professor Departments of Clinical Neurosciences & Surgery University of Calgary Clinician Scientist Hotchkiss Brain Institute

Dr Konrad P. Weber, MD Consultant Neuro-Ophthalmologist Departments of Neurology & Ophthalmology University Hospital Zurich Switzerland

22 RANZCO Affiliates

RANZCO Affiliates

ORIA Funding Addresses Unmet Needs in Ophthalmology Research

In 2019, the Ophthalmic Research Institute of Australia (ORIA) invested $641,739 on 12 research projects. This snapshot of four of the funded projects illustrates how ORIA is addressing unmet needs in ophthalmology research. For more information about the impact ORIA is having and details of all 12 funded projects please see the ORIA Research Funding & Impact Report 2019. Blocking the genes that cause blindness Retinitis pigmentosa (RP) is an inherited eye condition that causes the light-sensi- tive cells at the back of the eye to slowly degenerate. RP affects 1 in 3,000 people worldwide and there are 8,000 patients in Australia. Although more than 100 genes may cause RP, a gene called PRPF31 is one of the most commonly implicated. Lead researcher, Dr Fred Chen has stud- Dr Fred Chen, Centre for Ophthalmology and Visual Science (Lions Eye Institute), The University of Western Australia ied DNA from families with this gene and found that not all family members (up to Understanding vision loss exactly how dengue virus interacts with 30%) who carry the gene develop RP. This caused by the dengue virus retinal cells at the molecular level. They intriguing observation led to the discov- are particularly interested in the immune Worldwide, deaths due to dengue virus ery that another gene called CNOT3 is a response to the virus. infection have reached 18,400 which is negative regulator of the PRPF31 gene “Defining the interactions between a 50% increase between 2005 and 2015. and is an excellent candidate for new DENV and retinal pigment epithelial In Australia, the number of dengue virus therapeutic strategies. By interfering with cells represents a first step towards infections is at a 20-year high. At present CNOT3 function using specially devel- developing effective treatment for den- oped RNA fragments, the PRPF31 gene no approved vaccines or anti-viral drugs gue retinopathy,” said Prof Smith. can still function adequately. are available to treat dengue virus. “The aim of this study is to induce par- Dengue virus infection may cause an Decoding the genetic risk tial knock-down of CNOT3 and thereby array of different dengue eye diseases. for giant cell arteritis increase PRPF31 expression from the nor- “Retinopathy, and particularly mal allele in retinal cells from patients,” pathology involving the macula, is well Giant cell arteritis (GCA) is an inflammatory said Dr Chen. described and most likely to adversely disease that causes headaches, joint and In the laboratory, specially cultured impact the vision,” explains Prof Justine facial pain, fever and may cause permanent retinal cells from RP patients will then be Smith. vision loss. It is the most common form studied to determine whether gene and “Ultimately any retinal inflammation of vasculitis in elderly people, with most cell function improve. resolves, but the prognosis of dengue patients over the age of 50, and making a “No treatments are currently available retinopathy is highly variable, ranging timely diagnosis and intervention is crucial for these diseases,” explains Dr Chen. from full resolution to permanent vision to prevent vision loss. “Successful completion of this project loss, irrespective of medical interventions “If untreated, GCA can cause catastrophic will generate essential pilot data to sup- to reduce inflammation.” complications including blindness, strokes, port in vitro and in vivo pre-clinical ani- Prof Smith and colleagues at Flinders as well as aortic dissection and rupture. GCA mal testing of an Australian made lead University have planned a program represents one of the few true ophthalmic drug candidate.” of laboratory research to investigate emergencies,” explained Prof Alex Hewitt. Eye2Eye Quarter 1 2020 23

“Even after successful treatment with corticosteroids, GCA relapses in 20-30% of patients. There is a significant need for more effective and safer treatments for GCA.” In ground-breaking pilot work, Prof Hewitt and his research team have identified a novel locus on chromosome 15 that is associated with GCA. Two implicated genes in this region (milk fat globule-EGF factor 8 MFGE8 and hyaluronan and proteoglycan link protein 3; HAPLN3) will be studied in this project to further elucidate the molecular mechanisms that may be involved. Targeting inflammation to prevent age-related macular degeneration Prof Justine Smith, Flinders University, South Australia Age-related macular degeneration (AMD) is the leading cause of vision loss in the Western world. “There are two forms of the disease, 'wet' AMD, characterised by choroidal neovas- cularisation, and 'dry' AMD, in which an atrophic retinal lesion develops,” explained Dr Nilisha Fernando, from The John Curtin School of Medical Research, The Australian National University, Canberra. “There are no treatments for dry AMD, it has been suggested that targeting retinal inflammation, a key feature of disease progression, could lead to the development of novel therapeutics,” she said. In this study, the research team will investigate microRNAs (miRNAs) which are ‘master regulators’ of gene expression. One microRNA in particu- Prof Alex Hewitt, Centre for Eye Research Australia, Victoria lar, called miR-223, is known to regulate inflammasome – a critical inflammatory ORIA Research Funding pathway that has been strongly linked to the progression of retinal degeneration. & Impact Report 2019 Using tissue from people with AMD in combination with an animal model, the therapeutic potential of miR-223 will be investigated. “These findings could be of major importance in shaping the therapeutic landscape for the treatment of retinal degenerations such as AMD, as well as other neuro-inflammatory diseases where inflammasome Scan the code using your mobile O RIA activation plays a key role in disease pro- phone’s camera app gression,” said Dr Fernando. ADVANCING EYE RESEARCH 24 RANZCO Affiliates

Ophthalmology New Zealand Update

ONZ welcomes the new year cautiously. Cautiously, as 2019 finished with too ONZ events many disasters that impacted too many Australians and New Zealanders. Twenty- one victims from the White Island tragedy → This year the ONZ Business Forum – The Other Matters, will have now died while the disastrous fires be held in June for a half day. We have many speakers lined that raged across Australia have resulted up to add value to your practice and profession. in over 20 deaths, with many being vol- → The ONZ Clinical Leaders Forum unteer fire fighters from as far as the US. 2020 has arrived with the coronavirus Dates to be advised on both our newsletter and in the website: and flooding in both Australia and New ophthalmologynz.co.nz/events Zealand. No wonder we ask ourselves We are only able to offer these events with the support of our what we can do to help! members and sponsors. We welcome the following sponsors for In the case of ONZ, it is “stick to the 2020: knitting” – continuing conversations with stakeholders, whether that be the Ministry of Health or private insurers. Silver Sponsors: On the latter, we continue to represent our members especially in the matters of lobbying for approval for new devices and treatments. This lobbying is a thank- less task with continual discussions on all sides and we thank our members for Bronze Sponsor: supporting us in this work. We will continue to provide a forum for ophthalmologists, both clinical via our Clinical Leaders Forum and commercially via the ONZ Business Forum – The Other Matters.

Younger Fellows

2020 SAVE THE DATE Business 22 - 23 August 2020 Development Workshop Eye2Eye Quarter 1 2020 25

ASO AGM held during the RANZCO 51st Annual Scientific Congress Dr Peter Summich Australian Society of Ophthalmologists Update

Welcome to 2020 – a new decade and Australian eye health policy and aiming to senior surgeons looking to their exit one which commences with a significant to ensure patients and members are strategy. We now offer delegates a num- opportunity for eye health to showcase represented and their rights and inter- ber of breakout sessions so they can on the international stage. Vision 2020 ests protected. 2020 should see the MBS choose topics most relevant to their prepares to measure its global initiative Review recommendations for ophthal- career stage. The expo is free to all ASO in preventing avoidable blindness, and mology finalised which presents positive members! Mark this event in your diary our very own Dr James Muecke AM has opportunities to reform MBS intricacies as one not to be missed. Register at the been awarded Australian of the Year for and ensure items are being used appro- ASO website. his local and international efforts to pre- priately. Recommendations to cut intra- One particular focus this year will vent blindness. I felt so proud for James vitreal rebates by 70% and introduce be in evaluating the merits of start up when I heard because he has been such nurse and optometrist-led intravitreal companies. There are many amongst us a modest and quiet achiever over many injections have been heavily opposed who would like to be seed investors in years. I also congratulate Prof Peter by most stakeholders, including the ASO small ventures who need to be aware of McCluskey AO and Dr David Workman and RANZCO. We are working behind the pearls and pitfalls. We will take a look at OAM for their recent Australian Day scenes to ensure those recommenda- the approach to these small but exciting Honours. tions are NOT endorsed by government. investments. In news just in, the Medical Services In 2020, the ASO will continue to Finally, I would like to happily Advisory Committee (MSAC) has showcase eye health by physically announce that ASO is offering 12 months approved a new MBS item for micro-by- demonstrating to our political leaders FREE membership to all trainees – yes, pass glaucoma surgery (MBGS) as a at Parliament House the importance of that means free access to our expo, free standalone procedure for patients with technology in ophthalmology and the business advice and resources, 12.5% open-angle glaucoma. MSAC has ruled impact it has on the everyday lives of discounted premium with MDA National that MBGS has an acceptable safety Australians. and most importantly, protection for profile and may delay or avoid the need your future patients and business. Visit for trabeculectomy in some patients ASO Business Skills Expo our website to join today. not adequately controlled with medical The ASO Business Skills Expo 2020 will therapy. once again be held at the Grand Hyatt ASO official website: www.ASOeye.org The ASO has been at the forefront of Melbourne on Saturday 20 June and efforts to argue the case for MBGS as Sunday 21 June. Our annual expo is Dr Peter Sumich a standalone procedure for over two about delivering ophthalmologists the President, ASO years. This started when approval for use business boost they need. That means of the goniotomy item number for MBGS new thinking, better skills, great effi- use was summarily revoked in May 2017 ciency and improved patient engage- which lead to severe limitations on clini- ment. Our expo is the only expo tailored cians’ ability to use this next generation specifically to the needs of ophthalmol- microsurgical technology. ogists and their practice staff. It aims The ASO will be utilising this momen- to address issues facing ophthalmolo- tum to draw the attention of politicians gists in all stages of their professional and the media to the big issues facing career from new Fellows, right through 26 RANZCO Affiliates

MDFA’S Response to the Proposed Changes to Medicare for Eye Injections

The proposed 69% cuts to the Medicare Our Campaign Actions also written to each Health Minister in Benefits Schedule (MBS) for intravitreal every other state seeking an opportu- In partnership with RANZCO, PwC injections, as outlined in the MBS Review nity to brief them. undertook an economic modelling exer- Taskforce Draft Ophthalmology Report, cise to determine the impact a 69% MBS has been the subject of much discussion Next Steps cut would have on patients and to calcu- since its release last September. MDFA believes that Australia can do better late the costs of any unintended conse- The Macular Disease Foundation (MDFA) by improving access to public services for quences in cost shifting to other parts of supports the work of the MBS Review those in financial stress and has raised this the health budget. While the proposed Taskforce and believes that health services as a priority with key state Health Ministers. 69% rebate reduction will deliver a should always be aligned with the most There is an excellent opportunity for $380M MBS and $428M PBS cost sav- up-to-date clinical evidence available and RANZCO and MDFA to work together on ings to the government (and taxpayers), be ‘fit for purpose’. While we support sev- improving access to affordable treatment these will be offset by increased health eral recommendations in the draft report, and improve current non-adherence rates. and welfare costs. The direct impact of we do not support any cut to the Medicare In the event the government proceeds the changes to the government is esti- rebate as this will invariably be passed to with a cut to the MBS, MDFA will ramp up mated to have a direct net cost of $168M patients. We are very concerned about its campaign more publicly. from 2019-2024, as people lose their the potential impact any cut will have on vision and require greater support from Macula Month adherence rates to sight-saving treatment. the health, aged care and social service MDFA will launch its annual awareness MBS cuts will also potentially jeopardise systems. Australia’s position as a world leader in campaign, Macula Month, in May 2020. We patient outcomes for AMD. The following is a snapshot of some of hope that RANZCO members will join us in MDFA’s campaign activities: supporting those living with, and at risk of, macular disease. Out of Pocket Costs 1. Communicated to the relevant mem- Under the current Medicare rebate of bers of our macular disease commu- Macular Disease Social $259.75, patients have an average of nity and fielded dozens of responses Impact Study $1,900 in annual out of pocket costs* about the impact of a proposed cut. while patients with both eyes affected This de-identified feedback informed Over the coming months, MDFA will send have almost double the costs (results of our campaign and were included in its first Macular Disease Social Impact an MDFA poll of almost 700 patients). For our submission. Survey to members who are living with a Australians on an aged pension of $24,000 2. Met with Minister Hunt who requested macular condition. This is the first survey per annum, this means they must often do that MDFA present the PwC find- in a longitudinal study to trend patient without many basics in order to retain their ings directly to the MBS Taskforce. reported outcomes and patient reported sight. Minister Hunt understands the dif- experience over time. Under the new rebate, out-of-pocket ficulties patients currently face and The aim of this important project is to costs are expected to rise from $1,900 to has committed to work with MDFA to gather better evidence of the impact of $3,900 per year (per eye) on average. This ensure the voices of patients are heard macular disease on our community, under- will hit the pockets of older Australians throughout the consultation process. standing what interventions are working who already struggle to afford the current 3. Presented our findings to the full and those that are least effective. This study costs of treatment. Taskforce in December in addition to will provide patient insight to help us better Access: Only a relatively small number of key members of Federal Parliament, understand systemic barriers to living an optimal life with progressive vision loss and IVI treatment is provided in a public setting including the Shadow Minister to inform MDFA’s advocacy agenda. which is already at capacity, and 18-23% for Health, the Hon Chris Bowen, If you are interested in engaging your of private treatment is bulk-billed. A cut to the Greens and other Coalition patients in this study, please contact Mark the MBS will threaten the viability of public backbenchers. Choo, Senior Policy Advisor at mark@ and bulk bill access for the most vulnerable 4. Met with several Department of mdfoundation.com.au Australians. Any cuts to the MBS will have an Health officials to brief them. The adverse effect on patients’ access to treat- Department have received numerous Dee Hopkins ment as the costs to deliver private services correspondence from consumers and CEO, MDFA is likely to result in fewer treatment options have referred concerned consumers especially in rural and remote Australia. This to the MDFA for assistance. *Note: This out of pocket cost applies to patients translates to 18,000 patients in more than 5. We developed a summary briefing who are not bulk billed and is comprised of the 70 rural and remote locations in Australia. paper for related peak bodies and ophthalmologists’ consultation fee, injection fee and OCT scan fee of which only the injection fee Adherence Rates: It is currently esti- related agencies to inform their receives an MBS rebate. The annual out of pocket mated that there is a 20-25% non-adher- own submissions in response to cost of $1,900 already includes the Extended ence rate for those on IVI treatment and that the Taskforce. We also met with the Medicare Safety Net rebate. there will be an additional 22% non-adher- Consumer Health Forum who sup- ence to treatment due to increased costs. ported our concerns in their own sub- The flow-on effect means that a significant mission to the Taskforce. proportion of Australians living with AMD 6. We have briefed the Health Ministers will suffer severe vision loss or blindness in in Victoria, NSW and ACT who have the next three years following a 69% rebate committed to supporting our position cut. in writing to Minister Hunt. We have Eye2Eye Quarter 1 2020 27

