Winter 2017 VOLUME 20 ISSUE 2 EYE2EYE 2the magazine of the leaders in collaborative eye care
IN THIS Leaders in RANZCO 2017 Join us in Perth for The road less collaborative care: Workforce Survey out RANZCO 2017 travelled: practicing ISSUE: living the RANZCO now! ophthalmology in a tagline rural setting When freedom becomes reality
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EYE2EYE 2the magazine of the leaders in collaborative eye care 24 37 Contents Message from the President 4 Censor-in-Chief’s Update 6 CEO’s Corner 8 Membership Spotlight 10 Annual Scientific Congress 24 Indigenous Eye Health 34 Policy and Advocacy Matters 36 International Development 37 Feature Article The road less travelled: practicing ophthalmology in a rural setting 40 42 62 Branch Musings 46 Special Interest Groups 49 RANZCO Affiliates 54 Ophthal News 56 RANZCO Museum 62 Obituaries 63 Calendar of Events 66 Classifieds 68 Front cover: Gantheaume Point, Broome, Western Australia
Eye2Eye is published by The Royal Australian and New Zealand College of Ophthalmologists as information for its members. The views expressed in the publication are those of the authors and not necessarily of the College. The inclusion of advertising in this publication does not constitute College endorsement of the products or services advertised. Editor: Laura Sefaj Design and layout: Francine Dutton The Royal Australian and New Zealand College of Ophthalmologists A.C.N 000 644 404 94-98 Chalmers Street Surry Hills NSW 2010 Australia Ph: +61 2 9690 1001 Fax: +61 2 9690 1321 E-mail: [email protected] Website: www.ranzco.edu 4 Message from the President
Message from the President Making the health system better
countries and provides excellent care Over the past few months, RANZCO to most of the population, particularly CEO, Dr David Andrews, and I have those in metropolitan areas and those had numerous meetings with federal with health insurance. Maintaining ministers, advisors and senior health the system, at reasonable cost, with bureaucrats in government and the the increasing demands of an aging Department of Health. We managed QUALITY EYE SUPPLEMENTS population, is the fundamental to bring a number of key issues to the challenge for all health ministers. attention of the Minister and senior at affordable prices As we move from a system that is department officials. based on healing the sick to an ideal of making the well healthier, this will Access to Care become even more difficult an issue. Both Minister Greg Hunt and Minister Our role is to advocate on behalf Ken Wyatt have declared a focus on of the patients that we look after, Indigenous eye health as part of Closing identifying problems and providing the Gap. The Rural Health Outreach solutions based on our knowledge of Fund aims to improve access to medical A/Prof Mark Daniell the practical issues we face delivering specialists in rural, regional and remote Advocacy has become a care. areas of Australia. This is essential for more important part of the reducing the health inequalities of people living in these areas, particularly work of the College over RANZCO not only delivers Indigenous people. Vision loss is an the past decade. While our essential part of that but is hampered the highest standard of MDeyes Once Daily AREDS 2 DRYEYE Forte - High Potency Formula health system is the envy by a lack of coordination of services. ophthalmological education ✔ Available as a Softgel Capsule or Powdered Orange Drink ✔ Concentrated Omega-3, GLA, Vitamin D3 & Antioxidants of many countries, it can We encouraged government to look at and sets professional improving the coordination of services ✔ Premium Ingredients ✔ Patented, Research-Based Formula for Systemic Relief “standards but also is now always be made better, and by better cooperation with the Visiting ✔ 6 Packs for $99 (MDeyes Caps) ✔ Improves Tear Quality & Production NCE DA EGA 3 deeply engaged with O I M + governments and health Optometrist Scheme and through L O V Y ✔ Precise AREDS 2 Formula ✔ Reduces Inflammation i
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government, hospital and G the development of regional hubs for AREDS 2 STEMIC D insurance companies can L RELIEF health services on key policy ophthalmology in Alice Springs and A + always make changes that F changes that impact the Broome. We strongly supported the O Proudly A R NT TS will make it worse! health system and your Roadmap for Closing the Gap for Vision MULA supporting and IOXIDAN The health budget is currently less practice. that has shown such positive results and than 10% of GDP which compares emphasised the need for more focus on © MD EyeCare 2017. favourably with other developed the problems of diabetes and cataract. For samples / (Aus) [email protected] Australian-made in a world-class brochures, please 1300 95 2001 e: “ pharmaceutical facility. contact MD EyeCare: 0800 443 652 (NZ) f: +61 7 3056 0969 Eye2Eye Winter 2017 5
Access to care in metropolitan areas we need to be in a strong position Unsustainable price rises lead to is hampered by an overburdened and to argue for rational adjustments patients dropping coverage and poorly funded public system. As cataract to the schedule. In glaucoma, we thereby increasing pressure on the waiting lists lengthen and outpatient highlighted the benefits of the new public system. Cases of doctors departments become choked with minimally invasive glaucoma surgery charging exorbitant fees are used as patients requiring intravitreal injections technology and ensured an expedited examples adding to this perception and glaucoma care, it has become clear review by the Medical Services of poor value and can be extremely that public hospital ophthalmology Advisory Committee. The RANZCO damaging to the profession as a needs to be better supported. Each of referral guidelines for glaucoma were whole. I plan to explore ways of the RANZCO state branches are working showcased as an evidence based reducing this risk. on innovative solutions that should be management system that should RANZCO not only delivers the supported by the department. ensure the best quality of care without highest standard of ophthalmological Workforce distribution is another key wasteful expense. Cost effective education and sets professional element of access to care in Australia. treatments for retinal diseases using standards but also is now deeply Strengthening regional centres and anti-VEGF biosimilars or Avastin engaged with government, hospital public hospitals will provide great were proposed and could save the and health services on key policy benefits in overcoming the workforce taxpayers many millions of dollars. We changes that impact the health maldistribution. RANZCO and the will continue to discuss the regulatory system and your practice. While we cannot succeed in every situation, by other colleges are developing regional issues with the relevant departments putting forward well thought through, training posts as a way of redistributing to see if this is possible in Australia. evidence based and economically the workforce. Private hospital industry sensible proposals and arguments we can often persuade policy makers to Health system viability RANZCO has been involved in the modify the system in a way that makes The other key issue we discussed Private Hospital Industry review. things better for us all. was maintaining the viability of the Premiums are under pressure as health system. Our turn before the consumers complain that the policies A/Prof Mark Daniell Medicare review is approaching and fail to offer good value for money. President, RANZCO
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© MD EyeCare 2017. For samples / (Aus) [email protected] Australian-made in a world-class brochures, please 1300 95 2001 e: pharmaceutical facility. contact MD EyeCare: 0800 443 652 (NZ) f: +61 7 3056 0969 6 Censor-in-Chief’s Update
Censor-in-Chief’s Update Selection for the RANZCO training program: addressing key areas
The selection process in ophthalmology because the better for the RANZCO training a medical profession understands and represents the cultural diversity program plays an essential of the communities we serve, the part in determining the better outcomes we will see for future of ophthalmology in those communities. This is perhaps Australia and New Zealand. particularly true given that ophthalmic care deals with an issue as emotive It is important therefore and sensitive as people’s sight, which that this process is as is so intrinsically linked to how they robust and transparent as are able to live their lives. possible, to ensure that To increase the number of Indigenous and minority trainees, future ophthalmologists the College will take a two-pronged are equipped to provide the approach. First, we will increase our best possible care for all engagement with Indigenous trainees people, across all areas of at an undergraduate level. We will engage with these undergraduates Australia and New Zealand. through the medical schools, RANZCO also needs to including their in-house Aboriginal, make improvements to the Torres Strait Islander, Māori and Dr Justin Mora Pasifika support networks, as well selection process in response as through organisations such as to recommendations from the Indigenous and minority the Australian Indigenous Doctors’ Australian Medical Council’s ophthalmologists Association (AIDA) in Australia and Te Ohu Rata o Aotearoa (Te Ora) in New (AMC’s) reaccreditation During their review of the College, the Zealand. AMC identified as a priority the need review. Second, we will adjust our Two key areas need to be addressed: for the College to engage more with selection process to encourage the paucity of Indigenous and minority Aboriginal, Torres Strait Islander, Māori applications from Indigenous ophthalmologists in Australia and New and Pasifika communities and to try to doctors, ensuring that the medical Zealand, including Aboriginal, Torres encourage more Indigenous people colleges, AIDA and Te Ora are aware of Strait Islander, Māori and Pasifika, and into ophthalmology. the changes and are able to promote the shortage of ophthalmologists in It is important that we improve them among their students and provincial and rural locations. representation of Indigenous people members. Eye2Eye Winter 2017 7
Adjusting our selection process to a responsibility to do what it can to and spend additional time in smaller increase the number of Indigenous meet the eye health needs of people centres during their first four years. doctors in our training program can be in rural areas. There may also be benefit in done in one of two ways. We could There are a number of tools that trainees joining the training program either allocate a certain number can be used to increase the likelihood earlier in their medical career, so of places per year for Indigenous that ophthalmologists will choose to that they spend less time studying applicants, as long as they meet a work in rural and provincial locations, in a major city and are more likely to defined minimum standard with including looking at how we select put down roots in a rural centre. This their CV and references, or we could trainees who are more likely to approach may also help counter the offer additional points in the general choose to settle in a smaller centre misconception that applicants require selection scheme for Indigenous long term. a higher degree in order to get into applicants but not allocate specific ophthalmology. places. In addition, the nature of The former is the approach practising in rural and provincial employed by other medical colleges, Currently 30% of Australia’s locations requires true general including the Royal Australasian population lives outside ophthalmologists who are capable College of Surgeons, and it has major urban centres of working independently or with proved to be very successful. a small number of colleagues in a Obviously, encouraging but only 17% of our “ophthalmologists practice smaller centre. We must therefore Indigenous doctors to become ensure that our trainees do not feel ophthalmologists does not end with in these locations. undue pressure to subspecialise and the selection process and we would instead ensure that they are mandated need to ensure adequate support to train in certain surgical procedures all the way through the training and interventions. RANZCO will process, just as support is offered to There is strong evidence“ from also look into creating more formal all trainees according to their needs. several countries, including Australia The College will seek guidance on and New Zealand, that the most provincial/rural 5th year posts with a this from AIDA and Te Ora. effective way to do this is to select focus on general ophthalmology and However, it is worth noting that, trainees who grew up in rural towns. skills such as glaucoma surgery. regardless of the need for better This is known as the rural background Another way to encourage more representation of Indigenous effect (RBE) and it has been shown to ophthalmologists to choose to practice people in ophthalmology, the have a strong positive impact. in rural and provincial locations is to College’s most important role is to Given this evidence, we will be address the lifestyle issues that often produce fully qualified, high quality considering criteria for preferentially deter people. ophthalmologists. All trainees, selecting some applicants from rural/ RANZCO will also work with the other without exception or compromise, provincial backgrounds. For example, specialist colleges to see how we can must pass the same requirements to those who spent at least five years of seek to broker better contracts through become fully qualified ophthalmologists school outside a major city. the health departments for those and this will remain the case going However, in addition to adapting working in smaller centres in order to forward. the selection criteria, there are also make the jobs more attractive. We will other factors that can have a positive also continue to lobby the federal and The shortage of impact. For example, the training state governments to encourage the ophthalmologists in program itself can be adjusted to development of policies that make provincial and rural encourage more ophthalmologists to rural opportunities more attractive for settle in rural and provincial locations. ophthalmologists. locations In Australia, it has been shown Currently 30% of Australia’s that those who train in rural clinical Conclusion population lives outside major schools, such as the University of It is undeniable that these groups, both urban centres but only 17% of our Queensland Rural Clinical School and Indigenous and rural, are currently ophthalmologists practice in these the Rural Clinical School of Western under-represented in ophthalmology. locations. There is no disputing that it Australia, are more likely to settle in a Not only does RANZCO have a duty to is difficult to recruit ophthalmologists rural environment. try to fix that, we are also required by into rural and provincial locations RANZCO has already begun the AMC to do so. The evidence shows in both Australia and New Zealand. implementing moves to ensure that that the methods outlined above will This has been a problem for years, is all trainees spend at least six months in progress our work and that this will recognised by the RANZCO Workforce a smaller centre as part of their initial help us all achieve our aims of better Committee and was also identified four years of training, giving them eye health for people across Australia by the AMC. Currently the shortfall greater exposure to rural life. and New Zealand. is made up by International Medical There may also be opportunities Graduates who are willing to work in the future for trainees to select a Dr Justin Mora in these locations but RANZCO has ‘rural/provincial stream’ in training Censor-in-Chief, RANZCO 8 CEO’s Corner
CEO’s Corner Endorsement as a deductible gift recipient
in medical knowledge or be used for education and training science can now be claimed within ophthalmology. The bequest has been well managed within the as a tax deduction. In New Benevolent Fund portfolio and now Zealand, donations over sits at about AUD1,000,000. Income NZD5 are tax deductible. from the bequest has been used for The use of the funds is very education and training purposes, but not identified as well as it could. With broad so long as they are the assistance of the Benevolent associated with education Fund Directors, Drs Brendan Nelson or research, and this is and Michael Steiner and Prof Stuart not restricted to work in Graham, we have wound up the Australia or New Zealand. Trevelyan-Smith portion of the Fund and transferred this to RANZCO. I know many Fellows are Income from the bequest will keen supporters of these continue to be used for education activities and are looking and training purposes. Dr David Andrews for an appropriate way to I’m happy to announce that donate or leave a bequest to enable specific activities to RANZCO has recently been RANZCO has recently been be undertaken in Australia, granted deductible gift granted deductible gift recipient (DGR) status in New Zealand or developing recipient (DGR) status in our our own right in Australia countries. “own right in Australia and and the equivalent charity One of the reasons for seeking the equivalent charity status status in New Zealand. The the DGR status was to ensure we in New Zealand. have good governance of existing approval in April by a special bequests. An example is the listing through Parliament in Trevelyan-Smith bequest which was Australia (only) means that parked, for want of a better word, “ in the Benevolent Fund many years We have separately wound up any donations (over AUD2) ago. The Trevelyan-Smith bequest the Benevolent Fund itself and to RANZCO for the purposes was provided from the estate of Mrs transferred the AUD$1,100,000 of education or research Marjorie Trevelyan-Smith in 2003, to to RANZCO as an entity that now Eye2Eye Winter 2017 9
has DGR status. The reason for this is that the Benevolent Fund is rarely called upon and does have very strict criteria for use in its current structure. By moving the funds, we are able to preserve the purpose but relieve some of the administration costs and time that comes with having a completely separate legal entity and directors. The funds will now be administered by the RANZCO Board and are still available for appropriate PERTH2017 TH benevolent purposes by members. I know 49 ANNUAL SCIENTIFIC CONGRESS many Fellows have donated in the past to the Benevolent Fund and I can assure EARLY BIRD REGISTRATIONS you that this is much appreciated and the funds have been used appropriately. FOR RANZCO 2017 This will not be affected by the change in corporate structure. If any RANZCO member has a need for financial assistance due to illness or misadventure, or knows NOW OPEN another member in need, you can have a confidential discussion with me in the first 28 OCTOBER - 1 NOVEMBER 2017 instance before making an application. On a different note, we are coming to PERTH CONVENTION & EXHIBITION CENTRE the end of what has been a year long major review of policies and governance matters relating to education, training and Be quick – early bird registration closes on complaints management. I am confident Wednesday 6 September! that we now have a suite of policies and processes that provide clear guidance, Visit http://ranzco2017.com/registration/ transparency of processes and decision making, natural justice and fairness to all people interacting with RANZCO. I would like to thank Brett Saunders, our in-house legal counsel for the past year, all those on committees and the Board who have been closely involved in this complicated process. Although some of the documents are highly detailed, they do provide a clear pathway to resolve any issues, but more importantly, they provide guidance that will ideally avoid small problems becoming bigger issues. Like all policies they will need regular review and may require small modification when tested with real examples, but we are now moving to the next step of communicating changes to Fellows and trainees in particular. Our Deputy CEO and Head of Education, Ruth Ferraro, has already been to many training sites to explain processes in detail, and I will be using the opportunity of other group meetings to explain the changes. We will be working with everyone to ensure the professional environment continues to be a great place to work and produces excellent outcomes for patients. Dr David Andrews Chief Executive Officer, RANZCO 10 Membership Spotlight
Membership Spotlight
THE LEADERS IN COLLABORATIVE EYE CARE
RANZCO: The Leaders in Collaborative Eye care RANZCO’s tagline is a proud professionals work together in the excellence in the broader eye care declaration of the role that interests of the patient. sector and working with other eye care Acknowledging that there is an professionals to ensure the best possible ophthalmologists play in the important leadership role for us to play eye health outcomes for patients and delivery of eye care as well as a in promoting a collaborative approach the best possible standard of care. recognition of the wider health to eye care is an important step, and one care professionals with whom that RANZCO has embraced through our tag line. However, understanding how to “The standard you walk they work. make that a reality can be more difficult. past is the standard you At an organisational level, the term It must begin with understanding what accept.” General David “leaders in collaborative care” represents leadership is, what collaboration looks Morrison the role that RANZCO seeks to fill, like and what the idea of care means, not just as the educator of future and both more generally and in a specific current ophthalmologists and the eye care sense. What does collaboration voice of the ophthalmology sector, but also as an enabler of better patient What is leadership? look like? outcomes through more collaborative Leadership is an easy concept to define; Just as true leadership is more eye care. By putting collaboration leadership is the act of leading a group than just management or being at the heart of what we do, we are or organisation, or the ability to do so. in charge, collaborative working is emphasising what is a universal truth But what makes for good leadership is a more than just working with other for ophthalmologists, that patients’ much more abstract concept. people. Whereas one might work with best interests are paramount and that Peter Drucker, often called the father people without much sharing of ideas they are best served when all in the of modern management and leadership and understanding of one another, eye health care sector work together theory, said that “Management is doing collaboration requires understanding towards that joint objective. things right; leadership is doing the right and sharing. By understanding not only Given the primacy of ophthalmology things.” the role that other collaborators play in in the treatment and management As leaders, RANZCO and our Fellows the overall project, but also how their of eye conditions, it behoves should ensure we are not merely doing understanding can benefit our own, and ophthalmologists, and RANZCO as things right, but that we are doing vice versa, we are able to, as a group, the representative body, to show the right things. That means not only work in diverse teams that can be both leadership in collaboration, setting promoting and delivering excellence rewarding and frustrating. The research the standard for how eye health care in ophthalmology, but also promoting evidence is clear that a diverse team can Eye2Eye Winter 2017 11
produce results far greater than the sum and influence of our voice and that of about what happens to them; and to of its parts, if individuals are respected, our members and demonstrate how treat someone with respect, kindness different perspectives are valued the eye care sector can work together and empathy, we must show that we and conflict managed. In contrast, a to deliver the best in eye care and eye care. conflicted team is every leader’s worst health for people in Australia, New This is true not just of the relationship nightmare, with wasted energy and Zealand and further afield. that doctors have with their patients, poor output. As ophthalmologists, RANZCO Fellows but also of the relationships that we all Smart organisations are seeking work collaboratively with all of these have with each other when working to understand how diverse teams groups, as well as with individual eye collaboratively on any project. We all can operate to their full collaborative care professionals, such as registrars work best within a team when we know potential. At the heart of a successful and trainees, optometrists, orthoptists, that the people we are working with diverse team stands the inclusive nurses, GPs and anaesthetists. RANZCO care not just about their individual leader – with the power to unlock the Fellows also work extensively with outcomes, but about those of the potential of the group. And the key is other Fellows and trainees, so it is whole group. We work better with not only team composition, but the also essential that these working people when they respect us, show us creation of an inclusive and collaborative relationships are collaborative, with kindness and understanding and value environment that enables everyone to free and open sharing of ideas. our contribution – when they show that contribute to their full potential. Through close collaboration, eye they care. With this in mind, RANZCO seeks to care professionals can ensure that This is a principle that RANZCO work collaboratively with a wide range each patient gets the care they need tries to follow and promote in all our of people and organisations, including in the most effective and efficient way interactions, both internally in our our Fellows, other representative bodies possible. interactions with our colleagues in and medical colleges, patient advocacy What does care mean to the RANZCO office and with RANZCO charities, federal and state governments, Fellows and externally with the wide health care providers, the medical RANZCO? range of stakeholders with whom we industry and our overseas counterparts. There is a reason that health services interact. By working collaboratively with all of are called care – health care, social care, these groups, RANZCO is able to share aged care – and it is surely that to treat messaging and policy, build the strength someone effectively, we must care How can we better live the RANZCO tagline?
