The magazine of the Medical Eye Specialists

News Volume 15 Issue 2, June 2012 Contents

President’s update 5

Chief Executive’s update 7

Branch updates 9 7 25 Ophthal news 13 Education and development 18

Annual Scientific Congress 21

International development 26

Pacific Eye Institute 28

RANZCO museum 31

Rural remote and Indigenous 32 ophthalmology

Indigenous health 35

Australian and New Zealand Cornea Society 38

The Dunlops 40

Plan for retirement 45

Eye Surgeons and Surgery in 28 New Zealand 48 Obituaries 51

Upcoming events 58

Classifieds 62

40 48

Front cover: A Nepalese man after having cataract surgery. Photographed by Dr Brad Townend.

RANZCO News 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. The Royal Australian and New Zealand College of Ophthalmologists A.C.N 000 644 404 Editor: Avril Cronk, Design and layout: Francine Dutton, Contributing writer: Denise Murray 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

RANZCO NEWS JUNE 2012- 3

XAL0259_XALTAN_RANZO_A4_v1.indd 1 10/02/12 4:31 PM President’s update

A recent trip to the American Academy of At the Washington meeting there was significant discussion Ophthalmology meeting in Washington with CE Susi about optometry with two US states having passed Tegen, Treasurer Dr Brad Horsburgh and RANZCO legislation allowing optometrists to use both lasers and the Board member and ASO President Dr Arthur scalpel. You can rest assured that in Australia, the same Karagiannis provided an opportunity for a first-hand pressures will be put on legislators to further increase look at the US health care system. Some 400 US the scope of practice of optometrists in this country. As a Ophthalmologists attended the four-day meeting, one profession we need to be proactive in both discussing the day of which was spent at the US Congress meeting issue and designing a plan for the future. politicians from both sides of the House. Many American ophthalmology practices now employ The US is currently spending 17% of GDP on health, optometrists as we do here in Australia and with this where as Australia spends in the order of 10%. Major integrated model patient flow and care can be optimised. funding pressures within the US Government are The American Cataract and Refractive Society has just suggesting a 5.9% cut in the health budget each year for established a special membership section for optometrists the next three years and then a seven-year freeze - a “hard to participate. Currently it is only open to optometrists who pill” to swallow when the health needs of the American work within ophthalmological practices. people are increasing. Our visit to America and learning about the US health The US has a Medicare system for those aged 65 years system particularly as it pertains to ophthalmology once and over and a Medicaid system for the disadvantaged. again highlights the importance of RANZCO establishing In order to participate in both these systems, specialists good relationships with our fellow Colleges around the and primary care physicians essentially have to bulk bill world. the Government and have limited ability to charge “co- I commend our Chief Executive, Susi Tegen for facilitating payments.” much improved links with countries such as the US, Great With the rising costs of providing healthcare across our Britain, India, Vietnam and many of our other Asian and nations there is a gap between what is provided under Pacific neighbours. It is important we work within the our Medicare systems and what we, as practitioners, international framework both in terms of teaching and need to charge in order to provide the infrastructure to research but also at a medico-political level. There is deliver high quality services. In the Australian system much we can learn from each other and therefore these the difference between what needs to be charged as relationships need to be fostered and protected into the reflected in increased average weekly earnings and future. Consumer Price Index and what the Government delivers In Australia the recent Federal Budget placed a series of in form of Medicare payments is picked up as gaps by caps on item numbers 42738 – 42740 in an attempt to patients. In the US system that difference is picked up reign in some outliers in our profession who charge for by the medical practitioner. This has led to many of our intravitreal injections; as much as four times that charged American colleagues being very unhappy with the system by counterparts for the same procedure. You are privileged in which they operate, over the last 12 months, 17% of US to practice medicine in this country and be able to charge Ophthalmologists dropped out of the Medicare/Medicaid medical fees at what level you wish - which you may claim system. is your right - but I suggest to you that it is your privilege A significant lesson I learnt while in the US was that the and certainly when those fees are applied to the tax Australian health system is one of the most balanced, payer funded safety net we need to ensure that we are all fair and equitable in the world. As medical professionals accountable and responsible. we provide a very high universal standard of care, which The threat to our system is if we don’t look after it, or if we remains affordable to both the patient and the system abuse it, we will lose it. We may find ourselves placed in at large. It is extremely important that as practitioners the same situation as our US counterparts where we can we recognise the strengths of the system and, more only participate in Medicare if we charge a set fee laid importantly, protect it into the future. This will require down by the government. proactive lobbying on behalf of our medical organisations, I am proud that more than 95% of our profession are which in our case is RANZCO and the ASO. responsible and are doing the right thing. However a In order to preserve what we have we must identify small percentage of our profession are certainly outliers any excesses in the system. There is always a small and threaten the future of the system we currently operate percentage of any profession that operates outside of under. what most of us would regard as normal guidelines. They need to be identified and brought back within Discussions over the next few weeks will be around the the “pack”. issue of intravitreal injections performed within a theatre

RANZCO NEWS JUNE 2012- 5 president’s update setting. Currently in excess of 80% of intravitreal injections workforce shortage”. It’s important that both state and are done in rooms with an ever decreasing number done in federal governments set clear guidelines around both day hospitals. By way of comparison in the US in excess of these policies to ensure that the system is not used of 95% of injections are done in rooms, and there is no to meet areas of “financial need” rather than areas of particular extra payment system for this procedure to be in “clinical need”. I believe RANZCO needs to be involved a hospital setting. in assessing the applications as an independent arbiter I have heard many arguments around preserving choice to ensure that true clinical area of need exists. RANZCO in terms of where a procedure may be done and I certainly plans to do work with both state and federal governments Chief Executive’s update support choice within the system but where that choice to more clearly identify a transparent process. causes significant further financial pressure to the system, Finally, I would like to say we are privileged to be working then one could argue against that choice. There are within our Australian health care system. We obviously very good indications for such procedures to as practitioners have been given certain rights but, with be done within a hospital setting but that should probably those rights come responsibilities. count for less than 5% of patients requiring this procedure. In taking our Hippocratic Oath we have to ensure that all In the past few months, RANZCO has been very As you may know, more than a third of our Fellows are The issue around patients’ private health insurance patients, no matter their financial circumstances, have having to pay gaps for procedures carried out in rooms active internationally, sharing information on, and involved not only with RANZCO committees, education access to high-quality, affordable medical services. Those benchmarking against a wide variety of issues critical and training and research, but also with international as opposed to a day hospital needs to be addressed services need to be affordable, both to the individual separately. to its peak position in Australia and the region. development in the Asia Pacific. In fact, more than 70% patient and to the system at large. I thank my colleagues Standards, training, examinations, curriculum review, of Fellows recently advised us (through our workforce Discussions need to be held with the government and who live by this Oath every day in their practice of patient access and service delivery, policy input, policy survey) that they wish to be more involved in RANZCO private health insurance funds to look at ways private medicine. We must ensure those most in need of vision feedback and the RANZCO workforce study, are to development activities. Opportunities arise in setting health insurance can fund procedures conducted in saving procedures receive them in a timely and affordable name but a few. curriculum standards, CPD, teaching or teaching doctors rooms. The number of patients requiring these injections way, both within the public and private system. in other countries how to teach their teams. will continue to increase with an ageing population and Let’s keep up the good work but also let’s keep our house Asia Pacific Ophthalmology therefore, the outcome of this current debate should ensure in order. RANZCO Leadership Program that we have a sustainable and affordable system in order At the recent Asia Pacific Academy of Ophthalmology to continue to provide this service. (APAO) congress in Busan, Korea, RANZCO Fellow RANZCO is the only organisation in Australia and NZ Dr Bill Glasson A/Prof Frank Martin addressed the members as their which represents, educates, trains and sets standards A further issue that has been raised with me is the RANZCO President concern around “clinical need versus the area of President and our Fellow. Like APEC leaders, all office for ophthalmology; this is our core business. However, bearers donned traditional costume to open the meeting. Australia and New Zealand have a very important role Similarly attired was Prof Hugh Taylor who will become outside of their shores and the research, experience Australian doctors have the unique practice overhead costs increase, US the new President of the International Congress of and innovation is of great interest. This is not only to privilege of being able to set their doctors must simply increase patient Ophthalmology (ICO). A/Prof Martin, Prof Taylor and ophthalmologists in the Asia Pacific, but to those in the professionals fees, independent of throughput. No (or relatively small) many other RANZCO Fellows contribute hugely to US, UK and Europe. The links we have made over the government intervention. Ours is out of pocket costs have encouraged our international profile, promoting RANZCO and our last two years have allowed for sharing of information and an honour system which must be high healthcare usage and health Ophthalmologists. This presence was reflected in the standards, linking of speakers, discussions of policies protected; to fail to do so will destroy insurance premiums to escalate increase in numbers attending APAO, from a few and trends (which mirror demographic needs), how one the system for those that follow. accordingly. Here's the thing… US Australian and New Zealand invited presenters and works in different systems and above all camaraderie and RANZCO fully supports the right of Health insurance premiums are participants only a couple of years ago, to more than networks. We will launch RANZCO‘s own parliamentary Australian doctors to set their own usually paid by one's employer rather 60 this year. This reflected the importance of RANZCO leadership program in June this year. and its Fellows in the Asia Pacific. fees. These fees must be justified than the individual (as in Australia). Dr Cathy Green, as Chairman of the APAO Leadership and reasonable. A typical US patient may cynically The Board was also well represented. Dr Stephen program, and I worked with APAO members and societies think … ‘Who cares what this service The American health care system Best and I met with APAO, International Council of and Dr Mike Brennan (Past President AAO) to deliver the costs because the boss is paying!’ finds itself in a financial cul-de-sac. Ophthalmology, the American Academy and various last session for the 2011 Leadership program and the This attitude may work well for an Ophthalmology societies within the Asia Pacific. It beginning of the 2012 leadership program. The purpose RANZCO visit to Major contributing factors to the individual but not so well for the was particularly useful to have so many Fellows and of the Leadership Development Program is to provide out-of-control health-care costs are country. organisations gathered in one place, albeit briefly! both orientation and skills development to future leaders the predominance of third-party The US system works until such time AAO midyear forum payers (health insurance companies as the doctor cannot work any faster. and HMOs), and the fact that most That point has now been reached. private health insurance premiums – new perspectives of Doctors are voting with their feet. are paid by one's employer. Over the last 12 months, 17% of home from afar In the United States private health US ophthalmologists have stopped insurance covers both in and out I agree entirely with sentiments treating Medicare patients. At this rate, of hospital expenses. For a typical expressed by RANZCO President within another 12 months one third of doctor’s office visit, the patient usually Dr Bill Glasson. The RANZCO US ophthalmologists will refuse to see pays nothing (or relatively little) out delegations have returned from the patients over the age of 65 years! of pocket to the treating doctor, this US convinced that Australia has removes price as a variable. Without In Australia we have healthcare that the best balanced public/private a price signal it is increasingly difficult works. It may not be perfect but the health care system in the world. for the US patient to decide which Australian health care system is the We spend less than 60% on health doctor represents good ‘healthcare best out there and we need to protect care compared to the US, and value’. its sustainability for both patients and yet achieve universal healthcare doctors. coverage. The system functions By law, US doctors must not charge Dr Brad Horsburgh with relatively light government more than the proscribed fee. From left: Dr Bradley Horsburgh (Board member RANZCO), Dr Ruth Williams (President AAO), Treasurer, RANZCO Federal Board oversight. These fees do not reflect increasing Dr Arthur Karagiannis (Board Member RANZCO), Ms Susi Tegen (CE RANZCO) Dr Bill Glasson (President RANZCO) practice overheads. As medical Member Dr David Parke II (Chief Executive AAO)

6- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -7 chief executive’s update of Ophthalmology in the Asia-Pacific region. Four of our -- Population which is more and more aware about health Fellows have now graduated from the program – Drs Colin or at least where to find it Chan, Samantha Fraser-Bell and Lyndel Lim, with Brendan -- Ageing populations and their needs Vote beginning the next class. -- Demographic changes in the health and medical Being involved, whether on one of the international workforce committees or the Leadership Program faculty involves an -- Political decisions element of risk taking; What if it doesn’t work as well as -- American Academy Ophtahlmology. hoped? What if the organisational priorities do not align? What if …. ? The risks and returns are both personal These are the sort of issues that the American Academy and organisational. Overwhelmingly they are worthwhile. recognises and have led to its annual mid-year meeting of Unless we keep questioning and striving, we will not ophthalmology leaders and politicians in the US Senate on innovate nor meet the challenges ahead. Capitol Hill, Washington. You might ask why we need to formally develop leaders The President (Dr Bill Glasson) and I attended the 2012 and whether or not some people just are leaders. It takes meeting following the APAO Busan meeting. Board a completely different set of skills to those excellent clinical member Dr Brad Horsbough and ASO President Dr Arthur skills you may have to lead a clinical team, a hospital Karagiannis were also in attendance. The meeting was board, a College committee, a School or other association extremely stimulating and informative. Dr Glasson spoke board. of the Australian healthcare system, which was very well received given the intense US interest in the current We, as a College, have a responsibility to our own “Obamacare” health bills. members and patients, to build the capacity to lead the next generation and deal with the challenges to deliver At this meeting I had the opportunity to catch up with one excellent accessible and affordable healthcare for the of our own young and very involved Fellows Dr Justine individual patient and for the community as a whole. The Smith from South Australia who has been working in the change drivers to be addressed include; US over the last 10-15 years as a Uveitis specialist. She Dr Bill Glasson, Dr Dianne Sharp, Ms Susi Tegen, -- Cost of health care currently chairs the American Academy Uveitis Society … wouldn’t it be great if she came back to SA! Dr Derek Sherwood and Dr Stephen Best at the -- Change in health systems and priorities New Zealand Branch meeting -- Value for money and outcomes We are very fortunate in Australia to have a health system so dissimilar to the US model. It is so because we drive -- Higher expectations from community and individuals no the debate on health and must continue to do so. The matter which country Leadership program is a small but important part of this. The main point is that we must all be involved. Susi Tegen Branch updates Chief Executive RANZCO P.S Congratulations to A/Prof Bruce Hadden on the What has your Branch been up to? release of his book “Eye Surgeons and Surgery in New Zealand”. This wonderful history is another great contribution from one of our Past Presidents.