CERA Update: New Melbourne Research Project Launches Major Assault on Age-Related Macular Degeneration

Melbourne researchers will lead the world’s most intensive investigation to uncover why some people with age-related macular degeneration (AMD) are at much greater risk of losing their sight. The world-first study, led by Prof Robyn Guymer from the Centre for Eye Research Australia (CERA) and the University of Melbourne, is the largest ever assembled to determine the causes of a high-risk form of AMD and develop new treatments to prevent vision loss. The team, which also includes researchers from the University of Melbourne, Walter and Eliza Hall Institute and universities in the US and UK, will bring together experts in eye health, artificial intelligence, genetics, stem cell research and bioinformatics to tackle the disease, which affects millions of elderly people worldwide. The team will work with optometrists to recruit hundreds of Australians with normal vision and AMD and utilise data from tens of thousands of eye scans internationally for the study. Age-related macular degeneration affects one in seven people over 50 years and is the leading cause of legal blindness and severe vision loss in Australia. The study has received $5 million from the National Medical Health and Research Council’s Synergy grants program, which supports teams of researchers to investigate problems that Study leader Prof Robyn Guymer and one of the Chief Investigators, Prof Erica Fletcher are too big to be solved by an individual researcher or a single group. “Currently, all cases of AMD are lumped Other Chief Investigators on the together as one disease but it is now project include Prof Erica Fletcher and clear there is at least one group of Prof Alice Pébay from the University of patients at increased risk of losing Melbourne; Prof Melanie Bahlo and Dr The new study aims to: vision,’’ Prof Guymer said. Brendan Ansell from the Walter and Eliza “Our recent LEAD study, which treated Hall Institute, and Dr Zhichao Wu from • investigate the specific patients with early stages of AMD to slow CERA. genetic and other factors progression, highlighted that the same that put one group Janine Sim-Jones treatment will not work for everyone. of people with AMD, Centre for Eye Research Australia “Understanding what is different amongst those already at high risk, at much greater about the high-risk group, who can be risk of losing their vision. determined by modern imaging techniques, and why this group is more likely • understand how different to lose vision, is the key to saving sight,’’ genetic factors influence Prof Guymer said. the normal functioning “In the past, AMD was diagnosed by of the eye. simply looking in the back of the eye, • develop new treatments but with new imaging techniques we to tackle this very high- can see subtle differences between peo- risk AMD group. ple and this provides important clues about why some are more at risk as their diseases progress. This has opened up an exciting new area of research.’’ 28 Feature News

Feature News

Australia Day 2020 Australian of the Year Honours Dr James Muecke

The Australian of the Year Awards proved to be a momentous occasion in the eye care sector. The awardees were announced in Canberra on 25 January which included Prof Peter McCluskey (Officer AO in the General Division) for his distinguished service to ophthalmology, medical education, eye health organisations and to the community; Dr David Workman (Medal OAM in the General Division) for his service to ophthalmology and international relations; Dr Indy Singh (Medal OAM in the General Division) for his service to the international community through eye care programs and Australian of the Year 2020, Dr James Muecke AM for his outstanding work in blindness prevention. We caught up with James, David and Peter to talk about their awards, ophthalmic work and what they plan to do in the future.

“I am inspired by positivity, the selfless and generous donation of time and expertise from my Aussie and Kiwi colleagues, and the willingness of our ophthalmic colleagues in poorer countries to learn, to enhance our profession, and to improve the sight and lives of their own people.” Eye2Eye Quarter 1 2020 29

What achievements in your career are What achievements in your career are you most proud of? The Australian of Medal (OAM) – you most proud of? I am lucky to have the Year (AOTY) Award is an absolute General Division had the opportunity to become an oph- highlight of course. However, obtaining thalmologist with the reward of seeing enough marks to enter medical school Dr David Workman the changes that can be made in people’s (but not enough for Sydney University lives. Over 30 years in private practice where I had hoped to study) changed has been very professionally rewarding the course of my life forever. The com- but has also given me the flexibility to prehensive and sustainable work we become involved in a diverse range of are doing with Sight For All which is activities. impacting on over one million people I have had various roles in the College each year is undoubtedly the crowning (in both training and politics) and over achievement of my medical career. 20 years at the RVEEH including Chair of the Senior Medical Staff and Head of What are you working on currently? two clinics. Mark Ellis also invited me to To date, we have undertaken projects join the Sumba Eye Program on its incep- in nine low income countries in Asia. tion and I have been involved ever since. However, we are now commencing edu- I have also been involved in Aviation cational projects in Africa, drawing on Medicine which has brought contact expertise out of the UK and Europe. with both civil and military pilots. All of What do you want to focus on for the these have enabled me to meet interest- future? For the next year (and beyond) ing and stimulating people. One of the I want to work with the Australian things of which I am especially proud, is Government and continue to raise when I am contacted to request my input awareness of the blinding complications into something, whether it be College, of diabetes which is a growing problem hospital, aviation or government. in our own communities. I have thoroughly enjoyed the relationships with my patients. Now that I am Who is inspiring you – whether within approaching the end of my career, many ophthalmology or in a broader sense? of them are asking me to stay on to "see I am inspired by positivity, the selfless them out"! I like people and I enjoyed and generous donation of time and chatting to them. Often, this chatting is expertise from my Aussie and Kiwi col- crucial to identifying their concerns and leagues, and the willingness of our oph- addressing them so that the patient feels thalmic colleagues in poorer countries “I was humbled like they have been heard. to learn, to enhance our profession, and to receive so What are you working on currently? I to improve the sight and lives of their am reassessing where I want to go in the own people. many messages of next few years. I am young enough that How did you celebrate upon winning congratulations. I I still have something to offer, and I am this special award? After the photos keen to do that. At the same time, I think and interviews had settled, I went back can't say I thought I it is reasonable to look for something a to the hotel with my family, old school little different to do. Obviously, what skills friends and other award recipients to was doing anything I have lie in ophthalmology and it would celebrate through the night. I only had special. Being so be logical to utilise these. To this end, I am two hours sleep (a grand total of four reducing the work I do in private with a over 48 hours), before having to rise at lucky, we should all view to finding a different area to work in. 4:30am for an intense three-hour media What do you want to focus on for the call out. After attending the flag raising give back something.” future? I have been in private practice ceremony by Lake Burley Griffin later for over 30 years. This has enabled me to that morning, my family and I headed have the flexibility to travel overseas and to Sydney with my fellow recipients to do the other extra-curricular things that be a part of the stunning Australia Day came along. Now is the time to look for celebrations at Circular Quay. other things. I enjoy volunteer work and 30 Feature News

I expect that this will still be the area What do you want to focus on for the that engages me. Exactly where, I'm not Officer (AO) future? Improving the opportunities for sure, but no doubt, something will turn research into blinding eye disease. There up. General Division is a quote that says, “The basis of good However, I am now able to make time Prof Peter McCluskey medicine is good research”. We must for things outside medicine. I have many improve the career opportunities and things that I have wanted to do when I funding for eye research in Australia and got “A Round Tuit”. I enjoy researching New Zealand. my family history. Golf, fishing, cooking Who is inspiring you – within ophthal- and travel are always welcome diver- mology or in a broader sense? There sions and I would love to do a combined are many who inspire me the most at cooking/French language course in France. present. Among them are my wife and family; my patients – I never cease to Who is inspiring you – whether be amazed at their resilience and ability within ophthalmology or in a broader to cope; and the ophthalmologists in sense? Just over four years ago, my the Uveitis Unit at Sydney Eye Hospital granddaughter was born. She had a who juggle family commitments, busy congenital heart defect and required clinical practice, clinical research and the first of several heart operations at working in the public sector with great the age of 2 months. Despite this rocky camaraderie, an incredible work ethic start, she is the happiest, most delight- and never ending good humour. It is a ful person I know. Whenever something privilege to work with such great peo- doesn't go my way, I now say to myself, ple. I am also inspired by the ophthal- "It's not Tetralogy of Fallot. Suck it up." mology trainees who have such a long It has given me a new perspective on and challenging journey just to get to what is important. be a trainee, let alone complete their In addition to this, when I return from training; and my colleagues who give up my overseas trips, I am really struck by What achievements in your career so much free time after hours for teach- how lucky we are in Australia. We saw are you most proud of? Looking after ing, administration and College work. a little girl in Sumba who was blind in patients with AIDS and HIV infection both eyes from glaucoma. She was in How did you celebrate upon winning and being involved in the extraordinary pain. We couldn't do anything about this special award? With my wife and advances in therapy for these patients. I her blindness, but some retro-bulbar family. It was an exciting and somewhat alcohol took away her pain. Yet if she also consider moving my family of four emotional day. We are planning a more had been born in Australia, she would children to London for a year for my formal family celebration. not have been blind at all. uveitis fellowship (and convincing my wife that this was a good idea) a great How did you celebrate upon winning achievement. Of course obtaining my this special award? With the most Doctor of Medicine by research after nine important people in the world – my years of part-time work and eventually family. I was also humbled to receive becoming a full-time academic. Lastly, so many messages of congratulations. leading the Save Sight Institute and “There is a quote I can't say I thought I was doing any- working with such talented researchers thing special. Being so lucky, we should that says, ‘The basis and clinician scientists, and developing all give back something. And, as I said a multi-disciplinary adult and paediatric above, it was after all, fun. of good medicine is uveitis clinics at Sydney Eye Hospital. good research’. We What are you currently working on? With many Save Sight Institute col- must improve the leagues, developing a real time web- based uveitis outcomes registry (Fight career opportunities Uveitis Blindness!) This is based on the and funding for eye very successful Fight Retinal Blindness! Registry that has been running for 10 research in Australia years and is used around the world to track patient outcomes for ARMD. FUB! and New Zealand.” is currently undergoing beta testing. It will be rolled out during 2020 and will lead to improved patient outcomes as well as many research opportunities.

Medal (OAM) General Division A/Prof Indy Singh Eye2Eye Quarter 1 2020 31

RANZCO Museum

Vintage Le Jockey Club Binoculars The RANZCO Museum regularly receives contributions of artefacts, some quite unu- sual, including this 11.5x8 cm leather coated chromed brass binoculars, donated by Marcello Cerchiara. In the 1900s, they were used by Paris Longchamp racegoers. Le Jockey Club remains to be the exclusive and premier racing club in Paris. Sir Norman Gregg – An Outstanding Contributor to Ophthalmology Vintage Le Jockey Club Binoculars Sir Norman Gregg was a paediatric ophthalmologist, elite sportsman and war hero. In 1941, an outbreak of rubella was followed by a high rate of congenital cataract. This association was made through Gregg’s careful observation when the case was presented to his practice. He published his findings in the Transactions of the Ophthalmological Society of Australia but was met with some scepticism. He continued on with further observations on the rubella embryopathy. Later, his work was confirmed by Lancaster in Sydney. The findings stimulated the field of teratology and the development of the rubella vaccine. His findings were eventually recognised and were The Races at Longchamp, 1866, painted by Edouard Manet followed by a stream of honours including the James Cook Medal. He was also knighted in 1953. The named RANZCO Gregg Lecture is delivered every year at Congress. You may find the list of distinguished recipients on the RANZCO Museum website (www.museum.ranzco.edu) under ‘Honour Roll’. The collection of citations and medals are displayed in the museum collection at the RANZCO office in Sydney. Dr David Kaufman Curator, RANZCO Museum

MUSEUM Collection of citations and medals of Sir Norman Gregg 32 Health and Wellbeing

Health and Wellbeing INCREASED PHYSICAL ACTIVITY KEEPS THE MIND HEALTHY Eye2Eye Quarter 1 2020 33