Be a leader Collaborate Show that you care • Get involved with • Be curious and open-minded • Care for yourself – remember Committees and Branches. about people and don’t make that mental health matters. • Exhibit good leadership assumptions. Understand who • Lead by example. in your professional and they are: their differences and • Extend the care you give to personal life. their similarities. patients to your peers and • Reflect on your ability to • Appreciate and seek different colleagues. communicate effectively ideas and perspectives from a across different social and diversity of people. • Be bold, challenge inconsistent and bad behavior and reward workplace scenarios. • Create connections so good behavior. • Think about and respectfully everyone feels respected challenge the status quo so and valued and can fully • Speak up when others are everyone can thrive and do contribute. being made to feel small. their best work. • Create a welcoming, safe and • Be aware of when people • Make sure you are doing the inclusive environment where need more support and right things, not just doing everyone feels confident to understanding. things right. speak their minds. • Show an interest in the people • Reflect on how you encourage with whom you work. your team(s) to devise new • Ask what do we need to do to and innovative ways to solve help everyone be productive. problems. 12 Membership Spotlight
Living the RANZCO tagline Interview with Dr Nicholas Toalster, Member of the RANZCO Diversity and Inclusion Committee
junior and senior doctors to act as a kind Q Why did you want to specialise of pastoral care and support. Basically, all in ophthalmology? interns were put in groups of about 10 A Drs Gregor and Heiner encouraged and paired with two residents to meet and inspired me to do medicine at least four times a year, or more if and eventually ophthalmology. I they wanted. Those residents then had graduated medicine at the University registrars from previous years acting of Queensland with honours in 2010 as their mentors and, overarching all and undertook intern and residency of that, were some consultants. The at the Royal Brisbane and Women’s idea was that you always had someone Hospital, where I met my partner close to your level that you could go to and now husband. We met at a work with problems, but that if anything very function, when we were both junior serious happened, there was someone doctors. We married in a small, unofficial more senior to call on. ceremony in 2014. Q How would you describe your training? Do you know of any doctor A In commenting on my experiences support programs? of training in medicine I would If you know of any support say that I was greatly shocked by Dr Nicholas Toalster programs similar to the the comparison of having worked in private ophthalmology and Babel Project, we’d love to Q Can you tell us a little bit about then public hospitals. Instead hear from you. Email us at yourself? of recognising, supporting and [email protected]. I’m 35 years old and currently encouraging skills, individuality and A initiative there was a culture of ‘just working as the Professorial Senior good enough’, ‘flying under the Registrar at Sydney Eye Hospital. radar’ and calling out mistakes. My Q There has been growing I was born in South Africa, went most vivid memory of this was as an attention to bullying, harassment and to primary school in Cambridge, intern. I was struggling to manage discrimination in medicine; what is England and high school in Brisbane, a patient by myself on the weekend your experience with this? Australia. so I rang the senior intensive care I would like to say that my unit (ICU) registrar, who agreed A experience within ophthalmology Q Can you tell us of your to help, only to be rung later by since moving to Sydney in 2013 to experiences in medicine before the ICU consultant and yelled at for start my training has been almost entering the RANZCO Vocational making an inappropriate referral. uniformly good. I think we are lucky Training Program? I was off duty at the time of the within ophthalmology that, compared call and the call was so aggressive I chose optometry as my first to many other specialties, we are kind A that I ended up breaking down in degree after graduating high school and supportive. However, as highlighted tears at my mother’s birthday party I with little thought as to what that was attending. This, and some other by the recent harassment and bullying occupation entailed. I graduated experiences, prompted me to co- survey, there is a considerable way to go. in optometry at the Queensland found the Babel Project with Dr Ruth Where have you trained? University of Technology in 2001 with Taylor at the Royal Brisbane and Q Primarily in cities or also rural honours and, after less than six months Women’s Hospital. The Babel Project locations? What are the pros and of working as an optometrist, I was was a junior doctor support program cons of each? asked by a group of ophthalmologists aimed at promoting a supportive in Queensland to work for them. environment amongst doctors. A I think the diversity offered in Drs Darryl Gregor and Peter Heiner the training network at Sydney Eye Can you tell us more about the ended up becoming my mentors in Q Hospital is wonderful. I have had Babel Project? life and work. They were incredibly the opportunity to work in varied encouraging, giving me responsibility A The Babel Project was a concept parts of Australia; from multicultural and support in equal measures. They that Dr Taylor and I came up with at the metropolitan Sydney to rural New South also treated my sexual orientation, end of our intern year. It was a support Wales and most recently Darwin and personality and individuality as assets program with formal and informal remote Aboriginal communities in the to be recognised and applauded. meetings between various levels of Northern Territory and Arnhem Land. Eye2Eye Winter 2017 13
I have been welcomed and accepted warmly in all these places. I would say that the most difficult part of specialty Comment from Dr Peter Heiner training is the burden and separation “Dr Darryl Gregor and myself ran a large ophthalmology practice from friends and family. I had to move at one stage where eight ophthalmologists worked. The practice away from my husband and family employed numerous technical staff with different qualifications to undertake my training in Sydney. to assist in the ‘work up’ of patients. This included orthoptists, Because my husband is also a specialty optometrists, science graduates and bio med science graduates. trainee we have both had to move It was amazing how harmonious the group worked. We actively all over Australia, from Townsville to encouraged all our employees to continue their career development. Melbourne. It is my personal belief that these incredible stresses on doctors are a “A good mentoring relationship requires mutual respect for the major contributor to the internal cultural professionalism of each party and a trust that the care of the patient problems within medicine and thereby always is the first priority. bullying and harassment. I think if we “The society we live in is diverse. To care for patients with eye disease, want to seriously tackle these issues ophthalmology should also be diverse. I believe ophthalmology has we need to look at flexible options been at the forefront of the surgical specialities in this regard.” for training, and I am pleased to see the beginnings of discussions taking place around these topics. Q How do you feel RANZCO is going with being diverse and inclusive and with tackling bullying, harassment and discrimination? A I was thrilled to be invited to be a member of the RANZCO Diversity and Inclusion Committee because, based on my prior experiences, I believe Comment from Dr Darryl Gregor that a culture that truly values and “Dr Peter Heiner and I first met Dr Nicholas Toalster in 2003 and promotes each individual to maximise within three minutes we recognised he had huge potential. their uniqueness has innumerable He had responded to an ad we placed looking for a clinical benefits. I think I was lucky to see how optometrist to oversee our refractive practice. Nick had great well this could be done in my early people skills and seemed to also have clinical skills. We continued career and then how badly this could to chat for about half an hour after the formal interview had be done later on. ended - his enthusiasm made it clear he would be an asset to us Q What are your plans for the - and we offered him the job. At that point Nick said something future? like, ‘I hope it won't make any difference but I want you to know I'm gay’. Well, it made a huge difference. Peter and I felt A In terms of my plans for the future, it took great courage for Nick to be so open about his sexuality I have recently been offered the and from then on we knew he would have the confidence to corneal fellowship position at the manage even the most difficult patient interaction and we also Sydney Eye Hospital and thereafter knew he trusted us. hope to take up a fellowship in glaucoma. My eventual hope is to “To me, mentoring is about building mutual trust and have a public position where I can obligations. Being a good role model is important but it’s also bring some of the positive attitudes essential to look for the good in the mentee and encourage their I was taught working in private potential. It’s about enabling the mentee to visualise themselves medicine to the public sector. in a position they desire, and to guide them on the best pathway to get there. I think it's also important to give the mentee the right to debate issues with you and to understand they’re an equal in those debates. They need to know discussions are a two-way street and their opinion is valued. As a mentor you occasionally have to dish out constructive criticism (and take it too) but it's important to sandwich this criticism with praise. “Nick brought positive cultural changes and energy to our organisation. With his help, we embraced sexual diversity in the workplace and in turn attracted patients with diverse backgrounds. We focused on the new, the different, the topical. We set the agenda. Put simply, diversity and open-mindedness brings growth and should be applauded but never mandated.” 14 Membership Spotlight OCULUS Oculus Interview with RANZCO Fellow, Dr Rebecca Stack Keratograph 5M More than just a topographer and building awards. We wanted to Keratograph 5M technology is a revolution in corneal topography • Meibo-Scan (Meibography of the upper and lower eye lid & create a local landmark as well as a A Life is always a juggle and the challenges alter all the time. For and dry eye analysis. The high-resolution colour camera and the 3D-Visualisation of the Meibomian glands surgical facility. The goal was to create integrated magnification changer offer a new perspective on the • R-Scan (Automatic detection and classification of the bulbar redness) a centre of excellence for eyesore with me it is about trying to keep things tear film assessment procedure. in balance as much as possible the best of technology and the best The Keratograph 5M measures corneal topography precisely. The • NIKBUT (non-invasive keratograph break up time) and reassessing every few months trained staff and, by doing so, to design built-in real keratometer and automatic measurement activation • Color CCD camera a patient experience that would be as and realigning. I am organised and guarantee perfect reproducibility of K values. Data is acquired by realistic. I have lots of help both non-contact measurement, automatically analysed and shown in • TF-particle movement pleasant and non-medical for patients comprehensive presentation formats. as possible. professionally and at home, a great • TF-lipid layer • Corneal Topography • Imaging The challenges have been ongoing! personal assistant, a nanny and Initially designing and building the housekeeper, a fabulous husband • Contact lens fitting • TF-Scan, Tear Meniscus Height facility and getting agreement from and a supportive extended family to • Oxi-Map all stakeholders was a challenge. After help. There is occasionally something opening, establishing the process and that gets missed and I am having to Complete Dry Eye Assessment learn to accept that (and I often wish TF-Scan, R-scan Meibo-scan Imaging TF-Scan protocols, passing accreditation and • White Placido-ring • IR-LED spots • Blue-LED spots • White-LED spots developing the team were some of the for a clone!) I notice that my male • Infrared (IR) Placido-ring challenges. Now growing the business colleagues are never asked how they and maintaining exceptional standards manage juggling work and family…! for patient care, keeping abreast of Dr Rebecca Stack Q You graduated from the technological advances and maintaining 2014-2015 RANZCO Leadership a competitive advantage are some of Development Program – what were Q Can you tell us a little bit about the challenges we face. some of the main things you learned yourself? Q What is it like working across from this program and how have A I am an ophthalmologist several sites (public, private, you applied these to your work? specialising in oculo-plastic surgery, teaching, etc.)? What are the pros This was a tremendous program. mum to two gorgeous girls and and cons of each? A I found meeting other young leaders ® married to a farmer. My professional Blephasteam Eaglevision Mastrota Optimel Lunch in the car if at all! It’s and hearing of their challenges and roles currently are Clinical Director A Moist heat Duraplug SuperEagle Expression Eye a constant juggle and difficult to successes inspiring and the contacts of the Ophthalmology Department Dry Eye: therapy Paddle Drops fit it all in. I enjoy the role at the will be useful for life. I enjoyed at Christchurch Public Hospital, New public hospital and have recently learning about the College structure Zealand; partner of Southern Eye taken on a management role as and having the opportunity to see Specialists, the South Island’s largest Clinical Director. It is great to work it in action. The most useful skills for ophthalmology group practice; and in a collegial environment and with me were a greater understanding of a shareholder of a private day surgical NEW from Rayner: registrars and medical students. There personality and leadership styles. This ® ophthalmic facility, Christchurch Eye are opportunities for research, teaching has led me to work more effectively Surgery. I am also on the RACE Board and ongoing professional development. in a team and to appreciate the skills RayOne Preloaded IOL of Examiners for RANZCO and the However, in a resource constrained other people can bring to the group to Board of Ophthalmology NZ. I am public hospital system there are ® ™ enhance the outcomes for all. A greater Introducing RayOne with patented Lock & Roll also a member of Global Women, an challenges with increasing demand and understanding of negotiation styles and technology for the smallest fully preloaded IOL incision organisation established to promote difficulty providing care to all that need gender diversity in the marketplace. As it. The private system provides better strategies as well as gender differences well as ophthalmology, I am passionate remuneration and opportunities for has encouraged me to further fight for equal opportunities for women in our about opportunities for women and more control over the way the work day RayOne® with is structured. Even working in a group profession. improving equality, especially with two patented Lock & Roll™ technology young girls to nurture. practice it is more isolated than working What do you do in your spare in a public department and there are Q for a smoother, more consistent rolling time? How do you unwind? Q You co-founded Christchurch’s additional pressures in managing staff, and delivery of the lens via micro incision first dedicated eye surgery - can you marketing and business development I don’t have much spare time. • Rolls the lens to under half its size before injection tell us more about this? What were A that need to be done in addition to Unwinding means turning of the • Easy to use, true 2-step system some of the main challenges? • Fully enclosed cartridge with no lens handling patient care. The mixture of both works devices and spending time with - Simple and intuitive, increases efficiencies for me. A Christchurch Eye Surgery is a my family and trying to fit in some • 1.65 mm RayOne® nozzle dedicated ophthalmic day surgical Q You have won several awards exercise. I enjoy spending time in - Smallest fully preloaded injector nozzle facility. It was developed as a including a mumtrepreneur award the outdoors with my family either • Full power range, from -10.0 to +34.0 Dioptres collaboration of ophthalmologists for Christchurch Eye Surgery – tell skiing, tramping, mountain biking - Largest fully preloaded power range available and evolved from post-earthquake us more about your experiences or trail running. I like an occasional Christchurch. 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The • NIKBUT (non-invasive keratograph break up time) built-in real keratometer and automatic measurement activation • Color CCD camera guarantee perfect reproducibility of K values. Data is acquired by non-contact measurement, automatically analysed and shown in • TF-particle movement comprehensive presentation formats. • TF-lipid layer • Corneal Topography • Imaging • Contact lens fitting • TF-Scan, Tear Meniscus Height • Oxi-Map Complete Dry Eye Assessment TF-Scan, R-scan Meibo-scan Imaging TF-Scan • White Placido-ring • IR-LED spots • Blue-LED spots • White-LED spots • Infrared (IR) Placido-ring
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1800 225 307 dfv.com.au NUCLEUS PROGRAM 16 Membership Spotlight
NUCLEUS PROGRAM A VISION OF QUALITY Introducing Nucleus: RANZCO’s practice accreditation program
In early April RANZCO was required for practice accreditation. The NUCLEUS Program supplies delighted to announce Accreditation can be awarded members with resources required to through an external accreditation comply with the NSQHS Standards. the launch of the highly- body, against the National Safety Each standard has its own gap anticipated NUCLEUS and Quality Health Service analysis workbook and relevant Program, exclusively created (NSQHS) Standards. Accreditation templates that can be used to develop documentation to meet the for RANZCO members and and adherence to the NSQHS Standards is mandatory for requirements of the NSQHS Standards, their staff to use in the licensed hospitals and day and close the gap between what preparation for practice procedure services in Australia, already exists in the practice and what is accreditation, or solely as a however it is not a requirement required. quality improvement tool. for ophthalmology practices. We anticipate that this will change in There are three primary applications the near future and have taken a of the NUCLEUS Program for proactive approach by promoting improving the safety and quality accreditation and assisting Fellows of care provided in ophthalmology towards reaching that goal. There The NUCLEUS Program clinics: are currently no requirements is now available to all 1. Quality improvement from the New Zealand Ministry of Fellows through the NUCLEUS can be used as a Health for practice accreditation, quality improvement tool for all RANZCO website. NUCLEUS however it is a Southern Cross aspects of an ophthalmology Insurance requirement for New practice. Quality improvement Zealand Fellows to comply For further information, does not solely concern medical with standards/procedures please refer to the care provided, it also includes produced by RANZCO for office practice processes and all NUCLEUS Program and room-based procedures, practice staff, including medical handbook, or contact therefore participating in the PROGRAM and non-medical staff members. NUCLES Program and working Monica Nation, Quality improvement involves towards accreditation will continually raising the quality Coordinator, Education of care provided to patients satisfy Southern Cross contract E: [email protected] resulting in safe, effective, requirements. P: +61 2 9690 1001. patient centred, timely, efficient 3. Training and recruitment and equitable health care. The NUCLEUS can also be used as a on-going cycle of monitoring training tool to assist management and review is essential in staff in recruitment, orientation, ensuring a practice is operating and ongoing training for all staff at the highest possible level members in policies, processes and providing the best care to and procedures. The NUCLEUS patients. program provides various 2. Preparation for accreditation templates that can be used during NUCLEUS can be used to assist the recruitment and training process, including position NUCLEUS ophthalmology practices with preparing the necessary documents, descriptions, staff training registers processes, policies and procedures and orientation check lists. PROGRAM Eye2Eye Winter 2017 17
Participants Epidemiology and a PhD in Medicine Ensuring ethics at Sydney University. His Glaucoma If you are a participant and have Fellowship was at Moorfields Eye concerns regarding a research project in human subject Hospital, London. that you are a part of, the key person research to raise your concerns with is the lead A/Prof Healey has been involved researcher for the project. In cases where with RANZCO for many years as The National Health and a participant feels uneasy voicing their Chair of the Educational Strategies Working Group, Director of Training Medical Research Council concerns with the researcher, the next point of contact will be the RANZCO (NSW), state and federal QEC member, (NHMRC) is the principal HREC or the nominated complaints organiser or speaker at many RANZCO organisation involved in officer. Contact details will have been branch meetings and annual scientific delivering support and provided within the written information congresses and, most recently, as sheet or consent form. member of the HREC. providing guidelines on Other volunteer appointments ethics and related issues Non-Participants include the Australia and New Zealand in the fields of health and People who are not directly linked Glaucoma Society, the Ophthalmic Research Institute of Australia (ORIA), human research in Australia. to a research project or who are not necessarily participants can also voice the Asia-Pacific Glaucoma Society It draws upon resources of any concerns that they may have (APGS), the Asia-Pacific Academy of all components of the health regarding the conduct of the research Ophthalmology (APAO) and the World system including governments, project. Non-participants who wish to Glaucoma Association (WGA). He is raise any concerns can direct it to either currently the Treasurer of the ORIA, medical practitioners, nurses, the lead researcher, the RANZCO HREC APGS and WGA. allied health professionals, or the researcher’s organisation. Contact A/Prof Healey has many research researchers, teaching details can be found through the interests including ophthalmic organisation’s website or switchboard. epidemiology and public health, cell and research institutions, biology, diagnostic test and screening public and private program Institutional Responses evaluation and genetics. He has been managers, service Regarding Complaints honoured with a number of awards administrators, community RANZCO has a complaints policy and including the International Young Clinician-Scientist Award from the health organisations, social a complaints form in place. These are available on the RANZCO website. Any Association of International Glaucoma health researchers and complaints that are submitted regarding Societies and the Achievement Award consumers. the conduct of a research project from the APAO. He has made over 230 will be handled in accordance to the scientific presentations at international The RANZCO Human Research RANZCO policy and will abide by the meetings throughout the world. He is an Ethics Committee (HREC) plays a requirements of the National Statement. editorial board member of a number of fundamental role within the Australian journals and has published 150 scientific system of ethical oversight of research RANZCO HREC papers based on original research. involving humans. As well as reviewing Members: meet With his background in both cell research proposals that involve biology and clinical epidemiology, human participants to ensure they are A/Prof Paul Healey A/Prof Healey brings valuable ethically acceptable as set out in the A/Prof Paul Healey is an experience in best practices for National Statement on Ethical Conduct ophthalmologist based in Sydney research design and implementation in Human Research, a vital role of with clinical and research interests in to the HREC. He provides scientific and the HREC is to protect the wellbeing glaucoma. clinical expertise to the Committee in and rights of participants involved in He is Director of Glaucoma Services, addition to his contribution to ethical research. Westmead Hospital; Consultant assessment. The ability to raise concerns that Ophthalmologist, Sydney Eye Hospital; can arise during a research project Director of Glaucoma Research, is imperative in ensuring that the Westmead Institute for Medical research conducted is ethical and Research; and Clinical Associate abides by guidelines set by the Professor, University of Sydney. After NHMRC. The question is “How do I training in Cell Biology as the first voice my concerns?” medical student to work at the Garvan The information below is an Institute, Sydney and subsequently at adaptation of information available the Institute for Molecular Medicine through the NHMRC website in Oxford, UK, A/Prof Healey went on regarding how different people to graduate with Honours from the can raise their potential concerns Medical School of the University of NSW regarding a project. before completing an MMed in Clinical A/Prof Paul Healey 18 Membership Spotlight
All About Women Festival 2017