he achieved his goal of changing our very moving and inspiring account.” behaviours,” says New Zealand Branch The NZ Branch held its Annual General Dr Stewart. Meeting during the conference. “One of The New Zealand Branch held its The program included a workshop the key areas of discussion was Health We, as a College, have a annual meeting in Hamilton from on ‘Mastering difficult interactions Workforce New Zealand (HWNZ) and 24-27 May at the new Claudelands responsibility to our own with patients’, and a surgical ‘How I the issues around health delivery in Conference and Exhibition Centre. It do it’ session. “Pat Bary, a Hamilton the future,” says Dr Stewart. “HWNZ ‘‘ was the first time the NZ Branch had urologist, talked about ‘change’, and wants optometrists to do more of members and patients, to met in Hamilton. how we effect change,” says what has historically been done by build capacity to lead the “The meeting was well attended and Dr Stewart. “One of the highlights of ophthalmologists, and there was a lot a great success,” says Conference the meeting was NZ rowing legend of discussion about a pilot project being next generation and deal Convenor, Dr Jim Stewart. “The Rob Hamill, who spoke of his trans- set up in Auckland involving cataract theme was ‘General Medicine for the Atlantic rowing experiences and the and glaucoma management.” with challenges to deliver death of his brother Kerry Hamill – who Ophthalmologist’. Among the speakers “We are a long way from reaching was killed by the Khmer Rouge in were specialists from other branches consensus. However, ophthalmologists excellent accessible and Cambodia when his yacht strayed into of medicine who spoke on topics of are better being on the inside, involved their territory.” affordable healthcare for the relevance to ophthalmologists.” and helping to mould change,” adds Dr “The keynote speaker was Prof Andrew “Rob travelled to Cambodia to retrace Stewart. individual patient and for the steps of his brother,” says Lee from Houston Texas. He is a The NZ Ophthalmic Nurses’ Dr Stewart. “He made a documentary great teacher and imparted a lot of Conference was held in conjunction the community as a whole. and spoke to eyewitnesses, Dr Ruth Williams, President, American Academy knowledge in a very entertaining way. with the NZ Branch meeting. “There perpetrators and survivors. He gave a of Ophthalmology and Ms Susi Tegen ” I think for most of us in the audience were a number of joint sessions 8- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012- 9 branch updates with ophthalmic nurses. These were well attended and the idea will be extended to future branch meetings,” says Dr Stewart. The social highlight of the meeting was the conference dinner held at the Vilagrad Vineyard, one of the Waikato region’s oldest vineyards. “The vineyard was established by immigrant Dalmatian family in 1922 and is currently run by the fifth generation – three brothers are Prof Mark Radford, Prof Graham Holder, Dr Anthony Pane and Dr Rowan the winemakers, the chefs and the Porter at the Queensland Eye Institute musicians,” says Dr Stewart. Dr Jim Stewart relatively common- fit this definition of best demonstrated in London. New Zealand Branch Meeting an orphan retinal disease. This will ensure that we are not only Convenor During Prof Holder’s visit to prepared for therapies such as gene Queensland he was able to transfer for RPE65 Leber’s Congenital communicate with all the categories Amaurosis, but also contributing Queensland Branch of IRD health workers and was internationally to find new genetic able to bring them together to share solutions. Educational Course on a meal and see a path forward to collaborate better to serve patients. Dr Rowan Porter, Qld Branch Electrophysiology Treasurer Prof Holder’s three one hour

Inherited Retinal Disease (IRD) lectures were outstanding. They 1. Weleber, RG. Clinical Progress in Inherited orphan was in the spotlight in late April covered firstly, an introductory retinal Diseases: RETINA 2005 Sup; VOL 25, No8, S4-7 when RANZCO (QLD) ran a Electrophysiology lecture to bring all three day Educational Course delegates to a level where they could on Electrophysiology at the benefit from the advanced lectures Queensland Eye Institute. All the following evening. The second South Australia IRD workers have benefitted from was correlations between IRD clinical Prof Graham Holder’s generosity findings and electrophysiology to Branch during his three month sabbatical better define the phenotype and The SA Branch has commenced in Sydney. Prof Holder is Director finally an Electrophysiology for planning for a Glaucoma themed of Electrophysiology at Moorfields Neuro-ophthalmology update. State Branch Scientific Meeting at Eye Hospital and a board member The program also included visits to the Novotel Barossa Valley Resort of the International Standards for the two electrophysiology labs, case April 6 - 7 2013. Electrophysiology body, (ISCEV). note reviews, poster presentations, journal club, nine live cases and a There is an on-going battle to retain Apart from learning to sail and conference link with the Chief Scientist a substantive ophthalmology service making his own acoustic guitar, of the Australian Inherited Retinal within the New Royal Adelaide Prof Holder has been assisting the Disease Registry and DNA bank at Hospital which will supersede the Sydney Eye Hospital upgrade the the Sir Charles Gairdner Hospital present hospital at a different site electrophysiology laboratory to that in Perth. A Prof Robyn Jamieson, a further along North Terrace, utilising of a Centre of Excellence in IRD. geneticist from the Children’s Hospital unused railyard land. It appears the Not only has he enjoyed his stay in at Westmead, joined us to discuss proposed building will struggle to Australia but he has brought IRD the role of the geneticist and next house the services that an ageing workers together as never before generation sequencing using exome population will require, particularly with the hope of better collaboration sequencing. This technique is more in ophthalmology, with a move to to upgrade phenotyping locally and reliable and affordable than current devolve a centralised ophthalmic genotyping nationally of these diverse genotyping microarray (gene chips) service into more peripheral hospitals. “orphan” retinal diseases. and gene sequencing, respectively. An “orphan disease” has an Twenty trainees and consultants Concerns regarding funding for public incidence of less than 1 in 1000 were able to access the lectures live eye health care continue. There is a and is generally considered by from remote sites using conference lack of transparency with only hospital pharmaceutical companies not software over the internet. operating list waiting times available, financially viable for which to develop It was great to meet Prof Graham whereas in most cases the waiting treatments. There are 600 orphan Holder away from the pressures of time to consultation prior to booking diseases affecting 9 percent of the running a department at Moorfields on a theatre waiting list is much population. 80 percent of these rare and see him enjoying his stay in longer. diseases are genetic. Virtually all Australia. We look forward to hosting Dr Grant Raymond, SA Branch inherited retinal dystrophies and him again in summers to come as he Chair degenerations- except age related helps us steer our collaborative efforts macular degeneration (AMD), which is to offer services at a level presently

10- RANZCO NEWS JUNE 2012 branch updates training programs in other States. This Victoria Branch New South Wales situation must be resolved as trainee numbers in this State are not meeting Update Branch Update current demands let alone the increase in WA’s population. The recent Victorian Branch The NSW Branch of RANZCO held Congratulations also to final year scientific meeting (17 March) was its annual scientific meeting on University of Western Australia a great success. Our international March 23-24 at the Crowne Plaza in medical student Marcus Sim recently guest, Dr Debra Goldstein, the Hunter Valley. The meeting was won the RANZCO (WA Branch) provided valuable and memorable highly successful with more than Prize for gaining the highest mark insights into current uveitis 250 Fellows attending –including in the ophthalmology component of thinking, while a generous (and some interstate delegates. The the Level 5 General Practice and brave) panel provoked thought, topics covered were infectious Ophthalmology units. discussion and controversy with disease, immunology, uveitis, their presentations on femtosecond anaesthetics, neurophthalmology, Ophthalmology research and clinical cataract surgery. genetics, rheumatology and teaching in Western Australia has endocrinology. Attending Fellows been significantly boosted by the The dinner function was held in a found these updates in general recent arrival of Professor John private Melbourne club and guests medicine highly relevant to their Forrester, a world leader in ocular were perhaps a little distracted from practice of ophthalmology and immunology. An ophthalmologist of the opportunity to catch up with their provided very positive feedback eminence, he was admitted as a friends and colleagues, due to the in their post meeting surveys. RANZCO Fellow earlier this year. startling collection of fine Australian Professor Forrester, who also holds In an effort to assist Fellows with artworks that we were privileged to be the Cockburn Chair of Ophthalmology their CPD, the Branch is offering to dining with. The Branch Committee at the University of Aberdeen, will be supply working spreadsheets to audit extends thanks and congratulations continuing his research into uveitis at a number of procedure items. This to Drs Tony Hall, Heather Mack, Julie the Lions Eye Institute and involved in is open to all RANZCO Fellows by Humphrey and Mr Nicholas Brislane teaching. and for their efforts in organising this emailing [email protected]. meeting. au for the working spreadsheets. This Numerous RANZCO members is a work in progress and we hope are represented on the State The Victorian Branch meeting is to collate feedback from Fellows Government’s Eye health Advisory expected to continue with its compact, to eventually establish national Group, dealing with planning issues high-impact format and Victorian benchmarks. at the new Fiona Stanley Hospital. members in particular are urged to Scheduled to open in 2014, this This year we will again participate take the opportunity to update their hospital will be the largest in the State in the NSW AMA career expo knowledge, augment their CPD audits but with inadequate (virtually nil) where young doctors can explore and reconnect with their friends and facilities for ophthalmology services. various careers in medicine. Many colleagues at the 2013 meeting. The committee is considering ways to have a misconception that a higher manage this shortfall using a hub and Preparations for the November degree is required to gain entrance spoke model. RANZCO Congress are well to ophthalmology training. This is advanced and delegates can expect a an opportunity to encourage young It is pleasing to report continuing high-quality scientific programme and medical doctors and students to progress with improving access to a memorable evening programme. choose a career in ophthalmology Indigenous and remote eye services. Tickets for some events will have and to dispel any misconceptions.“ Prof David Mackey to be limited and early registrations WA Branch Chair are advised. When the Congress Dr Sam Lerts is in Melbourne it is appropriate NSW Branch Chair to acknowledge Victorians who Ophthal News have made special contributions to Western Australia Western Australia will host ophthalmology and Fellows who wish the annual ANZGIG meeting “One of the main things I took out of it was that despite to make nominations for recipients of at the Esplanade Hotel Branch Update having to use limited technology, the developing countries College awards should communicate Fremantle on 7-8 February Exposure to developing world with the Branch Committee. are able to achieve results that are very good.” After a successful WA Branch 2014. surgery valuable to trainees Dr Townend found the surgical exposure particularly Committee members are happy to meeting in February, planning has Hanspeter Killer, head useful. “In my training in Sydney, I had very little exposure discuss the awards process with any begun for next year’s meeting, to of division of Neuro- As a Fred Hollows Foundation Fellow and the recipient to the older extracapsular style of cataract surgery. I Fellows who are considering making a be held in the Swan Valley on 2-3 ophthalmology and of the Westmead Eye Registrar Fund Scholarship, had developed the opinion that almost any cataract was nomination. March 2013. Strabismus, Kantonsspital Dr Brad Townend was able to spend six months of ‘phaco-able’ and that extracapsular surgery tended to Congratulations to Drs Chandra Aarau in Switzerland, has his final year of training working in Fiji, Nepal and produce unacceptable refractive outcomes and morbidity. Dr Andrew Crawford Balaratnasingam and Joshua Yuen been invited to give the Lowe Alice Springs. Dr Townend (Currently working on the During my time overseas I was exposed to manual Small Vic, Branch Chair who recently passed their RANZCO Lecture and Bill Morgan, who Central Coast) describes his experience as invaluable Incision Cataract Surgery (SICS) and this presented Advanced Clinical Exams. Inadequate is well known for his research in his professional development. “I went because I an excellent option for managing dense cataracts. In resourcing to supervise trainees into glaucoma, will present was looking forward to being trained in very different developing countries phaco cataract surgery is not feasible continues to be a problem. With only the Gillies lecture. conditions, using different skills, seeing different as the machines are expensive to buy, maintain and run one position available in WA this year, problems and using different technology to solve in terms of consumables. SICS is a great alternative. It we lost five Western Australians to those problems. And it didn’t disappoint,” says Dr Townend. is basically sutureless extracapsular surgery utilising a