It is well established that physical activ- depressive disorder in as little as four ity enhances mental health and wellbe- weeks. While the way in which exercise ing. Scientific research is further deep- exerts this effect is not fully under- ening our understanding of how the stood, the mechanism is thought to be type, duration and intensity of exercise similar to anti-depressant medications can optimise these mood-boosting ben- which act by increasing hippocampal efits. Particularly encouraging for time- neurogenesis. poor medical professionals is that even a small increase in the amount of exercise can have significant positive effects. As little as one hour of exercise a week, at any intensity, can prevent depression “…even relatively according to international research led by a team at the Black Dog Institute and small amounts of published in the American Journal of Psychiatry. The study included longitudi- exercise – from one nal data from 33,908 healthy adults over hour per week – can a period of 11 years and analysed exercise levels and symptoms of depression. deliver significant The results demonstrated that around 12% of future cases of depression could protection against be prevented by participating in just one hour of exercise per week. depression.” According to the study’s lead author A/Prof Samuel Harvey: A recent Australian systematic review “Most of the mental health benefits of and meta-analysis found that aerobic exer- exercise are realised within the first hour cise had positive effects on left hippocam- undertaken each week. pal volume, an area of the brain that usu- “These findings are exciting because ally shrinks as we age. The review, which they show that even relatively small identified 14 eligible studies, reported amounts of exercise – from one hour per that exercise prevents the normal vol- week – can deliver significant protection umetric decreases in the hippocampus against depression.” associated with aging. Researchers at Similar observations were made in a the Western Sydney University hypothe- UK-based study of 60,000 adults which sised that exercise-induced production of found that even people who exercised brain-derived neurotrophic factor (BDNF) only one to two times a week (called may be the mechanism which helps ‘weekend warriors’) had health benefits prevent age-related deterioration of the including significantly decreased mor- brain. tality risk. Writing in the journal Neuroimage, the “One of the most striking findings was study authors concluded that: “Aerobic that one or two sessions per week of moderate or vigorous intensity leisure time exercise interventions may be useful for physical activity was sufficient to reduce preventing age-related hippocampal all-cause, cardiovascular disease, and deterioration and maintaining neuronal cancer mortality risks regardless of adher- health.” ence to prevailing physical activity guide- Another likely anti-depressant mech- lines,” explained study author Dr Gary anism is that exercise significantly O’Donovan, Loughborough University, decreases levels of the stress hormone UK. cortisol. Aerobic exercise is more effec- Evidence from randomised trials tive than resistance exercise in lowering has also demonstrated that both aer- cortisol and as the number of exercise obic exercise and resistance training sessions per week increases, so does the can improve the symptoms of major cortisol-lowering effect. 34 Health and Wellbeing

This is supported by the results of negative impacts of poor mental health. research conducted at the Department Of doctors surveyed who had ever felt of Neuroscience, Yamaguchi University anxious or depressed, jogging and other Graduate School of Medicine, Japan which forms of exercise were a commonly iden- “Of doctors surveyed observed that moderate-to-vigorous phys- tified coping technique for both males ical activity significantly improved mental (37.1%) and females (35.9%). who had ever felt health compared to walking. Subjects par- “Doctors are more likely to seek treat- ticipating in moderate-to-vigorous activity ment than the Australian population and anxious or depressed, were more likely to have enhanced coping are able to manage some of the negative skills; they were more accepting, had more effects of poor mental health,” stated the jogging and other drive and were less likely to feel anxious. report. forms of exercise were The researchers noted that: “Compared The research is clear that physical with no moderate-to-vigorous physical activity has significant mental health a commonly identified activity at all, as few as one to two days benefits. Although most guidelines per week (lasting at least 10 minutes focus on minimum recommended levels, coping technique for each time) of moderate-to-vigorous even modestly increasing the amount or physical activity was associated with a the intensity of exercise can have meas- both males (37.1%) variety of benefits related particularly to urable mood-boosting effects. coping with challenging situations.” and females (35.9%).” Ruth Hadfield Indeed, many health professionals may already be self-prescribing physical exer- References available upon request. Please email cise. The Beyond Blue National Mental RANZCO. Health Survey of Doctors and Medical Students (2019) reported that doctors have a greater degree of resilience to the

WAYS EXERCISE BOOSTS YOUR 6 MENTAL HEALTH

9 Protects against depression 9 Helps reduce stress & anxiety 9 Acts as a distraction from negative thoughts 9 Aids memory & thinking skills 9 Improves sleep 9 Builds resilience & ability to cope Eye2Eye Quarter 1 2020 35

Motivation to Get Moving: RANZCO Fellows Share Their Stories

“I was waiting at the start feeling very pete for The Netherlands in the 24-Hour A/Prof Peter van nervous about the distance and a bit of a World Championships.” fraud, but I managed to finish in the top He has since represented The Wijngaarden 10,” said Peter. Netherlands four times at the 24-Hour He went on to finish first in the World Championships and also at the Ultra-marathon runner Australian Universities Marathon European 24-Hour Championships. Championships and then third in the A/Prof Peter van Wijngaarden is not Finding time to train is not a problem Auckland Marathon in New Zealand. only a successful ophthalmologist and for Peter who simply runs the 15 or so “I placed third in the Auckland researcher, he is also an accomplished kilometres to work every morning. He Marathon which was on the weekend of athlete. Peter is a marathon and ultra-mar- is motivated both by the psychological the RANZCO Congress, so I participated athon runner who participates in extreme challenge of endurance events and also in the marathon and then presented my endurance events such as the World 24 his knowledge of the anti-aging benefits. research at the congress on the same “Some of my early research, supervised Hour Running Championships, the Ultra- weekend,” he said. by Prof Jonathan Crowston, involved tour du Mont Blanc and The Great Ocean A turning point in Peter’s running looking at the effect of exercise on neu- Walk 100s Trail Ultramarathon. career occurred while competing in the roprotection and glaucoma prevention in “I first got into running in my intern Ultra-tour du Mont Blanc, a 171 km race mice.” year – I was at a rural hospital, working 14 around Mont Blanc with an astounding “Exercise prevents stress and damage, hours a day, two weeks on and a weekend 10,300m ascent (Mt Everest is 8,848m to including to the optic nerve,” he said. off, and basically living at the hospital,” put that ascent in perspective). The race said Peter. started in the French Alps from Chamonix “I started running in the morning, in and Peter was running close to the front the forest around the hospital for mental of the pack when at 40km he had a seri- relaxation.” ous fall and cut his knee open, requiring The very first race that Peter entered stitches. That was the end of the race for was The Puffing Billy Running Festival him. “Exercise prevents in which runners compete against the “I was bitterly disappointed, but I was steam locomotive Puffing Billy through back in the UK three weeks later and stress and damage, the Dandenong Ranges in Victoria. This entered my first 24-hour running cham- including to the was a turning point for him as he did quite pionship on a 400m track to console well in the race and was approached by a myself,” he said. optic nerve.” running coach who invited him to train “I surprised myself by winning and with a group of elite runners. He signed it turned out to be quite a prominent up for his first marathon, the Sydney event. A week later, the Dutch national Marathon, during his PhD. team selectors approached me to com- 36 Health and Wellbeing

Dr Jane Khan Swimmer

How long have you been swimming? I really only learnt to swim when I arrived in Australia in 2003. Before that I was definitely a doggy paddler! Now I swim 8km per week split into two 2km sessions and one long 4km session. What keeps you motivated to train? Do you notice any impact on your mental wellbeing? Mind and body! Not only is swimming a great way to keep fit but it also allows time to medi- tate. Concentrating on technique for every stroke (and trying not to forget to breathe) means that day-to-day stressful thoughts have little room to intrude. However on occasions, if something Dr Jane Khan and her husband Dr Riaz Khan really is troubling me, or I have something to plan such as lectures or talks, I swim at ers on the last sea swim I did were so bad 60-70% pace and use the solitude to work it was like someone had thrown gelatine through problems or make plans. laced with acid in the water. Someone was also unfortunately taken by a shark How do you find the time? It is fixed in one of the spots I used to swim reg- “Put regular exercise in my schedule. That means on the two ularly in so I’m definitely more hesitant mornings that I pay my babysitter to get when sea swimming nowadays. I find in your schedule - the kids ready for school, come rain or the pool more relaxing. hail I still go for my swim as my nanny/ don’t put it off. Your babysitter is already in the car on her Any advice to others looking for moti- life is happening now way! It’s an expensive swim by the time vation to increase their weekly phys- I’ve paid for her as well as the pool fee ical exercise? Put regular exercise in and you want to keep but that’s the price I’m happy to pay for your schedule – don’t put it off. Your life my fitness and sanity. is happening now and you want to keep the mind and body fit.” I have participated in triathlons and the mind and body fit. Swim-Thru events in the past. The sting-

from my home. So, I just get up each Dr Stephen Best morning at 5:10am. The group provides great motivation and up to 20 dads from Cyclist all walks of life participate so we have good conversations. I am finished train- How long have you been cycling? I ing and home again by 7am so I have first learnt to cycle at the age of five time for a shower and breakfast, and I years growing up on the West Coast of am at the clinic for an 8am start. I feel New Zealand, but I took up more serious that I have a good start to the day! cycling at around the age of 40 when I Do you notice any impact on your transitioned from running due to knee mental wellbeing? Some weeks I will injuries. complete two solo rides and this is a Over the years I have taken part in great time for thinking and maintaining fundraising sponsored rides but the best mental wellbeing. Over the years I have was the South Island leg of the National also had the privilege of having a couple Heart Foundation Ride. We cycled 1,032 of our registrars and Fellows join in with km over 6 days and collectively raised the cycle group which has been great for over $1.7 million. team building. What keeps you motivated to train? Any advice to others looking for moti- How do you find the time? I joined a vation to increase their weekly physi- local group of dads in our suburb called cal exercise? Regular exercise is a great Nga Koro which is Māori for ‘old men’. luxury and I certainly believe that it is We ride every Tuesday, Thursday and worthwhile making time for it. Saturday with optional rides on the other days. The only rule is to turn up at 5:45am at the ‘club house’ which is 5km Eye2Eye Quarter 1 2020 37

Dr Arthur Karagiannis Hot yoga practitioner

How long have you been practising by 5pm. I also still do workouts in the hot yoga and how did you get into it? gym and indeed both complement each I have been practising hot yoga for the other…yin and yang! better part of seven years. We practice Any advice to others looking for moti- in a heated room which is 36 degrees vation to increase their weekly physi- Celsius and each session is 75-90 min- cal exercise? Yoga can be practised by utes long. The room is heated to this anybody and indeed there are several temperature to simulate the tempera- ophthalmologists in the College who ture in Calcutta, India. have been practising for much longer I was first introduced to yoga by my than me, and a few are even qualified anaesthetist who is a qualified yoga yoga teachers. I myself went from being teacher. Initially, I was very sceptical of a sceptic to now being partway through the benefits of hot yoga as I had been teacher training. more focused on weight/resistance Personally, there is more value in training. But I realised over time that spending three to four hours a week yoga practice, in particular hot yoga, has practising hot yoga than the same had a significant positive impact on both amount of time hitting and chasing a my physical and mental wellbeing. little white ball! How do you find the time? I make time for yoga classes on the weekend and Monday nights after work. My staff know that I need to be finished in the clinic

Mind Skills for Enhanced Performance for Young Ophthalmologists

In October 2019, ophthalmology training mindfulness, meditation, and well- The attendees were excited to get to ees from the Royal Victorian Eye and Ear being. The team utilised a method called know their minds in more depth and look Hospital (RVEEH) commenced a novel acceptance commitment training (ACT) forward to applying this to their surgical training opportunity by focusing on their with an aim to enhance ophthalmology practice, professional relationships and minds rather than their technical skills. trainees’ performance in their high-pres- day-to-day lives. The program of training was designed sure environments by cultivating psycho- This project has been generously sup- by Dr Jacqueline Beltz and A/Prof Diane logical wellbeing, self-compassion and ported by an educational grant from Webster, Directors of the Clinical Training acceptance. It is a technique that hopes Johnson & Johnson initiated by Dr Beltz Victorian Network, RANZCO and The Eye to develop crucial mind skills that will and supported by the RVEEH’s Philanthropy and Ear in conjunction with Dr Jo Mitchell, assist trainees to work sustainably at a Department. Ophthalmology trainees attended as part of their dedicated training a clinical psychologist from “The Mind high standard. Trainees were introduced time at RVEEH. Room” in Collingwood. to psychologic flexibility, identification of Over multiple days, trainees undertook their personal values and greater under- Juliette Wittich a structured course in mind skills includ- standing of their mindset and thoughts. Communications Coordinator, RVEEH 38 Health and Wellbeing

The Practice Managers Advisory Group talks about Health their health initiatives in In Practice their respective practices.

“A staff member that has a happy balanced life is the best employee. We have an annual staff symposium where the full team of 40+ staff and some of the doctors come together to learn and enjoy each other’s company. A meditation session will be included this year. A beautiful staff room for the team to relax and catch up in is a focal point of our practice which is important for wellbeing.” Donna Glenn Gordon Eye Surgery, NSW

“We value our staff and work with them to provide a supportive, engaging and collegiate workplace. Work/life balance is essential - holidays and time in lieu are monitored closely to prevent build up and lead to possible burnout. Rostering is responsive to staff needs and preferences as much as possible. For example, someone might prefer to start later to get to a pilates class or finish earlier to attend a dog walking group. We support and sponsor external activities such as staff members participating in the Fred Hollows ‘CoastTrek’.” Lara Sullivan Bayside Eye Specialists, VIC

Be prepared to change your view of IOLs. Built on the trusted TECNIS® platform and designed to give your patients distance to intermediate VA.