For one weekend in March Group, Dr Nisha Sachdev, attended the idea that women should change each year, the Sydney Opera along with Alex Arancibia, RANZCO’s to fit in with a system that isn’t built General Manager of Membership for them, or by them, is problematic,” House plays host to the All Services, and Emma Carr, General About Women conference, said Alex. “So, rather than fixing Manager of Communications. women, we need to look at the “I’ve attended the conference in the which takes place on or environments and systems in which past,” explained Emma, “and I’ve always around International we all live and work and see how we Women’s Day and is now in found it to be very inspiring and thought provoking. It is an important can adjust those so that they work its fifth year. The conference reminder of the challenges that many equally well for women and men.” features notable female women face in work environments Dr Semmonds agrees, saying “I speakers from around the and in general life, as well as of the think what most women want is world, including authors, progress that has already been made.” equality and respect. It is amazing The conference aims to invigorate business leaders, scientists, that women still earn less than men discussion on important issues and for the same job and hours. There is journalists, actors and ideas that matter to women today, still a lot of unconscious bias and this political figures. with a broad range of speakers on is something we need to address at a All About Women brings together varied topics. One of the topics that College level. I took a lot away from was discussed in a number of events thousands of women (and men!) who the conference, including much that want to discuss and learn about women, was women in the workplace. Leading could benefit the College. I would feminism, equality and diversity. This Australian commentator on women in definitely recommend more Fellows year, that audience included at least two the workplace, Catherine Fox, spoke RANZCO Fellows and two members of about the topic of her new book, Stop attend in the future, including the RANZCO staff. RANZCO’s Vice President, Fixing Women: Why Building Fairer men, if they’re brave!” Dr Di Semmonds, and the Chair of the Workplaces Is Everybody's Business. RANZCO Younger Fellows Advisory “Stop Fixing Women points out that
Recognition for Clinical and Experimental Ophthalmology peer reviews
Scientific journals such CEO has now teamed up with If you wish to become a reviewer as RANZCO’s Clinical and Publons to make it easier for for CEO, please contact the Managing reviewers to track and showcase Editor, Vicky Cartwright, at Experimental Ophthalmology their peer review contributions. [email protected]. (CEO) rely on a network of After completing a CEO review, the reviewers to facilitate the reviewer is asked if he/she wishes the 4.4 Clinical & Experimental Ophthalmology review details to be automatically peer review process. Each in treatment-naïve patients... year around 400 scientists forwardedS TA onto R T Publons. If they agree,STRONG and theS TAY reviewer is signed STRONG1- 6 Clinical & Experimental and doctors spend anything up with Publons, the CEO review is from 30 minutes to several then added to their Publons record. Ophthalmology
Volume 45, Number 2, March 2017 hours assessing papers Scientists and doctors can use their 210 Volume 45, Number 2, March 2017 Pages 91– ISSN 1442-6404 that have been submitted to Publons record as proof of their peer review contributions when applying PBS Information: Authority required for the treatment of wet age-related macular degeneration, diabetic macular oedema, Microbiome in meibomian central retinal vein occlusion and branch retinal vein occlusion. Refer to PBS schedule for full Authority Required information. gland dysfunction CEO, and providing detailed EYLEA is not listed on the PBS for myopic choroidal neovascularisation. for promotion or submitting grant Corneal diameter in Chinese children Please review the full Product Information before prescribing. Efficacy of Hydrus versus selective MINIMUM PRODUCT INFORMATION EYLEA® [aflibercept (rch)] INDICATIONS: EYLEA (aflibercept) is indicated in adults for the treatment of neovascular (wet) age-related macular degeneration (wet AMD); visual impairment due to macular oedema secondary to central retinal vein occlusion (CRVO); visual impairment due to macular oedema secondary to branch retinal vein laser rabeculoplasty occlusion (BRVO)*; diabetic macular oedema (DME), visual impairment due to myopic choroidal neovascularisation (myopic CNV)*. CONTRAINDICATIONS: Known hypersensitivity to aflibercept and constructive comments or excipients; ocular or periocular infection; active severe intraocular inflammation. PRECAUTIONS: Endophthalmitis, increase in intraocular pressure; immunogenicity; arterial thromboembolic Anti brotic use after Ahmed applications.events; bilateral treatment; risk factors for retinal pigment epithelial tears; treatment should be withheld in case of rhegmatogenous retinal detachment, stage 3 or 4 macular holes, retinal break, valve implantation decrease in best-corrected visual acuity of ≥ 30 letters, subretinal haemorrhage or intraocular surgery; treatment not recommended in patients with irreversible ischemic visual function loss; population with limited data (diabetic macular oedema due to type 1 diabetes, diabetic patients with HbA1c > 12 %, proliferative diabetic retinopathy, active systemic infections, concurrent eye Endogenous Klebsiella pneumoniae conditions, uncontrolled hypertension, myopic CNV: no experience in the treatment of non-Asian patients, previous treatment for myopic CNV and extrafoveal lesions*); see full PI for effects on fertility, pregnancy, lactation, effects on ability to drive or use machines. ADVERSE EFFECTS: Very common: visual acuity reduced*, conjunctival haemorrhage, eye pain. Common: retinal pigment endophthalmitis in Australia epithelial tear, detachment of retinal pigment epithelium, retinal degeneration, vitreous haemorrhage, cataract, cataract cortical, cataract nuclear, cataract subcapsular, corneal erosion, corneal to help the Editors make a CEOabrasion, intraocularis pressure very increased, vision blurred, grateful vitreous floaters, vitreous detachment, in jectionto site pain, falloreign body sensation the in eyes, lacrimation increased, eyelid oedema, injection Access to anti-VEGF for neovascular AMD site haemorrhage, punctate keratitis, conjunctival hyperaemia, ocular hyperaemia. Others: see full PI. DOSAGE AND ADMINISTRATION*: 2 m g aflibercept (equivalent to injection volume of 50 μL). EYLEA is for intravitreal injection only. The interval between doses injected into the same eye should not be shorter than one month. Advice on treatment initiation and maintenance of Functional vision tasks using Argus® II therapy specific to each patient population is described in the section below. Once optimal visual acuity is achieved and/or there are no signs of disease activity, treatment may then be continued with a treat-and-extend regimen with gradually increased treatment intervals to maintain stable visual and/or anatomic outcomes. If disease activity persists or recurs, the treatment interval may be Non-English diabetes shortened accordingly. Monitoring should be done at injection visits. There is limited information on the optimal dosing interval and monitoring interval especially for long-term (e.g. > 12 months) RANZCOtreatment. The monitoring andFellows treatment schedule should be determined bywho the treating ophthalmologist contribute based on the individual patient’s response. If visual and anatomic outcomes indicate that management project publication decision and the the patient is not benefiting from continued treatment, EYLEA should be discontinued. For wet AMD:: Treatment is initiated with one injection per month for three consecutive months, followed by one injection every two months. Long term, it is recommended to continue EYLEA every 2 months. Generally, once optimal visual acuity is achieved and/or there are no signs of disease activity, the Late outcomes of orbital treatment interval may be adjusted based on visual and/or anatomic outcomes. The dosing interval can be extended up to every 3 months. For CRVO:: Treatment is initiated with one injection per rhabdomyosarcoma month for three consecutive months. After the first three monthly injections, the treatment interval may be adjusted based on visual and/or anatomic outcomes. For BRVO: Treatment is initiated with theirone injectiontime per month for three consecutiveto months. review After the first three monthly injections, for the treatment intervalCEO may be adjusted based, onand visual and/or anatomic outcomes. For DME: Treatment Incidence of limbal stem cell de ciency is initiated with one injection per month for five consecutive months followed by one injection every two months. After the first 12 months, the treatment interval may be adjusted based on visual and/or anatomic outcomes. For myopic CNV: EYLEA treatment is initiated with one injection of 2 mg aflibercept (equivalent to 50 μL). Additional doses should be administered only if visual and/or anatomic outcomes indicate that the disease persists. Recurrences are treated like a new manifestation of the disease. DATE OF PREPARATION: Based on PI dated July 2016. Approved PI available at Melatonin on hypoxia-induced VEGF authors improve their papers. http://www.bayerresources.com.au/resources/uploads/PI/file10294.pdf or upon request from Bayer Australia Ltd, ABN 22 000 138 714, 875 Pacific Highway, Pymble NSW 2073. in retinal pigment epithelial cells is pleased*Please note chan thatges in Product this Information work. can now Mouse model for uveal melanoma References: 1. Eylea Product Information, July 2016. 2. Schmidt-Erfurth, U. et al. (2014) Intravitreal aflibercept injection for neovascular age-related macular degeneration. Ophthalmology. 121:193- 201. 3. Brown, D.M. et al. (2015) Intravitreal Aflibercept for Diabetic Macular Edema - 100-Week Results From the VISTA and VIVID Studies. Ophthalmology. 122(10):2044-52. 4. Ogura, Y. et al. (2014) Intravitreal Aflibercept for Macular Edema Secondary to Central Retinal Vein Occlusion: 18-Month Results of the Phase 3 GALILEO Study. Am J Ophthalmol. 158:1032–1038. 5. Heier, J.S. et al. (2014) The work is unpaid, and Intravitreal aflibercept injection for macular edema due to central retinal vein occlusion: Two-year results from the COPERNICUS study. Ophthalmology. 121(7):1414-1420. 6. Clark, W. L. et al. (2016) be documentedIntravitreal Aflibercept for Macular Edema Following Branch Retinal Vein and Occlusion: 52-Week Results given of the VIBRANT Study. Ophthalmolo thegy. 12 3:330-336. EYLEAA® is a registered trademark of Bayer Group, Germany. Bayer Australia Limited, ABN 22 000 138 714. largely unrecognised. recognition875 Pacific Highway, Pymble, NSW 2073. November it 2016 deserves. BRA177 L.AU.MKT.11.2016.0243 Eye2Eye Winter 2017 19
World Orthoptic Day 2017
projects that involved assessing adults and children with different eye diseases or disorders, such as strabismus, cataract and glaucoma and then collect DNA samples to be sent for analysis. In this way, we are able to compare each individual’s eye problems – or lack of – with their genetic make-up and try to uncover the gene changes that result in their eye disease. We often look closely at families with hereditary eye disease as this gives us vital clues as to the possible gene changes that cause these conditions. This knowledge helps us better understand how these conditions occur and perhaps develop better treatments or strategies for earlier Sandra Staffieri diagnosis to limit vision loss. It has been exciting to marry my clinical To mark this year’s World integral part of the eye health care skills with research skills and be Orthoptic Day, which took team, performing all the preliminary given the opportunity to be at the examinations and assessments forefront of gene discovery, cutting- place on 5 June, we spoke to prior to the examination by the edge technology and gene-therapy, Sandra Staffieri on her role ophthalmologist. Orthoptists and which is on the horizon. After so as a Clinical and Research ophthalmologists will often discuss many years looking after children Orthoptist at the Centre for difficult cases and formulate the best with irreversible vision loss, I can see management plan for that individual the hope that research can provide Eye Research Australia. child or family. for future generations. In some cases, orthoptists will work What role do orthoptists You’ve done quite a bit of Q in their own private practice with Q play in treating eye problems in work in retinoblastoma care, can paediatric patients being referred for children? you tell us a bit about that? assessment or management of eye A Orthoptists undertake specific movement problems (strabismus) and A I have been the Retinoblastoma training to examine, diagnose, manage vision loss (amblyopia). Orthoptists Care Coordinator at the Royal and treat a variety of childhood eye are also active in the area of paediatric Children’s Hospital in Melbourne conditions, most commonly this low vision. Through organisations such for 23 years. What started out as includes strabismus (turned eye) and as the Royal Institute for Deaf and essentially an administrative role, refractive error (glasses). A child’s Blind Children and Vision Australia, has become much more than that. vision develops from birth until around an orthoptist can assess children with I coordinate all the care of children seven or eight years of age and any significant vision impairment in their with retinoblastoma as there are condition that affects the eyes can own home environment or school many doctors, nurses, allied health significantly affect vision development. personnel and teachers involved setting and then provide a report to Less commonly, a child can develop eye in each child’s care and treatment assist parents or teachers to provide a problems that are usually associated over many, many years. I also spend with adults – like cataract and safe environment for the child as well time counselling parents, providing glaucoma. These conditions can be as suggest ways to best optimise their information and assistance as quite devastating to the child’s vision vision for learning. required. With the support of a development and treatment is not as Can you tell us about your Centres of Research Excellence grant straightforward, particularly in the case Q work with the Centre for Eye from the National Health and Medical of cataract, as it would be in an adult. Research Australia as a research Research Council (NHMRC), I was able to start looking at causes of delayed How closely do you work with orthoptist? Q diagnosis for retinoblastoma in ophthalmologists on a day to day I have been extremely fortunate basis? A Victoria. The findings of this research to have spent the last 10 years at the paved the way for me to undertake A Orthoptists usually work in Centre for Eye Research Australia a PhD to develop and evaluate an public hospital clinics or private as a research orthoptist in the awareness program for parents practices with an ophthalmologist. Clinical Genetics Unit. I have had to recognise and respond to the Orthoptists are very much an the opportunity to work on many very earliest signs of the disease. 20 Membership Spotlight
I have been fortunate enough to are very anxious and distressed. My war. Sometimes we lose the war for be supported for my studies by an role is very much one of counselling both eyes. NHMRC public health postgraduate and explaining the disease again, the I guess the other difficulty is scholarship. treatment options and prognosis. In wondering if, had the child been the acute stage, parents can be very It must be hard working with diagnosed earlier, might the outcome Q worried about a red eye or some new children affected by serious eye have been different. The two most sign or symptom. I like to think they conditions, such as retinoblastoma. common signs of retinoblastoma are can call me at any time and together What role does the orthoptist play a white pupil or an eye turn. The child we can decide if they need to be seen in helping parents cope with the will be otherwise well, so it is common urgently and, if so, I can facilitate that. situation? for these early signs to be overlooked Yes, it is hard sometimes, because simply because parents don’t know A I spend a lot of time with parents you do develop a relationship with not only at the acute stage – at first the child and the family over time but any different. In developed countries, diagnosis and during treatment – but I guess I am only doing what I think I the child will lose their eye, and also in the months and years that would want someone to do for me if might need chemotherapy, but they follow to review the information I were in their shoes. I cannot begin will survive. In developing countries they have been given and help them to imagine, even after all these years, though, they will likely lose their life. navigate their way through the health how it must feel to be told your child It is challenging for me to think that system. Not only does their child has eye cancer – because usually they the majority of children in a developing have cancer, they will also likely have are not even sick. country with retinoblastoma will die a vision impairment of some kind. In because of delayed diagnosis, when What’s the most challenging addition, I support the survivors of Q really it is the most survivable paediatric retinoblastoma (many of whom we part of your role? cancer in a developed country. looked after a generation ago!) who A It is my privilege to care for I look forward to my research then have their own children with the children with retinoblastoma and their same disease. I spend considerable perhaps developing a sustainable families, but the most challenging and cost-effective program to raise time answering questions they might thing is feeling helpless. Sometimes awareness of these early signs of have after they have been to see the there is nothing more that can be genetic counsellor. done and the child needs to have their retinoblastoma. Looking further ahead All parents and survivors are affected eye removed. They might I hope to be able to examine how provided with a lot of information have gone through many months such a program might be adapted and that is often complex and difficult of invasive treatments including implemented in developing countries to understand, at a time when they chemotherapy, and we still lose the to save lives. This July we’re raising funds for medical research to help end blindness. Help us find a cure for eye disease. Register today juleye.com.au
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Complaints to regulators drive ophthalmologists’ medico-legal matters
Why do ophthalmologists seek Avant’s support? Our “The media coverage of complaints could also be driving data provides some clues and our experts provide awareness among the public about the avenues available insight into which matters are becoming more prevalent for making a complaint,” he says. and why. Communication issues are a leading cause for complaint, Avant has over 70,000 members and insures more than as noted by the NSW Health Care Complaints Commission half of all doctors in Australia. Our size means we handle in its 2016 Annual Report: “although clinical care remains a broad range of medico-legal matters across the country the largest allegation category, complaints about and have extensive claims data to draw upon. Our scope doctor-patient communication have increased more of work allows us to attract the very best medico-legal significantly than other categories, highlighting the experts across every relevant area of law and jurisdiction importance of the doctor-patient relationship.” and offer our members unparalleled defence. Looking at the new cases managed in the 2015–16 financial year Positive resolution for ophthalmologist highlights the different challenges doctors face across each specialty. Here we look at your area of practice and communication complaint highlight the matters we have helped our members with In one case, an employee at a health facility made a last year. complaint to the relevant state regulatory authority The frequency of ophthalmologists’ claims has increased about an ophthalmologist member who had performed by 14% over the average of the previous three years. ophthalmic surgery on a patient. The ophthalmologist The number of ophthalmologists who are members of had reviewed the patient following surgery while a Avant has increased over the last four years, however we representative from the health facility was present. The have accounted for this increase by looking at cases per employee at the health facility, who was not present at 1,000 members. Our data shows that one in eight Avant the consultation, alleged that the member spoke to their ophthalmologist members had a claim last financial year. colleague in an unprofessional manner and the patient was inappropriately managed. The matter was referred to AHPRA and Avant helped the member respond to the allegations. Ophthalmologist claims by type 2015 – 16 Supporting our philosophy of working with members to resolve matters favourably and efficiently, the complaint 10% 5% Compensation was resolved within months. Our medical defence team
Coronial obtained a supportive witness statement which confirmed that the ophthalmologist had not been unprofessional. Complaint to regulator 20% Ultimately, The Medical Board of Australia accepted that Employment dispute the member’s management had been reasonable and Medicare appropriate, and decided to take no further action. For tips
65% Other and advice on improving communication visit avant.org. au/avant-learning-centre/ and go to the ‘Communication’ icon.
Complaints to regulators increase Avant supported more than 130 cases for ophthalmologist members in the last four years. In the Ophthalmologist claims per 1,000 members last year, 65% of these were complaints to regulatory authorities (the highest proportion in comparison to other specialities) and 20% were compensation 100 Average 2012-15 90 claims. In the last year, the number of cases involving 80 2015-16 70 complaints to regulators increased by 40%, which is well 60 above the average for Avant members. 50 40 30 Andrew Vandervord, Practice Manager, Legal 20 Professional Conduct – NSW at Avant Law, believes there 10 are a number of factors that may be influencing the rise Compensation Coronial Complaint Employment Medicare Other in complaints to regulators. He cites the ease with which to regulator dispute patients can make complaints as a factor as patients can now make a complaint online in all states and territories. ADVERTORIAL - AVANT
Compensation matters remain high • benefit and potential complications of procedures • the risks and the alternative treatment options you Although the frequency of compensation matters discuss decreased for ophthalmologists last year, they were the • any questions the patient raised. second-most common area for which ophthalmologists sought Avant’s support. “In the event of a complication or adverse outcome of Commonly, compensation complaints concern which the patient has been warned, the patient is much a complication of treatment that had not been more likely to accept the consequences and less likely to mentioned or fully understood, but then materialised. litigate or complain if they had a good understanding of For example, a patient sought compensation from the risks involved,” she says. an ophthalmologist member after alleging that You can find the video at avant.org.au/avant-learning- they suffered significant complications following a centre/ under the ‘Consent’ icon. procedure, including vision loss. Ultimately, the matter was settled, but it highlights the importance for This article has been reproduced with the permission ophthalmologists to warn patients of any possible risks of Avant. Information is only current at the date the of a procedure and to document this discussion and article was originally published. Visit avant.org.au/news/ the patient’s consent. ophthalmologists-medico-legal-matters/ In our five-minute video, Jo Montgomery, Senior Risk Professional indemnity insurance products are issued by Manager at Avant, provides recommendations about Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. your clinical and legal responsibilities when gaining The information provided here is general advice only. You consent and discussing material risk. should consider the appropriateness of the advice having “Asking patients, ‘What is the one thing you’re worried regard to your own objectives, financial situation and needs about?’ and other similar open questions will help you before deciding to purchase or continuing to hold a policy in identifying risks material to the patient,” she says. with us. For full details including the terms, conditions, and Contemporaneous notes should always accompany exclusions that apply, please read and consider the policy discussions about treatments and these should cover wording and PDS, which is available at www.avant.org.au or all aspects of the consent discussion such as: by contacting us on 1800 128 268. 24 Annual Scientific Congress Eye2Eye Winter 2017 25
PERTH2017 49TH ANNUAL SCIENTIFIC CONGRESS
28 OCTOBER - 1 NOVEMBER 2017 PERTH CONVENTION AND EXHIBITION CENTRE Join us in Perth for RANZCO 2017! RANZCO’s 49th Annual Scientific Congress is coming to Perth on 28 October – 1 November 2017. The Scientific Program Committee and RANZCO have been working hard to develop the Congress program, which offers a variety of symposia, workshops, presentations and keynote addresses from renowned local and international invited speakers. The Scientific Program Committee Chair, Prof Helen Danesh-Meyer, says there has been an excellent response to calls for abstracts and that planning is progressing well. “The Scientific Program Committee is very excited by the depth and breadth of submissions of courses/ symposia for 2017 from all states in Australia as well as from New Zealand. The Special Interest Groups have particularly been focussing on submitting symposia that address cutting edge issues in ophthalmology. We are also pleased to announce a new symposium that will showcase internationally recognised RANZCO members,” said Prof Danesh-Meyer. “We are looking forward to reviewing submissions and we encourage everyone to submit papers, posters, films and audits.”