12- RANZCO NEWS JUNE 2012 RANZCORANZCO NEWS NewsJUNE June2012 2012-13 13 ophthal news scleral tunnel. In experienced hands the operation can be ophthal news performed quicker than phaco, and the fact that there is no suturing means there is little astigmatism induced. A number of randomised controlled trials have shown that for dense cataracts such as those in Nepal, SICS produces outcomes that are just as good, if not better, than phaco (where with dense cataracts the risk of complications with phaco increase and there is more corneal oedema), describes Dr Townend. “I would now consider using SICS as a primary approach to dense cataracts, and have found greater confidence in managing difficult cataracts and surgical complications through my experience in the Developing World. There is a strong case for expanding the scope of registrar training to include exposure to surgical techniques such as SICS”. When asked if he found any similarities between the three regions, he said “I found it to be very similar in terms of lack of access to care, but very different in the way the cultures work to help themselves. The local doctors in Nepal in particular were very proactive in building up skills, systems and services – and the patients showed similar initiative in service uptake and compliance. The Pacific is also “In Nepal a man brought his father in for becoming more that way. Despite being in our own backyard surgery. The man had been forced to leave work Alice Springs was one of the more challenging and difficult to become a full time carer for his blind father. areas to get results in. The patients there had a different This lack of income meant his young children cultural mind set.” were not being educated, and that there was RANZCO President rides in Pollie Pedal Dr Townend would like to continue what he started. “I would minimal food to go around. When I restored the like to definitely keep working with the Hollows Foundation. Dr Bill Glasson recently participated in the annual Pollie Pedal with Tony Abbott to raise funds for Carers Australia, My experience not only made me a stronger surgeon father’s sight they were both incredibly grateful. $548,000 was raised. Congratulations to all those involved! but also broadened my mind to help me think outside my Doing deeds like this really made me feel like previous square. In conjunction with the Hollows Foundation I was providing something valuable to the whole and using relationships built while in the Pacific Islands, I am community, a good example of the Hollows now working with my father to build a clinic in the Solomon work.” Islands and will be going out later this year to operate there.” RANZCO welcomes AAO Director of Ophthalmic Society Relations

newspapers, print advertisements in he peopled the Australian bush with Gail Schmidt is the Director of Ophthalmic ORIA partners with art and lifestyle magazines and visual mythological figures, painted in an Art Society Relations for the American Academy of media. A brochure highlighting the Nouveau style. Ophthalmology (AAO). work of the ORIA will be available the National Gallery In some of his most admired images, Among her roles, Ms Schmidt leads the implementation at the exhibition and we will be The spirit of the plains 1897, Pan of the Academy’s annual Mid-Year Forum in Washington, acknowledged at the official media of Australia, Canberra 1898 and his several versions of DC; a meeting of US ophthalmology leaders and preview and official opening along Flamingos, Long created haunting members of Congress. She also leads the Academy’s with invitations to events and tours of Sydney Long – Spirit of the images of the Australian landscape Young Ophthalmologist Committee, oversees the Senior the exhibition. The Gallery has kindly Land exhibition, National with decorative, musical qualities and Ophthalmologist Committee and is responsible is the offered auction items for the RANZCO gentle symbolism. Seeking imagery Academy’s Leadership Development Program, which Gallery of Australia, Eye Foundation’s JulEYE campaign. which conveyed the ‘lonely and assists in identifying and training future leaders at both Canberra 17 August - The branding of the ORIA and the primitive feelings of this country’, he the local and national levels. exhibition on the NGA’s website has 11 November 2012 captured something of the soul and now commenced, see http://nga.gov. Gail recently visited RANZCO to meet with the Board The ORIA was bequeathed the tenor of the Australian bush. au/Long and staff and discuss the RANZCO Leadership copyright for reproduction of Sydney The exhibition of Sydney Long’s works Development Program and Mid Year Forum, both of Long’s works in order that it would Sydney Long is Australia’s foremost will be on display from 17 August to which are running for the first time this year. While in gain a benefit in promoting both Art Nouveau painter, whose work is 11 November 2012. Such a focussed Sydney, Executive Assistant, Ms Alex Terry, took Gail for its works and the works of Sydney much loved. His art flourished in the presentation, looking in depth at the a sightseeing Bridge Climb tour. Long. The ORIA has negotiated a imaginatively stimulating atmosphere best of Long’s paintings, watercolours partnership with the National Gallery of Sydney in the 1890s and 1900s, Gail’s visit was highly successful with the Board and and prints is the first major survey of of Australia, Canberra whereby it when he achieved early success RANZCO staff impressed with the wide range of his work for over forty years – and offers the ORIA substantial exposure with one of his best-known works, activities that the AAO, and Gail in particular, undertake. promises much to kindle the visual with its branding on all publicity By tranquil waters 1894. It was a imagination. for the exhibition in major national precursor to the paintings in which From left: Ms Gail Schmidt and Ms Alex Terry, RANZCO Executive Assistant 14- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -15 ORIA: Helping Australians ophthal news

O R I A ophthal news to see more clearly Advancing eye research

How often do we think The ORIA receives no about the wonder of sight? government funding and the Usually only when something funding it provides annually goes wrong and then how has enabled many eye surgeons relieved we are when our and scientists in related fi elds, sight can be improved or to enrich Australian medicine restored. However, each year and surgery through their in Australia 10,000 people contribution to clinical practice, lose part of their vision or go medical education and medical blind. Despite the common research. Betty Churcher AO was the misconception, vision loss is ORIA can’t guarantee that the fi rst female director of a not restricted to the ageing research they fund will fi nd a cure state art gallery and the fi rst and can affect people at any for some of the more challenging woman to be Director of the time in their lives. eye diseases many Australians National Gallery of Australia, The loss of vision can be suffer from. Nonetheless, real Canberra. Recently, Betty’s devastating and is felt breakthroughs in eye disease sight, the one faculty she more acutely when simple treatment since the ORIA’s values above all others, activities such as looking inception have been realized deteriorated to what she at a beautiful artwork are through research continuing to describes as, ”like having made challenging. Images are benefi t all Australians who have midnight sitting on your distorted and the real beauty debilitating eye disease. shoulder – a big, black of artworks, and their ability presence”. Like thousands The ORIA was bequeathed the to touch, inspire and engage of Australians, Betty suffers copyright for the reproduction people, are compromised. from macular degeneration, of Sydney Long’s beautiful and became an ambassador The Ophthalmic Research artworks. The ORIA and the of the ORIA’s fundraiser, the Institute of Australia (ORIA) NGA are proud to be in RANZCO Eye Foundation has been funding research partnership for The Sydney Long, in 2007. into eye disease, in Australia, The Spirit of the Land, Exhibition for nearly 60 years. During (17 August – 11 November 2012). Throughout my life I have this time, the ORIA has seen and experienced so ,, The ORIA is the research provided millions of dollars many beautiful things, from arm of the Royal Australian The event, which involves eye health “As an Ophthalmologist, I witness to fund research into all my childhood and adult Eye health professionals walking sections of firsthand the challenges that those and New Zealand College of major diseases, including years, watching my own the newly opened Te Araroa national with vision loss face every day. Ophthalmologists (RANZCO) walkway, takes place over the EyeTrek Te Araroa is not only a great macular degeneration children grow, and of course community asked to and its charitable fundraiser is weekend of 3 and 4 November, 2012. opportunity to raise money for blind which has impacted on viewing some of the best art There are four specially selected and partially sighted people, but also The RANZCO Eye Foundation. walk for blind and Betty Churcher’s vision. in the world - all of which routes including regions around to further strengthen the relationship are fi xed in my memory. Auckland, Wellington, Queenstown between the eye health community partially sighted and the Queen Charlotte Track, which and the RNZFB”, he says. I have always valued my will take in some of our country’s most “I am taking part in EyeTrek Te Araroa sight and the wonderful breathtaking scenery. Kiwis knowing that every kilometre I walk visions captured through This special fundraising event will help will raise valuable funds to help future Access to books is a basic right my eyes. For my sight to fund the RNZFB’s B-Speak campaign, proof the RNZFB’s digital library for that everyone should enjoy. This set up to ensure that blind and generations to come.” be partially taken away is why New Zealand’s eye health partially sighted people have the same professionals are being asked to To find out how you can get involved from me is unfathomable. opportunity to access reading material show their support and take part in in EyeTrek Te Araroa or to make a I support the work of The as anyone else. EyeTrek Te Araroa, a fundraising donation to B-Speak, please visit RANZCO Eye Foundation walk for the Royal New Zealand The inspiration behind the event is www.eyetrek.org.nz or phone 0800 enormously and remind Foundation of the Blind’s (RNZFB) Dr Stephen Best, Vice President of 366 283. everyone that their sight new digital library. RANZCO. is truly a gift that should never be taken for granted. Sydney Long 1914 National Gallery of 16- RANZCOThe NEWS Spirit JUNE of 2012 the Plains RANZCO NEWS JUNE 2012 -17 Australia, Canberra ,, RANZCO News June 2012 17 Advertisement education and development Fellows to become examiners in the book. The recommendations from the successful and a medal winner has Ophthalmic Science were published examiners were collated into a single been nominated by the examiners. in RANZCO News, on the AAO document, which was then distributed RACE examinations were held in OneNetwork and RANZCO website. to all meeting participants to review February and March this year, with Following consultation with and prior to the workshop. RVEEH the venue for the clinical approval from the Chair of Ophthalmic The review panel identified the component. 28 RANZCO trainees and Sciences, Regional QEC Chairs, essential elements to be included nine Specialist International Medical Subject Leaders, the Censor-in-Chief, in the curriculum standards, and Graduates (S-IMG) presented as the Chair of RACE and the RANZCO recommended an improvement in candidates of the trainees 21 passed, CE, in March 2012 14 Fellows were the organisation of the information three achieved a partial pass, and appointed to join the Ophthalmic to assist trainees. The Physiology four failed and will re-sit the exam. Sciences Board of Examiners. examiners and RANZCO education Feedback on the S-IMG candidates We congratulate these Fellows staff, will continue to work on was provided to the Committee. on their appointment: Drs Paula refining the learning outcomes and Berdoukas, Stuart Carroll, Simon performance criteria of the curriculum RANZCO Online Dean, Magda Guzowski, Patrick standards before submitting the Lockie, Randev Mendis, Neil Murray, revised standards to the Curriculum Learning Portal Ian Reddie, Daya Sharma, Shanel Committee for sign-off and ultimately (MOODLE) Sharma, Kiran Sindhu, Angelo Tsirbas, to QEC for endorsement. Over the past 10 months there has Kristen Wells and Christine Younan. In an attempt to make the volume of been a seven-fold increase in the Two current OS examiners who were work more manageable for trainees, number of visits to MOODLE. July previously involved in the Genetics the Physiology examiners have 2011 saw just over 670 visitors, by exams (Drs Andrea Vincent and also agreed to update and, where April 2012 that increased to over Tasha Micheli) have agreed to be re- necessary, expand the Physiology 4,700 visits. Part of this increase can deployed to examining in OBCK and Study Guide to include references to be attributed to a new page being anatomy respectively. the new text book and/or alternative created for RACE which has allowed sources of information where required. The newly appointed examiners trainees and examiners to access were provided with both general The strengths and challenges of the past papers, examiner’s reports and and subject-specific information to current Physiology assessment were the best responses for individual inform and assist them in performing also explored in detail. A revised questions within the written sections their duties, as well as access to format for future Physiology exams of the exams. In addition to this there the RANZCO learning management was proposed and discussed, details are new PowerPoint presentations Education and Development system, Moodle – where they can of which will be communicated to in the area of general clinical download these and other examiner Trainees and Directors of Training in ophthalmological resources. Additional resources and past exam papers, coming weeks. clinical resources will be added within as well as participate in discussion Congratulations to Dr John Dickson the next month. To support our senior Fellows RANZCO has forums. (Physiology Subject Leader) and Supervisors and clinical tutors In addition, the new examiners in the team of Physiology Examiners also have access to six education anatomy, optics and physiology were (Drs Peter Wellings, Jean-Louis symposium talks which took place at revised its CPD requirements provided with copies of the prescribed De Sousa, Shanel Sharma, Vivek the last two RANZCO congresses. text books for their subjects. Chowdury and Peter Hadden) Some of the talks end with excellent induction assessment. Trainees as well as the rest of the review CPD New senior Fellows The 2012 annual meeting of the OS question and answer discussions, are expected to submit all required panel – including Dr Cathy Green and OBCK examiners is scheduled which give insight into dealing with the The online 2011 CPD Diary is CPD requirements reports to RANZCO within two (Chair of Ophthalmic Sciences and to be held at the RANZCO office on difficult task of providing constructive now closed with an audit of 5% weeks of completing a rotation, in OBCK), Dr Mark Renehan (Censor- Senior Fellows (above the age Saturday 20 October. It is anticipated feedback to trainees in clinical of Fellows’ claims underway. order to have their training time in-Chief), Dr Michael Hennessy of 60) make up nearly 30% of that this meeting will include a special settings. Fellows who have been selected accredited. We wish them all well as RANZCO’s Fellowship. Many have a induction session for new examiners. (DoT at POWH), Dr Matthew Green to participate in the audit can they commence on their journey to limited scope of practice, but would (Trainee representative), Ms Penny Specialist International download a Guide to Preparing become our future Fellows. Physiology Curriculum Gormly (General Manager: Education for a CPD Verification Audit from still like to remain registered as a Registration for the RANZCO and Development), Ms Antonelle Medical Graduates the “Fellows” contents in the “specialist” with APHRA. Review selection for training to commence Clemente-Marquez (Education members’ area of the RANZCO To support our Senior Fellows, In the past three months the S-IMG in 2013 closed on 1 May. There On 5 May 2012, a workshop was Support Officer) and Ms Sonja Cronjé website. RANZCO has revised its CPD committee has conducted eight were 91 applicants. Referees are conducted at the RANZCO office (Manager: Curriculum, Assessment requirements. Retired Fellows interviews of ophthalmologists trained Fellows who are not selected currently being contacted. Interviews in Sydney to review the Physiology and Indigenous Health). will now be exempt from the audit overseas. Of those eight applicants to participate in the audit and will take place throughout August curriculum standards. In the weeks requirement. All Retired Fellows now interviewed three were declared who have met RANZCO’s 2011 with the process being finalised leading up to this meeting, much Advanced Exams CPD requirement will receive need to report 50 CPD points per substantially comparable to a recently through the National Ophthalmic preparatory work was done. Each of In Feb 2012 28 candidates presented a Certificate of Continuing year. For more information please graduated RANZCO trainee and five Matching Program on 3 September. the Physiology examiners conducted at venues in Sydney and Perth for the Professional Development. Fellows contact Eden at [email protected] were declared partially comparable a preliminary revision of the current Ophthalmic Pathology examination. participating in the 2011 member and will undergo further assessment. Appointment of new curriculum standards. This was done This is the first time the exams have audit will receive their Certificate RANZCO met with NSW Health in Trainee Selection in order to ensure that all the essential been held concurrently in more upon successful verification of their Ophthalmic Sciences February to outline the structure and The 35 trainees selected to areas or elements of the subject were than one centre, the process went CPD claims. Such Fellows will be purpose of Periods of Supervised commence training in 2012 have and OBCK Examiners covered, as well as to update the very smoothly. It is expected that exempted from the annual member Practice and the costs involved. By started training and have now In late 2011 and early 2012, calls for reference materials in line with the future pathology exams will be audit exercise for one CPD cycle. approaching NSW Health directly, completed their compulsory expressions of interest from eligible latest edition of the recommended text decentralised. All candidates were

18- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -19 education and development

From left: Ms Sarah Stedman, Dr Antonelle Clemente-Marquez, and Mr Craig Dobney The Education team welcome we aim to establish assessment position(s) in one or more hospitals three new members across the state. NSW Health will be discussing this proposal with various Antonelle Clemente-Marquez, Education hospitals. RANZCO intends to discuss Support Officerwas a Corporate General positions for Periods of Supervised Practitioner for two years in the Philippines and a practice with other state health Registered Pharmacist for eight years. Antonelle provides departments. administrative support to the Education and Development On March 19 the parliamentary report team particularly in advanced exams, curriculum Annual Scientific (which made 45 recommendations) development and review, advanced trainee support, CPD into the Registration Process and and S-IMG assessment. Support for Overseas Trained Doctors was tabled. The Committee is currently Craig Dobney, Education Support Officer working with RANZCO to respond to who had 10 years in the banking industry and seven this report. years working in healthcare. Craig provides administrative support to the Education and Development team Congress I (Dr Mark Renehan), would like to acknowledge the contribution to particularly in the Ophthalmic Sciences exams (Anatomy, the training program from so many Physiology, COPEM, Optics, OBCK), basic trainee Fellows. It is particularly good to see support, including work based assessment reporting, RANZCO 2012 Congress the number of younger fellows actively networks and training post accreditation, selection, involved in all aspects of training their mentoring, Indigenous health, evaluations and web site future colleagues. Your expertise, review. energy and enthusiasm contribute The countdown is on… Sarah Stedman, Memberships Coordinator to the dynamic nature of the College who has 10 years experience in managed investments, and augur well for the future of our focussing on adviser/client services, product management, Registrations to open this month, look out for updates on profession. communications, due diligence and stakeholder/project Dr Mark Renehan management. Sarah’s role includes membership, Censor-in-chief scholarships and managing the administrative component ranzco2012.com.au! of the scientific program for the RANZCO Annual Scientific Congress.

20- RANZCO NEWS JUNE 2012 RANZCORANZCO NEWS NewsJUNE June2012 2012-21 21 annual scientific congress You instigated the idea that Dr Daniel Chiu annual scientific congress non-local speakers be given Speaker highlights RANZCO A Fellow since 2000, Dr Daniel Chiu a Melbourne based “buddy” Council Lecture - this year. Can you explain has been a recipient of the KG Howsom Medal for Excellence, the Professor Mark Gillies Annual what the “buddy” is and ARVO travelling scholarship and how the idea came about? the Cedric Cohen Medal. Prof Mark Gillies MB BS, PhD, FRANZCO, a clinician-scientist who specialises in diseases of the macula, directs the Macular Research Group at the Save Sight We (the local committee) will assign Scientific Have you lived in Melbourne Institute of the University of Sydney. This group pioneered the use of intravitreal speakers with no local knowledge long? triamcionolone acetonide for diabetic macular oedema through a series of access to a Melbourne based Fellow NHMRC-funded randomised clinical trials. Congress who can assist them. It’s a great way I left Hong Kong when I was in high to foster international and interstate school, and have been living in Mark is a Sydney University Medical School Foundation Fellow. He was the Chief With only five months to go relationships with people who have Melbourne since (minus a year in the Editor of Clinical and Experimental Ophthalmology from 1995-2002. He served UK when doing my Fellowship). I on the Board of the Fred Hollows Foundation since its inception in 1992 for 12 until the RANZCO Congress in similar interest areas. And also gets more Melbourne based Fellows am a consultant at the Eye and Ear years and was a member of the Federal Qualifications and Education Committee Melbourne Co-Chairs of the actively involved in the Congress. Hospital and also have a private of the Royal Australian and New Zealand College of Ophthalmologists 1995-2002. Local Organising Committee practice in East Melbourne. I enjoy He was the Co-Scientific Chair of the Australian Ophthalmic and Visual Science The idea really came about from bushwalking and spending time with Meeting from 1997 - 2002. He is a member of the Macular Society and a director Drs John McKenzie and Daniel an interest of mine, to have the Chiu speak to RANZCO News on my children aged 14 and 7 years old, I of the Ophthalmic Research Institute of Australia. Program Committee (who choose live in Kew. their motivations for joining the the speakers) connect in more with Sir Norman Gregg Lecture - committee and progress so far. our local committee. Thus far we’ve Why did you decide to had great interest from local hosts/ co-chair the Organising Professor Brenda L. Gallie buddies, so I think it will go very well. Dr John McKenzie Committee? Professor Brenda Gallie, FRCPC, MD is a Senior Scientist at the Division of The Congress dinner will Applied Molecular Oncology, Ontario Cancer Institute and Affiliate Scientist at A RANZCO Fellow since 1987, I saw it as a challenge, I want to help the Division of Visual Science, Toronto Western Research Institute. Prof Gallie is Dr John McKenzie works out be at Ormond College contribute to the running of the annual an ophthalmologist who focuses her work on the rare cancer of children’s eyes, of Western Health, The Royal Dinning Hall this year in RANZCO congress and gain some retinoblastoma. Victorian Eye and Ear Hospital, and Melbourne University. What experience along the way in running has a private practice. His specialty was the background to that an event. Her clinical and basic research focus on retinoblastoma has resulted in the is in ocular oncology and he also discovery of fundamental principles of tumor suppressor genes and the regulation practices general ophthalmology. decision? How often does the local of activity of the retinoblastoma gene (RB) and protein. Prof Gallie has developed He has four children, aged between The Hall is one of Australia’s finest Organising Committee a highly sensitive and cost effective methodology for identification of RB gene 18 and 23. Neo-Gothic buildings, I know it well meet? mutations at The Hospital for Sick Children. This work has achieved the only as I lived in Ormond College for two efficient and sensitive test for RB mutations in the world. Ongoing basic research Have you been a Chair of years as an undergraduate and two John (Dr McKenzie) and I meet with studies address the molecular basis for the retinal tissue specificity of induction of an Organising Committee of my children have also spent a year some members of the Committee cancer by RB mutation. before? there. It will provide a great contrast once a month via teleconference, and between the other venues which are we meet with the whole committee in I have been on a number of all very new. Melbourne once every three months. Melbourne Congress Committees, but this is the first time I’ve been The theme came from a Committee What are you most excited Chair. I’m interested in making the discussion on how similar the dinning about for the Congress this 2012 Congress something that people hall looks to the one in the Harry year? genuinely want to attend. Potter movies. The magical theming ideas just grew from there. It’s just a I am most excited about the new Are you on any other bit of fun really, we hope everyone will venues this year, the new Melbourne RANZCO Committees? enjoy the theme and get into the spirit Convention Centre, Eureka Tower and Invitation to participate in of it. Ormond College Dinning Hall are all I’m also on the Victorian state branch What are you most very unique. I think the delegates will committee and a member of the really enjoy them. THE AUSTRALIAN INHERITED RETINAL DISEASE ocular oncology special interest group. excited about for the 2012 Congress? Are things running REGISTER AND DNA BANK Why do you think From a learning point of view I’m smoothly so far do you Melbourne is a good venue looking forward to the new IT and think? In 2009, Retina Australia funded the establishment and development of an Australian Inherited Retinal Disease Register for the Congress this year? social media elements we’re adding and DNA Bank. This resource now contains DNA and associated clinical and family history information from 3000 Yes, everything is on track. A huge to the Congress. As ophthalmologists participants. All IRDs are relevant to this project, with the exception of age related macular dystrophy. Genetic analysis amount of work goes into a Congress, The RANZCO Congress has not we should all be utilising IT resources of DNA is being progressively carried out. As results are obtained for a participant, we offer to report those results to the I’m enjoying contributing to this one, yet been to the new Melbourne to their full potential in our everyday participant via their ophthalmologist or genetic counselling service. There is no charge to the patient or ophthalmologist and look forward to it all coming Convention and Exhibition Centre. It’s practices. We encourage all Fellows for this service, which has arisen incidentally as a result of this research project. We will soon be mailing some together in the end. a great venue, which really highlights to participate in social media at the information and sample patient brochures to you, inviting you to encourage appropriate patients to participate in this the “new Melbourne” which is Congress. project. spreading, especially around Yarraville For more information please contact Dr John De Roach and Docklands. Chief Investigator, Australian Inherited Retinal Disease Register and DNA Bank Department of Medical Technology and Physics, Sir Charles Gairdner Hospital Nedlands, WA T: (08) 9346 2327 F: [email protected]

22- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -23 Looking for somewhere to eat/drink while at the Congress?

Rock Pool Bar and Grill The Boat Builders Bar Nuevo 37 Caper and the AFL stars of the Aboriginal eye health video Eyes You’ll be spoilt for choice in Melbourne, with lots of great restaurants and bars located in the South Wharf and Southbank areas – walking distance from the Melbourne Convention and Exhibition Centre. Hip-hop music video spreads eye-health

Common Man South Wharf www.thecommonman.com.au messages to Indigenous communities The Boat Builders Yard Common Man Restaurant is located RANZCO Fellow, Dr James Muecke, component was achieved with minimal has just released his first album and close to South Wharf DFO. They are www.theboatbuildersyard.com is the Founding Chairman of Sight cost – all the video and musical teams his popularity is climbing. He was open 7 days a week for breakfast, For All*, based in Adelaide, South donated their time. featured on the ABC’s Artscape in a The Boatbuilders Yard is a bar and lunch, dinner and drinks. They offer Australia. One of Sight For All’s documentary by Shalom Almond in café which brings a new style of breakfast/brunch options and modern The Common Man Restuarant I would be delighted for any Aboriginal initiatives in 2011 was to produce 2010. He is a huge footy fan and was relaxed and informal European-style Australian cuisine for lunch and dinner. eye health teams to use the video to eating and drinking to Melbourne. and release a musical track ‘Eyes’ raise awareness. thrilled for the opportunity to meet and to highlight the problem of eye work with a few of his heroes. He also The whole project took nearly one 7 days a week from 7am till late. disease amongst Aboriginal people has a generous humanitarian spirit Southbank year to complete. We are currently in Australia. and is concerned for the poor state of Nuevo 37 preparing a study to assess the Rockpool Bar and Grill health of his people. Kahlia Alice is a www.nuevo37.com.au “Eyes” has been viewed 1,776 times impact. www.rockpool.com/melbourne on You Tube so far. It has also be vocalist and a friend of Caper’s. She has a beautiful voice. Nuevo37 is located beside the Yarra Rockpool bar and grill is located at shown widely in outback communities, What has been the reaction river and offers relaxed dining. the Crown complex. They offer fresh on ABC’s current affairs program, from the Aboriginal Are you involved in any other Nuevo37 has a riverside entrance via seafood and Steakhouse cuisine the 7.30 Report, and it is soon to be community? unique eye-health initiatives? Dukes Walk, or you can enter through featured on an Aboriginal children’s with a great emphasis on their steak Everybody loves it, particularly the Yes, we are soon to release a the Hilton Melbourne South Wharf on TV program. In November 2011 it types and cuts, and extensive wine Crows and Power supporters, as ‘patient pathway’ video to allay fear in Convention Centre Place. won the RANZCO Pfizer Film Festival list. Lunch - Sun to Fri: 12 noon – Aboriginal players from these two Aboriginal patients coming to Adelaide during RANZCO’s Annual Scientific Open 7 days for breakfast, lunch and 3:00pm Dinner - Mon to Sun: 6:00pm [AFL - Australian Football League] for cataract surgery. – 11:00pm Congress. dinner teams feature in the video! AHCSA View the video: http://www.youtube. Melbourne Public In the following, Dr Muecke tells how Booking recommended [Aboriginal Health Council of South com/watch?v=wI5NAkeeibE Melbourne Public the music video came about. Australia Inc.] was very much behind www.melbournepublic.com.au Spice Temple Café Baci What was your involvement the project and it was launched in November last year. It is due to Melbourne Public café, bar and www.spicetemplemelbourne.com www.crownmelbourne.com.au/ with the music video 'Eyes'? be screened during the pre-match dining room is located at South Wharf The Spice Temple is located in the Cafe_Baci I produced the project and entertainment at the upcoming Crows- Promenade near the Hilton Hotel. It Crown complex. It offers modern Asian commissioned the artist Caper to Power Showdown. offers a selection of bar snacks and Cafe Baci is located in the Crown complex Ophthalmic Film Festival 2012 cuisine. Yum Cha: 7 Days: 12.00pm - write the song after discussing the meals available 7 days a week for and Open 7 days for breakfast, lunch and The CEO of the Crows, Steven For information about how to enter the 2012 3.00pm Dinner: 7 Days from 6.00pm dinner. concerning issue of Aboriginal eye Trigg, is a patron of Sight For All lunch and dinner. health. I decided to use hip hop as the Ophthalmic Film Festival, visit the link on Booking recommended and was delighted to be involved. I RANZCO’s website: Citizen Café & Bar Cervo Café and Bar - medium as it incorporates the spoken subsequently asked the CEO of the http://www.ranzco.edu/images/Allergan_film_ www.melbournepublic.com.au/ Left Bank www.crownmelbourne.com.au/site/ word and is very popular amongst Power at the time, Mark Haysman, festival_medium.pdf load/1155/cervo Aboriginal youth – who were our who was also very enthusiastic. citizen-cafe-bar www.leftbank.com.au target audience. Can you tell us a little about Incorporated within the Melbourne Left Bank is an upmarket bar/ Cervo Café and Bar offers a taste of Italy I then found a young film-making * The majority of Sight For All’s activities are Public precinct, Citizen café and bar restaurant offering everything from in a relaxed environment. company, Urtext, who created the the singers in the video, directed toward enhancing the cataract surgery rate in the Asia region, through education, offers a signature blend of coffee and breakfast to cocktails. video after my ‘brief’ of combining Caper and Kahlia Alice? Open 7 days for breakfast, lunch and infrastructure support, health promotion, and the two great loves of the Aboriginal Caper (Colin Darcy) is a young up- café style food. Open 7 days a week Open 7 days for breakfast, lunch and dinner. assisting local ophthalmologists with the people – music and football – to and-coming Aboriginal hip-hop artist from 8am. dinner knowledge and tools to increase the surgery rate deliver a powerful message. This from Whyalla, South Australia. He in their own countries.

24- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -25 international development Studies) from The University of Newcastle. process and working in RAPID as She has been involved with eye health in the Coordinator of the International a development context through working Ophthalmology Development Register with The Fred Hollows Foundation for (IODR) project. approximately five years. Most recently RANZCO is represented on the she worked on The Foundation’s peak bodies involved in international Indigenous Australia Programs (IAP), development (e.g. Vision 2020 based in Darwin, as a Senior Programs Australia, the Global Consortium, Officer. Kate’s role as Project Officer International Agency for the Prevention Asia-Pacific includes managing projects, of Blindness and International Council developing project proposals, liaising of Ophthalmology) and liaises with the with stakeholders, representing RANZCO donor community (e.g. Australian Agency on inter-agency working groups (Global for International Development) ensuring Consortium) and supporting the its positions are known and consistently International Ophthalmology Steering promoted. Committee. Kate Morrison

In March 2012 Sheldon Watson joined Dr Neil Murray, RANZCO as Project Support Officer. Chair International Ophthalmology Sheldon has over 11 year’s administration Steering Committee experience including five years project and support experience. He has worked within the health care industry in the United Kingdom, Ireland and Australia. Sheldon’s role as Project Support Officer covers a varied and wide range of support for the RAPID team and the RANZCO Policy unit. Having been with RANZCO since 2010, Lauren Hodgson also joined RAPID in December 2011. Lauren now shares her time between working in RANZCO’s Education and Development Department, coordinating the Specialist International Sheldon Watson International Development Medical Graduates (S-IMG) assessment RANZCO’s international ophthalmology

development activities RAPIDly expand! RAPID currently manages in Nadi, Fiji. The meeting was a portfolio of collaborative Future projects attended by various specialist groups, and ophthalmology is taking a leadership role in ensuring and funded projects which Several future projects in the The International International was represented by PacEYES high quality ophthalmic education and reflect RANZCO’s international Asia Pacific region are now in the Ophthalmology Steering treasurer Luisa Cikamatana Ophthalmology professional standards for eye-care in pipeline, partnering with a variety of development strategic Rauto and Pacific Eye Institute Committee (IOSC) was the Asia Pacific region. RAPID have governmental and NGO agencies. For Steering Committee direction: General Manager Losalini two main aims: example: formed in May 2011 at the Tavaga. This meeting allowed for request of the RANZCO At the recent IOSC meeting, a. To develop and promote • In February 2012, Penny Gormly, networking and programming for Board. The brief was to members – professional standards and policy The Pacific Eye General Manager Education the next stage of engagement in relation to the practice of eye- recommend an international Drs Neil Murray (Chair), Heather and Development, on behalf of with the Pacific islands region. Mack, Cathy Green, Mark Renehan, care; and RAPID, observed the Indonesian ophthalmology strategy Institute • In May 2012 RANZCO hosted Garry Brian, and Gerhard Schlenther b. To foster, develop and promote National Ophthalmology Board Ophthalmology Resident based on RANZCO’s core and Susi Tegen - agreed that educational and training The Pacific Eye Institute (PEI) is an Exams held in Jakarta and Training (ORT) Management strengths (education and the IOSC brief has been largely opportunities to meet the eye-care eye care training institution in the met with representatives from Committee representatives from fulfilled. Accordingly, the IOSC needs. Pacific Islands region. With AusAID a number of Universities to the Ministry of Health Cambodia, professional standards) will soon recommend options for funding through the International inform future programming in The RAPID team, managed by the University of Health Sciences and to create the capacity RANZCO Asia Pacific International Agency for the Prevention of collaboration with Indonesia. Gerhard Schlenther (General Cambodia, and The Fred Development (RAPID), ensuring Blindness (IAPB), and in collaboration Resulting from this visit RANZCO to deliver on the strategy. Manager, Policy & Development), has Hollows Foundation Australia. continued governance through with Fred Hollows Foundation New is now exploring provision of The process was to be grown significantly during this time. The meeting resulted in a signed appropriate mechanisms, and the Zealand and PEI, RANZCO is assistance with National Board Statement of Intent signifying sustainable, built upon participating in multifaceted system disestablishment of the IOSC. In April 2012 Kate Morrison joined Exams and training in specialist further long-term tripartite strengthening that includes a attracting designated RANZCO Kate has a Master of Arts areas of interest. collaboration on the development RANZCO's international development complete curricula review, areas of (Development Studies) from the • In April 2012 Gerhard Schlenther of the ophthalmology profession, funding, and was not to use goal is to contribute to the reduction special interest teaching visits and a University of New South Wales and attended the technical meeting education and workforce support RANZCO’s existing funds. in avoidable blindness and vision RANZCO fellow faculty position held impairment. To achieve this, RANZCO a Bachelor of Arts (Communication of Pacific specialist clinicians, in Cambodia. by Dr Gary Phelps. (Read more about nurses and bio-medical engineers PEI on the next page).

26- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012- 27 pacific eye institute technology or our favourite toys. In some of these and trauma, as well as preventable blindness due to regions, you can just be thankful to find a half-full bottle cataracts. An emerging problem is diabetic retinopathy. of topical anaesthetic or phenylephrine to smooth out At the moment there’s only one Solomon Island doctor your day.” working for 600,000 people; the whole of the Solomons. With my training and another colleague training as well, “The overwhelming impression is of the dedication and it should help, but it still won’t meet the need.” effectiveness of the core PEI teaching staff,” says Dr Phelps. “PEI Founder, Dr John Szetu, splits extensive In the Solomons, eye care is low on the list of health administrative time with teaching; Dr Roger Dethlefs priorities. “Maternal health and paediatrics is first priority is the lead teaching and consultant ophthalmologist; and eye care comes right at the bottom of the list,” says Dr Biu Sikivou directs the diabetic clinic and diabetic Dr Posala. “It’s an ongoing challenge to get a budget to outreach programs; and Graeme Nicholls, a New fund eye programs locally.” While most of the eye team Zealand optometrist, directs the technician and nursing is based in Honiara, the capital of Solomon Islands, Pacific Eye Institute education.” the team also travels to outlying islands to do about 12 outreach visits each year. In addition to the eye clinics and surgery conducted in Fiji, PEI trainees are involved in monthly outreach In 2010 Dr Posala moved back to Fiji to start the surgical programs throughout the South Pacific region. masters program. He is in his final year. “What the “These outreach visits provide surgical services and PEI is doing is really good,” says Dr Posala. “They’re ongoing education to remote clinics,” says Dr Phelps. training ophthalmologists to be able to work back in our “All the while the prime mission is the teaching and countries. We touch on a lot of sub-specialty activities supervision of ophthalmologist in training.” – not to the extent of sub-specialty training as seen in Australia and New Zealand – but we can tackle general Dr Phelps says these efforts have provided access ophthalmology, cataract surgery and use lasers to treat to eye care for thousands. “Equally important it has diabetic retinopathy.” established the Pacific Eye Institute as a provider of ongoing ophthalmic education and training for local Dr Posala says teaching support from RANZCO is doctors who, for social or patriotic reasons, are likely invaluable. “We want RANZCO to be even more involved to remain in the Pacific area – thus building a self- with PEI, making sure the ophthalmologists trained here sustaining ophthalmic community.” are actually up for the demands of their setting back PEI home. Rather than rely entirely on visiting eye-care “As a RANZCO teaching ophthalmologist, my roll of teams from Australia and New Zealand, we need more supervision and guidance in the diabetic and medical people who are locally trained – and then well supported retinal clinics – while assisting with general teaching – from a body like RANZCO. It’s going to be a long ride but will hopefully accelerate the achievement of an ongoing, I think we’ve started off in the right direction.” local, sustainable ophthalmology service,” adds Dr Phelps. In some of these regions, you can Dr Claude Posala checks a patients Dr Claude Posala - trainee just be thankful to find a half-full eye at the Pacific Eye Institute as Dr Posala’s journey to ophthalmology involved more than ‘‘ RANZCO Fellow and teaching bottle of topical anaesthetic or a decade of moving, with his wife and young family, back ophthalmologist, Dr Gary Phelps, and forth from his homeland in the Solomon Islands to looks on. phenylephrine to smooth out Fiji for his medical training. “I moved to Fiji to study medicine at the Fiji School of your day. Medicine and graduated in 2002. After graduating, I went RANZCO Fellow Dr Gary Phelps Dr Gary Phelps - teacher back to the Solomons for my internship and then worked One of the initiatives he would like to see RANZCO as a GP in a rural hospital,” says Dr Posala. “I wanted involved in is to get” Fellows to work alongside local shares his experiences as a teaching Dr Phelps has been working at PEI since January 2012 to become a surgeon but the waiting list was very long. ophthalmologists in-situ in the Solomons. “What will be as a teacher and mentor for ophthalmology trainees. One of my colleagues, Dr Mundi Qalo Qoqonokana said beneficial in the future, as each one of us graduates ophthalmologist at Fiji’s Pacific Eye He and many RANZCO Fellows before him have given they were looking to train an ophthalmologist for the and goes back to our own setting, is for a RANZCO lectures, shared their knowledge, experience and skills, Institute (PEI) and two ophthalmology Solomons, so in mid-2006 I joined the eye department in Fellow to periodically visit PEI graduates wherever we and worked side-by-side with trainees in clinics and Honiara Hospital.” are stationed in the Pacific and have a short attachment trainees tell us about the work operating theatres. with us in our own local setting. This will enable local Dr Posala never looked back. When the Pacific Eye PEI students are trained specifically to provide eye care ophthalmologists to be updated in new developments. being done to equip Pacific Island Institute moved from the Solomon Islands to Fiji in in Pacific conditions. “At present there is a small team Sometimes when you’re stuck in remote areas on your 2007, Dr Posala moved to Fiji to complete a Diploma of ophthalmologists to return to their of three general ophthalmologists striving to ensure that own for a long time, you can get behind, a bit stale. It’s Ophthalmology. “After completing the diploma, I had to a group of eight trainees reach a level of competence good to have someone refresh your skills and help look homelands to enhance eye-health move back to the Solomon Islands to work for a couple to safely function independently in sparse conditions,” at problems from a different perspective. I think this kind of years. PEI’s masters program wasn’t up and running services into the future. says Dr Phelps. “We also have sub-specialist of thing will be an important and valuable partnership if yet, so while I waited to start my masters, I put the things ophthalmologists from Australia and New Zealand visit Fellows can do this.” RANZCO is involved in a joint initiative between I had learnt to good use in the Solomons clinic. That year for a week or two at a time, providing education in their the PEI and Fred Hollows Foundation New Zealand of doing the Diploma of Ophthalmology really improved Dr Posala plans to return to the Solomons after specialty areas.” (FHFNZ) to help train ophthalmologists in the the quality of surgery and services I could provide.” graduation. “My immediate task when I go back is to look Pacific Island region. The project is funded by Dr Phelps says the clinics are hectic and there are a at the eye-care program and make sure all the activities AusAID’s Avoidable Blindness Initiative through number of exotic tropical conditions you’d never see Those two years working in the Solomons also alerted are moving towards the targets we’re trying achieve in the Vision2020 Global Consortium, with the aim to in Australia or New Zealand. “We can spend an entire Dr Posala to the extent of eye-health needs in his the priority areas. In the long term, when that’s up and build the Pacific region’s capacity for greater self- evening searching for a diagnosis. I smile at how we country. “There’s a lot of infectious eye disease, injury running, I’m interested in teaching other doctors in the sufficiency in eye care. used to whinge back home if we did not have the latest

28- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -29 pacific eye institute Pacific region. It will be wonderful to help train people to do Part of the masters in ophthalmology involves eye what I’m doing now. There’s a lot of work that needs to be research, and RANZCO Fellows assist PEI trainees where done and we don’t have enough of our own trained people required. “There hasn’t been a lot of research conducted to do it.” in the Solomons as a whole,” says Dr Pikacha. “However, museum attending RANZCO conferences and hearing what other “It will still be a long time before we can be self-sufficient people have done in other places, gives us ideas of what Sharing our heritage with eye care in the Pacific region. However, I think research we could be doing. We don’t even have a lot RANZCO will only be more and more involved in the PEI of baseline information, so in the future we’ll continue to ophthalmology training program and will continue to make get these questions answered through good research the training of a really good standard.” projects.” follows that the rays proceeding from the object to Dr Nola Pikacha - trainee When Dr Pikacha completes her masters in 2013, she the lens will be parallel to its axis (Fig. 1). If now a Dr Pikacha was born in Papua New Guinea. Her parents plans to return to the Solomons to work. “Priority eye- Much work has taken place since the last scale be placed in front of the object oo a correct worked as doctors there and in the Solomon Islands, and health areas include making primary eye care more issue computerising the catalogue of exhibits reading of the size of the object will be obtained, no she grew up in and around hospitals where her parents accessible to people – through training and equipping currently in the museum collection. matter what the position may be. ophthalmic nurses – and stepping up eye-health education worked. She went on to do her undergraduate medical A training course was run in Melbourne to train The Keratometer is constructed upon this principle. training in Fiji, graduating in 2003. so the population comes forward more readily for eye operators in the complexities of the computer care.” The stop (1. Fig.2) is is situated in the posterior focal “I had always wanted to do obstetrics and gynaecology system for exhibits. The program allows a huge plane of a +6-diopter lens mounted within the tube but that changed after my internship. As part of the “Over time we will get more established with monitoring range of search and display options. (2). The opposite end of the tube carries a vulcanite internship we had to do an eye rotation, and I spent a and measuring our outcomes. That way we can see The Museum storage area has received new ring (3), by means of which the instrument may be couple of months in the eye department with Dr Szetu in improvements and also see areas we need to strengthen, storage cabinets for sorting myriads of small rested upon the margin of the orbital cavity of the the Solomons. That sparked my interest in ophthalmology,” and continue to improve quality measures,” she says. articles still to be catalogued. patient’s eye. Within the ring a scale (4) divided into she says. Dr Pikacha says one thing she’ll miss when she goes back The Royal Victorian Eye and Ear Hospital will half millimetres is so mounted that its upper edge In 2008 Dr Pikacha completed a post-graduate Diploma at to work in the Solomons is the collegiality; having tutors soon to celebrate their 150th anniversary and may pass accurately through the centre of the ring. PEI in Fiji. She then moved home to the Solomons to work and Fellows in the clinic and operating theatre. “But at least discussions are underway on the form of an In front of the ring the tube has a large excision for two years before returning to PEI in 2011 to commence we can still email them and get assistance,” she says. “It exhibit to highlight the lives and achievements through which sufficient light may reach the scale her Masters in ophthalmology. helps our continuous learning and benefits our patients. and the patient’s eye. And when Fellows visit the Solomons, we can book in all of prominent ophthalmologists at the hospital. “Having RANZCO Fellows come to PEI to help train us is The scale (4) is situated near the anterior focus of our cases that have been saving up for the sub-specialty Mystery Solved the lens, and the same applies to the cornea which great. Gaining experience from them broadens your mind visits. These visits are a great learning experience for us as Another object on display at the RANZCO is to be measured, and hence both the scale and the and skills. We have good discussions about theory and well, working alongside them.” clinical matters and it has been invaluable in terms of sub- Canberra exhibit that stumped even the most cornea can easily be seen magnified 1.5 times by specialties too.” Dr Phelps concurs. “This joint initiative of PEI, FHFNZ astute was … the Wessley Keratometer an eye placed in front of the stop (1). The tube has and RANZCO is working,” he says. “The trainees are another excision (5) in front of the stop (1). Within One of the things Dr Pikacha appreciates is ongoing bright and competent surgeons and well versed in general Dr David Kaufman this excision the tube carries a small white mark (6), mentoring. “When we’re back working in the Solomons, ophthalmology. They are committed to advancing eye care Museum Curator upon which the patient is required to fix his sight. A it’s great to have that link with them via email or phone, in the Solomons, and their ongoing contribution to the white screen (7) serves to illuminate the fixing mark and being able to ask advice. Even if we’re out in the development of eye health in their region highlights what with diffuse reflected light. remote islands, and don’t have much backup for diagnostic this initiative is all about.” capabilities, their support and advice and a second opinion from them really helps.”

Prof. WESSELY’s Keratometer. Dr Nola Pikacha with a patient. The Keratometer is an instrument for determining Image courtesy of Kristian It goes without saying that a cornea of any diameter quickly and without trouble the diameter of the Frires/The Fred Hollows may be measured with the instrument. All that is cornea, that is the more transparent of the sclerotic. Foundation New Zealand necessary is to rotate the instrument whilst the In addition, it is eminently suitable for measuring the hard rubber ring is placed upon the fingers which distance between the corneal vertex and the apex of are being used for stretching the eyelids apart. The the spectacle lens, which is a most important datum instrument is also available for measuring the pupils; in many prescriptions. it may, in fact, be used for measuring the diameter of An instrument that will without much trouble bodies of any shape whose greatest diameter does enable one to measure the width of the cornea, not exceed 20 mm. and no more, is in itself valuable enough; a much The Keratometer affords a particularly simple and more complete instrument, however, results if the reliable means of measuring the distance between measurement supplies information as to the volume the apices of the cornea and the spectacle lenses. of the eyeball, since Prof. WESSELY has shown that To carry out this measurement it is best to unscrew the diameter of the eyeball is invariably proportional the vulcanite ring. The observer should then so place to its volume, and that this relation is not affected by himself that the centre of the line of the instrument is the patient’s age. at right angles to the patient’s line of sight when he Since the curved profile of the cornea renders it is looking straight ahead. For example when setting impossible to apply a straight-edged scale the plan an empty trial frame and measuring the distances has been adopted of eliminating errors by measuring between the edges. the image if an object as seen by parallel rays with the eye applied as the principal focus of a lens, i.e. by what is know as a telecentric arrangement. When the observation is made through a stop situated in the posterior focal plane F’ of a lens it RANZCO museum update 30- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -31 rural and remote areas Rural, Remote and Indigenous Ophthalmology Darwin/ Northern Territory

Only two permanent ophthalmologists and clinics,” he says. Diabetes-related eye serve the eye-care needs of the Top end disease, cataracts and eye trauma are the of Australia, supported by visiting sub- main causes of loss of vision. specialists and registrars from interstate, Dr Nishantha says indigenous health workers local optometrists and indigenous are actively involved in some of the pre-op health workers. RANZCO News talks to education regarding cataract surgery and Darwin Fellows, Dr Tharnarmalingam diabetes education. “Diabetes-related eye Mahendrarajah and Dr Nishantha disease remains a big problem. We visit Wijesinghe about working in the ‘Top some communities with 3000 people and End’. 500 of them will have diabetic eye disease. Pictured above: Dr Mahendrarajah Dr Mahendra, as he is widely known, Each of the diabetics is supposed to have operating has been working in Darwin since 1999. their eyes checked each year; it’s a huge Pictured right: Dr Wijesinghe (right) Originally from Sri Lanka, he completed his workload. We can only do 20-40 a day on with patient Valama and Vicky Lu fellowship training with Prof Frank Billson in remote outreach visits, so we need help from register from Sydney Eye Hosptial Sydney in 1998 before moving to Darwin. GPs, optometrists and nurses.” “At that time, Dr Masoud Mahmood and Dr “One recent development, through liaising Nitin Verma were working in Darwin. Later with Fred Hollows Foundation, we’ve “Many RANZCO Fellows have willingly contributed. Doug ‘Wishlist’ for the future when Dr Verma left, Dr Rob McKay took managed to get six fundus cameras in six Coster came for many years. The ones who take part over. I started working with them, and my towns and are training GPs to take retinal in sub-specialty weeks now include: Peter McCluskey The hard work, determination and persistence of these main role was to do the outreach visits to photos, annually, of each diabetic patient,” (uveitis), Frank Martin (paediatric ophthalmology), Gina Darwin Fellows, and their colleagues before them, has remote communities.” says Dr Nishantha. “The images are then Kourt (oculoplastic), Raf Ghabrial (oculoplastic), Stewart advanced eye-health delivery in the Northern Territory. Over the years, colleagues retired or moved sent to us in Darwin to check. If the fundus Lake (vitreoretinal), John Males (corneal), and John “We have 23 slit lamps in 23 communities, which were interstate, until Dr Mahendra found himself camera program works well, we will try Crompton (neuro-ophthalmology and squint).” organised by the Fred Hollows Foundation. It was a very the sole resident ophthalmologist in Darwin to expand it into other areas – funding useful development,” says Dr Mahendra. He and Dr from 2006-2008. “During that time I worked permitted.” Non-compliance and no-shows Nishantha continue to lobby for more updated equipment in both the public and private hospitals in Dr Mahendra says in some communities, a and facilities. Dr Mahendra says one of the challenges they experience Darwin and conducted regular outreach visits combination of lack of diabetes education “We have to do a lot of negotiating and fighting for is getting patients to show up for treatment. A lot of effort to remote communities. Two registrars from and low personal motivation means people ophthalmic equipment. Recently, after a long battle, we goes into screening patients for eye surgery, doing pre-op Sydney would intermittently rotate through. often skip appointments to have their eyes managed to secure two phacoemulsification machines education, booking blocks of operating theatre time at the In 2008 Dr Frances Booth began a two-year checked. “However, we’ve worked out and two microscopes – one set each for the Katherine various hospitals, and flying staff in. stint, primarily doing the outreach work,” says that indigenous patients tend to keep their and Gove Hospitals,” says Dr Mahendra. “Now we’re Dr Mahendra. dialysis appointments, so when they come in “It is not uncommon to have 20 people booked in advance fighting for a Yag laser, an Argon laser and an IOL Master for eye surgery in Katherine or Gove hospitals, and then Dr Nishantha travelled a similar path to Dr for dialysis, we can do the ophthalmoscope for Katherine and Gove hospitals – which are all essential when we arrive on the scheduled day, only five will turn Mahendra – coming from Sri Lanka and while they’re there.” tools for the management of diabetic eye disease and up,” says Dr Mahendra. “The health workers then have to completing his fellowship training with Prof cataract surgery. Ideally each hospital would have a set, race around in jeeps to try and find the patients and bring Billson in Sydney. He moved to Darwin however even some portable equipment would be great – Expanding services them in. Sometimes we’ll put drops in their eyes to dilate four years ago and commenced work as we can take them with us between hospitals.” them in preparation for assessment, and when you come a consultant in 2011. He works in Royal Historically if patients needed sub-specialist eye care not available in the Northern back in 10 minutes, they’ve gone; disappeared.” The ophthalmologists are also striving to update the clinic Darwin Hospital and does the majority of the and some of the equipment in the Royal Darwin Hospital Territory, they had to be flown to places like On some occasions, when the specialist eye surgery outreach work. – some of it still in its original state from 1989. “Over the Adelaide for treatment – more than 3000km cannot be done in Katherine or Gove hospitals, patients Each year he visits 25-30 remote years I’ve gone to all the Chief Ministers and all the Health away. A number of years ago are flown to Darwin for surgery. “We’ll be in theatre ready communities to conduct eye clinics; the Ministers here, putting the case to them for the essentials Dr Mahendra began to organise sub- to operate and yet they won’t turn up to hospital for their closest 150km from Darwin and the furthest to deliver good eye care,” says Dr Mahendra. “Promises specialist surgery blitz weeks – where surgery. When we ring their remote clinic nurses, they tell more than 1000km. “In addition to that, each aren’t always kept.” Fellows from interstate would spend a week us ‘Doctor, we put the patient on the plane to Darwin this month we fly to either Katherine Hospital or in Darwin, operating on the difficult cases morning’. So we know they’ve come to Darwin but they’ve Gove Hospital and do a week of eye surgery He puts forward a compelling argument for greater support. best handled by a sub-specialist. just not shown up at the hospital. These things happen.” “Take for example the vitreoretinal sub-specialty week

32- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -33 rural and remote areas Afterward he came back to see me and brought me kangaroo meat ‘‘ as a gift, to show his gratitude. Whatever they have, they bring. These are the things that make my day.

we held recently, where we did 27 For Dr Nishantha, it is ”distressing when cases with the visiting sub-specialist. so many people – particularly in remote Imagine if those 27 patients had to areas – only seek help when their vision fly to Adelaide or another capital city has deteriorated to light perception only. for that surgery? Imagine the cost “Once they have cataract surgery and to government and upheaval for the can see again, they’re so happy. One patient?” lady I did cataract surgery on was so overjoyed because she could see her Memorable experiences boyfriend for the first time.” Patients appreciate what’s being done Working in Australia’s Top End has for them. In 2008 the mother of one of it challenges and it’s unforgettable Dr Mahendra’s patients nominated him moments. One day when Dr Mahendra for an award and he won a Pride of was doing cataract surgery in Gove Australia Medal. In the following year, Hospital, he was in the process of another patient nominated him for the putting in the new lens when the power ‘Local Hero’ category for Australian of Dr Tharnarmalingam went off completely in the operating the Year awards. Mahendrarajah theatre and the backup generator also failed. “It was a difficult situation and the “I am a Hindu and part of my spiritual patient was getting distressed. We got belief is that where there’s a need of all the staff to hold torches, I was able your service, you are to serve there,” to finish the surgery and the patient was says Dr Mahendra. “Many people in the very happy.” NT don’t know about eye health. They don’t understand the disease, why it One of Dr Mahendra’s favourite occurs or what can be done about it. My moments was shared with a patient in job is to help them understand, to make Indigenous Health Katherine back in 1999. “He and I had them feel comfortable, as well as try to a few long discussions about various fix the eye disease.” things, not just eye disease. He held my hand at one stage and said ‘You are like CLOSE THE GAP my brother. You are like my brother’. Afterward he came back to see me and brought me kangaroo meat as a gift, to show his gratitude. Whatever they have, they bring. These are the things that Dr Nishantha Wijesinghe make my day.” National Close is a leading cause of the health The RANZCO Indigenous and Rural gap – emphasising the need for Health Committee nominated WA the Gap Day genuine, meaningful partnerships with Fellow Dr Angus Turner and Susi Aboriginal and Torres Strait Islander Tegen to represent the College on The rates of blindness in peoples in the planning and delivery this CPMC Subcommittee for the next Indigenous adults are six times the of eye health care. two years. We congratulate Dr Turner rate in mainstream Australia. While and thank him for taking on this very 94% of vision loss is caused by important task. preventable or treatable conditions CPMC Indigenous Did you know ... (refractive error, cataract, diabetes Sub-Committee Get involved! and trachoma), about 35% of Indigenous adults have never had The Committee of Presidents of RANZCO is participating in a Ophthalmologists are happier than an eye examination. Medical Colleges (CPMC) has project managed by the Royal an Australian Indigenous Health Australasian College of Surgeons On 22 March, National ‘Close Subcommittee, which advocates (RACS) to develop an Indigenous the Gap’ Day, 14 RANZCO staff most specialists in the USA? for improved health care services health and cultural learning portal members showed their commitment to Indigenous patients and designed for health specialists to reconciliation and achieving equity communities. This subcommittee working in rural and remote in health outcomes by signing the aims to facilitate the training of Australia. ‘Close the Gap’ pledge. RANZCO’s Respondents to a recent Medscape survey (included 29,205 US physicians more Indigenous doctors and Chief Executive Ms Susi Tegen signed The portal, nichelearning.info, will across 25 specialty areas) were asked to rate how happy they were with their lives specialists, as well as the inclusion the organisational pledge on behalf of contain searchable information of Indigenous health in the training outside of medicine. Ophthalmologists were found to be the fourth happiest specialty, RANZCO. on Indigenous health and cultural of all non-indigenous doctors – to with Rheumatologists reported being the happiest. The theme this year was ‘Power professional development activities help address the gap in Indigenous and resources, which will be through Partnership’. Vision loss life expectancy.