TECNIS and TECNIS Eyhance are trademarks of Johnson & Johnson Surgical Vision, Inc. Australia: AMO Australia Pty Ltd, 1-5 Khartoum Road, North Ryde, NSW 2113, Australia. Phone: 1800 266 111. New Zealand: AMO Australia Pty. Ltd 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, New Zealand. Phone: 0800 266 700. © Johnson & Johnson Surgical Vision, Inc. 2019. The product for health and medical safety. Before use it is important to read the instructions for use, warnings and possible changes associated with the use of the product. PP2020CT4185 Eye2Eye Quarter 1 2020 39

Be prepared to change your view of IOLs. My Ophthalmic Adventures in Indonesia Built on the trusted TECNIS® platform and designed to give your patients distance to intermediate VA. In the Bowels of Moorfields From Wellington to Toronto Of High Seas and Island Visions Triathlete Couple Conquers Ironman

StoriesFeature TECNIS and TECNIS Eyhance are trademarks of Johnson & Johnson Surgical Vision, Inc. Australia: AMO Australia Pty Ltd, 1-5 Khartoum Road, North Ryde, NSW 2113, Australia. Phone: 1800 266 111. New Zealand: AMO Australia Pty. Ltd 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, New Zealand. Phone: 0800 266 700. © Johnson & Johnson Surgical Vision, Inc. 2019. The product for health and medical safety. Before use it is important to read the instructions for use, warnings and possible changes associated with the use of the product. PP2020CT4185 40 Feature Stories

Feature Stories

Operating in Bali - inserting a Virna GDD, 201 Eye2Eye Quarter 1 2020 41

My Ophthalmic Adventures in Indonesia Prof William Morgan I realise that I am indulging in my own The John Fawcett recounts his ophthalmic opinion and reflecting on my own expe- Foundation rience over 20 years working with peo- Family commitments really precluded me journey through his ple from Indonesia to develop glaucoma from doing much which got in the way involvement in Indonesia. services. I tried to synthesize a set of of extensive foreign travel for the next overarching strategies which were not 10 years. It wasn’t until the early 2000s formed at the outset but rather have that I became aware of the John Fawcett evolved over time and, once again, sim- Foundation working in Bali, Indonesia, ply only reflect my own views. Glaucoma initially concentrating on the large cata- is very common in Indonesia with a prev- ract burden and training there. That NGO alence of some 5% in over 50-year-olds developed extensive relationships with and a seven in 1,000 blindness preva- the local hospitals and ophthalmological lence in that age group. community. They approached me in 2004 I believe that one’s own personal abil- to see whether I would take an observer ity and passion should drive your own from Bali for three months, Dr Agus. He project when it comes to working with worked with myself and others for three the developing world. I strongly believe months at Royal Perth Hospital and at “I believe that one’s that this is an opportunity for us as oph- the Lions Eye Institute specifically for thalmologists to use all of our personal glaucoma. During that time, he taught own personal ability strengths, which include knowledge, me how glaucoma was the second most passion and personality in a partially common cause of blindness in Indonesia and passion should virgin territory. In this sense it really is after cataract which was increasingly drive your own quite an opportunity. It frees you up in being dealt with through local train- a way that you won’t experience here ing. Microsurgical techniques had only project when it comes in Australia where there is so much reg- recently come into the country and surgi- ulation. I have been lucky to have had cal techniques like trabeculectomy were to working with the very strong support from many people only being performed rarely. The public at the Lions Eye Institute and elsewhere had access to only pilocarpine and timo- developing world.” in Perth. lol drops in Indonesia at the time. There was essentially an open field with a vast First experience with problem. Indonesia The Fawcett Foundation was keen to develop a second focus on glaucoma, In 1994, Prof Ian Constable asked me to given its problem in Indonesia. I visited go with him to Surabaya to teach some the country in 2005 and spent a week glaucoma surgery. It was a great trip for in Denpasar, Bali performing surgery a first year consultant. It was interesting and doing clinics with Dr Agus and also doing a Molteno Tube with a micro- meeting other local ophthalmologists phone whammed up against the face including a young trainee, Dr Rahayu. mask. She and several others were clearly In 1995, Dr Richard Cooper had a visit- bright and had good surgical hands so ing ophthalmologist from Jakarta, Dr Ikke they learned quickly and were encour- Sumantri, work with us for three months aged to do observerships in Perth. They in Perth. She was clearly energetic, intel- were keen to teach others. You will ligent and learnt quickly. She returned notice that I made no bones about mak- to Jakarta and worked steadily with the ing judgements about people and I think University of Indonesia to build an aca- you have to do this if you want to get demic department there. effect for your efforts. My family came to 42 Feature Stories

Bali the following week and according Affecting Jakarta have a clever fancy project in one of our to local advice, we travelled around Bali Western universities but the technical I felt I was beginning to infect Bali but capacity in Jakarta at the time was more for a week. I also examined some eyes, hadn’t had any affect elsewhere. As problematic. There is research equip- including one particular child with con- luck would have it, Dr Ikke Sumantri ment but it is very difficult, time-wise, for genital glaucoma who, unfortunately, contacted me in about 2010 asking if I an ophthalmologist to perform exten- had gone well beyond any remediable would take a young, keen and intelli- sive basic science type research given the treatment. However, that particular case gent ophthalmologist from Jakarta for time constraints and the extraordinarily and others stuck in my mind, illustrating three to six months in Perth. This was Dr busy clinics that they have to perform in. the enormity of the problem. Virna Oktariana, who many of you would Hearing about the fate of trabeculecto- know as she presented at the 2017 So in my head I had a vision of the mies and the fate of those patients, as RANZCO Congress in Perth. She worked problem and I was beginning to get an well as the cost of glaucoma drainage for six months in Perth and was a keen understanding of the local customs, devices, made me search for a poten- skills and infrastructure. I kept commu- observer. She learned quickly and was tial solution. I said to Virna, why don’t nicating with Dr Agus and the Fawcett very interested to not only learn the fine we try and create a glaucoma drainage Foundation and arranged to visit Bali at points of trabeculectomy surgery but device that can be built in Indonesia at least once and sometimes twice a year also glaucoma drainage device surgery. It a cheap cost? It would help solve that was through her and Dr Ikke that I found since that time. problem and it would also give your out that trabeculectomy frequently institution and your country increased The dream failed in Indonesian patients with both infrastructural techniques to alter and angle closure and open angle glaucoma, I wanted to perform service in Bali. change glaucoma surgical devices in the where at that point those patients often Perhaps more importantly, I wanted to future. She checked with her superiors in went blind because glaucoma drainage Jakarta and they were keen to proceed, train the local ophthalmologists in safe devices were so expensive. They cost trabeculectomy techniques (as safe as so we made plans. The rest is history as a approximately $1,400 for the device device has been made and we launched trabeculectomy can be). This involved and there was little skill available in it in Jakarta in June 2019. showing them what sort of patients to Indonesia for their insertion. This is not The whole process has taken eight select and avoid knowing that severe a criticism of the local ophthalmologists years. It began with technical drawings complications will affect the willingness but simply an effect of their experience by both myself and Dr Oktariana, con- of family, friends and whole villages at resulting in so few being inserted that sidering the surgical skill level of local times to come for treatment. I began no skill base was developed. Patients ophthalmologists and the manufactur- to dream about thinking of Indonesia would frequently have trabeculectomy ing capacity available in Indonesia. The as like agar culture media and that per- which would then fail and then have a design brief was to create a drainage haps I could insert improved techniques, second trabeculectomy which would fail device made of obtainable materials rather like an infection, in specific sites faster and then go blind. that could be machined locally and also which would be most fertile for their designed to make the surgical insertion multiplication and expansion through as easy as possible to facilitate training. the rest of the nation. At the time, Bali This has been done and we have built had the easiest access, with regular a polymethyl methacrylate plate which flights from Perth only taking three and “I began to dream can be lathed into shape and a silicone a half hours, relatively good infrastruc- tube glued in position with two suture about thinking of holes. It is shaped for easy insertion ture and good access with the connec- between two rectus muscles via a limbal tions between the Fawcett Foundation Indonesia as like agar incision. We performed animal stud- and local ophthalmologists. culture media and that ies in Jakarta and began human trials I was involved with the local ophthal- four years ago. To date, some 500 plus mologists in arranging a week’s visit perhaps I could insert devices have been inserted with results which would generally go like this: The that approximate those from Molteno first day spent performing at a clinic and improved techniques tubes and Baerveldt tubes. Dr Oktariana in the afternoon, giving didactic teaching in specific sites which is teaching units in other centres to per- specifically addressing clinical problems form this surgery with the national roll- seen. On the second day, performing would be most fertile out occurring now. surgery while in the afternoon giving some didactic sessions on the surgical for their multiplication Learning by involvement technique and problems. The third day and expansion through My involvement with Jakarta was more would be spent doing post-operative than just this as I began to visit Jakarta review of patients and seeing more the rest of the nation.” and Bali each year, spending two and a half days at each site after 2008. Dr Ikke patients (usually in a different location) Sumantri is an excellent entrepreneur and then the fourth day performing more who raised money to build a six-story surgery. More clinic happens on the fifth Dr Oktariana was keen to do a PhD eye hospital attached to the University day as well as post-operative reviews. This with me at the Lions Eye Institute. In this of Indonesia which has been built and was performed through the University of situation I am often filled with dread as is called “RSCM Kirana”. It has been Udayana at Sanglar Hospital and also at my own research can be somewhat eso- incredible to watch the infrastructure the Bali Memorial Eye Hospital which the teric and I am thinking on what I can do improvements over the last 10 years in Australian government had partially built and suggest that will have a practical Jakarta alone. The theatres there have and furnished with equipment. This had application to the problems in Indonesia Zeiss operating microscopes, advanced occurred following the Bali bombing. and also be doable in Jakarta. It is fine to phaco machines and the clinics have Eye2Eye Quarter 1 2020 43

the usual Humphrey visual field-testing speak at various meetings in Indonesia and other sectors related to glaucoma. gear, lasers and optic nerve morpho- and have expanded my contacts there My dream is to continue building long- metric imaging devices. Local ophthal- as a result of those meetings as well term relationships, helping where I can mologists are very keen to learn how to as visits from other ophthalmologists help and learning where I can learn. The optimise the use of this equipment in while teaching in either Bali or Jakarta. amount of learning that I can derive their particular situation and it has been We also had observers from Malang and from Indonesia is increasing. I hope to incredibly satisfying being involved in Surabaya in East Java. We recently con- encourage others to join me in both teaching and learning. cluded two memoranda of understand- teaching and learning. I hope and plan I use the word ‘learning’ in the last ing between the Lions Eye Institute and to begin organising local registrars from sentence because over the last 10 years I the University of Udayana and also the Perth to visit centres in Indonesia where have increasingly learnt more and more University of Brawijaya in Malang. We we have strong relationships for their about myself as I have visited those com- have recently signed an affiliation agree- own benefit. This will build into part of munities. The volume of patients seen is ment with the University of Indonesia, my own succession plan and hope that huge as well as the range of pathology. I Jakarta as well. local registrars will become local oph- have seen cases of certain diseases that thalmologists and will continue to visit I have never seen in Australia, and that Continuing the dream Indonesia and foster relationships with has been a unique learning experience My current dreams are to continue my our largest neighbour. for me. I have also witnessed how they redundancy, i.e. to go up and observe Prof William Morgan approach their training and how they more rather than operate and give sim- FRANZCO, WA are attempting to scale up their own ple advice, but also to learn. For example, training. For example, Udayana in Bali Dr Oktariana has performed 200 glau- has 60 training registrars and Jakarta has coma drainage device insertions in one 70 training registrars. They have a formal year (at four per week). I doubt whether training program which rivals our own. any surgeon in Australia has done that The scale of ophthalmology training is and she has done these operations on a “The amount of quite spectacular. range of pathologies which again would Over the last 10 years we have had exceed any one particular person’s expe- learning that I can multiple observers from Jakarta spend rience in Australia. She is in a position three months here in Perth with myself to give us advice on certain types of derive from Indonesia and others. Drs Giubilato, Clark, House, cases and so part of my reason for vis- is increasing.” Yuen and others have helped with this itation is to learn from her. She is not training. We have had five ophthalmol- alone and there are others in Indonesia ogists from Bali. I have been invited to who are developing skills rapidly in this

Performing animal experiments with prototype GDD in rabbits, Bogor, Indonesia, 2013

Dr Virna Oktariana, Prof Ari Fahrial Syam (Dean of Faculty Medicine, University of Indonesia) and Prof William Morgan after signing an affiliation agreement in 2019

Dr Virna inserting a glaucoma drainage device into a patient’s eye, 2019 44 Feature Stories

In the Bowels of Moorfields

Travelling Scholarship I write this having recently completed an date a screening tool for choroidal naevi 2018 Update – Dr Roderick ocular oncology fellowship at Moorfields that was created by Prof Bertil Damato. Eye Hospital, which was supported, Hopefully, it will prove to be an easy to O’Day received the RANZCO in part, by the RANZCO Travelling use tool for optometrists to help triage Travelling Scholarship Scholarship. As one of four highly spe- these common lesions. Award in October 2018 and cialised ocular oncology centres in the Another highlight for me was getting UK, the unit is incredibly busy. It cares for to work alongside Fellows from all over has now reported back more than 200 newly diagnosed patients the world who, as well as being won- on his scholarship year of with uveal melanoma per year as well derful colleagues, have become great learning and cycling in and as the myriad of other ocular lumps and friends. One of London’s and Moorfields’ retinoblastoma at the Royal London greatest strengths is that they attract around London. Hospital. A fellowship at Moorfields has some of the greatest minds from all over truly been a fantastic way to see a huge the world, and I feel lucky to have got to volume of many rare conditions, many of meet and work with so many of them. which I had only previously seen when Living in London is expensive, but A/Prof Qureshi ran ‘weird and wonderful’ with the help of the RANZCO Travelling Wednesday morning angio meetings at Scholarship, we were able to live cen- RVEEH (trainees from Victoria will under- trally in Islington, a short 5-minute bike stand that reference, and the fear those ride from Moorfields. This made a huge “One of London’s and sessions created). As with the excellent difference to our lifestyle. My bicycle Moorfields’ greatest clinicians I trained with in Victoria, I was turned out to be the best investment I incredibly lucky in the consultants I made in the year, allowing me to travel strengths is that they worked for in London, being Miss Victoria between Moorfields, Royal London Cohen, Prof Mandeep Sagoo and Mr and St Bart’s, as well as to many of attract some of the Ashwin Reddy. I also regularly had a the- London’s pubs, restaurants, and great atre list with Mr Amit Arora, about whom outdoor swimming pools, or ‘lidos’. My greatest minds from all the only negative thing I found was his wife, Penny, and I made the most of fondness for Spanish music in theatre. living in the UK pre-Brexit and travelled over the world, and I as much as we could throughout the Through their generosity in teaching year. The biggest highlight of all came both surgical and clinical oncology skills, feel lucky to have got towards the end of our time in London, I feel well prepared to return to Australia. with the arrival of our daughter, Lucy, to meet and work with A major highlight for the year was the in November. She will surely always be dynamic research focus at Moorfields. grateful to RANZCO for the British citi- so many of them.” I was lucky enough to collaborate with zenship her birth in the UK bestowed on my colleagues on numerous projects her! throughout the year and will continue to upon my return to Australia. One of the Dr Roderick O’Day more exciting projects has been to vali- FRANZCO, VIC