Registration is now open! Go to www.ranzco2017.com/registration/ to register. Early bird registration closes on Wednesday 6 September! 26 Annual Scientific Congress
Social Program
Welcome Reception Graduation and Congress Dinner Awards Ceremony and President’s Reception Date: Saturday 28 October 2017 Date: Sunday 29 October 2017 Date: Tuesday 31 October 2017 Time: 18:00 – 19:30 Time: 18:30 (for a 19:00 start) – Time: 19:00 – 22:00 Venue: The Summer Gardens, Perth 22:00 Venue: Fraser’s Kings Park Convention and Exhibition Venue: Winthrop Hall Fraser Ave, Centre West Perth WA 6005
Senior & Retired Practice Managers’ Younger Fellows’ Fellows’ Dinner Dinner Dinner
Date: Monday 30 October 2017 Date: Monday 30 October 2017 Date: Monday 30 October 2017 Time: 19:00 – 22:00 Time: 19:00 – 22:00 Time: 19:00 – 22:00 Venue: The Terrace Hotel Perth Venue: The Reveley Bar Venue: The Public House 237 St Georges Terrace, Eastern Promenade, 263 Adelaide Terrace Perth WA 6000 Riverside Drive, Perth Perth WA 6004 Eye2Eye Winter 2017 27
and ultimately at the resolution of Prize in medicine in 2012 (together with myopia through a short-term eye Sir John Gurdon who had developed Invited drop treatment. nuclear transfer in 1958) and basically Prof Sherwin gained his PhD in Cell showed that differentiation was no Speakers Biology from the University of Kent, longer a one-way street and cells could Canterbury, UK. From there he took up reverse to a less differentiated stage. This NAMED LECTURES an academic position at the University is the basis upon which regenerative Council Lecture of Manchester where he specialised in medicine has become a reality – ageing Prof Jonathan Crowston molecular parasitology. He moved to cells can be turned back to a more Sir Norman Gregg Lecture the Department of Ophthalmology at developmental state and should Dr Noel Alpins AM the University of Auckland in 1998 to potentiate regeneration of the affected Dame Ida Mann Lecture begin targeting corneal dystrophies tissue. and disorders using ocular stem cells, Prof Trevor Sherwin How has your work contributed cell reprogramming and corneal Q Fred Hollows Lecture engineering. to research and treatment of ocular Dr Geoffrey Cohn OAM disorders and what are some of your UPDATE LECTURES Q Tell us a little bit more about the most ground-breaking findings / work / research you’re involved in. innovations? Glaucoma Update Dr Anne Coleman A The main focus of my laboratory is A My laboratory has been working Retina Update applying emerging technologies to the on limbal stem cells and keratocyte Prof Lyndon da Cruz eye. That has centred around the use progenitors cells with an aim of Cataract Update of stem cells and has recently moved restoring function back to the limbus Bonnie Henderson into cell reprogramming. Conventional after trauma/injury/disease. Much Oculoplastic Update therapies for most diseases or disorders international research has focused on Prof Don Kikkawa focus upon halting the disease isolation of limbal cells which were progression but, in most cases, do not exclusively epithelial (limbal stem cell) Paediatrics aim to restore the functional losses Prof Michael Brodsky or stromal (keratocyte progenitor cell) that occurred whilst the disease was in order to decipher their individual ongoing. We aim to use both of these roles in corneal homeostasis and wound technologies for in vivo regeneration repair. Our research aims to determine of tissues, not only structurally but functional complexes of cells that are also functionally. If we can harness the capable of restoring both epithelial ability to restore tissues and organs and stromal repair components to the to a previous healthy condition, then damaged area. We reason that the in we will not only unlock the ability to vivo limbal niche is formed by a complex treat disease, but also to reverse the consortium of cellular components degenerative effects of aging in those that interact to form this unique region tissues. of the ocular surface. Thus we have concentrated on isolating limbal cells What prompted you to specialise Q by their functional ability to form stem in regenerative medicine and cell spheres in culture and which, by what are some recent, interesting their very nature, will include a diversity discoveries in this area? of cells both epithelial and stromal that Prof Trevor Sherwin A The use of stem cells in medicine contribute to the formation of the limbal has always been a very attractive lure niche. Named Lectures for many scientists and clinicians and Subsequent to isolation of these the possibility of using stem cells to cure spheres we are investigating their Prof Trevor Sherwin ocular disorders has been a passion potential use in corneal restoration after Dame Ida Mann Lecture of mine. The ethical limitations on implantation. the use of embryonic stem cells have Concurrently with this work, in Prof Trevor Sherwin’s research team at been surpassed by the discovery of collaboration with Prof Colin Green and the University of Auckland specialises somatic stem cells and the introduction Dr Carol Greene, we are working on in applying regenerative medicine of induced pluripotent stem cells. In being able to reprogram corneal cells solutions to ocular disorders. Currently 2006, a team of scientists led by Shinya in the eye in situ, so that we ultimately the team is focusing on the use of Yamanaka at the Riken institute in aim to switch on different functionalities stem cells and cell reprogramming Japan showed that fully differentiated in the corneal cells to promote to regenerate corneal tissue. Two cells from human skin could be regeneration. This would represent international patents focus on the reprogrammed into a state resembling corneal engineering in the living eye restoration of innervation following that of embryonic stem cells with the as opposed to engineering new tissue ocular surgery, rebuilding the corneal simple use of four transcription factors. in the culture dish for subsequent stroma of keratoconic patients This discovery won Yamanaka the Nobel implantation into the eye. 28 Annual Scientific Congress
ill-informed or premature introduction Q What do you see as your most into the clinic. A I have spent most of my career eminent accomplishment in your investigating methods of teaching. I career? Q Tell us an interesting fact about have attempted to improve the ways yourself. in which we educate learners by A I think the most eminent standardising methods of evaluation accomplishment is the current A I love to cook and usually relax and feedback. Most physicians would collaborative work (with Prof Green in the evening whilst preparing the agree that learning a medical field, and Dr Greene) where we are working evening meal. Ultimately I aim to get especially a surgical field, is a difficult towards reprogramming the corneal good enough so that when I retire from and lengthy process. Developing keratocytes to produce a different research I will be the first Professor to databases, for example, can help collagen matrix molecule which restores appear on Masterchef Australia. track outcomes and highlight areas integrity and, possibly, even visual that need improvement. We hope to function to the keratoconic cornea. We change educational systems to not only have been able to induce the production improve the quality and reproducibility of type II collagen by keratocytes using a of surgical training but also increase combination of two exogenous factors. patient safety during the training The deposition of this new collagen process. restores rigidity and plasticity to the Q What prompted you to specialise corneal stroma without compromising in cataract and refractive surgery and corneal clarity. The technology works in what are some recent breakthroughs human tissue in the laboratory and in in these areas? vivo in animal models. A I love the ability to significantly Q You’re presenting the Ida Mann impact a person’s life by a quick and Lecture at RANZCO’s 49th Annual elegant procedure. The immediacy Scientific Congress, can you give us of replacing a cloudy lens with an a sneak peek of your presentation? Dr Bonnie Henderson artificial lens, with the added bonus What will be the focus of your lecture? Dr Bonnie Henderson of decreasing their dependency on spectacles, was inspiring. The field of A Because my interests lie in Cataract Update cataract surgery has changed since I regenerative medicine, I intend to focus Dr Bonnie Henderson is an entered ophthalmology. At the time of on how far research has progressed internationally recognised expert in my residency, phacoemulsification was towards this goal. The eye has long cataract and refractive surgery. She is still so new that many attending had represented a willing organ in which not yet mastered the technique. Since a partner at Ophthalmic Consultants to trial new technologies, from the first those days, we have seen the explosion of Boston and a Clinical Professor at corneal transplant to the pioneering use of technology with innovations Tufts University School of Medicine. Dr of medical lasers. The eye is also at the in refractive intraocular lenses, Henderson is the Associate Editor for the forefront of the current race towards improvements in phacoemulsification Journal of Refractive Surgery and serves regenerative medicine. Clinical trials systems, and the introduction of as the President of the American Society are being conducted around the world femtosecond lasers. Corneal refractive of Cataract and Refractive Surgery. on stem cell transplantation and gene surgery also evolved during these Dr Henderson completed her therapy for eye conditions. I aim to decades to become a widely accepted ophthalmology residency at Harvard highlight some of this international and safe alternative to glasses or contact Medical School, Massachusetts Eye research whilst also giving insights lenses. and Ear Infirmary. She graduated from into the current work from my Dartmouth College and from Dartmouth Q How has your work contributed laboratory. Medical School with high honours. to your field of expertise and what are some of your most ground-breaking What will the audience be Dr Henderson’s principal research Q findings / innovations? able to take away from your involves cataract surgery outcomes presentation? and innovative methods of teaching, A Recently, I have been investigating including the development of a the causes of dysphotopsias after Hopefully the audience will A digital-based method for teaching uncomplicated cataract surgery. I already be aware of the potential of cataract surgery. She has invented was perplexed at why some patients stem cell and cell reprogramming and commercialised several medical complained of seeing a dark shadow therapies. The presentation aims instruments including the modified in their peripheral vision after what to highlight where we are so far on capsule tension ring, astigmatism appeared to be an uneventful surgery. our journey towards regenerative correcting markers, and a capsule After reading the published literature medicine in the eye whilst also polisher, her interests in which she on negative dysphotopsias, I theorised demonstrating the need for restraint donates to charity. that one of the reasons may be the and research to ensure that the placement of the intraocular lens. We promise provided by the new Q Tell us a little bit more about the performed a prospective multicentre technologies is not derailed by work / research you’re involved in. trial to investigate the theory and found Eye2Eye Winter 2017 29
a slight change in the position had a attending surgeon when needed. Congress-associated significant reduction in the incidence The program is now used in training of negative dysphotopsias. This finding programs around the world and can be workshops will be the focus of my Cataract Update accessed through ASCRS (www.ascrs. Optometry Education Workshop lecture at RANZCO’s 49th Annual org or www.cataractmaster.org). Date: Saturday 28 October 2017 Scientific Congress. Q What will the audience be able to The Optometry Education Workshop Q What do you see as your most take away from your Cataract Update will cover a range of topics pertinent eminent accomplishment in your Lecture at RANZCO’s Congress? to optometrists, with a focus on career? A I hope to present an easy surgical appropriate referral guidelines. While I was on the fulltime faculty manoeuvre to reduce the incidence of Chaired by RANZCO Immediate at Harvard’s Massachusetts Eye and negative dysphotopsias. Past-President, Dr Brad Horsburgh, Ear Infirmary, I created a cognitive the workshop will feature a range of reality computer program to teach Q Tell us an interesting fact about well regarded speakers with plenty phacoemulsification cataract surgery. yourself. of time for Q&A. The program was created with the help A I went to watch a friend who was GP Education Workshop of my colleagues, A/Prof Adam Neaman competing in a triathlon and was Date: Saturday 28 October 2017 and A/Prof John Loewenstein, and is hooked. I was turning forty, barely called Cataract Master®. The program knew how to train but entered my first The GP Education Workshop will attempts to play the role of a surgical race anyway. I borrowed a friend’s old cover a range of topics pertinent mentor. While virtual reality programs mountain bike, wore my daughter’s to GPs seeing patients with eye allow people to practice the physical Dora the Explorer bike helmet and diseases and injuries or those aspects of microsurgery, we believe nearly drank half the lake during the needing eye care management. that most novice surgeons are lacking swim. Since then, I have completed Chaired by RANZCO Past-President, the cognitive aspects and require the twenty races, even finishing in the top Dr Bill Glasson, the workshop will intellectual input that they usually three in my age group in a few of them. feature interactive sessions and a receive with a live attending surgeon Each year, I become slower and more range of well regarded speakers. who is sitting next to them during sore. However, I am hoping the pace of the case. The program was created to advances in orthopaedic surgery rivals allow learners to ‘perform’ surgery on a that of ophthalmic surgery and will be computer program and receive just- able to offer me new body parts as I in-time feedback from a computerised wear out my old ones.
SAVE THE Ophthalmic plastic surgery and teaching methods in DATE low resource settings 27 OCT 2017 An International Development Workshop Convened by the RANZCO International Development Committee, in collaboration with the Australian and New Zealand Society of Ophthalmic Plastic Surgeons (ANZSOPS). On Friday 27 October 2017, Perth (Directly preceding the RANZCO 49th Annual Scientific Congress). Oculoplastics has a diversity of disease manifestations, treatments and treatment variations. The workshop will allow for interactive discussions and presentations exploring contextual differences in limited and better resourced settings, as well as relevant teaching methods. 30 Annual Scientific Congress
Help shape Congress App The Congress app allows you to access details about speakers, the RANZCO program and the industry exhibition from the palm of your hand. You can find speakers and sessions related to your specific area of interest, create Congress 2017 a personalised schedule of your Congress sessions, take notes and view detailed maps of where events are taking place. The app will be available Get involved by submitting closer to Congress. your Papers, Posters, Films Keep up to date! and Audits now! Ensure you keep up to date with all the exciting developments as Congress draws closer by visiting the Congress website: www.ranzco2017.com Visit www.ranzco2017.com to make your submission Key Dates Closing date 3 July 2017 Paper/Poster/Film/Audits Submission Deadline: 3 July 2017 Early Bird Registration Closes: 6 September 2017 Late Rate Registration Commences (Fellows Only): 3 October 2017
Contact
PAPERS POSTERS For more information, contact the Congress organisers: Think Business Events Level 1, 299 Elizabeth Street Sydney NSW 2000 AUSTRALIA Tel: +61 2 8251 0045 Fax: +61 2 8251 0097 FILMS AUDIT Email: [email protected]
Senior & Retired Fellows
Monday 30 October 2017 Dinner7pm to 10pm The Terrace Hotel Perth 237 St Georges Terrace Perth
Please register online for this event www.ranzco2017.com Eye2Eye Winter 2017 31
RANZCO2017 going GREEN in Perth This year the RANZCO Congress will be going green to help reduce wastage and shrink our environmental footprint with a range of initiatives.
No more clunky Recycle and Hydration EarthCheck collateral reuse We’ll be doing away with At the end of your time PCEC will have numerous In May 2008, PCEC the Congress satchel at Congress, please look water stations around was proud to receive and program handbook. for the lanyard recycling the venue and RANZCO EarthCheck Benchmarking At the end of each stations and drop off your is hoping that reusable in recognition of the Congress, staff usually lanyard to be recycled or water bottles will be Centre’s commitment collect and then dispose reused. provided by a sponsor. to the environment. of numerous satchels RANZCO and the Perth If you already have a EarthCheck is recognised and program handbooks, Conference and Exhibition reusable water bottle, as the world’s largest many of which cannot Centre (PCEC) will be please bring it along and environmental be repurposed due to working with OzHarvest avoid the wastage of small benchmarking, sponsor branding. This to manage any excess plastic cups. certification and year, reusable cotton tote food from the meal breaks management solution bags and photocopies of at Congress. OzHarvest is designed specifically for the program book can be the first perishable food sustainable travel and requested at the time of rescue organisation in tourism businesses to registration. Australia. They collect validate their carbon quality excess food and claims and guide their deliver it, direct and free sustainability initiatives. of charge, to more than 900 charities.
Younger Fellows
Monday 30 October 2017 Dinner7pm to 10pm The Public House 263 Adelaide Terrace Perth
Please register online for this event www.ranzco2017.com 32 Annual Scientific Congress
The 2016 RANZCO Practice Managers’ Conference session panel discussion with RANZCO Fellows RANZCO Practice Managers’ Conference 2017
The 12th Annual RANZCO The organising committee is the conference. These points will Practice Managers’ working on a program aimed to give be allocated on completion of the an invaluable platform for interesting Conference will be held conference and will need to be applied and stimulating discussions, covering for on an individual basis with proof on 28 – 30 October 2017 important topics and hot issues with of attendance. An electronic letter at the Perth Convention a comprehensive, in-depth update of attendance will be provided by and Exhibition Centre, and exchange of research-based RANZCO after the conference. CPD offering a unique forum for knowledge. points are not automatically added A social program that includes the to the Practice Manager’s AAPM all stakeholders to learn highly anticipated conference dinner membership profile; members will from each other’s practice, on Monday night (30 October) will need to use the self-service area of allow participants to catch up with exchange experience and the website and add them manually. establish personal contacts. friends and colleagues and enjoy the fabulous fusion of flavours and Further details can be found on the The success of last year’s cultures that Perth has to offer. AAPM website – aapm.org.au conference held in Melbourne For this year, delegates have a Please visit the Practice Managers’ holds promise that taking choice to register for the full three-day Conference page of the RANZCO part in the forthcoming conference or a one-day pass valid for Congress 2017 website (www.ranzco2017.com) for updates conference will provide an any day of the conference. Once again, Australian Association and detailed information, including excellent opportunity for a of Practice Management (AAPM) the program, conference registration, repeat of this success. CPD points have been allocated to accommodation and travel. INTERNATIONAL FRI 7 – SUN 9 CONVENTION JULY 2017 CENTRE SYDNEY A BRAND NEW PERSPECTIVE
VISIONSUMMIT MASTERCLASSES DESIGNJUNCTION Hear from the biggest line 3 days of expert advice on Showcase of premium up of world class leaders. practical dispensing to international & Australian Earn CPD Points. improve your business. eyewear brands. Earn CPD Points.
REGISTER NOW: ODMA2017.COM.AU 34 Indigenous Eye Health
Indigenous Eye Health
Close the Gap for Vision by 2020 National Conference 2017 delegates The gap for vision in Indigenous eye health is on track to be closed by 2020
Over 120 participants The conference was hosted by Indigenous Australians compared to from across Australia Professor Hugh Taylor and the non-Indigenous Australians, pointing Indigenous Eye Health team at the to more work needing to be done attended the Close the University of Melbourne and was over the next four years,” Professor Gap for Vision by 2020 supported by Roadmap to Close the Taylor said. National Conference 2017 Gap for Vision partners including The Roadmap to Close the Gap in Melbourne to discuss RANZCO, Optometry Australia, Vision for Vision (the Roadmap) is a Indigenous eye care. 2020 Australia and the National whole-of-system, evidence-based Aboriginal Community Controlled framework with 42 interlocking The conference, which Health Organisation. recommendations to improve coincided with National Professor Taylor told Eye2Eye Indigenous eye health. Of the 42 Close the Gap Day on 16 “The conference showcased a Roadmap recommendations, 11 March, helped identify key remarkable representation of the are fully implemented and work is Indigenous health and eye care progressing on the remaining 31 areas for action. These sector initiatives and achievements recommendations. Over 18 regions, included the funding and over the past few years and covering more than 40% of Australia’s development of sustainable highlighted the remaining Indigenous population in urban, eye care system reforms, challenges. regional and remote areas, are currently data collection, sharing “We know very good progress implementing Roadmap regional is being made in Aboriginal eye approaches. and analysis, engagement health as evidenced by the recently RANZCO members played a key with jurisdictional published National Eye Health role at the conference and provided health departments, and Survey where blindness rates have valuable input and experiences that geographically spreading halved, going from six times higher informed proceedings. Dr Rowan in Indigenous than non-Indigenous Porter highlighted the success of improved eye care outcomes Australians to three times higher. the Indigenous Diabetes Eyes and across the whole of the “However, vision loss has remained Screening (IDEAS) van in diabetic country. three times more common for retinopathy screening and treatment. Eye2Eye Winter 2017 35
An important element in improving screening rates has been the provision of non-mydriatic cameras for use in 20 Aboriginal Medical Services around Queensland. Dr Tim Henderson, from Alice Springs, talked about the challenges faced in delivering eye care in Central Australia and the need for more ophthalmology support and resources. Recruitment of more ophthalmologists to work in rural and remote regions is paramount to meet the demand of cataract surgery for Indigenous patients. Even then, regions with a good ophthalmology workforce face their own challenges. The wait time for surgery of an Indigenous patient is Interview between Drs Ben Clark (left) and Tim Henderson usually longer when compared to a non-Indigenous patient in all states and territories of Australia. Dr Ben Clark, an ophthalmologist from Barwon Health, Geelong, Victoria is working The Complete Package to improve local cataract surgery pathways for Indigenous patients. The proposal is to run a fast-track THE COMPLETE VIEW cataract clinic, initially once per Capturing 200° of the retina, in a single non-contact image month, with the option to run more frequent sessions, if required. This would ensure that surgery is received in a timely manner. Dr Clark said “I thought the conference presented a great opportunity to network and meet 3 variants now available with people in the sector. In terms of rg / af rg / af / fa rg / af / fa / icg the fast-track clinic at Barwon Health, it is still a work in progress. However, Color Fundus I’m quite hopeful that it will be of additional benefit in improving Central Pole Fundus Indigenous eye health outcomes.” The conference confirmed the Red Free importance of ophthalmologists being involved in local and regional Choroid stakeholder groups, ensuring closer Fundus collaboration with communities Autofluorescence to reduce known barriers for care Fluorescein and championing systems reforms Angiography that better deliver equitable eye Indocyanine Green health outcomes. With less than Angiography four years left to close the gap for *Products each sold separately vision by 2020, ophthalmologists and RANZCO will play vital roles to ensure Contact Us the improvement of eye health T: 08 8444 6500 outcomes for Indigenous people. E: [email protected] Visit www.optos.com to find out more! Indigenous Eye Health, © 2016 optos. All rights reserved. Optos® , optos® and optomap® are registered trademarks of optos plc. P/N GA-00281 AU / 1 The University of Melbourne 36 Policy and Advocacy Matters
Policy and Advocacy Matters Transient Ischaemic Attacks: when urgent referral is required TIATRANSIENT ISCHAEMIC ATTACKS Transient Ischaemic Attacks (TIAs) are warnings (TIA) AND THE EYE of possible serious problems, therefore URGENT investigations and review by a stroke physician are You have been given an urgent referral needed. Patients experiencing ocular TIA, such for suspected TIA. as amaurosis fugax, are at increased risk of a It is CRITICAL that you follow up cerebrovascular accident. In these circumstances, your referral and timely medical assessment is indicated. medication. A patient information sheet on TIA is available for download from the RANZCO website. The information can be printed as a colour A4-size, double sided handout and made available in clinics/ Please see more details about practices for patients suspected of having had a TIA to advise them TIA on the otherside of this brochure of the seriousness of the situation. For more information about the TIA patient information leaflet, please contact [email protected]. TIA Patient Flyer
OUT NOW! RANZCO 2017 WORKFORCE WORKFORCE SURVEY SURVEY Did you know? While 80% of RANZCO practicing Fellows are based in major urban centres, over 40% have indicated practicing in regional, rural, or remote areas in some capacity. (2014 RANZCO Workforce Survey) The RANZCO Workforce Survey plays a key role in helping the College plan its ongoing activities to support the Fellowship. Given the fast changing medical and policy landscape, knowing where we stand helps us chart a course to where we wish to be. If you have not received your unique link to the survey yet, please contact [email protected] Eye2Eye Winter 2017 37
International Development
Dr Dalin Piseth Chea with her family Pushing the boundaries
Cambodian ophthalmologist coursework. With strong commitment Q Tell us a little bit about yourself Dr Dalin Piseth Chea recently to do research about eye banking in my – your work, your professional second year, I met the required score graduated with a Master responsibilities, etc. for all the core courses in the first year in Public Health from the A I am an ophthalmologist in an eye to go for the 24-unit thesis pathway in University of Adelaide. unit at Calmette Hospital, Cambodia. the second year. The first-year program In addition to every day clinical work, was very comprehensive and covered Supported by the Australia an introduction to epidemiology, my colleagues and I are actively biostatistics, health economics, Awards Scholarship from the participating in community outreach qualitative research, Indigenous Australian Department of activities organised by the hospital. I am health and health policy. The program currently working on two projects. The Foreign Affairs and Trade, focuses on empowering students to first project concerns transformation Dr Chea is the first graduate of think creatively about the policies of the currently resource-limited unit the Cambodian Ophthalmology and practices that prevent disease, to a comprehensive ophthalmology prolong life and make a difference to Residency Training Program to department in our five-year action people’s health. While the core courses obtain a postgraduate degree plan. This department will also become from the first year have brought broad a qualified ophthalmology training overseas. In this interview, knowledge on core subjects in the field centre in Cambodia. Another project of public health, the second year of this Dr Chea speaks of the positive is the establishment of the first eye degree was mainly about researching outcomes from her studies bank of Cambodia and the first cornea eye banking in low resource settings, in Australia, notwithstanding surgical training program in Cambodia. which was significantly practical for my project planning in Cambodia upon my Tell us about your Master in some of the challenges, Q graduation. including leaving her eight- Public Health – how did it all come about, how long was it for, what was Q Why public health? month old baby behind in order the focus, etc.? to be, what she calls, “a highly A Since we are lacking human A The Master of Public Health at the resources in the field of public health, committed human resource for University of Adelaide was a two- particularly in the eye care setting, the country”. year, full time master’s program by eye care program planning is not 38 International Development
well established and connected with personality trait of being silent about the major project of the two projects clinical practice, especially in each eye personal issues, I finally had an open I am currently working on. We are unit. Thus, while I was looking for an discussion with my course coordinator seeking support from international opportunity to have a clinical exposure and supervisor about issues arising stakeholders and local stakeholders in cornea subspecialty in Australia, in the last semester, which hugely to make this project take off from I chose this degree to pursue and changed the situation and eventually a very new experience toward a acquire knowledge that can contribute helped me graduate with very good self-sustained eye banking and eye further to the eye care sector in results. I would say being able to donation program in Cambodia. Cambodia. Plus, the Master in Public maintain good physical and mental Health has research components that health while studying abroad is the Q What has changed since I was able to learn and apply to help most important element to manage all returning to Cambodia? How has develop research programs for the kinds of situations. Also, to overcome your master’s influenced your work? Cambodian Ophthalmology Residency the challenges arising unexpectedly, A Although I have not extended Training Program. seeking support systems is very my work further than the eye unit at beneficial. Calmette Hospital, the eye banking What were some of the Q project which is planned to be under challenges of doing a postgraduate Did you have mentors to assist Q the National Program for Eye Health degree overseas and how did you you? is a very good application of what overcome them? A I had a very helpful and supportive I have gained from my master’s. In A Leaving my family behind, mentor in A/Prof Craig Lockwood who addition to policy planning that especially my eight-month old was my supervisor on my master’s the Master in Public Health has daughter, to pursue this study was research thesis. I have learnt a lot from taught me, the research in eye the hardest decision I ever made. It him as well as from other colleagues banking in a low resource setting was about balancing between being in the research institute, the Joanna reflects many practical situations a responsible person for a family and Briggs Institute, at the University of that I can apply in the Cambodian being a highly committed human Adelaide. Systematic reviews and setting. Another aspect of this resource for the country. I did not scoping reviews conducted by the project is the process of the program have many challenges in regards institute are very good evidence based planning and implementation. A few to a culture shock since I am a well- practice research methodologies that ophthalmologists and residents who adapted person. However, other I have learned and will surely apply have been in contact in regards to personal issues became unexplainable to my work place. In addition, I had a working on this eye banking project in a new environment where I was clinical mentor, A/Professor Richard are interested in working together as alone and could not feel comfortable Mills, who is a corneal surgeon at a team and a local committee of the sharing any personal stories. In Flinders Medical Centre. Apart from project. This is a new working culture addition, being an international the methodology, his mentoring is which has not been adopted by my student whose background was important for the technical content of colleagues in the field. Thus, provided from a developing country where the research. that this way of working and planning basic knowledge acquired from as a group is significant in enhancing Tell us more about your thesis undergraduate studies was below Q one’s potential for different tasks, I ‘Eye banking in developing countries’ the standard compared to Australians, am encouraging my colleagues and and your plans to establish an eye everything was new and tough for our junior ophthalmologists to work bank in Cambodia. me. Plus, the new education system in this way rather than focusing only and language barriers were inevitable A The full title of my research thesis on one particular interest individually. challenges. The last semester was is “National and operational policy and As a result, we will be able to make the most difficult time. Having a planning requirement to establish an more changes toward efficient and two-year old daughter to take care eye bank in a low resource setting: a effective policy planning and program of in my second academic year and scoping review”. This scoping review implementation. having to meet all requirements to provides insight into the nature and Q What advice would you give complete a 24-unit thesis plus other direction of existing evidence from to junior residents in Cambodia family responsibilities, time and task research papers. For a policy maker considering studying abroad? management needed to be arranged who is interested in starting up an very carefully. Balancing what I could eye bank and corneal transplantation A As an old saying goes “Learning manage to do and what I must do was service in a low resource setting, the is an unstoppable journey”. Studying a challenging situation, and it was a mapped literature from this study abroad is an adventure. The more we more struggling situation compared serves as a tool for framing the take the journey the more we want to being a single student doing a planning and development of policy something more adventurous and postgraduate degree overseas. I would positions contextualised by resource the more we feel excited about it. not have achieved this degree without availability for a feasible, functional Continuing education helps to change the great support, encouragement and sustainable eye banking and our current situation and shape our and advice from my family, the student eye donation program. Gaining a profession to something beyond support system at the university, lot of experience and knowledge the repetitive routines. Without friends and senior ophthalmologists about eye banking from this research pursuing the Master in Public Health in Adelaide. Having overcome my outcome, to establish an eye bank is and conducting the research in eye Eye2Eye Winter 2017 39
banking, I would be stuck in the and work on any project for both a society with a better livelihood in same way of learning and working study and career pathway. return. There is only one step to make as I was upon becoming a certified this a possibility; it is to believe that ophthalmologist. I would not know as Q What about those who may be more reluctant to move out of their we can do it and we will work hard to much about the global eye banking comfort zone – what advice would achieve it. I find my comfort zone can situation, and how to start this project you give to them? be anywhere when I learn to adjust in Cambodia. Without getting out of to many different situations and train my comfort zone, I would not have A Getting out of our comfort zone is myself to be more proactive and met the many experts and highly a frustrating decision, especially when creative toward a positive and friendly experienced surgeons and researchers we have a currently stable career life, whose knowledge and experiences a lot of family responsibilities and an environment. My journey is not always cannot be strictly found in books. unpromising situation upon returning. smooth, and I fail a lot of times, yet I Networking is the most important However, I believe that a strong still keep going and remind myself to resource-seeking strategy that needs commitment to a better change will reassess my capacity and limitations, to be carried along when we start out eventually provide our family and so I know well what I can achieve.
RANZCO extends an invitation International to ophthalmologists from Asia Pacific to apply for the Scholarship opportunity to participate in the Ophthalmic plastic surgery and teaching methods in low Program resource settings International Development Workshop to be held on Friday 27 October 2017, and attend the RANZCO Annual Scientific Congress (28 October – 1 November 2017) in Perth, Australia. To be eligible for a scholarship you will be an ophthalmologist from a developing country and have an active interest or expertise in oculoplastics. Scholarship recipients are expected to present on a relevant topic at the International Development Workshop on 27 October, attend Congress scientific sessions relevant to their interest, engage with Congress attendees, and be open to shared learning. Applications are to be submitted through the International Scholarship Application 2017 Form available on the RANZCO website. 40 Feature Article Eye2Eye Winter 2017 41
The road less travelled: practicing ophthalmology in a rural setting Ophthalmology is a fulfilling career that can take you down many paths. From treating patients in a clinical setting, working as an academic at a university or research institute to providing eye health services to rural and remote communities, the opportunities to make a positive impact are countless and extend beyond borders, cultures and locations. In this issue of Eye2Eye, we speak to five RANZCO Fellows involved in outreach work who recount the many rewards, and unique and memorable aspects, that come with providing ophthalmic services in rural and remote areas of Australia and New Zealand.
Gantheaume Point, Broome, Western Australia 42 Feature Article
Western NSW Dr Ashish Agar Dr Ashish Agar has been providing ophthalmology services in Far West NSW as part of his work with the Outback Eye Service (OES), based at the Prince of Wales Hospital (POWH), for almost 20 years. He is also Director of the Ophthalmology Service at Broken Hill Hospital and Chair the RANZCO Indigenous Committee. “At POWH we have a great legacy left by Prof Fred Hollows, who started his pioneering outreach work here decades ago,” explains Dr Agar. “Under Fred’s successor, Prof Minas Coroneo, the OES has grown and been integrated into the academic university department of ophthalmology, and thus our RANZCO accredited registrar training program.” The POWH training program requires all registrars to spend at least six months working with the OES and with the Royal Flying Doctor Service clinics as well as a rotation living in Broken Hill. Sunset over Broken Hill “It was really a great experience as While the range of ophthalmic budget. They are the backbone of a registrar, way back at the turn of the conditions one comes across in every visit by me or one of my 15 millennium,” recalls Dr Agar, “and I am regional NSW may not differ greatly specialist colleagues on rotation, along fortunate to be able to continue this with our RANZCO accredited registrar work now as a consultant, serving from metropolitan sites, the main these unique communities and difference lies in the remoteness of the from POWH. An optometry team, also training the next generation.” settings. based in Sydney, has been affiliated The OES serves almost two thirds “Our workday depends on where with the OES for over 15 years now, of NSW, from Dubbo to Broken Hill we are,” explains Dr Agar. “Broken Hill and is an integral part of the service to Lightning Ridge, and just about visits cover three days and we use as there are no local practitioners everywhere in between. It covers commercial regional airlines. The other in most locations. Locally we do 600,000 km² and serves a population OES sites, such as Bourke, are only have Aboriginal health workers and of 125,000, providing the only accessible via the Royal Flying Doctor nurses who join us, and of course we specialist ophthalmology service to Service. So, it’s an early morning drive work very closely with local GPs. The almost the entire area. Importantly, to Sydney’s civil aviation airport in relationship amongst these disparate this region is home to the highest Bankstown and a two-hour flight in groups is really quite good, as we proportion of Indigenous residents to work. We usually stay a night and complement each other and have a in NSW, as well as some of the most return to Bankstown the next day in clear common goal.” socio-economically disadvantaged time to get home for dinner. It’s the And the best part of regional work? communities in Australia. best commute ever!” “Without a doubt it's the patients,” says “It’s quite simply an honour serving Working in remote areas also Dr Agar. “Bush folks are, like country these remote communities,” says means greater reliance on colleagues folks everywhere I suppose, a different Dr Agar. “My work is certainly cut and other health professionals. mob. Genuine, forthright and forever out for me as the only glaucoma “Collaborative care is just a fact of flexible and accommodating, in even subspecialist in the OES. The general life out here. We can’t exactly refer to the most trying of circumstances. ophthalmic pathology though is fairly a subspecialist colleague down the Not to mention fun! The waiting standard, with cataracts being the road, so one’s general ophthalmology room is usually the source of much main surgical procedure. Age-related training is constantly being tested,” laughter, and this more often than macular degeneration is increasing says Dr Agar. not carries on to the consultation but the rise of diabetic retinopathy, “Our team is amazing. The OES chair or operating table. Our patients especially in the Indigenous consists of a core group of only three there are also very grateful for the community, is the most worrying,” full time staff who defy all the odds OES’s commitment and therefore very explains Dr Agar. and keep us running on a shoestring supportive.” Eye2Eye Winter 2017 43
While faced with particular fellowship as there is a huge burden Dr Mehta believes that working with challenges, Dr Agar says that remote of diabetic eye disease in rural and rural patients can be very rewarding and Indigenous work offers unique Indigenous communities, plenty and satisfying and allows for a sense of and memorable flavours of of cataracts and a good number of ‘giving back’ to the community. ophthalmology. paediatric cases. It has also been “We are so fortunate in “Being away from home is never great for pushing my comfort zones ophthalmology to be able to make an easy, but one trip every six to eight surgically - operating on a dense improvement to a person’s quality of weeks is not too onerous and, after traumatic cataract in Derby on an life and most patients, whether in the 17 years, we’re quite used to it now! Indigenous patient who doesn’t want city or the country, are very grateful for Working out of your comfort zone is to leave town and where the nearest the service we provide. Rural patients a chance to get a better perspective vitreoretinal surgeon is in Perth, are great to work with; they are quite on things, and of course being able presents itself with a different set of easy going, have a good sense of to give back to some of our most challenges,” explains Dr Mehta. humour and love to have a good chat.” disadvantaged Australians is always But it is these very challenges that In addition to a supportive and rewarding,” says Dr Agar. often lead to great initiatives. “In 2016, grateful community, there are many “Few areas of our clinical lives are so the Lions Outback Vision mobile wonderful aspects that come with rewarding, and I think trainees realise outreach truck, the Lions Outback working in Australia’s remote regions. this once they have the chance to Vision Van, came into operation. The “The opportunity to travel, camp experience it. This may also be their Van does two circuits around WA a and see outback Australia is a definite only exposure to Indigenous health, year, visiting 16 centres at least twice perk of this job,” says Dr Mehta. “I’ve which is such a crucial area for all of us throughout the year. been lucky enough to see some to be engaged in, and will increasingly “The Vision Van is basically a fully beautiful and remote parts of WA and become a necessary part of vocational equipped clinic on wheels with travel with a fantastic team.” training.” facilities for biometry, corneal “The sunsets at Gantheaume Point topography, OCT, visual fields, or Cable Beach in Broome are always Western Australia wide-field angiography, laser and a spectacular. We’ve also been fortunate Dr Rhuju Mehta treatment room for injections and enough to go camping at Millstream- minor procedures. This wonderful Chichester National Park which has Dr Rhuju Mehta is currently initiative allows us to bring city some beautiful gorges and swimming undertaking a fellowship with holes.” Lions Outback Vision in Perth. The facilities to country patients. Operating fellowship involves outpatient-based happens at the local hospitals with Whangarei, New Zealand usually 10-12 cases a day,” explains Dr and surgical outreach trips to rural Dr Brian Kent-Smith and remote parts of Western Australia Mehta. as well as working with Indigenous “I am also involved in telehealth Dr Brian Kent-Smith, the newly patients. and do consults via Skype with elected Chair of the RANZCO “I’m based at the Lions Eye Institute country patients who are seeing their New Zealand Branch, is a general in Perth and travel to different towns optometrists or GPs. In addition, I ophthalmologist in Northland, New in the region. Having grown up in teach the Rural Clinical School medical Zealand working in both public a small town in the Pilbara, I feel students at the various centres.” and private practice. He is based in quite at home in rural WA and enjoy While the clinical workload, such as Northland’s largest town, Whangarei, the atmosphere, pace of life and diabetic eye disease and cataracts, is but does clinics in some of the smaller environment it offers,” says Dr Mehta. similar to what one would be exposed centres too. “I travel every alternate week to a to in a metropolitan setting, working Northland is a long, thin province at rural town for five days. The trips can in regional sites calls for greater the top of New Zealand’s North Island be to towns as small as Leonora, with reliance on other health professionals. with a population of approximately a population of just over 1000, or to “We have a co-dependant 160,000. Whangarei is Northland’s larger centres like Broome. Most of relationship with local optometrists largest town, with a population of the trips I go on are surgical trips so and GPs, we rely on them for around 77,000 people. Despite being we have three days of clinics and two our referral base and to organise only 170km from Auckland, as the full days of operating.” telehealth follow-ups or initial crow (or rather, as the plane) flies, Dr Mehta became interested in consultations. We also organise Whangarei and the surrounding areas regional work during her first year of education sessions with GPs, nurses are a world away from New Zealand’s training in Melbourne after hearing and optometrists,” explains Dr Mehta. biggest city. Half of Northlands’ land A/Prof Angus Turner speak of his “We also work closely with Aboriginal is given over to forestry and farming, outreach work. liaison officers who play a key role in with agriculture one of the major “I was seeking a fellowship ensuring patients attend clinic and foundations of the economy. experience that would be challenging theatre. On our surgical trips, the The rolling countryside is and allow me to work in a different local hospital and theatre staff have complemented well by the countless environment to what I was used to always been very welcoming and beautiful beaches that attract visitors in Melbourne. It is a fantastic general accommodating.” and underpin the growing tourism 44 Feature Article
sector, as well as a strong fishing industry. Dr Kent-Smith enjoys the lifestyle that he and his family have here, having joined the community two decades ago. “I did my training in South Africa but decided to move my family to Whangarei 20 years ago and haven’t regretted it for a minute,” says Dr Kent-Smith. “I particularly love the ocean – fishing, diving, kayaking and swimming. It’s a wonderful lifestyle and my family love it here.” “I love working in Northland. We see a wide range of ophthalmic conditions over a broad age spectrum which keeps the day interesting,” explains Dr Kent-Smith. But just like outreach work in Australia, working in non-metropolitan New Zealand comes with its challenges. “Some of our smaller towns are a long distance from Whangarei and it is not possible to fully equip every centre. Some patients have to travel long distances to the hospital but minor procedures can be performed in some of the smaller centres,” says Dr Kent-Smith. “But being away from large cities, having a degree of autonomy and having easy access to beautiful beaches are some of the things I enjoy most about Whangarei.” Whangarei, New Zealand Top End, Northern need to fly to most places on charter in rural areas leads to greater Territory planes so it’s definitely a different professional development for those Dr Tharmalingam experience to working in a big city,” starting out in ophthalmology and Mahendrarajah says Dr Mahendra. medicine in general. Dr Tharmalingam Mahendrarajah or Dr Mahendra notes that while “We see a variety of pathologies Dr Mahendra, as most would call him, working in remote areas can be in Darwin so trainees can gain a began his ophthalmology career as difficult at times, the experience is wealth of experience and there are a registrar in Darwin and now works unique and offers many benefits, many opportunities to develop their as the head of the ophthalmology especially for those keen to experience skills further. We get lots of visiting department at the Royal Darwin something different. specialists here and we do have Hospital. Due to a shortage of “Something that stands out in rural many subspecialty treatments in specialists in the region, he was one areas is the friendly environment and Darwin - giving trainees some great of the only ophthalmic surgeons in the laidback lifestyle. In a rural setting, opportunities to work with skilled Top End for a number of years, while you are exposed to many different professionals from all over Australia,” also supporting both the Royal Darwin cultures and you get to engage with adds Dr Mahendra. Hospital and Darwin Private Hospital. different communities. Since you’re However, Dr Mahendra stresses “I live in the northern suburbs of dealing with all aspects of general that it is important for those starting Darwin, in Top End, which stretches ophthalmology, you’re also dealing out in rural medicine to be prepared across 400,000 km² and our with all kinds of patients whereas in to overcome some of the challenges ophthalmology department works metropolitan areas there are more that come with working in remote across Darwin, Katherine, Gove and subspecialities and you may not have communities – cultural differences, 33 other Indigenous community as much exposure to such a variety of meeting patient demands and the lack clinics so we have quite a bit of patients,” explains Dr Mahendra. of appropriate equipment. ground to cover. Because of the vast Dr Mahendra believes that the “It’s great to work with different distances between communities, we diversity of eye conditions in patients communities and gain a better Eye2Eye Winter 2017 45
understanding of different cultures and a team effort, involving the I have formed with many of the but it is important to be culturally broader health care community. patients, most of whom can still see sensitive when you’re working with “On most trips the passengers very well! I also value and enjoy the different communities. They may consist of the complete eye support and companionship of the have different values/beliefs to you care team – myself, a registrar, an OES team.” and some may even refuse surgery or orthoptist, an optometrist and a Dr Hennessy encourages trainees medication.” dispenser. When we land in Lightning to take part in outreach programs Ridge, the rural service coordinator, What he enjoys most about his to experience the many advantages outreach work is the work-life balance who lives near Dubbo, meets us of working in rural and remote that it offers – there are many things to at around 9.15am. On the ground, communities, both professional and do and see in Darwin with its tropical the local community health centre personal. weather, rich Indigenous culture, provides the examination rooms to tourist attractions and stunning treat patients and clerical staff to “POWH trainees are required to landscapes. handle patient check-ins.” participate in the POWH rural activities “The wild life is spectacular and While Dr Hennessy acknowledges – six months working (and living) in you can enjoy the true outdoors. that there are many challenges visiting Broken Hill, six months travelling to What I enjoy the most are my ophthalmologists face when working remote NSW clinics at least once per afternoon walks on the beach; the in remote areas, such as logistics, week. It is regarded as a valued and sunsets are breathtaking! I also like equipment maintenance and funding desirable element of their training, to go down to the weekly Sunday issues, the rewards are well worthwhile they all embrace the opportunity with markets, where you can buy some and include the fulfilment that comes enthusiasm, and, usually, continue fresh produce from farmers and try with providing eye health care services in a role with the OES once they are to disadvantaged communities and international cuisine.” qualified and return from overseas building longstanding relationships fellowships,” says Dr Hennesey. Lightning Ridge, NSW with local patients. “You cannot overlook the firsthand Dr Michael Hennessy “The logistics of maintaining a service outside usual private experience you gain providing eye Dr Michael Hennessy started his practice/public hospital eye health care for people who may work in Lightning Ridge, NSW as part clinic arrangements can be very face significant barriers in accessing of his ophthalmology training at the challenging,” explains Dr Hennessy. specialist services because of where Prince of Wales Hospital (POWH). “Overall, I enjoy having a busy clinical they are located geographically. You He now splits his time working in day that is out of the ordinary, and also get to travel to less populous remote areas with the Outback Eye value the longstanding relationships areas of our wonderful country.” Service (OES), his role as a Senior Staff Specialist Ophthalmologist at POWH and Conjoint Associate Professor at the University of NSW, as well as running a part-time practice in Bondi, Sydney. “In 1995, I was asked to restart the clinic in Lightning Ridge which now involves running six fly-in, fly-out, one-day clinics per year,” explains Dr Hennessy. “These clinics are general ophthalmology clinics, with local Indigenous patients accessing services, often with support from their local Aboriginal Medical Services eye health worker. “My typical Lightning Ridge visits start by arriving early in the morning at Bankstown Airport, Sydney to board the Royal Flying Doctors plane by 6:45am (usually a Beechcraft KingAir, which is a pressurised twin turboprop that carries one pilot and ten passengers plus a lot of portable gear!)” Visits to rural and remote communities, such as Lightning Ridge, require extensive planning The Royal Flying Doctors aircraft landing in Lightning Ridge 46 Branch Musings
Branch Musings
Drs Luke Northey, Nisha Sachdev and Di Semmonds promoting ophthalmology at the AMA & ASMOF Medical Careers Expo New South Wales The delegates shared the efforts Agency for Clinical Innovation, is and dream of Dr Michael Giblin, being reviewed and a response is Chair who organised the co-hosted ISOO being formulated. A/Prof Andrew Chang meeting, making it one of the most The Australian Medical Association Vice Chairperson successful ISOO meetings ever. (NSW) and the Australian Salaried Dr Robert Griffits As convenor of the RANZCO NSW Medical Officers Federation (NSW) Hon Secretary section, Dr Gina Kourt compiled a hosted their Medical Careers Expo Dr Daya Sharma most informative scientific program. in May 2017. It was well attended by Hon Treasurer Fellows and trainees had the students from all medical schools. Dr Christine Younan opportunity to learn from stellar The participation of the NSW Country Vice Chairperson international experts as well as local Branch at the Expo continues to be Dr Neale Mulligan luminaries in the important subjects successful in raising the profile of of oncology and oculoplastic ophthalmology with many students The 2017 RANZCO NSW surgery. Enthralling international requesting further experience in this Annual Scientific Meeting speakers included Drs Carol and profession. was successfully held on Jerry Shields, Prof Bertil Damato, Drs Diana Semmonds, Nisha Dr Ralph Eagle and Prof Hans Sachdev, Daya Sharma and 24-25 March in conjunction Grossniklaus. vocational trainee Luke Northey with the International Society An educational symposium for were NSW Branch Committee of Ocular Oncology (ISOO). general practitioners was held on members in attendance to answer The theme of the meeting the Saturday afternoon. queries from medical students The RANZCO NSW Branch was Ocular Oncology and regarding the ophthalmology Committee are working on the issues training program and a career as an Oculoplastic Surgery. Over of diabetic screening, upskilling ophthalmologist. Dr Sachdev provided 400 delegates attended of general practitioners and an invited presentation on life as an the meetings at the new modernising the Terms of Reference ophthalmologist. of RANZCO Branches. Cataract International Convention Surgery Utilisation Benchmarking A/Prof Andrew Chang Centre at Darling Harbour. in NSW hospitals, released by the Chair, RANZCO NSW Branch Eye2Eye Winter 2017 47