(L-R) Dr Kelsey Roelofs, Dr Rod O'Day, Prof Mandeep Sagoo, Dr Guy Negretti, Dr Beatrice Gallo, CNS Nana Gyasi-Twum and CNS Sinead Hanrahan Eye2Eye Quarter 1 2020 45

From Wellington to Toronto

Travelling Scholarship Glaucoma management is in an exciting Under the GAASS 2019 Update era. Recent developments have seen the Fellowship – Dr Nick field merge traditional 'tried and tested' Andrew delves deep methods with new minimally-invasive Next, I headed to Toronto to be the first into his scholarship techniques. I was therefore wonderfully ophthalmologist from the Asia Pacific to do Ike’s Glaucoma and Advanced Anterior experience while lunching fortunate to have fellowship training that spanned the full breadth and depth Segment Surgery (GAASS) fellowship. in Wellington and his high- of modern glaucoma care. With my wife, Here, my increase in clinical and surgical performance glaucoma Theresa, and one-year-old son, Jack, we skills was only matched by my increase in caffeine tolerance. This fellowship is like training in Toronto with first travelled to Wellington to train with Prof Tony Wells and Dr Jesse Gale. We any other high-performance fellowship, copious cups of coffee in then headed to Toronto to train with only more so. It is absolutely no surprise hand. the inimitable Dr Ike Ahmed and his col- that Ike is world famous. His work ethic and attention to detail are stunning; he leagues Drs Devesh Varma and Diamond is constantly looking to do things better Tam. and perhaps most impressive of all, he Laying foundations in appears to have achieved mastery of Wellington the literature on glaucoma and anterior segment surgery. Lecturing every week, “Wellington reshaped We arrived in Wellington in February serving on the editorial boards of major 2018, right in time to catch one of the journals, and a leading consultant with my thinking on so city's best summers in history. It's a spec- industry, he is well ahead of what is com- tacular harbour city and we were lucky ing and how this fits into the historical many fundamental to get a great apartment near the water. picture. aspects of glaucoma.” Tony was trained by Sir Peng Khaw in In GAASS, the fellows run the clinic Moorfields and Jesse was trained by Keith and do the surgery, which is a great Martin in Cambridge. From this pedigree privilege and responsibility. I was grate- it's no surprise that I learnt what can most ful to have a terrific co-fellow, Jeb Ong simply be described as "very sound" glau- from Montreal. In clinic, no stone is left coma management. Wellington reshaped unturned. In fact, most are examined my thinking on so many fundamental with a microscope. Both Tony and Ike aspects of glaucoma. Although Toronto have wonderfully equipped centres, and would be the icing on the cake, my foun- therefore, between the two of them, I dations were laid in Wellington. got experience with virtually every diag- I was principally with Tony, who is an nostic and surgical gadget available. In expert in corneal biomechanics, subcon- Toronto, supervision was close but done junctival glaucoma surgery, bleb man- remotely. Between the electronic medi- agement, and angle closure. My main cal record (EMR), Slack messaging app, focus was in trying to download Tony's and clinic email, Ike provides constant immense experience in bleb manage- input and feedback. In fact, I would usu- ment. It was fantastic to be able to review ally not be aware that he had travelled to every bleb with Tony and then discuss the other side of the world for the week- what we could do to optimise it further. end until I saw the Instagram post. Tony is one of these gifted ambidextrous The GAASS fellowship is a two-in- surgeons and he taught me meticulous one. It's approximately 50% glaucoma and robust techniques for tubes and and 50% complex anterior segment. trabs. To rapidly build my skills, I also The surgical volume is fantastic. You spent many nights in the wet lab placing are only limited by your ability and the hundreds of sutures in pig eyes. clock. If you're capable, the sky is the My fondest memories of the fellow- limit in this fellowship. You're in thea- ship were my daily lunches with Tony on tre two to three full days per week and Cuba Street. Here we would ruminate each list comprises some MIGS (iStents, on cases, brainstorm research ideas, and Hydrus, OMNI 720, AbIC, GATT, Kahook plan our next "big invention" that would dual blade), some subconjunctival revolutionise ophthalmology! Projects I glaucoma surgery (tubes, trabs, Xen, worked on included new tube surgical PreserFlo MicroShunt) and some com- techniques, multiple repeat SLT, diode plex anterior segment cases (dislocated iridoplasty, bimatoprost SR injections, cataracts, IOL exchanges, IOL re-fixa- and new IOP measurement techniques. tion with sutures or capsular tension And of course, in between all of this, I also segments, iris prostheses, iris suturing). spent time clinging for dear life aboard Each list feels like a career’s-worth of 'Blink', Tony's carbon fibre sailing bullet. experience in seven hours. Ike is obses- 46 Feature Stories

sional about surgical technique and no committed shouldn't apply but if you're one leaves the OR unless their operation hard working and hungry to learn, then is perfect. The skillset obtained is very many would say that this is the best fel- broad. Importantly, there is no single lowship in glaucoma and complex ante- "workhorse" MIGS procedure in GAASS, rior segment surgery in the world. which reflects the fact that all proce------“…efficiency never dures have their sweet spot. To break up I'd like to thank all those who devoted the surgical intensity you also get "easy" their time and expertise to training me, days of just cataracts – 30 cases per list. comes from hurrying, both in Australia and during my fellow- If you can keep the pace, then you do all but from executing the surgery. You quickly learn that effi- ships. It's hard to imagine better training. ciency never comes from hurrying, but In my travels for fellowship and meet- each step perfectly and from executing each step perfectly and ings, I am reminded of just how good our doing it once. The saying, "Perfection is training is, both as medical doctors and doing it once.” not when there is nothing left to add, it's as RANZCO Fellows. This is a standard we when there is nothing left to take away" can all be proud of. Importantly, I also certainly rings true. want to thank Allergan and RANZCO for In summary, the GAASS fellowship is a very kindly supporting these travelling superb opportunity. They're not there to scholarships, which help new fellows hold your hand or spoon feed you, but extend their training. all the conditions are provided in which to learn. It's a high intensity fellowship Dr Nicholas Andrew with a case mix that's both high volume FRANZCO, QLD and complex. People who aren't 100%

Dr Nick Andrew with his wife Theresa and son Jack in Chicago for the American Academy of Ophthalmology Meeting

Dr Nick Andrew gave an “Ahmed 2.2” Toronto Maple Leafs hockey jersey to Dr Ike Ahmed on his last day as a reference to his 2.2mm diamond knife keratome Eye2Eye Quarter 1 2020 47

Dr John Willoughby and his crew at the 2019 Sydney to Hobart Yacht Race Of High Seas and Island Visions

Fellow Dr John Willoughby In a curious overlapping of terminolo- ophthalmology world, he is known as gies, doctors and sailors have had, for Sailor Johnny. He participated in the most recently finished his most of their careers, a Log Book. For Sydney to Hobart Race 2019 which to last race at the 2019 Sydney doctors, a record of patients and visi- him was a slight feeling of deja vu as he to Hobart race and will now tors; the CPD diary, a digital logbook of thought that his 2017 race was going to experiences and reflections. Curiouser be his last. focus on his charity, Vision to know that for seafaring folks, the term “I missed it a lot in 2018 so in 2019, I of Islands. ‘logbook’ has been deeply embedded thought I’d give it another rattle,” he said. in their maritime activities. What was once a log cast overboard to measure a Through Hell or High Water ship’s progress by counting actual knots For someone who was leading the 2014 in an attached string and recording it Sydney to Hobart race but had to pull in a book has now become an actual out to help in a plane crash, one would ‘Log Book’ of their adventures. Explorer think of that moment as the most chal- Captain James Cook’s Log Book was piv- lenging race of his to date. But as with otal in tracking his legendary journey most cases of ‘last hurrahs’, his time in in discovering the Pacific Island nations the 2019 race proved to be the biggest 250 years ago. challenge. Sailor John Willoughby is not your Sometime in between 26 December ordinary explorer. Within the confines 2019 and 1 January 2020, Dr Willoughby of his clinic and charity, he is Dr John and his crew had to sail under a new Willoughby: A RANZCO Fellow for 41 moon, in pitch black weather, high seas, years and to this day operates at his and a wind that kept increasing, reach- practice at Gawler Eye & Laser Clinic in ing up to 32 knots. A big wave came from Adelaide, South Australia. Outside the behind, slapped his boat and knocked 48 Feature Stories

his crew across the cockpit including his “I want to work in conjunction with was recently contacted by the Royal skipper, who was helming at that time. other trainees and personnel in that area. South Australian Yacht Squadron and the “His life jacket went off and blew him up We need to train people that already have Cruising Yacht Club of South Australia like Michelin man,” he said. Another one basic eye training. I hope to help them lift to organise a race to Kangaroo Island in of his crew had to put her feet up to stop their game to become fully qualified. If March as an effort to raise support and herself from going down the side when we could bring trainees and consultants bring tourism back to the island. the big wave hit and broke both of her from Australia to participate and help, ------feet, which later on was unfortunately that would be really good as well.” joined by a broken wrist. One could only assume that Dr John “She got three broken limbs but she More than just a sailor Willoughby’s Log Book would be vastly can still sail,” Dr Willoughby explained. Dr Willoughby is a full-time ophthalmol- different yet strangely similar to Cook’s. It “She’ll actually be sailing with me soon. ogist and has been in practice for 41 would be filled with not discovery but a They make ‘em tough in South Australia years. He still keeps busy by doing about sheer intent to traverse the high seas and alright.” a thousand operations per year. Other deliver eye care to those hard-to-reach They were running at second place over- than the Sydney to Hobart races, he has islands. His voyages would have the all until these events happened, but Dr done other offshore racing in the past. similar look of Cook’s determination that Willoughby remained thankful and in “We’re quite competitive. We’re a load nothing should stop the main object of high spirits. of old farts. We hardly train at all. We’re not his expedition. In this case, to bring sight “Out of 157, we were second. But we like these Olympic sailors or professional back to the islands. ended up coming about two-thirds of teams that sail every weekend or so and “If I can leave a working charity, Vision the way down to the fleet. We went from participate in all the races,” he laughed. of Islands, behind when I retire and have second down to 98. It wasn’t my best Apart from being an eye doctor and people continue the ophthalmic work I race by any means, but we did finish it,” sailor, Dr Willoughby is the owner of Bay of have started,” Dr Willoughby said, “that Shoals Winery in Kangaroo Island. He also he explained. would be the biggest achievement. That considers himself as an inventor. would be my legacy.” His vision for the islands “I have invented a few gadgets. I’m plan- Dr Willoughby has now put up his yacht, ning on doing some innovative stuff with the Enchantress, for sale as he wants to building a new harbour in Bay of Shoals. focus more on his work with his non-profit “I’m just a lateral thinker but I usually give eye surgery clinic, Vision of Islands. They the ideas to other people. There’s never provide eye services free of charge in the enough time in the day to do all of these.” When asked about his Pacific Islands extending to Tonga and Tuvalu. Into the horizon dream, he described a “Vision of Islands is designed as a sup- Currently, he is involved with helping out plement to what services are already in in the rebuild of Kangaroo Island after boat with an operating the area. In Tonga, they may have good the bushfire devastation in the last cou- theatre capable of service on the main island of Tongatapu ple of months. in the Vaiola Hospital, but what they need “We’re now having a sort of publicity bringing facilities and is assistance to get better equipment and campaign to book them out and get supplying personnel out to the smaller people to keep the wheels of business equipment to hard- islands,” he said. turning over.” When asked about his dream, he Widely proud of his competitive streak to-reach areas in the described a boat with an operating theatre and busy mind, Dr Willoughby never Pacific. capable of bringing facilities and equip- hesitates to involve himself in projects ment to hard-to-reach areas in the Pacific. that tap into his maritime interest. He

“They make ‘em tough in South Australia Dr Duke Mataka from Tonga operating in Tuvalu for Vision of Islands helped by Instrument Nurse alright”, Dr Willoughby says of crew member Laite from Fiji Lisa Bettcher. Eye2Eye Quarter 1 2020 49