Western Australia support by committing funds for their with the University Udayana, Bali, signed ongoing educational activities such as a memorandum of understanding with Chair the two OSCE practice sessions each the Centre of Ophthalmology and Visual Dr Nigel Morlet year. We are also planning an annual Sciences, University of Western Australia. Hon Secretary Branch Dinner to thank those Fellows As a result, the WA Branch extended Dr David De La Hunty actively involved in training and to an open invitation to PERDAMI Bali Hon Treasurer congratulate those registrars successful ophthalmologists to attend any of our Dr Tom Cunneen in their College exams. local meetings as guests, and we were The Branch’s continuing education visited by Drs Mas and Hani for the The Western Australian program is now fully evolved into the meeting in March. We hope this unique health services structure new format: at the end of February/ relationship with Bali ophthalmology continues to evolve with the early March, we have the Inter-Hospitals will flourish over the coming years. former Southern Health Meeting which is hosted by one of the One of the most successful teaching hospitals each year and held at philanthropic enterprises in Australian Service now split into two. the Perkins Institute as a day-long Grand ophthalmology comes from the Royal Perth Hospital, which Rounds style format. It concentrates on efforts of a dedicated band of Perth houses our largest public eye the interface between ophthalmology ophthalmologists who had the foresight clinic, has become the hub for and the rest of medicine; the two-day to set up a not-for-profit ophthalmic WA Branch meeting, which has day surgery, now known as the Perth the new Eastern Area Health international and interstate invited Eye Hospital, which recently celebrated Service. guests discussing ophthalmic topics 30 years as the premier stand-alone eye The Southern Area Heath Service of interest, held in mid-May; and the surgery facility in the state. Funds from now has the Fiona Stanley Hospital Pathology – Imaging Meeting held in ongoing operations are distributed by as the hub, but without consultant late September or early October, which the charitable Eye Surgery Foundation, ophthalmology services as they is another Grand Rounds style meeting owner of the Perth Eye Hospital, to many are still based at the downgraded at the Perkins looking specifically at ophthalmic causes and research efforts. Fremantle Hospital. The on-call across ophthalmic pathology and imaging Apart from providing AUD1,000,000 both areas is shared by all consultants topics and cases. Our recent General to Lions Eye Institute and long term as the Fiona Stanley work is currently Meeting in March voted to slightly support for the Bali Eye Project of the triaged to Royal Perth Hospital increase the local Branch fees which John Fawcett Foundation, the Eye because Fiona Stanley Hospital does now include the registration cost of the Surgery Foundation is now the major not have an after-hours service. As two-day Branch Meeting. funder of the Timorese ophthalmology the small unaccredited ‘clinic’ at The routine is different this year, training program. This is coordinated Fiona Stanley is principally staffed by however, as the RANZCO Congress is in by Drs Phil House and Ross Littlewood registrars, they are rotated for only Perth in early November. We hope to along with A/Prof Nitin Verma from one session from both hospitals so as hold the pathology imaging meeting as Hobart, and we are delighted that to not lose training time. Eventually a seminar within that program, and the a large contingent from the Timor we hope to have these awkward Branch Meeting has been put back to be program will have a fully funded visit to arrangements better resolved, but for a post-Congress satellite meeting to be Perth for the Congress in November. now the current arrangements just held at the Cultural Centre in Margaret Dr Jo Richards has produced a great suffice. River on Saturday 4 November. We collective audit for the Branch and We have expanded the training have an excellent contingent of local general College to participate in the program to 11 trainees with a new talent and a few guests discussing the topic of antibiotic use. Again, it will training post accredited at the Sir very latest in international ophthalmic follow the now well established quality Charles Gairdner Hospital. This is a result innovation resulting from their very cycle process, but this time, it will run of the appointment of more consultants own fine efforts. To follow we will enjoy over two years and involve a didactic and good availability of operating time a long degustation lunch at Leeuwin session at the RANZCO Congress. This at both Sir Charles Gairdner Hospital and Estate. is a great way to gain those elusive Osbourne Park Hospital facilitated by Early March we were treated to a great upper category continuing professional the fine efforts of the Department Head, day of lectures and cases around the education points, as well as to reflect on Dr Vignesh Raja. Located on the same topic of vascular disease at the Inter- your particular practice pattern in light campus as Sir Charles Gairdner Hospital, Hospitals Meeting convened by Drs Jane of the feedback about other colleagues’ the newly completed Children’s Hospital Khan and Fred Chen from Royal Perth patterns of practice and the didactics is still waiting to open; hopefully enough Hospital. The meeting was auspicious presented in the process. We hope theatre availability will be provided to as it provided tangible evidence of many in the Branch will participate keep all our current training posts in closer ties with our neighbouring again, as we had over two thirds doing paediatric ophthalmology. The Western country, Indonesia. Not so long ago so with the colour vision audit from Australia Branch executive recently RANZCO signed a memorandum of last year. endorsed the newly formed Western understanding with the Indonesian Australian Ophthalmic Registrars College of Ophthalmology. More Dr Nigel Morlet Society. We will provide them tangible recently, the PERDAMI Bali branch, along Chair, RANZCO WA Branch 48 Branch Musings
New Zealand from Ernst & Young to develop a to be congratulated on winning the modern model of care for age-related K.G. Howsam Medal for achieving the Chair macular degeneration. RANZCO has highest marks in the RANZCO final Dr Brian Kent-Smith had substantial input to this report examinations for 2016. Dr Lindsay Hon Secretary & Hon Treasurer via the Clinical Directors’ Forum in McGrath will undertake a fellowship Dr Andrea Vincent Wellington in April and at an eye in ocular oncology and oculoplastics RANZCO’s New Zealand health sector workshop the following later in the year. Dr Cameron McLintock week. The final report was due by Branch ran an advocacy will do a corneal fellowship at the end of May 2017, and RANZCO the Queen Victoria Hospital, East campaign in late 2016 urging is hopeful that it will lead to positive Grinstead. the New Zealand government long-term service change. The Queensland Branch Annual to act over the serious delays Ultimately the long-term Scientific Meeting Organising capacity issues in publically-funded to follow-up appointments Committee extends a warm ophthalmology services cannot invitation to all our interstate that had led to multiple be resolved unless more resource colleagues to this year’s scientific cases of preventable and is assigned to ensure hospital meeting to be held from 4 to 5 irreversible blindness. eye departments have sufficient August on the beautiful Gold administrative staff, allied health The Ministry of Health (MoH) Coast. This year's meeting will be and ophthalmologists, as well as a festival of all things retina. The responded on 23 December by up-to-date equipment, facilities announcing an allocation of NZD program includes topics covering and adequate drug funding. diabetic retinopathy, age-related 2 million to District Health Boards The RANZCO NZ Branch is (DHBs) in 2017 to develop and maculopathy, paediatric retinal pleased that adequate funding of disease, uveitis and Indigenous improve eye health services. RANZCO ophthalmology services is now firmly ocular health. welcomed this first step by the on the agenda of the DHBs and the International speakers include government to resolve the crisis and New Zealand MoH. The RANZCO NZ Dr Cathy Egan and Prof Adnan Tufail ensure that patients receive timely Branch will continue to work with and from Moorfields Eye Hospital Medical and essential care. monitor these agencies to ensure the Retinal Service and Prof Nicholas Jones A RANZCO NZ Branch Advisory needs of our patients are met. Group has been working with the from Manchester Eye Hospital Uveitis MoH as it allocates the funding to Dr Stephen Ng Service. Noted local speakers will further DHBs. The RANZCO NZ Branch will Former Chair, RANZCO NZ Branch enhance the program and include ensure that the funding is used to Prof Paul Mitchell, A/Prof Robyn adequately manage the follow-up Queensland Jamieson, A/Prof John Grigg, Dr Robyn crisis. Preliminary data from the DHBs Chair Troutbeck, A/Prof Andrew Chang, indicates that many have already Dr Russell Perrin Prof Mark Gillies and A/Prof Alex made significant progress in reducing Hon Secretary Hunyor. We hope this will be a great the backlog of patients waiting for Dr Mark Chiang opportunity to learn, catch up with old overdue follow-up appointments. friends and enjoy the warm Queensland Hon Treasurer Dealing with the overdue follow- winter sunshine. Dr Oben Candemir ups, while critical, is not enough. Eye Dr Russell Perrin health services need to undertake The RANZCO Queensland Chair, RANZCO Qld Branch initiatives to prevent the crisis Branch Committee is from recurring and to manage the continuing increase in demand as delighted to announce that the population ages. four Topham Scholarships Alongside the one-off funding, have been awarded this RANZCO the MoH has committed to a long year. Each scholarship is Queensland Branch term national program to support ophthalmology services. This for $15,000 and intended to Annual Scientific will include developing clinical encourage and assist final Meeting prioritisation tools, follow-up year registrars travelling 4-5 August 2017 management, new models of care overseas to undertake and workforce modelling. RANZCO Sheraton Grand Mirage further studies and broaden will sit on a newly-formed multi- Resort, Gold Coast disciplinary MoH panel to provide their knowledge. 71 Seaworld Dr on-going advice and strategy. Dr Brett Drury will undertake a Main Beach, QLD, Australia The RANZCO NZ Branch has glaucoma fellowship at Manchester C: Ty Fleming been instrumental in ensuring Royal Eye Hospital. Dr David Gunn P: +61 7 3851 4298 that the MoH has proceeded with will undertake a corneal fellowship commissioning an in-depth report at Bristol Eye Hospital. David is also Eye2Eye Winter 2017 49
Special Interest Groups
International Convention Centre in Darling Harbour, Sydney ISOO 2017/NSW RANZCO ASM Report
The combined International retinoblastoma, lymphoma and eyelid Very special thanks to Denise Broeren and Dani Palmieri from Think Society of Ocular Oncology and orbital tumours to those attending the RANZCO NSW Branch component Business Events who were the reason (ISOO) Biennial Conference of the combined conference, which ran why everything went off without a and the RANZCO NSW Branch from Friday 24 March to Saturday 25 hitch and why there were so many Annual Scientific Meeting, March. wonderful comments from delegates, some 150 locals and some 300 from which ran from 24 to 28 Dr Gina Kourt put together the most detailed and diverse program for the every corner of the world. March, in its entirety, was, RANZCO meeting, which included Thank you also to Dr Rana’a Al Jamal, simply put, the best ocular educational videos, amongst many an ISOO delegate currently based in oncology conference ever other highlights. We would like to London, who very kindly agreed to act as the conference photographer. held anywhere in the world thank Dr Rob McDonald for assembling a module within the conference for the to date. Drs Michael Giblin and Gina Kourt general practitioner. Convenors, ISOO 2017/NSW RANZCO The conference venue was the Another highlight was the combined ASM newly rebuilt International Convention session on what the ocular oncologist Centre in Darling Harbour, Sydney, can learn from our knowledge complete with a panoramic harbour of cutaneous melanoma. For this outlook. Aboriginal elder Uncle Chicka session, individuals who need to be Madden opened both the RANZCO acknowledged include those from NSW Branch Annual Scientific Meeting the Melanoma Institute of Australia. and the ISOO 2017 with his Welcome One of the invited speakers was to Country on behalf of the Garigal Australia’s own Professor Max Conway, people. who wowed the crowd with his most The international leaders in ocular erudite presentation on conjunctival oncology were present and, of them, melanoma. Drs Carol and Jerry Shields from the The social events were outstanding, Wills Eye Hospital in Philadelphia, the highlight being the dinner in a Prof Bertil Damato from the University marquee on the grounds of Sydney of California in San Francisco and Hospital, Australia’s oldest hospital, Dr Santosh Honavar from Hyderabad, where Sydney’s two top magicians, India delivered illuminating didactic seemingly without effort, suspended sessions on conjunctival tumours, the audience in disbelief. Drs Gina Kourt and Michael Giblin 50 Special Interest Groups
NOSANeuro-Ophthalmology Society of Australia
Neuro-Ophthalmology Society of Australia
On 14-17 September, Sydney will include commentary from neuro- dinner (16 September) at the will host the 33rd Clinical radiologist Dr Yael Barnett and Postales Spanish Restaurant under pathologist Dr Svetlana Cherepanoff. and Scientific Meeting of the Sydney GPO Building, 1 Martin Finally, we will also have shorter case Place. Please register early for the the Neuro-Ophthalmology presentations and posters. The aim of conference as dinner spaces will be Society of Australia (NOSA) the meeting is to provide an update limited. and the NeuroVision Training on neuro-ophthalmic research and its The organising committee welcomes application in day-to-day practice. you to join us for these four days of Weekend. The NeuroVision Training neuro-ophthalmology in Sydney. Please We are pleased to announce that Weekend (16-17 September) go to http://nosa.com.au/ for more our key-note speakers will be Drs is aimed at those needing an Nancy Newman and Valerie Biousse update on the more basic side details or to register. from Emory Eye Centre, Atlanta, of neuro-ophthalmology. These Drs Clare Fraser, Kate Ahmad, Georgia. Drs Newman and Biousse two days are perfect for trainees Mitchell Lawlor are best known for editing the major in ophthalmology, neurology neuro-ophthalmic text Walsh & and neuro-surgery; in particular, Hoyt's Clinical Neuro Ophthalmology. pre-RACE candidates should attend. They are engaging lecturers, who However, the weekend sessions The Neuro-Ophthalmology infuse their talks with practical best- will be equally valuable for general Society meeting will practice, evidence-based medicine ophthalmologists, consultant feature: and a good dose of humour. There neurologists, orthoptists and anyone • Keynote lectures on giant will be a focus on treatment updates who needs to learn more about cell arteritis and idiopathic for giant cell arteritis and inherited neuro-ophthalmology. Some intracranial hypertension optic neuropathies. In addition, sessions are more didactic, covering • Update on inherited optic we have Dr Steffen Hamann, from the basics of afferent neuro- neuropathies and optic Copenhagen, Denmark giving us an ophthalmology, neuro-radiology, disc drusen update on the diagnosis and future retinal mimics of optic neuropathies • Lots of clinical cases for management of optic disc drusen. and higher visual processing. This discussion Finally, Dr Mike Burdon, President of the year we will also include a debate Royal College of Ophthalmologists (UK) on the treatment of non-arteritic The NeuroVision Training will give us an update on idiopathic anterior ischemic optic neuropathy Weekend will feature: intracranial hypertension and a series and a series of cases discussing • Afferent of educational cases. swollen optic discs. Plenty of time is neuro-ophthalmology The two-day NOSA meeting (14-15 given for audience questions. • Neuro-imaging update September) will also feature research The social program also promises • Debate on the treatment of updates from the Asia-Pacific region to be fun with the NOSA dinner at NAION and clinico-pathological correlation the beautiful Bentley Restaurant (14 cases (Walsh-Williams cases), which September) and the NeuroVision Eye2Eye Winter 2017 51
ANZSRS Retina Symposium 2017 Medicare Item numbers FA and other imaging techniques, particularly autofluorescence. OCT for OCT alone is not sufficient. Angiography The recent addition of two new item is particularly important to prevent numbers for OCT in limited situations misdiagnosis and the resultant is welcomed by both ophthalmologists unnecessary treatment, as well as to and their patients. The use of these identify subtypes such as polypoidal item numbers is restricted to assessing choroidal vasculopathy. eligibility for people receiving PBS In retinovascular disease, including funded intravitreal therapies (11219) retinal vein occlusion and diabetes, and to follow up people receiving angiography is pivotal to evaluating intravitreal ocriplasmin (11220). ischaemia, both in the macula and Approval for such intravitreal therapies peripheral regions, which may require can now be given on the basis of OCT treatment and monitoring as part of The 2017 Retina Symposium as well as fluorescein angiography (FA). the overall management plan in and was held in Sydney over Although there are instances of itself, and also impacts management in which FA can be avoided or is decisions for macular oedema. two days on Saturday 3 and contraindicated, it has long been the Dr Jennifer Arnold gold standard to evaluate people Sunday 4 June. Chair, ANZSRS with macula and retinal pathology, As well as regular updates on and remains a pivotal investigation macular degeneration and that should not be abandoned. retinovascular conditions, this year’s In neovascular AMD and other program included sessions on genetic macular pathologies complicated diseases and genetic testing, and the by neovascularisation, diagnosis emerging imaging modality of OCT and management is now based on Angiography. multimodal imaging including OCT,
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RANZCO Affiliates
also enjoyed the unique experience of launching the world’s first luxury Q What do you see as some of the key challenges lying ahead for ESF resort for people with spinal cord and how do you plan on tackling injury on Sydney’s Northern Beaches. these? I have a passion for health and medical research having spent a good A Apart from the obvious proportion of my career working in challenge of raising money in a this space. The work of ESF resonated highly competitive marketplace, with me – the combination of raising I think the challenge for us is money to support the brightest to engage our stakeholders – minds in research and leveraging the ophthalmologists, researchers, skill and knowledge of Australian donors - keep them engaged and ophthalmologists to build capacity remain relevant to them. and deliver quality health outcomes From an organisational capacity in the developing world was a perspective, building scale and powerful motivator for me. I believe efficiency is always hard for small very strongly in our mission and that not-for-profit organisations. Building the work we do has the potential to strategic partnerships that can prevent vision loss. support this will be critical. Q You have extensive experience Q Can you tell us a bit about Lisa Cheng in the not-for-profit sector, what some of the projects ESF is do you enjoy most about working currently working on? Meet Lisa Cheng, in this sector? A My most immediate focus will The people. Not just the visionaries be on raising funds from the 2017 the new CEO of and their passion but the people you JulEYE campaign. It has achieved The Eye Surgeons’ meet every day who take hope from some great success in driving the work that you do; that it will one awareness of eye health but this Foundation day deliver greater quality of life or has not necessarily converted into even save their life or the life of a fundraising. So, my focus will be on building greater fundraising capacity Can you tell us a bit about loved one. Q for the campaign primarily through your background, what you were It’s also the grit and the can-do doing prior to your work at the Eye online and digital channels but we attitude that defines many of the are also looking at ways to engage Surgeons’ Foundation (ESF) and people who work in this sector. I like what drew you to the role? people in a fundraising event or being around passionate people activity that we could take to each A I have worked in the not-for- driven to get results. major city across Australia. It’s early profit sector for 25 years. The last 15 Q How is ophthalmology different days yet but I am confident we have years I’ve been in senior leadership to the other medical fields you have got a solid foundation to build from. roles for health-related organisations worked in? How do you see the - Royal Rehab, Children’s Tumour Q organisation changing in two Foundation, Prostate Cancer I’ve worked in children’s health, A years, and how do you see yourself Foundation of Australia, The Children’s childhood cancer, prostate cancer, contributing to that change? Hospital at Westmead and Children’s spinal cord and brain-injury. All very Cancer Institute Australia. In my last different fields of medicine but they A First I’d like to thank and role, I was Executive Director of the seem to all be driven by the desire to acknowledge the work of Jacinta Royal Rehab Foundation, raising deliver the best possible outcomes Spurrett, former CEO of ESF, who money for research and innovative for their patients. So, I’m not too sure resigned in September 2016. I’d like projects in the disability sector. I they are that different. to think that in the next two years we Eye2Eye Winter 2017 53
will have built some recurrence into communicating impact. share the same values and vision our revenue streams that is grounded • Build an inspiring brand to reach to improve eye health care through in quality relationships with our and engage donors and the public research, education, collaboration donors. This will result in an increase in – based around telling the stories and advocacy. fundraising and an increase in funding of our organisation. I see our relationship as a very for mission focused projects. • Develop a channel to reach important, strategic one that I see this coming through a more and engage Fellows and their underpins our ability to achieve our focussed effort on storytelling and patients – to be a charity of vision. The leadership, knowledge communicating to our stakeholders choice. and expertise that RANZCO brings why we need donations and how and • Create a public presence to ESF is fundamental to our role in where we direct them. I also want through eye health programs – supporting projects that will create a to strengthen the strong strategic through advocacy and stories future where no one is blind. alliances we have with RANZCO and the about our impact. ORIA. • Operational efficiency and Q What do you like to do outside effectiveness – through of work, what are some of your Q What goals would you like to strong governance and being hobbies/interests? achieve for the ESF over the next transparent. five years? A I’m a mum to Madeleine, my Q Tell us a little bit about the 8-year old daughter. Like all mums, A I’d like to have made visible, relationship between ESF and my weekends are spent driving measurable progress on each of our RANZCO and how you see the two to and from sporting and social five Strategic Objectives: organisations working together. commitments – for us that is karate • Raise funds for profound and and soccer. I also love to read – I lasting outcomes in eye health – A ESF is the result of a unique and have set myself the challenge of through a transparent and robust lasting alliance between RANZCO reading 30 books this year. I enjoy process of identifying projects, and the ORIA, both leaders in good design, food and wine, a good raising and allocating funding and advancing eye health care. We movie and I like to stay fit and active.
The Kim Frumar and effort to make this program a complete subspecialty training in success. eye centres of high quality outside Cambodian The international lecturers Cambodia. Scholarship involved in the program will The scholarship is funded by be phased out over the next donations, and is coordinated by The Eye Surgeons’ few years. It is envisaged that The Eye Surgeons’ Foundation. It Foundation is pleased to recent graduates of the training is hoped that the scholarship will announce that Dr Kossama program will replace these visiting continue each year. ophthalmologists as lecturers. In Donations can be made via Chukmol has been order to gain subspecialty training awarded the Kim Frumar The Eye Surgeons’ Foundation at these lecturers will be funded www.eyesurgeonsfoundation.org.au. Cambodian Scholarship for by the Kim Frumar Cambodian 2017. Scholarship. Dr Kossama Chukmol will Since 2007, the Ophthalmology do a 12-month fellowship in Residents Training program glaucoma with A/Prof Manchima in Cambodia has provided Makornwattana at Thammasat a structured general University in Thailand. She will ophthalmology training to the then return to Cambodia with local ophthalmology residents. subspecialty expertise that will It has been supported, financed greatly benefit the next generation and coordinated through the of ophthalmology residents and cooperative efforts of RANZCO, patients. the Fred Hollows Foundation, the The Kim Frumar Scholarship Eye Care Foundation, the Christian has been created in the memory Blind Mission and the Cambodian of the late Dr Kim Frumar. The National Program for Eye Health. scholarship will continue the Over the last 10 years RANZCO work that Dr Frumar was doing and many of its members have in Cambodia. It will financially committed considerable time support Cambodian graduates to Dr Kossama Chukmol 54 RANZCO Affiliates
The policy arm of ASO has been Now in its fourth year, the Expo ASO update hard at work in recent months has become a valued educational preparing submissions on a broad As usual, life is busy at event for ASO members and range of issues, from responding non-members alike. the Australian Society of to MBS amendments through to The focus of the Expo is to explore Ophthalmologists (ASO) providing advice on proposed the business-side of being an eye headquarters. Currently medication regulations for orthoptists. specialist and this year our learning It is when developing these program centered around the theme we are planning our submissions that the breadth of ‘Practice Values and Building Your second visit to Canberra knowledge and industry insight our Business’. for the year where ASO organisation can provide really comes Topics explored included the representatives will hold to the fore. Submissions and position intricacies of both selling and a series of meetings with statements developed by ASO draw purchasing a practice, marketing parliamentarians on both on direct bedside analysis from an ophthalmology business, sides of politics. doctors working in the range of understanding advertising sub-specialties of ophthalmology. regulations, and insider updates on a Our goal is to make further This ensures that they offer the most headway on issues impacting on range of issues within the healthcare practical industry input available. ophthalmologists and their patients. sector in relation to ophthalmology For this reason, ASO continues to The most notable of these is, of as a craft group. be an important voice in the health course, the ongoing MBS Review and Delegate feedback on this year’s policy direction. private health insurance reform. Expo has been overwhelmingly Meantime, our work with ASO Business Skills positive. Well done to Expo collaborative partners such as Coordinator, Dr Nisha Sachdev, for her RANZCO, the Council of Procedural Expo 2017 work in pulling this innovative event Specialists, the Australian Medical More than 100 ophthalmologists, together. Association, the Royal Australasian practice managers, and day hospital Now planning begins for Expo College of Surgeons, and the owners and managers gathered 2018. Australian Health Practitioner at the Intercontinental Hotel in Regulation Agency remains busy and Sydney’s Double Bay last month for Dr Michael Steiner varied. the annual ASO Business Skills Expo. President,ASO
Are you a member of the ASO? If you are interested in becoming a member of the ASO, visit www.asoeye.org to download an ASO membership form. Eye2Eye Winter 2017 55
Representing the interests of ophthalmologists and their patients throughout New Zealand bullying, to a workshop by Ernst & Website ONZ Update Young on the delivery of services to Our website is currently under manage macular degeneration. It is pleasing to report that Funding and finding solutions development and we are looking things are getting busy to improve the issue of follow up forward to incorporating members’ for our committed team at appointment backlog was a major suggestions for its content. Ophthalmology New Zealand theme of this workshop. Following on from last year’s public awareness Sponsorship for ONZ (ONZ). Thanks to those that campaign, which highlighted Finally, and in order to assist us to give answered our survey, we instances of ophthalmic patients a better service to our members, we have been able to identify losing vision due to delayed follow-up are happy to announce our sponsors a number of ways ONZ can in the public system, the government for 2017. Our sponsors have been has offered extra funding. But it is chosen for their unique understanding better serve our members up to the clinical leaders to find the of the needs of both specialists and and the ophthalmologists of solutions. It was a very productive the NZ medical environment. They NZ as a whole. meeting for sharing difficulties in were also invited to present at our managing the delivery of ophthalmic forum in their area of expertise. Clinical Directors care in NZ and finding out how others have found successful approaches. • ANZ Bank – for their Meeting understanding of what finance On 4 April 2017, ONZ convened Business Forum you may need and how to the Clinical Directors Meeting in In response to our members’ structure this. Wellington. Previously this meeting suggestions we planned the • Crowe Horwath – for their had been convened by one of Inaugural Business Forum understanding of the issues in tax the Clinical Directors, Dr Dallas ‘The Other Stuff – Practicing and accounting. Alexander, with support from ONZ. Ophthalmology in NZ in 2017’. • Legacy Life – for their The meeting is for all ophthalmic The forum was held on Sunday understanding of what level of clinical leaders in the public 14 May, following on from the insurance is appropriate at what system. Clinical directors, and/or RANZCO NZ Branch meeting. The stage. their deputies, from nearly all the forum included a presentation by We welcome and thank our sponsors ophthalmology departments in NZ Southern Cross Insurance about for assisting us. attended. their members’ survey that grades Topics covered ranged from patients’ experience with individual Dr Michael Merriman competency, sexual harassment and ophthalmologists. Chair, ONZ
ONZ Business Forum The Other Stuff – Practicing Ophthalmology in NZ in 2017
In our recent survey ONZ asked the ophthalmologists of New Zealand if they were interested in a Business Forum that AGENDA looked at commercial matters unique to New Zealand. The majority voted in support of this, therefore we are pleased to announce the first ONZ Business Forum for 2017. Accounting in your practice – pitfalls and perils.
The Commerce Commission – We have booked this event to follow on from the NZ RANZCO What you can and can’t do in Meeting at Pahia, and look forward to welcoming both ONZ practice. members and RANZCO Fellows. Risk Management with your CPD points: RANZCO has approved this CPD activity for 4 career. points in the Risk Management & Clinical Governance category, level 1. Strategic Planning – Why planning your career works. Date: 14th May 2017 Venue: The Rangatira Room, Copthorne Hotel and Resort, Quality Accreditation – Why this Bay of Islands is important in New Zealand Time: 8:30 – 1pm medical business. Cost: $100 for ONZ members and $200 for non Members Southern Cross – Survey Results
Please RSVP on this form, by 14th of April and scan to: [email protected]
Please note any special meal requests
Method of payment
Internet Banking : By cheque/post to: Name - Ophthalmology NZ Incorp ONZ / Treasurer No - 020536-0161128-00 PO Box 630 Under reference put – “Business Forum 2017 “ New Plymouth
Event sponsors
*NB ONZ is NOT GST registered. RECEIPTS will be issued at the meeting 56 Ophthal News
Ophthal News RANZCO Fellows honoured by APAO for their contributions to eye health
RANZCO Fellows Dr Laurence Sullivan, A/Prof James Elder, Prof Frank Martin, Prof Peter McCluskey, Prof David Mackey and Dr Jonathon Ng received awards recognising their long-standing service to eye health in the Asia-Pacific region at the 32nd Asia-Pacific Academy of Ophthalmology (APAO) Congress held in Singapore in March. Congratulations also to RANZCO Fellow, Prof Charles Dr Laurence Sullivan Prof Frank Martin McGhee, for being appointed with Drs John Szetu and Biu Sikivou for and an Associate Professor in the as the 21st President of the a week each year for a number of years. Department of Paediatrics of the APAO. Dr Sullivan has been involved in University of Melbourne. curriculum development with the A/Prof Elder graduated from Outstanding Service in RANZCO team for the ophthalmic medicine at the University of Prevention of Blindness residents in training program in both Melbourne in 1981. He undertook Phnom Penh and Suva. He was a ophthalmology training at the Royal Awards founding member of the RANZCO Victorian Eye and Ear Hospital and The Outstanding Service in Prevention International Development Committee, was awarded Fellowship of RANZCO of Blindness Awards are given to and continues to volunteer with this in 1987. He undertook further individuals or organisations whose committee. advanced training in paediatric and contributions are instrumental in the Dr Sullivan’s current activities genetic ophthalmology at the Royal prevention of blindness in the Asia- include the promotion and support of Children’s Hospital, Melbourne and Pacific area. scholarships for postgraduate studies the Hospital for Sick Children, Toronto. Dr Laurence Sullivan for young ophthalmologists from His surgical expertise covers most Dr Laurence Sullivan was honoured Cambodia and he is also involved in areas of paediatric ophthalmology with the APAO Outstanding Service the development of the Cambodian including infant cataract, childhood in Prevention of Blindness Award in Eye Bank to provide corneas for corneal glaucoma, strabismus oculoplastics recognition of his involvement in transplantation in that country. and management of retinoblastoma. international development over many Prof Frank Martin years. Achievement Awards Dr Sullivan’s interest in international The APAO Achievement Award Prof Frank Martin serves on the APAO development began when Prof Hugh Program was established in 2008 to Council and is currently Chairman of Taylor asked him to visit Nepal. Dr recognise individuals for their time the APAO Advisory Committee. He Sullivan travelled to Tilganga a number and contribution to the scientific was APAO President from 2007 to of times, working with Dr Sanduk Ruit programs of the APAO Annual 2011. The APAO Achievement Award in the mid 1990s. He also worked in Congress. recognises Prof Martin’s involvement Fiji with Dr Jerry Beeve and the Beeve in teaching and lecturing at the APAO Foundation on Yasawa Island, where A/Prof James Elder congresses. In 2015, he received the Dr Sullivan proposed to his (now) wife. A/Prof James Elder is an Golden Apple award for teaching in When Dr Sullivan’s children became a ophthalmologist at the Royal the APAO region. little older, he returned to volunteering Children’s Hospital (where he was “The late Prof Arthur Lim inspired in the Pacific region. He taught at the Director of the Department of me to become involved with the Pacific Eye Institute in Suva, working Ophthalmology from 1994 to 2009) APAO,” said Prof Martin. “Involvement Eye2Eye Winter 2017 57
Prof Peter McCluskey Prof David Mackey Dr Jonathon Ng in ophthalmology in the Asia-Pacific contributions to teaching and symposia on cataract surgery and region has given me the opportunity education have been acknowledged postoperative endophthalmitis and to travel to countries that I otherwise with the award of the 2013 Golden chairing of free paper sessions and would possibly not have visited. I Apple Award for Best Teacher in presentations on research conducted have developed friendships with the Asia-Pacific. His 2017 APAO with the Eye and Vision Epidemiology ophthalmologists in my region. It achievement award acknowledges Research Group in Perth. The most has also led to a number of Fellows his sustained contribution to the recent research has looked into the travelling to Sydney to further their scientific program of APAO conferences. effects of cataract on driving using a driving simulator. At the upcoming training in paediatric ophthalmology Prof David Mackey RANZCO Congress in Perth, interested and strabismus at the Children's Prof David Mackey is Professor of Fellows will have the opportunity to Hospital at Westmead.” Ophthalmology and Director at the visit and try the simulator themselves. About eight years ago, Prof Martin University of Western Australia Centre The state-of-art simulator is fully founded the Asia-Pacific Society for Ophthalmology and Visual Science immersive and comprises a motion of Paediatric Ophthalmology and and Managing Director of the Lions platform to recreate inertial forces for Strabismus. The Society will be having Eye Institute. His genetics research maximum realism. its inaugural meeting in Hong Kong in into eye diseases over the last 30 years October 2017. has included extensive collaboration Prof Peter McCluskey with eye researchers in the Asia-Pacific Prof Peter McCluskey is Professor and region. Chair of Ophthalmology in Sydney Prof Mackey was appointed as RANZCO will be co- Medical School at the University Regional Secretary (Australia and hosting the 35th APAO New Zealand) on the APAO Council of Sydney and Director of the Save Congress in Auckland, Sight Institute at Sydney Eye Hospital. in April 2014 and Chair of the New Zealand in 2020. His primary clinical focus is vision APAO Membership Committee. The threatening chronic inflammatory eye challenging role for the Membership APAO is one of the Committee is to evaluate the eligibility disease while his laboratory research oldest supra-regional focuses on mediators of inflammatory of very diverse national and regional eye disease. He has ongoing clinical ophthalmological societies for ophthalmic societies, and laboratory collaborations in the membership of the APAO. With these founded in 1960. APAO United Kingdom, Vietnam and the two commitments, Prof Mackey has 25 key member United States. attends a full day of Committee and organisations comprising Prof McCluskey has contributed Council meetings at every APAO Congress as well as online evaluation six major regional regularly to the teaching and scientific subspecialty societies and program of the APAO conferences over and approval of submitted documents the past 10 years in the areas of medical that often require translation from 19 national ophthalmic education, uveitis and inflammatory local languages. societies from different eye disease. He has given invited Dr Jonathon Ng countries and territories symposium presentations, subspecialty Dr Jonathon Ng, a Western Australian in the Asia-Pacific region. day presentations and scientific paper Fellow, received the APAO Achievement presentations. He has also contributed Award in recognition of his to organising and coordinating achievements and contributions symposia at APAO meetings. His to the APAO. This includes invited 58 Ophthal News
New APAO President to be elected President of APAO and I look forward to working with At the President’s Dinner of many talented colleagues in building the APAO Congress, RANZCO rapport between ophthalmologists Fellow, Prof Charles McGhee, around the Asia Pacific region and was appointed as the 21st welcoming delegates to APAO President of the society. Auckland 2020,” said Prof McGhee. RANZCO will be co-hosting the 35th “The Asia Pacific Academy of APAO Congress in Auckland, New Ophthalmology is one of the largest Zealand in 2020. representative professional bodies in ophthalmology and the academy and APAO is one of the oldest supra- its member societies have worked regional ophthalmic societies, closely with RANZCO over many years founded in 1960. APAO has 25 key in relation to education, provision member organisations comprising six of eye care and collaboration on major regional subspecialty societies international conferences – including and 19 national ophthalmic societies APAO Sydney 2011. It is a great from different countries and territories personal and professional honour in the Asia-Pacific region. Prof Charles McGhee
A/Prof Nitin Verma invested with prestigious position from the Hospital of St John of Jerusalem RANZCO Fellow A/Prof Nitin Verma CStJ AM OTL was invested into The Most Venerable Order of the Hospital of St John of Jerusalem in the Grade of Commander on Saturday 6 May at Government House, Sydney by the Governor of NSW, the Deputy Prior His Excellency General The Honourable David Hurley AC DSC (Ret ’d). A/Prof Verma will be chairing the recently announced formation of the Asia-Pacific branch of the St John Ophthalmic Association (SOA). The Asia-Pacific branch of the SOA will join the United Kingdom and North American Priories in partnering with the St John of Jerusalem Eye Hospital Group to increase its capacity to save sight and restore lives. The first meeting of the SOA will be held in Perth on Friday 27 October 2017. The purpose of the SOA (Asia-Pacific) is to join with the efforts of the United Kingdom and North American branches in providing practical opportunities to collaborate with and assist the St John Eye Hospital in A/Prof Nitin Verma receiving the investiture from the Governor of NSW, Jerusalem via: General David Hurley (Re'td) • training (both locally in Jerusalem and internationally) • research (clinical and laboratory) St John invites interested RANZCO members to join • mentoring the SOA (Asia-Pacific) by expressing your interest via • teaching programmes, and email to [email protected] • staff appointments. Eye2Eye Winter 2017 59
RANZCO Fellow and former rugby great honoured at the National Portrait Gallery
A portrait of RANZCO Fellow Dr Mark Loane is the latest addition to the National Portrait Gallery’s permanent collection. The work is the final in a series of three commissioned portraits of Australian rugby greats and marks Dr Loane’s achievements in both medicine and sport – Dr Loane is a former rugby international who made his debut for the Wallabies against Tonga at the age of 18 when he was a second- year medical student at the University of Queensland. Dr Loane was appointed Wallabies captain in 1979 against the All Blacks, and led the team to the first Bledisloe Cup victory in Australia in 45 years. He is the youngest forward selected to represent Australia since WW2 and, most likely, Australia’s youngest forward of all-time. Dr Loane retired from rugby in 1982 to pursue studies in ophthalmology, receiving the Cedric Cohen Medal for the best pass in the eye surgery first part exam in 1984. Dr Loane built a successful career in ophthalmology and dedicated his life to improving the eye health of rural, remote and Indigenous Mark Loane 2016 communities, especially in the by Joachim Froese remote areas of North Queensland. inkjet print Collection: National Portrait Gallery, Canberra In 1999, he set up the Cape York Eye Commissioned with funds from the Patrick Corrigan Portrait Commission Series 2016 Health project to provide eye health services to the region’s remote and Indigenous communities. In 2011, he Mr Angus Trumble, Director of the ophthalmologist for his medical work was awarded the Order of Australia Portrait Gallery, believes the portrait with disadvantaged patients in remote (AM) in honour of his work with is a worthy addition to the Gallery’s areas,” said Mr Trumble. Indigenous communities. collection, noting Dr Loane’s successful The photograph of Dr Loane joins the The portrait, a photograph taken and meaningful career spanning two two other works in the series added to by Canadian-born Joachim Froese, very different fields. the Gallery Collection – Ken Catchpole shows Dr Loane in a hospital “Dr Loane is fondly remembered OAM by Gary Grealy and Mark Ella AM changing room, the setting alluding for his achievements on the football by Nikki Toole. The portrait is now on to his accomplishments on and off field as a former captain of the display to the public at the National the field. Wallabies, and is greatly admired as an Portrait Gallery in Canberra. 60 Ophthal News
Grant to investigate the eye as a monitor of disease activity and repair in multiple sclerosis RANZCO Fellow and Centre for Eye Research Australia (CERA) Deputy Director and Principal Investigator Dr Peter van Wijngaarden has been awarded an Incubator Grant from MS Research Australia to further his research on the eye as a monitor of disease activity and repair in multiple sclerosis (MS). The visual pathway in the brain is often affected in MS and measuring damage via the visual system is attractive. The ability to correlate the Dr Peter van Wijngaarden loss of visual function, measured with routine eye tests, with non-invasive “By its very nature, incubator Dr van Wijngaarden will use his markers of structural change is a major funding allows us to embark on funding to develop a laboratory model advantage of studies of the visual innovative research that might not of MS that is based on damage to the system. attract funding under conventional optic nerve and to allow researchers to “I am delighted to receive the funding schemes. The work will test new therapies that aim to repair damaged myelin in MS and determine support of MS Research Australia provide insights into the mechanisms if they are effective. to conduct this important work. The of injury and repair in MS and may project is an extension of research “The funding will allow me to further serve as a useful model in which to that I undertook during my post- develop collaborations with Dr Tobias doctoral fellowship at the University test therapies that aim to enhance Merson, from Monash University, and of Cambridge and draws on local regeneration of the central nervous Associate Professor Bang Bui, from expertise in models of optic nerve system, with the aim of improving the Department of Optometry at the injury and recovery,” said Dr van outcomes for people with this disease,” University of Melbourne,” said Dr van Wijngaarden. he said. Wijngaarden. World’s first professional qualification course for eye bankers The Centre for Eye Research “The course, placed within the and eye tissue custodians. They will Australia (CERA) and the University of Melbourne’s Medical develop skills that can be applied to School, will leverage from the all stages of eye tissue management University of Melbourne are accumulated knowledge and expertise including donor selection and recovery, introducing the world’s first of our system and from leading world recipient donor management, tissue professional qualification experts in the field,” he said. examination and legal and regulatory The genesis of the course is the course for eye bankers – the requirements,” said Dr Pollock. growing sophistication and technical The online course, international in custodians of human tissue for advancement of the sector combined content, is designed in two parts: firstly, with an international call for education eye transplant surgery. a one subject Specialist Certificate at a higher level and for professional “The international course has been minimum qualifications. minimal qualification (one 12-week developed in conjunction with sector The course is ideal for those new semester), with the option to continue partners the Eye Bank Association of to eye banking and those working in towards the Graduate Certificate level Australia and New Zealand (EBAANZ) relevant sectors wishing to improve their (two additional subjects). and Donatelife Australia,” said Dr Graeme knowledge and skills. Both courses are now accepting Pollock from CERA’s Lions Eye Donation “Graduates will transition beyond applications and the Specialist Service, who leads the course academic the fundamentals of eye banking and Certificate course work will start in and teaching team. emerge as knowledgeable professionals September 2017. Eye2Eye Winter 2017 61
Vision 2020 Australia welcomes funding for Indigenous eye health Vision 2020 Australia and non-Indigenous populations. The Running until June 2019, the welcomes Australian prevalence of vision impairment and program will fund the installation of blindness among Indigenous Australians retinal cameras, aiding increased rates Government funding for a is three times that of non-Indigenous of diabetic retinopathy screening by national program to increase Australians. The good news is 94% of Indigenous primary health care services access to eye health and vision vision loss in Aboriginal communities is and supporting referral pathways for care services for Aboriginal preventable or treatable.” comprehensive eye examination. Health workers, including general Australians. Vision 2020 Australia members, Brien Holden Vision Institute and practitioners, will have skills to interpret The initiative will provide eye health images taken with a retinal camera The Australian College of Optometry, testing equipment, along with relevant and understand when patients need will co-lead the new Provision of training and support, to health services to be referred to an optometrist or Eye Health Equipment and Training in more than 100 sites across Australia. ophthalmologist. program, working with the Aboriginal This will greatly increase access to Slit lamps will be provided at some detection and appropriate care of eye Health Council of South Australia, the of the 100 locations, which is essential diseases for Aboriginal and Torres Strait Centre for Eye Health and Optometry equipment for visiting optometrists Islander people. Australia. or ophthalmologists to conduct Carla Northam, CEO of Vision 2020 The organisations will work comprehensive eye examinations on Australia, says “Initiatives such as these collaboratively to implement site. are essential to improve eye health the program with guidance from Health workers in Aboriginal health outcomes for Indigenous Australians. representatives from the Aboriginal services will also be able to explain the “Significant and troubling inequities and Torres Strait Islander health service impact of undiagnosed or untreated in eye health exist between Aboriginal sector. eye health disease to their patients.