Triathlete Couple Conquers Ironman

RANZCO Fellow Dr Katherine Smallcombe and her husband and Practice Manager Brian Corff not only have a growing ophthalmology practice in Brisbane but they were also the only amateur triathlete couple to qualify for and race the Ironman World Championship which was held last October in Hawaii. Earlier that year Katherine and Brian placed first and Dr Katherine and husband Brian at the World Ironman Championship in Hawaii third in their respective age Fitness and physical activity has always a solid base of fitness for many years. groups at the Asia Pacific been at the forefront of their relation- Stepping up to an Ironman distance race Championship in Cairns. ship having met each other while rid- was a natural progression for us. After ing mountain bikes across Tibet to Mt my second child six years before, I was Everest. To date, they have competed in quite unfit and overweight. I made the more than 40 triathlons. conscious decision to regain my health knowing that it would take three or so How did the interest in triathlons years before I was back to pre-pregnancy start? fitness. Katherine: I’ve always been active – running the odd half marathon or riding Brian: My results have been slowly to work. Brian and I actually met on a improving for four years. In January 2019, cycling trip in Tibet. It wasn’t until I met I finally committed to race at Ironman Brian and saw his interest in triathlon Cairns in June, which would be my first “Someone once that I decided to sign up for my first Ironman since 2010 because we had two event – a half Ironman race which I com- beautiful children in between. I was hop- described medicine pleted a few months after my ophthal- ing for a little break from training after as ‘a jealous mistress’ mology second part exam! that, but we unexpectedly qualified for Brian: My first triathlon was in 2004. the Ironman World Championships, so in that it can easily Two years into my first full-time job after we did a further 16-week build leading university, I was looking for something into Kona. become all consuming. active to do after work. I had a couple It's very rare for a couple to qualify for Chasing the elusive of friends who were curious about tri- the World Championships. What was athlon and we decided to compete in your reaction when you found out ‘more’ at work can our first race as a team. I drew the short that both of you had qualified? straw and had to do the 10km run. My Katherine: Apart from a married couple occur at the expense first solo race was a few months later who are pro-triathletes, we are the only of other important and after that, I was hooked. married couple in the world who qual- How long did you have to train for ified for the World Championships in parts of life such as this? 2019. Getting to share such a major life Katherine: The easy answer is that we event together was really very special. marriage, family had four months between when we Brian: It really was quite surreal. We relationships and qualified at Cairns Ironman until the were elated. People sometimes say it’s World Championships in Hawaii. In impossible to qualify for Kona when you physical health.” reality however, we have been building have kids, it’s impossible to qualify when 50 Feature Stories

you have a full-time job, or it’s impossible to qualify at the same time as your partner. There is a quote I love that says: “It’s kinda fun to do the impossible.” What did the both of you do to prepare – physically and mentally? Katherine: For the physical part, I leave that up to my amazing coach who is one of the best in the world at what she does. The mental preparation mostly comes from training. Getting the physical work done day after day in the midst of family and work commitments, even though you may be tired or sore or have other things you’d rather be doing. Learning not to listen to that little voice in my mind that is trying to convince me to miss a session or sleep in, is where you build mental toughness. Brian: The training is gruelling, both physically and mentally, but it builds up gradually. Through that process, you learn that your body and mind are capable of much more than you originally thought. It’s important to take those lessons on board and to develop a level Dr Katherine Smallcombe of KindSIGHT of self-confidence that you deserve to be there racing against the world’s best. Why do you think it's important for also gives me more energy, helps me to people in the industry to have a bal- manage stress better and I also enjoy the ance of both work and play? social aspect through connecting with Katherine: Someone once described my teammates who are high achievers medicine as ‘a jealous mistress’ in that in their own careers. “It is just so important it can easily become all consuming. Brian: KindSIGHT’s growth has closely to remain active in Chasing the elusive ‘more’ at work can mirrored our improvement in triathlon. I occur at the expense of other important think this is because the harder we work, your adult years and parts of life such as marriage, family rela- the more we need to train to keep things tionships and physical health. There is in balance. To me, it is a huge source to achieve some goals no point being massively successful in of stress relief, structure and lifestyle one aspect of your life if everything else enhancement. We hope to be an inspira- outside of the work is a disaster. ‘Play’ can shift our focus and tion to our employees, our patients and environment. Success helps get the balance back by allowing the community we serve. us to experience many other wonderful for us involves a well- things that life has to offer. Brian: It is just so important to remain rounded lifestyle.” active in your adult years and to achieve some goals outside of the work environment. Success for us involves a well- rounded lifestyle. Some practitioners “Play’ can shift our seem to lose sight of that and drive for work-related success at the expense of focus and helps get their own well-being. I also hope we are setting a wonderful example for our kids the balance back that being active as an adult is totally by allowing us to normal. experience many other How does your active lifestyle positively influence the work that you do wonderful things that at KindSIGHT? Katherine: Training for Ironman not only life has to offer.” helps me to remain physically active as I get older, but it is also so important for my mental wellbeing. It is a wonderful tool for personal growth as it constantly challenges what I think I am capable of. It Eye2Eye Quarter 1 2020 51

GET CPD APP

The RANZCO CPD app is now available INVOLVED! for mobile download. Fellows may log into the app using your RANZCO All expressions of interest will now be username and password (same advertised on the RANZCO website username and password for logging in to and updated as necessary. Just click the RANZCO portal). on ‘Get Involved’ to view the list. For Offline capabilities are now available so interested applicants on any of the you may enter your CPD activity while EOIs, please make sure to submit a CV offline and it will automatically sync of no more than three pages and a to your online CPD Diary once you are cover letter. connected to the internet. Fellows can enter their CPD events, points and reflections directly into the app as well as upload evident of attendance at events.

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Member Profile

Prof Peter McCluskey and A/Prof Clare Fraser were RANZCO Welcomes Two New elected to the RANZCO Board Directors Board at the Congress 2019 Council Meeting in Prof Peter McCluskey • Improving RANZCO’s relationship Sydney. They have brought with universities to maximise the Peter Joseph McCluskey, former Chair collaborative education opportuni- along with them their of ORIA, is also the Director of the ties for our trainees. knowledge, personality and Save Sight Institute at the Sydney Eye • Improving the profile of, and passion in their ophthalmic Hospital and Professor and Chair of opportunities for, the high quality expertise, and have kindly Ophthalmology at the University of internationally recognised research Sydney. Most recently, he was awarded done in Australia and New Zealand. shared their journey in this Officer (AO) in the General Division • Becoming policy makers to improve member profile. of the Order of Australia during the eye health, especially from diseases Australia Day Awards on 25 January. such as diabetic retinopathy and What motivated you to nominate glaucoma. to join the Board? RANZCO and oph- What area of ophthalmology are you thalmology have some big issues to most passionate about? I want to deal with at present including: the MBS ensure that the next generation of oph- review, lack of rural ophthalmologists, thalmologists are as well trained as I was inequity of access to expensive new and inspire them to become involved in therapies and training the next genera- research. tion of ophthalmologists. I believe that How do you balance your involve- due to my experience in private and ment with the College and everything public sector clinical practice, as well else you have to do? With great dif- as my academic work as a clinician sci- ficulty! I depend on my long suffering, entist, I can add value to the Board and amazingly supportive wife and family the Fellowship in trying to deal with to make sure I do things outside of these issues. work. My grandchildren have greatly What areas of the College have improved my work/life balance. you been engaged with the most? What do you think will be the greatest I have been involved in registrar training reward from serving on the Board? for 30+ years and am currently Chair of the largest registrar training network in Helping to solve some of the major chal- Australia and New Zealand. The Sydney lenges facing RANZCO. Eye Hospital network has 42 accred- ited training posts across its network. I have served on other college com- mittees such as the ORIA Board and the Therapeutics Committee, and have chaired the Uveitis SIG and the Professorial SIG. Broadly speaking, what do you see are the greatest opportunities for the College across Australia, NZ and the region? • Ensuring equity of access to sight saving treatment for all in the Prof Peter McCluskey community. Eye2Eye Quarter 1 2020 53

I chose RANZCO – and that’s why I’m not A/Prof Clare Fraser on the board of the cat shelter. The rain was at a steady drizzle when we What areas of the College have caught up with Clare at her neighbour- you been engaged with the most? hood café. It was a slow and quiet start Probably ORIA and the Scientific Review before her schedule officially kicked Committee. I was on the panel to review in. Booked with an array of research the grants and then I took a step up on to and clinical tasks, she looked calm and the Board. I’ve been very involved in the relaxed, ready to take on the day. research side of things. I started off on What motivated you to nominate to little things when I was younger, like the join the Board? I’ve been trying to think Falls and Cataract in the Elderly Advisory about this question for a while and it’s Panel which was many years ago; and probably going to be a multi-pronged then the Leadership Development answer. Program, NSW Branch Committee, I’ve always thought that it’s better to ANZEF and ORIA. I’m also the Vice be a part of something than to be on the President of the Neuro Ophthalmology outside. You need to know the workings Special Interest Group. and have an understanding of all the Is there a big difference between moving parts and components before being in the RANZCO Board to all those you can really make any judgement. With roles you took on before? The RANZCO that in mind, I’ve always wanted to step Board is much more holistic. You have forward. A few people, however, have to take into account everything, what been a little negative: “You’re not really a interests everybody. Not every member born leader. You can’t learn that.” But my is interested in research, for example, so mentor, Nancy Newman, took on a board you have to have a bigger outlook rather A/Prof Clare Fraser role in her organisation and when I asked than just being narrow focused as some her why she did it, she said, “I wanted to of the other roles were. be in a position where I could make life better. I didn’t want you to have the same Broadly speaking, what do you think struggles as I had.” She took it on in order are the greatest opportunities for the to make a better legacy. College? I think our greatest assets are When I won the prize for the the ophthalmologists. They are what Leadership Development Course, I RANZCO is all about. I think engaging the Fellows, maximising what they do and “I think our greatest used the money to go to the Australian helping them do what they do best is the Institute of Company Directors three- assets are the greatest opportunity we have. We’ve got day course. There was a journalist there so many amazing and dedicated people ophthalmologists. who came up with a list of boards I who are part of RANZCO and we need should apply for: One, a cat shelter that to help them tell their stories. We are the They are what looks after homeless cats and the sec- leaders in collaborative eye care and we ond was RANZCO. Hearing the latter was need to help our people to do that; make RANZCO is all about. a little intimidating. I knew it was a big their life as easy as possible to achieve our ask and I felt that I was way too junior. We are the leaders mission and purpose. Christine Younan was a big encour- in collaborative eye agement. It was really a series of peo- What about the opportunities in the ple in my life who, along with my own Asia Pacific region? RANZCO has such care and we need to desire, pushed me to be a part of it. I high standards of education. We make help our people to do think as women we need a little bit more great ophthalmologists. The Australian of a push. But Jodie Fox, creator of the trainees are probably some of the best that…” company Shoes of Prey, always said, “Do and so our strength as education pro- something before you’re ready.” viders and setting good standards is So, when the journalist at the course beneficial to those regions. I believe in asked me, “Do you want to look after educating them to become the best cats or do you want to be on RANZCO?” ophthalmologists. 54 Member Profile

What area of ophthalmology are you most passionate about? I’m a neuro ophthalmologist and that’s always been my passion. I’ve always wanted to be a neurologist until I met ophthalmology. Then I decided that that was more interesting. I think I’m more passionate about neuro ophthalmology because to me, it’s more holistic. The cases that come to a neuro ophthalmologist are absolutely fascinating. It’s usually people with cases that don’t really fit in one or the other. New cases lead to new understanding. My fascination is with how the brain affects vision. How do you balance your involvement in the College and everything else? Since I got busier, I do some set things in my schedule that I really try hard not to miss. Three hours on a Wednesday night, I do a sculpture class. It’s very different to ophthalmology because it’s very creative. The one thing that my teacher told me is that I’m terrible at sculpting eyes. I can’t do faces and eyes. In my last sculpture, the person had their head bowed and covered with their arm so I didn’t have to sculpt their eyeballs. He says its because I know too much. I tend to sculpt what I know, not what I see. Also last year, I bought a boat. We sail every Friday night. I try really hard not to accept things on those days. I also just make time to be at home. I think once you get this busy, you just have to schedule these days in. I keep the balance by scheduling and having to pick a creative outlet and an ANZEF activity outdoors. The Australian and New Zealand Eye Foundation What do you think will be the greatest reward from serving on the Board? (laughs) I didn’t do this for the reward. No, but I think the greatest reward will be the colleagues: working with the people on the Board, the members and the staff HELP PREVENT AVOIDABLE BLINDNESS of RANZCO. I think the people you get to interact with and learn from will be my ACROSS AUSTRALIA,NEW ZEALAND personal learning and reward. And tying & DEVELOPING COUNTRIES it back to what I said in the beginning, perhaps leaving a slightly easier path for the people who will come behind me: TOTAL RAISED SINCE JUNE 2018 the trainees, female ophthalmologists and the researchers. $1,009,727 Raised from this financial year to date, $667,157 in bequests and $106,100 from members & public

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Australian and New Zealand Eye Foundation Eye2Eye Quarter 1 2020 55

Women in Ophthalmology New Chair

Two Fellows have now What motivated you to take on A further challenge is the constella- joined the ranks to become a leadership role in Women in tion of unconscious bias, discrimina- Ophthalmology? I want more women tion and sexist ‘microaggressions’. The Women in Ophthalmology’s to have opportunities to achieve their effect of these factors can be espe- new Chair and Deputy potential in ophthalmology. The chal- cially pernicious because they operate Chair. In this Member lenge we face is highlighted by the fact in subtle ways to undermine gender that, both in surgical and academic equity. Profile, new Chair Prof careers, there are proportionally few What changes would you like to women in leadership positions, despite Helen Danesh-Meyer make during your tenure? To help no lack of talented women. discusses her vision for the address a problem as wide and as deep Personally, I have been fortunate as gender equity, we need multiple special interest group and to have been strongly supported by complementary approaches and lots expresses her commitment excellent male and female mentors. I’ve of goodwill. I am keen, for example, worked in mostly supportive and mer- to gender equity. Dr Robyn to help develop platforms to enable itocratic environments. In RANZCO we ready identification of talented women Troutbeck will be alongside have a surgical College that is actively to consider for leadership positions. her as Deputy Chair. and seriously committed to addressing We have started work with RANZCO to issues of gender equity. develop a Speakers Bureau so that con- Yet, systematic barriers persist. Some ference organisers can draw on women of these barriers also present challenges (and men) who have the capacity and for male ophthalmologists seeking to experience to lead. Another priority achieve a balance between their per- are initiatives that proactively equip sonal lives and professional leadership women to support their transition roles. However, the impact of those into leadership roles, when the time is barriers on women is disproportionately right for them. For example, we have large. For example, our initial research initiated steps to consider structured in 2007 identified that women ophthal- mentorship programs (including both mologists dedicated 45% of their time ophthalmology and non-ophthalmol- to childcare compared to 10% for men. ogy mentors). We need to provide crea- Women ophthalmologists were more tive ways to support women who have likely to work part-time and had higher not had linear career trajectories. One rates of frustration about having to approach we are exploring is the crea- choose between family and career. Our tion of research awards (accompanied 2019 update survey found that, unfortu- by mentorship) that target able candi- nately, the situation had not significantly dates who have had limited research changed. Women ophthalmologists opportunities due to caring responsi- continued to report significant obstacles bilities. Such targeted measures need, Prof Helen Danesh-Meyer to career advancement, including those of course, to be underpinned by a related to caring responsibilities, inad- heightening of educational and aware- equate mentorship, and rigid timelines ness initiatives to address unconscious for promotion/tenure. Women ophthal- bias and discrimination. mologists also reported they were more “[We need to] likely to experience discrimination and Will there always be a need for a bullying. Women in Ophthalmology Group? recognise that the Always is a long time! The issues are What are the biggest cultural chal- complex and multi-dimensional. Until lenges to gender equity faced by oph- quest for gender equity we completely address the ‘glass ceil- thalmologists and trainee ophthal- ing’, ‘sticky feet’ (unconscious behaviour is everyone’s business mologists? An initial challenge is to rec- women exhibit that keep them mired ognise that the quest for gender equity is – it’s a responsibility in ‘lower’ corporate ranks) and ‘leaky’ everyone’s business – it’s a responsibility pipeline – that women particularly of men and women alike. of men and women experience in surgical specialties – we A second challenge is the need for will need such groups as Women in alike.” more transparent processes to identify Ophthalmology. future leaders. This applies, for example, to selection of speakers for major If not an ophthalmologist, what meetings and recruitment to senior would you be? An All Blacks Head positions at hospitals and universities. Coach. By contrast, many organisations still rely on informal networks, a ‘club culture’ of ‘shoulder tapping’ colleagues. 56 In Practice

In Practice

Healthcare Practice Management for Patient Satisfaction

Why this Book was Written • Physical infrastructure – often referred to as practice “ambience”. We wrote this book for it to become a practical toolkit for any practice. We What gets in the way of these per- included action plans, checklists and ceived values? What can produce nega- consideration tools that can be tailored tive attitudes to practice consultation? for each practice allowing them to cre- There are a range of possible answers: ate their own individual blueprint. a breakdown in relations between cli- This book aims to positively influ- nicians or practice staff and patients, ence communication between person- systems which fail to put patients first; nel in healthcare practices and their or a physical environment that antago- patients. We recognise that healthcare nises patients. practices are highly regarded professional organisations in the community. There is an assumption that those involved will work together to provide A “SUCCESS excellent clinical treatment in a caring FORMULA” environment. There is evidence, however, suggest- ASSOCIATED WITH ing that some patients are dissatisfied A PATIENT’S VISIT with their experience at the practice. COULD BE DEFINED AS In order to explain this dissatisfaction, A COMBINATION OF: we reviewed the organisation and Colleen Sullivan gives us a structure of healthcare practices in Attitudes and this book. We are not suggesting that 1 competence of all peek into her practice man- all communication between health- personnel. ager book Successful Practice care personnel and patients result in a negative experience. Rather that most, Management: Exceeding Technology- Patient Expectations which she if not all, healthcare practices could improve some aspect of communica- based systems co-wrote with Prof Geoffrey tion between personnel and patients, 2 within practice Meredith. Focusing on while acknowledging that relation- infrastructure. Chapter 1 and 10, she high- ships between practice and patient are often complex. Expertise, lights the importance of the knowledge and role of personnel in patient Patients look for satisfaction from their 3 consultations. This is often referred experience of value. to as “perceived value” and is derived clinicians. from four practice areas: • Clinicians – trained experts with experience, expertise, knowledge and skills to be applied in patient Developing Key Assets – consultations. Personnel and Practice • Support staff – practice managers, Systems clinical and administrative assistants In Chapter 10, we focus on two key to support clinicians. assets for any professional practice – personnel and practice systems. While • Practice systems – both clinical patients view the consultation with and operational. Eye2Eye Quarter 1 2020 57

the clinician as a major source of value, contact from the practice. What follows • What are the characteristics of the total visitation experience is critical from that initial communication repre- patients of the practice? Are these in creating value for patients. A high pro- sents a launch of systems linking the prac- characteristics likely to continue in portion of the patient’s visitation time is tice and patient: information gathering, the future or could there be changes? associated with personnel rather than practice attendance, patient interviews, How will the practice respond? clinicians. There is also a high propor- arrangement of pre-consultation tests or • Are teams of personnel currently tion of activities associated with practice procedures and the clinician consultation. used in the practice? visits that are linked to effective and efficient systems. Strategies linked to Practice The answers to these questions will vary The term “assets” is often used to vision from practice to practice but practice describe physical resources used by an A professional practice vision considers vision must incorporate personnel strat- organisation in its development and to where each practice is going and how the egies. Personnel represent a major asset provide support for future strategies. In practice will achieve over time. A practice of every practice and are a major factor a financial context, assets are regarded vision may focus on: for any change in practice vision. as physical resources such as land, building, plant and equipment. However, for • The needs of patients; Colleen Sullivan a healthcare practice, these may be of • The needs of future clinical referrers; minor importance in terms of practice activities and development. The prac- • Services currently offered; tice may view assets as people, practice • Services potentially available in THINK ABOUT THIS image, reputation, expertise and clini- the future due to developments 9 Consider your practice cian knowledge and experience. The in technology and the healthcare vision. personnel who support clinicians are industry; 9 Can it be improved? key assets in terms of creating value for • Personnel either employed on a full- 9 In what ways can it be patients. time basis or external on a part-time implemented in your basis; practice? • Current practice systems; THINK ABOUT THIS • Systems potentially available in the future due to developments in 9 While the above technology; commentary lists • Practice succession. personnel and systems as two key assets, These concepts of a practice vision must there are other practice incorporate personnel – their strengths, assets. weaknesses and opportunities for development. This raises a series of questions: 9 List some other assets of your practice. • Is the range of services offered by personnel adequate to meet patient needs?

A second key asset for the practice is • Is the practice aware of the experience effective practice systems. Systems bring and expertise of personnel? Are control and organisation to the prac- clinicians aware of the knowledge of tice and are critical to practice success. those personnel, their experience and In Chapter 10, we look at how systems expertise? affect practice organisation, personnel, • Can additional services be introduced patients, planning and control. Practice by personnel perhaps through a multi- systems begin for patients with initial disciplinary practice? 58 In Practice

Effective Communication in Practice

Katherine Wagner, Senior Here are her Top Three Tips for Effective Communication Consultant Psychologist, In Practice: gave a thought-provoking 9 Better body language equals better communication. and insightful talk at the 2019 Research suggests that communication is around 70% body language, 23% RANZCO Practice Managers’ tone and only 7% words. This suggests it’s wise to be careful about how you are Conference. Entitled seated or positioned, what you are doing with your arms and what your tone is “Effective Communication in conveying. On the phone, the estimations change to around 75% tone and 25% words. So where appropriate, sit up straight and SMILE when you are talking and Practice”, the regular work- use a positive problem-solving tone – this usually comes through. shop facilitator for Associated 9 Active listening. Listening takes effort and is not a Counsellors Employee passive action like hearing. If you show that you have listened, the Assistance focused on how person you are communicating with will feel much more respected and is more likely to share or collaborate. Make sure that you have the mindset or intention we can better communicate to really HEAR the message. Use open-ended questions and periodically check with colleagues to help that you have heard correctly. You can show genuine interest by asking “what achieve common goals effi- else happened?” or “tell me more about that”. ciently. She also highlighted 9 Prepare accordingly. When you are preparing to have a challenging discussion, think about what you ideally want the person to KNOW and FEEL how effective communication after the conversation and prepare your mindset, body language and words helps to better relate to accordingly. To be assertive, ensure you are hard on the issue but soft on the patients in their experience in person. Use the three-step model of “when you … I feel … in the future I’d like…” to ensure it is practical and not just about them. If you start to feel yourself our practices. She has had 20 reacting, then stop and calm down with positive Short, Sharp & Specific (SSS) years of experience including thoughts such as “This will be over soon”, “I can handle this” or “this is not about corporate and government me”. A break in the conversation is also sometimes needed. training and coaching relating Associated Counsellors Employee Assistance to wellbeing and mindful- Website: www.employeeassistance.com.au. ness, stress awareness, building resilience, suicide prevention, communication, and sleep and mental health awareness.

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The 38th World Ophthalmology Congress, 25 - 28 February 2022

icowoc.org Eye2Eye Quarter 1 2020 59

Promoting Positive Mental Health in Practice

Burnout, mood disorder, 9 Build a positive workplace. substance abuse and The workplace can be a cause of psychological distress. However, to the contrary, suicidal ideation are very it can also play a protective role buffering against stress and mood disturbance. A positive workplace has an inclusive, nurturing, person-centred culture that commonly experienced by encourages open communication. Consider training a ‘Mental Health First doctors and medical stu- Aider” within your practice to enable everyone to feel comfortable seeking dents in Australia. Often, help – confidentiality is critical. A positive workplace is supportive and offers all doctors and others working staff supervision and/or mentoring. A positive workplace also encourages staff to engage in things that foster good mental health, such as work/life balance, in healthcare ‘sweep’ such mindfulness practice and physical exercise. issues ‘under the carpet’ for 9 Foster a workplace where people look out for each other. fear of being judged or their All staff members should be offered basic training in mental health. Staff should career being impacted. This keep an eye on each other. Uncharacteristic changes in behaviour or appearance, isolation can have a delete- such as sudden weight loss, always turning up late, making frequent errors or anger rious effect on the person’s outbursts, can suggest there might be an underlying issue. Start the conversation with the colleague in an unthreatening manner. For example, “I’ve noticed that wellbeing. you’re not coming to the lunchroom anymore, you used to love socialising – is Identifying these issues and everything going okay? Draw on personal experience where possible, such as, “I supporting our colleagues went through a stage when I felt like shutting my door and not talking to anyone within an ophthalmology – is this how you feel?” practice was the focus of 9 Support and listen. Dr Miranda Say’s talk at If anyone in the practice comes to you wanting to discuss a stressor or any other mental health issue, prioritise making a specific time to talk, or find someone that the 2019 RANZCO Practice can. Sometimes the most important thing is simply to be a listening ear. However, Managers’ Conference. A depending on the issue, the colleague might be offered time off work, or fewer Clinical Neuropsychologist duties for a given period to enable some self-care. Ensure the person knows they with both clinical and are supported and valued. You can get more information about how to best help them by asking if they have been through this kind of thing before and, if so, what research experience in did or did not help. You can offer to help practically by sitting with them while they the UK and Australia, Dr phone the GP or offering to make an appointment for them with a psychologist. Miranda highlighted some If the matter appears to be severe or urgent, it may be appropriate to get them tips and tools that can be to an emergency department. The Mental Health Line (1800 011 511) is a useful used to promote positive resource. mental health in colleagues. 9 Follow up. Always follow up with people – suggest a specific date to meet again to discuss things. This shows the person that you are genuinely invested in their wellbeing. It can also be helpful to identify a goal that they will do in that time, which might include some self-care or speaking to a counsellor.

References available upon request. Please email RANZCO. BUILD FOSTER SUPPORT FOLLOW UP 60 Obituaries

Obituaries

Dr Arthur David McGowan Steele 16 December 1935 – 2 December 2019

he was too old and lacking in experience. Undeterred, Arthur gained an appointment at the Mayday Hospital in Croydon where he was tutored in anterior segment surgery by Dermot Pierse. Residency at Moorfields followed in 1973. An initial interest in oculoplastic surgery was fostered by Prof Barrie Jones but sudden changes in Moorfields’ requirements regarding consultant staff expertise led Arthur to revert to anterior segment surgery. He spent time learning refractive surgery with Barraquer in Bogota before being appointed to the consultant staff at Moorfields in 1976. Arthur was a highly skilled extra-capsular cataract surgeon and embraced intraocular lens implantation at a time when many colleagues were reluctant; the legacy of the results of the earlier, unsuccessful implant iterations was still fresh. He was also a gifted and meticulous corneal graft surgeon and excelled at some of the early manual refractive surgery techniques such as epikerato- phakia and radial keratotomy.