Researchers aim to prevent concussion deaths With no accepted, singular and be used by non-medical diagnostic tool for concussion, the professionals at all levels of sport team is working with Randwick with a view to preventing long- Rugby Union Club to validate lasting damage, especially to concussion tests that will aid the developing brains in children and development of a more accurate adolescents. It is believed that system to diagnose mild traumatic visual testing may prove to be the brain injuries (mTBI). most reliable, portable and easiest Neuro-ophthalmologist Dr Clare to implement test in schools and Fraser of the University of Sydney’s amateur sports. Save Sight Institute is part of Throughout the 2017 rugby season the team researching how the the research team will do a range processing of information from of tests on players from Randwick the eyes can be used to diagnose Rugby, including ground-breaking concussion. She said the main visual tests that measure disruptions Dr Clare Fraser issue when it comes to addressing in the brain’s visual stimulus concussion is its broad definition processing. A team of researchers led and underestimated danger to by RANZCO Fellow Dr Clare player health. “We predict that if there is diffuse brain injury (concussion), electrical Fraser and Dr Adrian Cohen “Our main concerns regarding mTBI surround the lack of strong impulses generated from the eyes at the University of Sydney diagnostic criteria and the lack of will be reduced or slowed and this is studying the causes, objective markers for diagnosis. change can be measured using our assessments and treatment Players risk serious health technique,” says Dr Fraser. of concussion in sport to complications if they return to play “We hope this will provide a quick and reliable measure to diagnose prevent health effects that too soon,” says Dr Fraser. The goal for the researchers is to concussion and also reveal when result in long term harm and develop a test that can accurately an injured player is showing good even death. and objectively diagnose concussion recovery.” 62 RANZCO Museum
RANZCO Museum
Gassed (1919) by John Singer Sargent It is now 100 years since the first use of poison gas in warfare. 1917 marked the highpoint of usage in which a quarter of the millions of shells lobbed by the combatants in WW1 were gas filled. Read more about the history of the weapon that struck terror, blinding and killing untold numbers, on the RANZCO Museum website at https://ranzco.edu/museum/ presentations.
Richard Keeler, Curator of the Royal College of Ophthalmologists’ (UK) museum has recently published a collection of 42 articles written over recent years. The articles are fascinating and informative, providing insight and breadth into the history of ophthalmology. They can be obtained Example of the Auto Plot Tangent Screen from https://www.rcophth.ac.uk/about/ donated to the RANZCO Museum by Dr Mark Steiner, Melbourne rcophth/museum/. The 2017 RANZCO Congress takes In 1945, Hans Goldmann in Bern, place in Perth, WA. I am shortly visiting Switzerland developed the bowl Prof Ian McAllister to plan the exhibit perimeter, a marked advance in Kinetic from his amazing collection. perimetry where the luminance Please keep up with all your and test size of the stimulus was donations of artefacts and memorabilia, standardised. A few are still in use, although I know of one in country they are most welcome. NSW where it stands as a unique The Ida Mann poster and Gullstrand slit Dr David Kaufman garden ornament mistaken as a lamp displayed at the RANZCO offices RANZCO Museum Curator sundial! In the ‘60s, Bausch and Lomb USA marketed the Auto Plot Tangent The Ida Mann meeting room at the Screen, which combined use of a RANZCO offices in Sydney, named in standardised tangent screen with a hand honour of the great ophthalmologist, driven pantograph to record subject features her original Gullstrand slit responses. Portable and simpler than lamp and a poster of her life’s work. the Goldmann perimeter, it provided an The slit lamp was donated by Past accurate recording of a kinetic field. President Dr Andrew Stewart. Eye2Eye Winter 2017 63
Obituaries Dr Anthony (Tony) King 16 April 1946 – 5 February 2017
Dr Tony King passed away at home on Sunday morning, 5 February 2017, following a seven-year battle with dementia. Early on in his diagnosis, Tony had insight into the disease that would eventually rob him of his brilliant mind, and realised he would not be able to communicate properly with his friends, family, colleagues and patients. Thus, although he would have blushed at being mentioned here in this esteemed publication, he wanted to make sure everyone knew he said “goodbye”. And now, finally, he can rest in peace. Dr Anthony King Tony will be remembered for his vitality, generosity and bonhomie; Upon returning to Sydney from being chastened in this way would a gentleman who cared greatly for South Africa, Tony attended Waverley have eaten away at most; however, all his patients and was a proud, College, graduating initially in 1962 without protestation and in quiet devoted and fiercely loyal family and again in 1963, where he excelled defiance, Tony simply said to the man. not only as a student but also in Brothers “well, you’ve got to do what Born in Sydney’s Eastern Suburbs the sporting arena. Tony played you’ve got to do” and achieved top to Dr Leonard and Edna King, Tony rugby and tennis and competed in marks, gaining entry into medicine. was the eldest of two children. His swimming at NSW state level. He Tony was a man of principle, but he father’s profession as an industrial even repeated his final year so he knew which battles to fight. chemist saw Tony and his sister, could play in the 1st XV rugby and As the son of a former Wimbledon Christine, spend their formative at the time was amongst the best tennis player and Rhodes Scholar, years in Johannesburg, South Africa swimmers in the state. Unfortunately Tony always felt he had big shoes to during apartheid. As a result, Tony for Tony, there were a few future fill, however despite all his sporting was acutely aware, even from a Olympic swimmers in the state at and academic achievements he young age, that some of us are that time, and when it was pointed rarely spoke of them. He always born lucky, whilst others are dealt a out to the Christian Brothers that believed that the key to his successes different set of cards. His resilience, perhaps his time would be better was his strong work ethic rather grace and sense of justice that may used concentrating on studying than natural intellect, remaining an have developed from this early time in his final year and playing rugby, incredibly humble man to the end. abroad led him to live by the refrain rather than at swimming training, as Tony graduated from the “there but for the grace of God go punishment, the Brothers dropped University of New South Wales in you or I” – which goes someway to him to the 2nd XV rugby, and made 1972 with an MBBS and obtained explain why this self-effacing and him mark out all the lines on the his FRACS and FRACO in 1980. gentle man was held in such high field every Friday afternoon, instead During this time, he held registrar regard – not least by his patients. of going to class. I am quite sure appointments at Royal North Shore, 64 Obituaries
St Vincent’s, Concord and the Sydney at the forefront of ophthalmological unable to walk and in a wheelchair, Eye Hospital. It was whilst working advances, consulting and sharing but consequently then had front as a Senior Resident Medical Officer expertise and, of course, he loved row seats in the Cathedral for the at St Vincent’s that Tony met the love the travel opportunities that pilgrim’s mass to witness the huge of his life, Anne, who was working as accompanied such international censer swing from the ceiling - a an anesthetics nurse. jaunts. It is therefore somewhat cruel highlight of the journey. Tony established his practices that, during the last conference he Tony had many passions and at Dee Why and Mona Vale in attended in Spain, he was struck diverse interests that he pursued 1981 and held appointments as a down with a mystery illness, never to with great fervour outside of Visiting Medical Officer at Mona Vale make a full recovery, which preceded his demanding workload. An Hospital from 1982 and at Rockcastle his diagnosis of early-onset appreciation of good food and fine Private Hospital. Tony’s particular dementia and eventually forced him wine, music and hi-fi, sports cars, art, field of interest was cataract to retire in 2011. rugby, just to name a few. He had surgery and he was a meticulous a bon vivant side to him which he and innovative surgeon who cared enjoyed sharing whenever possible immensely for the well being of all with his friends and colleagues. A his patients. He was highly regarded by his colleagues and patients alike He was highly regarded by natural scholar and surgeon, Tony’s for his clinical and surgical skills and his colleagues and patients love of reading and researching, his he was a steadfastly patient and alike for his clinical and attention to detail and precision compassionate doctor. surgical skills and he was extended well beyond the operating Tony was the Treasurer (1986- “a steadfastly patient and table. He believed that the secret 1994) and Chairman (1997-1999) compassionate doctor. to the perfect golf swing lay of the RANZCO NSW Branch. Not somewhere in the pages of the only in charge of the purse strings, hundreds of golf books he bought colleagues recount that Tony always over the years. ensured only the best wines were In spite of his advancing illness“ Tony was an adoring husband and sourced for College dinners, such and with sarcoidosis of the lungs, devoted family man to his three was his love and enthusiasm for a Tony courageously managed one children, Alexandra, Christopher fine drop. If there was a person who final overseas trip in 2013 with and James, with an equally devoted knew more about wine, we are yet to wife Anne by his side. He could and loving wife, Anne, who nursed meet him or her. have chosen anywhere for his final him at home right to the end. We As a member of the 2002 hurrah, but instead of taking a were awestruck at Tony’s bravery, International Congress of cruise or putting his feet up at a fortitude and uncomplaining Ophthalmology Committee, part resort (as was strongly suggested acceptance of his devastating of Tony’s remit was to organise the by his children), ever the intrepid diagnosis. Brave, stoic and modest, trade exhibits. Like many of his traveller, Tony walked the final he faced death as he lived his life colleagues, he thoroughly enjoyed 130km of the Camino de Santiago and will be enormously missed. attending conferences, developing de Compostela, without a guide. By and extending his knowledge to stay the end of the pilgrimage, he was Mrs Alexandra King-Perzi Eye2Eye Winter 2017 65
Dr Richard C. Troutman 16 May 1922 – 5 April 2017
He authored and co-authored nine Award from the American Academy books and hundreds of scientific of Ophthalmology, and in 2002 he articles. He was Professor and Head endowed the State University of New of the Division of Ophthalmology York Down State Medical Centre at State University of New York with a $1,000,000 gift from the Downstate Medical Centre from Microsurgical Research Foundation to 1955-1983. He was Surgeon Director set up the Chair of Ophthalmology. at the Manhattan Eye, Ear and We were lucky to have been Throat Hospital in the latter part of his fellows and got to know him his career. Dick was instrumental in personally; George Thomson in the design and use of the operating 1971-1972 and Michael Lawless in microscope for ophthalmology, 1986-1987. Dick was a driven person, at a time when such a thing was wanting always to succeed and be controversial. In 1965 he co-founded better. His fellowship program trained the International Microsurgery Study ophthalmologists from around Group when instrumentation, sutures the world from 1971-1991; mostly and suture materials were starting ophthalmologists from the United to be used in conjunction with States, but two from Australia and microsurgery. He worked tirelessly a small number from Europe. They Dr Richard C. Troutman MD to promote new techniques of became a family to Dick Troutman microsurgery and was instrumental and his wife, Suzanne. We would meet Dr Richard C. Troutman MD, in establishing practical skills transfer regularly at the American Academy DSc, died at his home in Bal courses at the American Academy of of Ophthalmology for dinner and at other times during the year, and his Harbour, Florida on 5 April, Ophthalmology in order to teach as many of his colleagues as possible. fellows were a source of friendship 2017. Dr Troutman was 94. He was a founder and past president and pride. He felt he had truly given He was a gifted surgeon, of the Castroviejo Corneal Society back to ophthalmology by passing on his skills and enthusiasm to a new exceptional teacher, an and co-founded the International Society of Refractive Surgery. He generation. Dick remained active and ophthalmologist loved by his set up the Microsurgical Research interested in ophthalmology up until patients, and the devoted Foundation and this continues just prior to his death, continuing husband of Dr Suzanne to fund two prizes: the Troutman to attend scientific meetings and Prize for best original article in the give advice to fellows on their work Véronneau. International Society of Refractive and publications, and career paths. His list of professional Surgery Journal, and the Troutman We loved him and he will be sadly accomplishments is profound. He was Véronneau Prize which is awarded missed. first and foremost an exceptionally for original corneal work. In 2000 he Dr George Thomson and skilled corneal transplant surgeon. received the Lifetime Achievement Dr Michael Lawless 66 Calendar of Events
Calendar of Events 2017 EVENT DETAILS CONTACT Ophthalmology Updates! Conference 29-30 July 2017 W: www.ophthalmologyupdates.com 2017 Westin Hotel Heritage Ballroom, 1 Martin Place Sydney, NSW, Australia AUSCRS Meeting 2017 2-6 August 2017 W: www.auscrs2017.org.au/ Hamilton Island Conference Centre Whitsundays, QLD, Australia Queensland Branch Annual Scientific 4-5 August 2017 C: Ty Fleming Meeting Sheraton Grand Mirage Resort, P: +61 7 3851 4298 Gold Coast 71 Seaworld Dr Main Beach, QLD, Australia American Society of Retina Specialists 11-15 August 2017 W: https://www.asrs.org/ Annual Meeting 2017 Hynes Convention Center annual-meeting 900 Boylston St Boston, MA, United States of America Health Business Excellence Program 26-27 August 2017 C: Renae - Sydney Hilton Sydney P: 0410 002 345 488 George Street E: [email protected] Sydney, NSW, Australia Australasian Academy of Facial Plastic 1-2 September 2017 E: [email protected] Surgery (AAFPS) & Blepharoplasty International Convention Centre Australia Sydney (ICC Sydney) Masters’ Symposium on Blepharoplasty Kent Street and Facial Rejuvenation Sydney, NSW, Australia American Society of Cataract and 5-9 September 2017 W: www.ranzco.edu and go to the Refractive Surgery (ASCRS) 2017 Los Angeles Convention Centre calendar of events 1201 S Figueroa St, Los Angeles, United States of America European Society Of Retina Specialists 7-10 September 2017 W: www.ranzco.edu and go to the (EURETINA) 2017 Barcelona International calendar of events Convention Centre Plaça de Willy Brandt, 11-14 Barcelona, Spain
International Cornea And Contact Lens 8-10 September 2017 W: www.cclsa.org.au/events/event/ Congress Sofitel Sydney Wentworth icclc-2017/ 61-101 Phillip Street Sydney, NSW, Australia
NOSA 2017 14-17 September 2017 W: www.ranzco.edu and go to the Sheraton on the Park calendar of events 161 Elizabeth Street Sydney, Australia
Joint GCMA/VMDA Medical Conference 21-23 September 2017 W: https://gcma.org.au/Fiji-2017- Warwick Le Lagon Resort, Efate, Conference.aspx Vanuatu Elluk Road, Off Kumul Highway, Erakor Lagoon Port Vila, Vanuatu Eye2Eye Winter 2017 67
EVENT DETAILS CONTACT European Association for Vision and 27-30 September 2017 W: www.ever.be/ Eye Research (EVER) Congress 2017 Acropolis convention center 1 Espace John Fitzgerald Kennedy Nice, France 49th RANZCO Annual Scientific Congress 28 October - 01 November 2017 W: www.ranzco2017.com Perth Convention and Exhibition Centre Western Australia Branch Annual 3-4 November 2017 C: Bec Piccoli Scientific Meeting Venue to be advised E: [email protected] Health Business Excellence Program 4-5 November 2017 E: [email protected] - Sydney Hilton Sydney 488 George Street Sydney, NSW, Australia American Academy of Ophthalmology 11-14 November 2017 W: www.aao.org/annual-meeting (AAO) 2017 Ernest N. Morial Convention Center 900 Convention Center Blvd, New Orleans, United States of America Dunedin Ophthalmology Clinical 20 November - 1 December 2017 W: www.ranzco.edu and go to the Course (Part 2 Course) University of Otago calendar of events 362 Leith St E: [email protected] North Dunedin, New Zealand APVRS 2017 8-10 December 2017 W: http://2017.apvrs.org 11th Asia-Pacific Vitreo-Retina Society Kuala Lumpur Convention Centre Congress Stall 7, Jalan Pinang, Kuala Lumpur City Centre Kuala Lumpur, Malaysia
QUEENSLAND BRANCH ANNUAL SCIENTIFIC MEETING SHERATON GRAND MIRAGE RESORT GOLD COAST 4-5 AUGUST 2017
ALL THINGS RETINA 68 Classifieds
Classifieds
Positions vacant OPHTHALMOLOGIST POSITION ASSOCIATE OPHTHALMOLOGIST NSW PORT MACQUARIE NSW LOCUM - TAMWORTH A high volume modern An opportunity exists in Port Calling new Fellows. Short or long ophthalmology practice located in Macquarie NSW, a rapidly term FIFO locum work OR bring Inner West Sydney. We are seeking a growing regional hub, for an your family and make your home board certified ophthalmologist to ophthalmologist to join our well- in the beautiful city of Tamworth. join our practice. established practice on a full-time One hour flying time from Sydney Existing ophthalmologists include or part-time basis. Arrangements and Brisbane. Fulfilling work, two subspecialty ophthalmologists, are flexible and include operating great lifestyle, affordable housing, one retinal and one corneal rights in the private sector at a excellent schools, no traffic. refractive ophthalmologist. purpose-built facility. Develop your subspecialty skills and The practice is able to offer a variety All sub-speciality interests welcome broaden your general experience in of sessions. We have a complete except glaucoma and vitreo-retinal. a supportive practice with plenty of range of the latest equipment in our work. This is a genuine opportunity clinic, including IOL Master, YAG/SLT/ P: +61 5527 8032 to be part of a supportive medical Retinal laser, Pentacam Topography, E: [email protected] community delivering outstanding OCT and Humphrey Field Analyzer. care to our community. Assistance Minor procedures, corneal collagen Practice for lease with travel and accommodation crosslinking and intravitreal available. injections are performed onsite in OPHTHALMIC PRACTICE IN INNER our spacious procedure room. WEST C: Dr Peter Hinchcliffe P: 0412 808 240 C: Donna Gomez or Hien Luong Established, state of the art, E: [email protected] P: +61 2 9789 6994 new and modern, purpose-built E: [email protected] ophthalmic practice available for OPHTHALMOLOGIST NSW lease. Designed with excellent OPHTHALMOLOGIST RURAL patient flow with four consultation Ophthalmologist wanted Sydney AREA, ALBURY WODONGA rooms, four rooms for investigation and Suburbs. Albury Day Surgery is looking equipment, laser room, and minor C: Lynne Cheesewright for expressions of interest from ops room. Close to public transport P: 0414 629 780 ophthalmologists who are and council car park. Includes five E: [email protected] interested in working with us staff underground car park. on a full time or part time basis. C: Khanh-Linh Luu RETINAL, WAGGA WAGGA Albury Day Surgery has a long P: 0488 110 886 history of providing high-end quick Ophthalmologist required 1-2 days E: [email protected] turnover cataract procedures and a month in Wagga Wagga, NSW. retinal surgery. We now have new Predominantly injection and laser. ophthalmology rooms with new All equipment and staff provided, equipment and five new two- Positions wanted accommodation is also provided. -bedroom units adjacent to the CONSULTANT C: John Vecchio day surgery. The units are available OPHTHALMOLOGIST SEEKS P: +61 2 6925 6997 for patients or visiting specialists. POSITION, AUSTRALIA E: [email protected] There is a car available for visiting specialists and the consulting Consultant ophthalmology MD rooms are fully managed. There FRCSGlasg searching for a job as an OPHTHALMOLOGIST IN ophthalmologist. DANDENONG is an opportunity to acquire an interest in the Day Surgery business C: Amr Ouda A position has become available if required. E: [email protected] for a part-time ophthalmologist in our Dandenong practice. We are E: [email protected] a boutique private billing practice LOCUM SOUTH WEST SYDNEY SENIOR OPHTHALMOLOGIST with three senior ophthalmologists AVAILABLE FOR LOCUM WORK working as part of our team. The Locum position available for clinic was recently refurbished and September 2017. Days and times Senior Adelaide-based we have updated all our equipment negotiable to suit applicants. ophthalmologist available for and now have state of the art Would suit a senior or semi-retired locum work anywhere in Australia facilities for our ophthalmologists practitioner as well as a younger and New Zealand. doctor looking for extra work. to practice. C: Dr Alec Jordan P: +61 3 9792 2156 P: 0416 803 377 E: +61 8 8267 2192