One reflects on the life having saved sufficient funds, he moved trajectory of some and says to the UK. He obtained work as an extra for the BBC, and earned his Equity card, “Everything about ‘’twas ever destined to be so’. as well as undertaking some repertory Arthur spoke of a That was not true of Arthur Steele. Born work in Scotland. However, in his book in Pyramid Hill – a diminutive town in The History of Moorfields Eye Hospital: deliberate precision: country Victoria some three hours north Forty Years On, Peter Leaver describes of Melbourne – he ended up on the other how Arthur realised ‘he was not the next his surgical techniques, side of the world in the United Kingdom Sir John Gielgud’, and he did, after a his diction, his as perhaps one of the pre-eminent ante- year, ‘finally purge himself of the desire rior segment surgeons of his day. for a thespian career’, and returned to grooming.” Arthur David McGowan Steele was born medicine. in 1935 into a medical family. He served in While studying for his general sur- the Royal Australian Medical Corps from gical exams in London, the option of 1955 to 1960, attaining the rank of cap- studying ophthalmology was raised. tain, with his medical qualification from He assessed it as a compact discipline the University of Melbourne. Although with a manageable knowledge base (he In later years, at a time when it would he worked as a general practitioner in read Lecture Notes on Ophthalmology have been easy for him to coast to retire- Melbourne, a dream of following a career by Patrick Trevor-Roper). He was ini- ment on the strength of these impecca- in acting had not been extinguished and, tially told that he had no prospects as ble extracapsular cataract surgery skills, Eye2Eye Quarter 1 2020 61

he was greatly admired for embracing Little: “You could always tease him as the innovation that phakoemulsifica- long as you respected the stripes.” tion represented. Arthur was aware To some, the inclusion of Waltzing that Moorfields was, at that time, not Matilda in his Order of Service at Chelsea at the forefront of cataract surgery. An Old Church in December seemed per- overarching NHS parsimony combined haps curious; for while Arthur could, in with the absence of high-quality evi- select company, seamlessly revert to the dence of phakoemulsification’s ben- vernacular of broad ‘Strine’, he had – at efits meant that even the Antipodes least outwardly – cast off all remnants embraced the technique a year or so of Australian-ness, and in his mellifluous earlier than London. With the excimer baritone accent, seemed more English laser too, Arthur pushed for Moorfields than the English. to be involved. The initial work was a More curious still then was a rumour semi-clandestine affair, with the laser that circulated that the dapper Arthur unit housed in a Platform 9¾-style side was a keen motorcyclist. A troubled room and awareness very much on a patient on Top Corridor (the old private need-to-know basis. wing of Moorfields) related that at her As well as being an innovator, and Saturday morning post-operative dress- an impressive clinician, he was a great ing (in the era of inpatient cataract care), teacher. He would deconstruct an oper- a man in biker leather gear had come to ation and analyse each of its component see her, sat on her bed, and had even parts. He abhorred redundant steps or movements. Everything about Arthur impersonated Mr Steele’s voice! It was spoke of a deliberate precision: his surgi- only in 1996, after his retirement, that cal techniques, his diction, his grooming. Arthur accepted a walk-on role in the His letters all carried a handwritten and Moorfields Residents’ Revue in full biker personalised salutation and closing. In attire, and the poor woman’s story was theatre there was the ritualistic draping vindicated. of custom-sewn covers over the arms Arthur Steele was a colourful and of the surgeon’s chair: steadying of the unique character, a skilled ophthalmolo- joints proximal to the surgeon’s hands gist, and a wonderful, loyal and support- reduces the tremor from the larger mus- ive mentor and teacher to a generation cle groups, one was told. of eye surgeons – including a number Arthur never really lost his sense of back in his birthplace of Australia – who the stage, and while he could be warm are the Steele diaspora; who remember and entertaining, he could also play him with real fondness and recognise the theatrical tyrant with aplomb: a their great good fortune in having pursing of the lips and a twitch of the trained with him. moustache – fondly parodied in so many Residents’ Revues – could herald the Dr Mark Walland onset of a withering critique. And woe FRANZCO, VIC betide anybody who obstructed the progress to his standing edict of ‘knife in at 0830’. His impatience in that setting was renowned, but a conspiratorial wink Dr Graeme Warwick Johnson shared with the trainee at the operating 1 January 1934 – 11 February 2020 microscope just before finally commenc- Obituary article to be published ing defused all the tension. In return, in in the next edition the words of Moorfields alumnus Brian 62 Obituaries

Dr Daniel Hart 14 October 1920 – 26 December 2019

Eye Hospital. Over the years, he kept in touch with fellow ‘Old Bristolians’ who did their residency there. Dr Dan qualified as an ophthalmologist in 1952 and in December that year, he and Margaret sailed home to Australia where he took up appointments at the Royal Brisbane and Brisbane Children’s Hospitals. He commenced private practice at Firhall where he shared rooms with his ophthalmologist brother, Dr James Hart, until Jim’s death in 1977. Dan was a very methodical and professional practitioner who loved his patients, especially the elderly. His warm bedside manner and sense of fun likewise endeared him to his patients. Dan was an active member of ophthalmological organisations starting with the Ophthalmological Society of Australia (OSA) in 1953. He became a member of the Board of the Ophthalmic Research Institute of Australia (ORIA) in 1960 for five years and set up research into eye melanoma in 1966. Dan Hart celebrating his 99th birthday with children (from left), David Hart, Peter Hart, Simon Hart & His ophthalmic journey led him to Tempe Harvey. become the second president of the Australian College of Ophthalmologists Daniel Roberts Lloyd Hart was born in age of 17. When World War II broke out on 9 October 1969. He was asked to speak Brisbane two years after World War I and the following year, some of his fellow at the Congress dinner – a night he would was delivered by Queensland’s first med- students left the course to join the war, never forget. Dan served the College as ical knight, Dr David Hardie. He was born while he stayed on to graduate from the president until October 1970. One of the into what was coined by journalist Tom shortened war course in May 1943. He main achievements of the College under Brokaw as “The Greatest Generation” then became a resident medical officer his presidency was to set high standards – those who grew up in the Great at the Brisbane General Hospital. It was for the education and examination of Depression and fought in World War II. a time before the introduction of penicil- people in ophthalmology, which remains Nine years later, Dan Hart attended the lin, when infectious diseases were wide- to this day, the College’s raison d’ ètre. 9th birthday of Sir David’s granddaugh- spread and life expectancy was short. This entailed the work of the nine-person ter, Anne Hardie, and was photographed A year later, he joined the Australian Qualification and Education Committee with 52 other grinning children on the Imperial Force (AIF) and served as a (QEC) under the able chairmanship of K.G. back lawn of the Hardie family home, a medical officer for the 65th Battalion Howsam. two-storey house – Firhall in Spring Hill, from 1945 to 1947, providing medical In an Eye2Eye feature article in 2019, Brisbane. Sir David and later his son, Dr care to his own troops and Japanese he reflected on his relationships with his John Hardie, (the Hart’s family doctor) prisoners of war in the Bougainville jun- colleagues in the eye industry: “…the col- consulted patients from the house. Little gle, and then serving with the British leagues I would meet from every state – did Dan know that he, too, would prac- and Commonwealth Occupation Force old and young – were to be friends, good tise as an ophthalmologist in the same in Japan. friends. No longer strangers.” building for 32 years. After marrying Margaret Smith, a After his retirement in 1997, Dr Hart Dan started a medical course at the Sydney physiotherapist, in September wrote an autobiographical history, Fido University of Queensland in 1938 at the 1950, he took up residence in the Bristol and Friends: A Family Story & The World Eye2Eye Quarter 1 2020 63

War II of Queenslanders. He was pleased Like many from “The Greatest to finish the book in 2005, shortly before Generation” who survived World War II, his wife, Margaret, died. It documents he had a wonderful marriage and vol- his family history from the 1700s, his unteered much time to improve standards within his chosen profession. Brisbane childhood, his career in oph- Dan would probably say that his most thalmology and his World War II service. important contribution to “The Greatest Generation” was being able to honour his young friends who do did not survive the war by recording their life stories in his autobiography. As his final words in Fido & Friends say, “I will never forget “…the colleagues I those young men – the fun they had and would meet from every what they did for all of us. I want to save them and my dear family and friends state – old and young from being ‘forgotten as a dream dies at the opening day’. We will all be forgotten – were to be friends, in the end, no doubt, but I sincerely hope Dr Daniel Hart good friends. No that the lives of these wonderful people will inspire many generations to come.” longer strangers.” Dr Daniel Hart is survived by three sons David, Peter and Simon Hart, and a daughter, Tempe Harvey and their families.

“I will never forget those young men – the fun they had and what they did for all of us.”

Old Bristolians at the then Australian College of Ophthalmologists Congress, Chevron Hotel, Surfers Paradise, October 1970. L-R: Jim Rogers (Hobart), Rob Bonner-Morgan (UK), Lindsay Douglas (Gosford, NSW), R. Lloyd Cahill (Sydney), Daniel R.L. Hart (College President, Brisbane), Tom Leckie (Bathurst, NSW), Grosvenor Burfitt-Williams (Sydney), Dave McAuliffe (Perth), Dermot Pierse (guest speaker, London), David Sabiston (Napier, NZ), John Hart (Sydney, no relation), Bea Bonner-Morgan (UK) and Dick Louden. (Courtesy of the photographer Dr Barry Taranto, Hobart) 64 Calendar of Events

Calendar of Events 2020

JUNE AUGUST OCTOBER

14TH EUROPEAN GLAUCOMA ASIA-PACIFIC ACADEMY OF 52ND RANZCO ANNUAL SCIENTIFIC SOCIETY CONGRESS 2020 OPHTHALMOLOGY (APAO) 2020 CONGRESS 2020 D: 30 May – 2 June 2020 D: 5 – 9 August 2020 D: 9 – 13 October 2020 P: +39 055 50351 E: [email protected] E: [email protected] W: ranzco2019.edu TASMANIA BRANCH MEETING 2020 5TH ASIA PACIFIC GLAUCOMA D: 12-14 June CONGRESS (APGC2020) THE INTERNATIONAL AGENCY FOR E: [email protected] D: 14 – 16 August 2020 THE PREVENTION OF BLINDNESS TH ASO EXPO 2020 W: https://apgc2020.org (IAPB) 12 GENERAL ASSEMBLY D: 12 – 14 October 2020 D: 20 – 21 June 2020 THE 2020 ROYAL CHILDREN’S E: [email protected] HOSPITAL PAEDIATRIC WORLD OPHTHALMOLOGY OPHTHALMOLOGY SEMINAR NOVEMBER CONGRESS 2020 D: 14 – 16 August 2020 D: 26 – 29 June 2020 E: [email protected] P:+61 3 9345 6347 AMERICAN ACADEMY OF E: [email protected] OPHTHALMOLOGY (AAO) 2020 OPHTHALMOLOGY UPDATES D: 14 – 17 November 2020 D: 29 – 30 August E: [email protected] JULY W: www.ophthalmologyupdates.com

2020 SYDNEY EYE HOSPITAL ALUMNI ASSOCIATION MEETING SEPTEMBER D: 25 July 2020 E: [email protected] NOSA 36TH ANNUAL CLINICAL P: 0402 891 804 AND SCIENTIFIC MEETING AND NEUROVISION TRAINING WEEKEND D: 10 – 13 September 2020 E: [email protected] For a complete list of events, scan the QR code. Eye2Eye Quarter 1 2020 65 66 Classifieds

Classifieds

FULL-TIME/PART-TIME Positions Vacant OPHTHALMOLOGIST – HOBART Practices for Sale We are seeking the services of an oph- or Lease PAEDIATRIC/GENERAL thalmologist for our long established OPHTHALMOLOGIST FOR practice with three locations in Hobart. SUNSHINE COAST PRACTICE FOR NEWCASTLE This position is offered on a full-time or SALE Paediatric/General Ophthalmologist part-time basis. Well established and equipped prac- required two days a week to join or Our facilities include fully computerised tice in Noosaville at the Sunshine locum in a busy general/paediatric equipment such as OCT, Fluorescein Coast, Queensland. practice that sees most of the paedi- angiography, SLT, Yag & Argon lasers atric patients in Newcastle, NSW (90 and fundus photography. Consulting 2 to 3 days per week. Longstanding referral base. minutes from Sydney CBD). You will be working with a team of Well appointed modern rooms. We are fully equipped with OCT, FFA, ophthalmologists with support staff Pentacam, IPL, optical biometry, SLT/ including optometry. We specialise in P: 0418 194 433 YAG/Argon lasers, portable slit lamp cataract surgery, diabetic and glau- E: [email protected] and auto refractor. This is an area of coma management and general oph- HIGH VOLUME CATARACT PRACTICE need (DWS). thalmology. We have a high surgical FOR SALE – INNER MELBOURNE volume. Confidentiality assured. Main practice is in a high profile loca- P: 0416 221 022 We are offering an attractive salary tion (north) with a satellite practice (in E: [email protected] package or percentage based associ- the south). Both practices are very well ateship. Early Equity is available for the equipped. RETINAL OPHTHALMOLOGIST, suitable candidate. MELBOURNE, VIC Established in 1997 by the current C: Dr Gordon Wise owner who retired late in 2019. Prior Seeking retinal specialist locum to cover P: 0419 379 214 to this, the practice generated around for maternity leave and prospect of E: [email protected] 1,500 operations per year and there are longer term clinics. LOCUM REQUIRED REGIONAL still a large number of referrals today Average of 1-2 sessions per week, VICTORIA, OCTOBER 2020 and a large recall base. but may increase depending on your Great opportunity to purchase a prac- availability. Seeking a locum ophthalmologist for Warrnambool, in south west Victoria, tice for less than the equipment value Modern clinic within 7km north of over 4 weeks from 28 September – 23 AND the bonus of referrals from day Melbourne CBD. October. one! Equipment includes Zeiss cirrus HDT This is a long established compre- P: 0402 011 099 5000 OCT, Zeiss Visucam 524 photo-An- hensive solo practice servicing a loyal E: [email protected] giography, HVF, Lenstar, topography etc. regional community. OPHTHALMIC PRACTICE FOR SALE - Paperless clinic with MedWiz clinical Full suite of lasers, angiography, visual TOWOOMBA, QLD software. fields and OCT. Experience in intravit- For sale – six room strata title suite in E: [email protected] real injections would be advantageous. nine suite double story building built P: +61 3 9372 7022 P: +61 3 5562 4488 in 1983 located in Toowoomba CBD, LOCUM OPHTHALMOLOGIST / E: [email protected] including two locked undercover car SESSIONS TO NEARLY FULL-TIME parks. AVAILABLE IN PERTH, JAN–JULY Two fully equipped consulting rooms, 2020 Want to post a classified ad minor ops room (with basic operating An opportunity exists for a locum oph- microscope) and instrument room. on the RANZCO website? thalmologist/sessions to nearly full- 532 laser, Tango SLT/YAG kaser, two time across Perth, WA, including the Kindly email Richard Teffer at Octopus computerised perimeters and fast growing Northern corridors. [email protected] automatic refractor. We cover a full range of comprehensive For the full list of Classifieds, 500K ONO walk in – walk out. ophthalmology services with well- please go to ranzco.edu and click P: +61 7 4632 9987 equipped rooms and surgery services. Classifieds at the top of the page. E: [email protected] P: +61 8 9301 5568 E: [email protected] BE ASO Business Skills Expo

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