34 RANZCO34- RANZCO News NEWS June 2012 JUNE 2012 RANZCO NEWS JUNE 2012 -35 indigenous health accessible through the portal from a with Prof Taylor, the report was co- diabetic examinations and more than range of health specialist providers authored Ms Andrea Boudville, Mr double the number of Indigenous – including many of Australia’s key Mitchell Anjou and Ms Robyn McNeil Australians using eye glasses. medical colleges. of the IEHU – which is part of the “What is needed are additional Melbourne School of Population The portal will seek to promote resources to increase the availability Health at the University of Melbourne. cultural awareness and engagement of eye care, and good co-ordination by health specialists working directly The Roadmap report makes 42 and case management of the patient with Aboriginal and Torres Strait recommendations for reform to journey,” says Prof Taylor. Islander communities for the treatment primary eye care, cataract, diabetic Prof Taylor and the IEHU are calling and management of patients. The eye disease, trachoma and refractive for Commonwealth, State and Territory portal also aims to inform and develop services across Australia. Governments to invest an additional specialists’ understanding and “Eye health problems among $19 million in 2012-13 and a total $70 awareness of Aboriginal perspectives. Indigenous Australians have the million over five years. Fellows who are interested in same impact on health and wellbeing The report includes costs-estimates Indigenous health and want to as trauma related conditions, and for the Commonwealth and State/ encourage professional development a bigger impact than alcoholism Territory Governments, and builds on – as a way of increasing professional and stroke,” says Prof Taylor. “The community consultation and control, interest, understanding and effective Roadmap is the first comprehensive the regional delivery of services and outcomes in the health of Aboriginal framework to ‘Close the Gap’ on the National Health Reforms. and Torres Strait Islander communities Indigenous eye health and draws – are encouraged to participate by together more than five years “We have worked hard and contributing feature stories or case extensive research and consultation.” consulted widely to ensure the studies about their experiences in recommendations are comprehensive “The Roadmap is affordable, working with Aboriginal and Torres and are well supported by the sector achievable and it puts eye health Strait Islander communities. If you and Indigenous community,” says Prof within reach for Indigenous are keen to contribute, contact Taylor. “The Roadmap will facilitate Australians for the first time in a Sonja Cronjé on +61 2 9690 1001 system changes to improve access century,” Prof Taylor added. or [email protected]. The to eye care and reduce unnecessary nichelearning.info portal is due for Prof Taylor says there is no reason for vision loss for Indigenous Australians.” launch in mid 2012. Indigenous Australians to suffer from “We know the problem and we have preventable blindness. “We have the A library of online Indigenous health- the solutions. With full support for solutions and we now have a plan that related resources and links has also the implementation of the Roadmap ensures better access to eye care – been started on the RANZCO website. we can close the gap for vision,” with will and government support, we Please let us know if you have Prof Taylor says. “The next steps for can solve this critical health issue.” any suggestions for other links or closing the gap on Indigenous eye resources that could be included here. The Roadmap calls for major reforms health - we hope - is the Federal to monitoring, accountability and Government’s commitment to the We are still calling for expressions coordination of Indigenous eye health Roadmap and funding its staged of interest from Fellows and trainees services, and additional funding to introduction.” who are keen to participate in the generate a 700 per cent increase in development of a Reconciliation The Roadmap report can be accessed cataract surgeries, 500 per cent more Action Plan (RAP) for RANZCO – to at www.iehu.unimelb.edu.au. identify clear actions and targets for how the College can contribute to reconciliation and help to ‘close the gap’. The RAP can only be developed with active involvement from members. Contact Sonja if you are interested in getting involved. Roadmap to Close the Gap for Vision A recent study from researchers at the University of Melbourne produced Australia’s first roadmap to close the gap for eye health among Indigenous Australians, showing that $70 million could ‘Close the Gap’ on Indigenous eye health. RANZCO Fellow, Laureate Professor Hugh Taylor AC, heads the Indigenous Eye Health Unit (IEHU) which Left to right: Mitchell Anjou (IEHU - Poche Research Fellow, Roadmap Author), produced the report ‘The Roadmap Justin Mohammed, Hugh Taylor, Warren Snowdon, Andrea Boudville (IEHU - to Close the Gap for Vision’. Along Poche Research Fellow, Roadmap Author) Photograph courtesy– Rachael Louise Ferguson 36 RANZC36- RANZCOO News NEWS June 2012 JUNE 2012 committees & special interest groups the various major cities across finished and we’re about to look at the be a Medicare item number for it and Australia and New Zealand. The 2012 report for the second stage – where what the best treatment is,” says A/ ANZCS meeting was held in Auckland we’ll be justifying item numbers, Prof Daniell. “Keratoconus was a in March, and the 2013 meeting will getting rid of some old item numbers, previously untreatable problem.” be held in Adelaide. modernising it, and seeking more A/Prof Daniell says ANZCS members appropriate item numbers for the new The annual meeting focuses on throughout Australia and New surgeries.” current best practice, ophthalmic Zealand are at the forefront of a research and controversies in cornea ANZCS members are also involved number of these new developments. and eye banking and relevant non- in the Eye Bank Association Australia “The first randomised controlled ophthalmic medical research. ANZCS New Zealand (EBAANZ). “Out of the trial for collagen cross-linking for is unique in the extent to which it cornea meeting we formed EBAANZ keratoconus was done in Australia; involves university departments of which is a very strong and cohesive we’re world leaders in limbal stem ophthalmology in its activities. Dr group,” says A/Prof Daniell. “Each cell transplantation; and a group from Rogers says the SIG benefits from of the heads of the Eye Banks meet Adelaide – including Prof Coster and the academic input and intellectual annually and discuss the various Prof Keryn Williams – are world- rigour this association brings. issues around sourcing corneal leaders in corneal transplantation tissue, advising regulatory authorities, and immunology. A Sydney group “Each meeting we invite some providing tissue safely and meeting (Drs Michael Lawless, Chris Rogers, speakers from university regulatory requirements. We share Prof Gerard Sutton) have been departments who aren’t necessarily cornea tissue between states and innovators in refractive surgery, and in ophthalmologists but who work territories of Australia and throughout New Zealand (Prof Charles McGhee in areas of intense medical New Zealand. The Eye Banks also and A/Prof Dipika Patel) have been interest which may overlap with talk to various donor groups such as innovators in corneal imaging – ophthalmology in some way,” says Dr Donate Australia, to try and get as confocal microscopy.” Rogers. “For example, the university’s many corneas as possible to enable department of immunology may have transplants.” research which has some impact on ophthalmology.” A/Prof Daniell says ANZCS works with the Therapeutic Goods Administration ANZCS’ annual meetings are and meets with the Hon Catherine generally held in March. The two-day King MP, Parliamentary Secretary program is designed to be interactive, for Health and Ageing, to discuss with almost as much time set aside for ways to get corneal donation discussion as for didactic papers and Committees & Special Interest Groups regulation better organised and more presentations. appropriate. “This relates to what A/Prof Daniell says ANZCS also sort of testing is obligatory and how Australian and New Zealand organises a number of combined corneal tissue is stored. We’re also symposia during RANZCO’s Annual collaborating regarding limbal stem Scientific Congress. “In the past cell transplantation in Australia.” Cornea Society couple of years we’ve had a combined symposium with glaucoma and a New developments combined symposium with ocular A/Prof Daniell says cornea is a The Australian and New Australian Fellow, Prof Doug Coster worldwide for its contribution to the immunology. Complicated patient very exciting area to work in at the Zealand Cornea Society established 29 years ago at Flinders understanding of corneal transplant cases often have an overlap between moment. “There are new operations University in Adelaide for people risk and prognosis.” sub-specialties, so these symposia and new treatments for previously A/Prof Mark Daniell (ANZCS) advises RANZCO interested in corneal disease, corneal are good for ophthalmologists RANZCO long had a cornea-related untreated disease, and a lot of interest on matters relating to transplantation and eye banking. wrestling with very difficult problems special interest group, called the in developing new techniques and and provide the opportunity to discuss cornea, eye banking, Prof Coster ran the Cornea and Eye Refractive Surgery and Contact Lens sharing tips with each other on how cases with other experts.” refractive surgery and Bank Meeting as an independent body SIG. “About four years ago it was to do them better.” contact lenses. ANZCS is and, for the first two decades, the decided this group and the Cornea A/Prof Daniell says ANZCS is also “Corneal transplants used to be also called on to advise meeting was always held in Adelaide. and Eye Bank group from Adelaide planning a conjoint meeting with the full-thickness transplants; now media, government, and “About seven or eight years ago, merge to become ANZCS,” says Dr Asia Cornea Society in the future. we’re doing component surgery, Prof Coster thought the meetings Rogers. “The majority of the group other bodies on these topics. replacing only the epithelium or the should rotate through Australian felt we should link with RANZCO, and Ongoing activities endothelium. We’re doing lamellar “The Australian and New Zealand states and New Zealand,” says Dr that’s when it became the Australian transplants of the stroma if its stromal Members of ANZCS are involved Cornea Society meets annually,” says Chris Rogers, Secretary Treasurer of and New Zealand Cornea Society.” disease and, for keratoconus surgery, ANZCS. “The one proviso was that in the Medicare Benefits Schedule A/Prof Mark Daniell, Chair of ANZCS. A/Prof Daniell was appointed rather than doing a full-thickness the meeting had to be run under the Review. This process involves looking “It is an open group. You don’t have inaugural Chair of the ANZCS, and corneal transplant we might do a deep auspices of a university department of at various ophthalmology-related to be a sub-specialist; any member of Dr Rogers wrote the Articles of anterior lamella keratoplasty (DALK) ophthalmology. Medicare item numbers, bringing them RANZCO can join.” Association for the group. – which improves the strength of the up to date and also trying to introduce Dr Rogers says Prof Coster, along cornea, is less likely to rupture, and is new item numbers where appropriate. History with Prof Keryn Williams, also Meetings also less prone to rejection.” The Special Interest Group grew out established the Australian Corneal The Australian and New Zealand “We’ve been involved in the MBS Other recent developments involve Graft Registry 27 years ago. Review for about 18 months,” says of the Cornea and Eye Bank Meeting. Cornea Society holds its annual collagen cross-linking for keratoconus. Dr Chris Rogers This was an annual meeting South “The Registry is acknowledged meeting in March, and rotates through A/Prof Daniell. “The first stage is “We’re looking at whether there can

38- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -39 What did you win the Charles Leonard the dunlops Newcastle’s Best Gimblett memorial prize for? Orthoptics was a very young specialty in Australia. There were no higher degrees available, so in the 1970s we conducted our own research into dyslexia and binocular vision having joined the team based at Newcastle Ten Pound Bet! University. All of your children went to Medical School. Were they good students when they were The Dunlop family: Seven younger? Sydney University medical All six were quite studious and didn’t need much encouragement. This served them well in high school and school graduates – four then again at university. Television didn’t arrive in the house until the moon landing, but apart from that they were encouraged to do what they wanted, as long as ophthalmologists they earned a living. RANZCO News spoke Dr Donald Dunlop Do you enjoy what you do? and Patricia Dunlop and three of their People have problems when their eyes don’t work properly. six children, Drs Catherine Dunlop, Iain I have always, and still do, enjoy helping my patients. I see Dunlop (past RANZCO President) and mainly the young who can’t get it together and the very old Anthony Dunlop to find out more about this who can’t keep it together. I am still working three days a week. extraordinary family and their interests in ophthalmology Donald Please note, while RANZCO News usually refers to individuals by their surname, we felt first names would be The first to do corneal grafts and lens implants in the easier in this case. Newcastle district and the first (with Dr Graham Pittar) to bring Botox into Australia, Donald is certainly a pioneer. Patricia How did you come to study ophthalmology? Dr Donald Dunlop met orthoptist Patricia Maguire while I contracted septicemia in 1948 while working as a medical doing his postgraduate exams at Moorfields Eye Hospital intern. I collapsed only hours after examining a patient, in 1949. He fondly remembers her as “the only girl who had fortunately however I was in a hospital with newly available The Dunlops injectable penicillin. My brother died of septicemia in New a ready smile for any poor soul in that struggling mass of post war survivors.” Guinea and my uncle in Ceylon. Bedridden for six weeks, I was so sick the chief censor from the College of Physicians Patricia won the Maddox prize for the best orthoptist in her visited me and said in no uncertain terms “Dunlop you’ll field, was dux of the British Orthoptic Society, President of never work again!” the Orthoptists Association (twice) and won the Charles Leonard Gimblett Memorial Prize for her research. Every step I took from that day forward was a triumph against his premonition. As I couldn’t do the type of How did you first meet Donald? physical work needed in some specialist professions – like breaking bones, I started to lean towards the idea of eye I went to Moorfields to train, and then stayed on staff to work. I couldn’t train in Australia, as all the positions were teach students from around the world. My colleagues and going to veterans, so I telegraphed London. A few months I were given six students each to teach. On the day I met later I was training in London to be an Ophthalmologist at Donald (in 1949), my friend had a dentist appointment, Moorfields Eye Hospital. so gave me her six students – one of which was Donald. I’m not sure it was love at first sight, but that dentist After Moorfields you retuned to Australia? appointment was certainly fate! We married in the UK in 1950. Yes. After obtaining my qualifications I returned to Newcastle. I had very little money and had to borrow You followed Donald back to Australia after 10 pounds from friends to bring my lovely new wife to you were married? Australia. We started in a practice in Newcastle’s CBD and had our first child Catherine in 1952, followed by Iain, Yes, my father thought emigrating out of Britain was the Jennifer, Helen, Gillian and Anthony. right thing to do. So I happily got on the boat to Australia and I’ve never regretted it. Australia is a wonderful country You were one of the first Australians to in which to live. bring Botox into the country, can you let us Donald and I joined an established practice in Newcastle’s know more about that? CBD. I did the orthoptics in the practice and have been We were the first non-Americans to learn how to inject the doing it ever since! newly released deadly cold war toxin, Botulinum (Botox)

40- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -41 the dunlops the dunlops at Professor Alan Scott’s research laboratory at the Smith with Dad, sending our results back to the USA. It was great After working in the UK and at Prince With her endocrinologist spouse she has a long history Kettlewell Institute in San Francisco. We brought some to work with both of my parents. We would all discuss the of Wales Hospital you started in the of developing centres of excellence in Phnom Penh, back which was seized by customs. They thought we best plan of action based on our experiences. I had great Cambodia and multiple “HOPE” practices in New Guinea. would poison people. In 1986 we started to experiment teachers. Newcastle practice before your Dad Gillian, the youngest daughter, who, like her brother Iain with it, sending our results back to the FDA in America. We retired? was HSC dux of her secondary school, wanted to be keep Prof Scott’s motto ‘Press On’ on our wall above our What do you do now? Yes, I started in the Newcastle practice in 1998, eight an artist but was firmly told she had to earn a reliable own motto ‘To make as many people as possible as happy I work in the family practice and I am Coordinator and years before Dad finished in 2006. It was great being able income. She became an ENT surgeon, specialising in the as possible for as long as possible’. Conjoint Clinical Lecturer in Ophthalmology at the to work with him and learn from his experience before he tricky work of reconstructing crooked and battered noses. University of Newcastle. I have four children and two much In 1972 Prof Barney Fenelon invited us to join his retired. Mum still works at the practice and is good at what She has also spent at least half her working hours in art loved dogs. multidisciplinary group of physicists, psychologists and she does. education, travelling the world’s museums perfecting neurologists at the University of Newcastle. We had grants I have recently observed a pupil change in strabismus her technique. She has been hung in the Archibald, has from the National Health and Medical Research Council (exotropia) which has not been reported before, (published The other Dunlop children painted the Governor General, the New South Wales and every year for 17 years. I became a NHMRC assessor in the CEO journal in November 2011). Victorian Governor as well as others and won the Refusès for many years, deciding which applications were worth Jennifer is a very busy laser and phlebology cosmetic award for best portrait as judged by her Fellow artists. funding. physician in Canberra, as well as being a Public Officer for Iain the Australian Women of the Year Awards. She is also the Patricia and Donald have 12 grandchildren to date, What did you think of your children Is it true you were originally studying to be ACT convener of the Sovereign Hospitaller Order of St. of whom they are very proud. Joseph of Jerusalem, Rhodes and Malta. entering into ophthalmology? a physician? A great return for Newcastle and indeed Australia on a Helen is a senior histopathologist and an Cytologist with a borrowed 10 pounds! Well, with Catherine I suggested dozens of other Yes, I trained to be a physician first, however like Catherine special interest in gynecological pathology. professions she might want to do. I thought it was too I landed on Ophthalmology in the end. I really liked doing competitive at the time. But I’m glad they all seem to enjoy things with my hands. Dad didn’t know of my decision for it as I did. It is wonderful work if you like helping people. some time, he thought I was studying to be a Cardiologist. I was lucky to have two of my children come to work in our Ophthalmology at the time was a ‘Cinderella specialty’, practice. I enjoyed working with them and was able to retire unless you knew someone it wasn’t a specialty that would in 2006 knowing my patients were in good hands. readily come to mind. So in that way my exposure to it growing up opened my mind to the idea. ATTENTION Photographers and budding What are you doing now? I had very little money so had to borrow I now work between the Canberra Eye Hospital and authors! 10 pounds from friends to bring my the Sydney Eye Hospital. I have just stepped down as ‘‘ President of the AMA in the ACT and have recently been lovely new wife to Australia. appointed as a member of the Federal AMA Executive Council. I was the President of RANZCO from 2007 to We want your photos/stories for RANZCO News! 2009. When I have time I enjoy sailing, golf and playing the piano. ” Please email [email protected] or call Avril Cronk on 02 9690 1001 for more I enjoy the difference between the Canberra and Sydney The Children practices. Canberra, being a large country town involves information and deadlines. All six Dunlop children (four girls and two boys) graduated a richly general ophthalmology practice whilst in Sydney I in Medicine from the University of Sydney. Only one other have a more specialised anterior segment interest. family has had six graduates from the same faculty in the 1920-30’s, and they were the famous Doctors Flynn, who started the Royal Flying Doctor Service. Anthony Do you think your early exposure to Catherine ophthalmology influenced your decision to The Blackmores Dr Paul Why did you decide to study become an ophthalmologist? Beaumont Research ophthalmology? No, when I did my internship I observed who the happy patients and doctors were, and that’s why I became an I had always planned to study medicine rather than ophthalmologist – not because I was exposed to it all my Fellowship for 2013 ophthalmology. I initially thought I’d do hand surgery but life. People are also very grateful when you restore the it was part of orthopedics and not accessible to me at the number one sense. The Blackmores Dr Paul Beaumont time. I tried ophthalmology as an intern at the Sydney Eye Research Fellowship for 2013 has now With ophthalmology you can control the hours more easily Hospital and really liked it¬ – and still do. The precision, opened. This two year fellowship, of mix of medicine and surgery, and interacting with patients than other surgeons, so you can do other things in your AU$50,000 per annum, will support research of varying ages appealed to me. life. Personally I’m very active; I enjoy kite surfing and have raced four Sydney to Hobart yacht races. into nutritional and/or lifestyle aspects of It’s lovely to have a job where you’re helping people and Ultimately, when I chose to become an ophthalmologist I Macular Degeneration. where you can interact with a range of personalities. was very fortunate as I had lots of teachers. When I was Everyday is interesting and there is always something Further details, including the application a registrar I would meet with Iain on Sunday nights. We’d new on the research side. documents, are available from http:// discuss the cases we were going to do in the next week www.mdfoundation.com.au/research/ Were you involved in trialing Botox with and problems we’d encountered the previous week. And in that way I had my own personal tutor. When I was a researchgrants/fellowship.aspx. The closing your father? date for applications is 22 June 2012. (left to right) Marcus Blackmore, 2011 inaugural fellowship medical student, Catherine would allow me to attend her winner Dr Liubov Robman, Dr Paul Beaumont After working at Prince Alfred in 1985 I went to the US to theatre lists on Sunday evenings at Prince Alfred Hospital. further my studies in strabismus. While there I observed I was very lucky. Prof Scott use Botox and on returning I started to use it

RANZCO NEWS JUNE 2012- 43 42- RANZCO NEWS JUNE 2012 RANZCO News June 2012 43 senior and retired committee

Three things are certain in life..... death, taxes and retirement

Plan Early for Retirement

To retire is one of the biggest decisions you will However, you will need to adjust to the fact that you are make in life. It involves many decisions, when a rooster no longer…but a feather duster. I can assure and how to retire, what to do with your practice, you that you soon get over it. There is a whole new world patients, staff, equipment. To whom you refer out there with so many places to see and things to do. Of course, maintaining good health is most important. your patients, to sell (if you can find a buyer) or If you can develop interests and hobbies early in your just walk away, how much money you need in professional life, you can enjoy them when you retire. retirement… It is very complex and the decision Retirement can be complete or partial, depending on is very individual and personal. personal circumstances. It is important to get your Dr Frank Cheok stopped operating in September 2006 finances right to enable you to achieve the objectives (but has continued to consult). Below is his advice on on your bucket list. retirement and the work of the newly formed Senior and Retired Fellows Committee. Disposing of your practice Dr Cheok has recently been nominated as a Senior The ideal situation is to find someone compatible to Fellow on Council. take over the practice. I was fortunate I had an excellent ophthalmologist who took my practice. I was also very When to retire – go out on your own happy to refer the surgery on and be confident that it would be well done. It was also important that the patient records terms were housed safely. If you are unable to have anyone Every Ophthalmologist / Doctor will retire one day. Plan take over the practice then you are left with cabinets full of early and seek advice from your retired colleagues. It is records which will need to be accessed at the request of an evolving process. Certainly ceasing to operate is the patient, doctors, lawyers, courts for seven years. biggest decision. I have always told myself that I would like to stop surgery while I was still operating well to maintain The Senior and Retired Fellows my reputation as a good surgeon. I did not want to operate Committee, 80 is the new 70! for too long, when diminishing surgical skills become obvious to colleagues and the theatre staff. The tap on the The Senior and Retired Fellows Committee was formed shoulder by one’s colleagues to suggest you should stop after the RANZCO 2011 Congress in Canberra, when CE operating is an awful way to end a surgical career. Susi Tegen and the Board, sought senior representation and input into RANZCO activities. A Committee was formed I have heard of surgeons who after a successful operating consisting of Drs Frank Cheok (Chair), Bill Barnett, Rob list announce that this is the last list. They say farewell, Henderson, Mal Tester, Alex Hunyor (Senior) and then stop surgery. I however gave myself six months. Tom Walker. As the last few operating lists approached, the tension and anxiety levels increased. We tend to become more The first items addressed were the Senior Membership anxious as we get older. The fear of making a mistake and Categories. Previously Fellows who reached 70 years had finishing with a bad result was very real. Fortunately I was free membership. However as the percentage of Fellows able to negotiate those last months and weeks without any over 70 years still working was quite significant, it was problems, much to my relief. Stress levels are certainly decided that it was not financially viable for the College much less after you stop operating. to continue to subsidise this group.

RANZCO NEWS JUNE 2012 -45 senior and retired committee RANZCO defines “retired” as meaning a fellow 70 yrs or older There is a big problem looming for working no more than two sessions a week or undertaking locums for no more than six weeks / year. retired doctors, coming to a head Did you know you on 1 July 2013 I refer to RANZCO’s Pamphlet of Fees for the details of the different categories and fee structure for Senior and can now access Retired Fellows. Public Interest Occasional Summary Practice Grandfathered Fellows (also called Limited Registration Journals from Retired Fellows who are not Grandfathered a. Fully Retired Fellows Occasional Practice) b. Retired Fellows on the General Medical Register This registration category was created by the c. Retired Fellows on the Specialist Register Australian Health Practitioner Regulation Agency ranzco.edu? Senior Fellows still in practice (AHPRA) in 2010 as part o a centralisation of After 40 yrs. As Fellow 50% reduction registration of all health occupations under the After 45 yrs. As Fellow 75% reduction control of the new AHPRA bureaucracy which took After 50 yrs, AS Fellow 100% reduction in Fees control of nearly 500,000 health workers. NB The College started in 1969. The years of The issue at stake is the intention by the recently membership of the Ophthalmological Society of appointed national regulator, AHPRA to abolish a Australia, (OSA) should be added to the years the Fellows and trainees can now access Journals directly from the RANZCO registration category entitled, Limited Registration College started to calculate the number of years you Occasional Practice (LROP) from 1st July 2013, have been a Fellow. having closed the category for new entrants from 1 website. The following article will show you how. It is essential Fellows notify RANZCO immediately on July 2010. retirement, including how much work you intend to do, so they can correctly allocate your fee category. Doctors on the Occasional Practice Register have First you will need to log in using Push the journals button on the Then, simply select the journal maintained some rights of referral, prescribing Speak to the Independent Ophthalmic Network (ION) or a your own personalised user name right of the screen (shown with the you are searching for and you will and test ordering. These would be lost once the member of the senior and retired fellows committee should and password. red circle) and a list of journals will be connected directly through to category is abolished in 1 July 2013, meaning you have any questions regarding retirement. We’d be If you have forgotten your password appear as shown in image 2 (a small it. If you were to select Clinical and the doctors in this category could not render any note of caution here – the website is Experimental Ophthalmology for happy to help. please contact [email protected] assistance to ant person which involved the use of connecting you through to another example, the screen in image 3 will After you log into the website, you clinical privileges. website and this process does take appear. The importance of senior Doctors – will see a ‘dashboard’, which should a minute or so). Don’t let wisdom be wasted Under the national registration scheme introduced look something like image 1. Please note, while the header screen in July2010, there are hundreds of other senior says it shows all issues back to 1986. Senior doctors can provide guidance, mentoring, teach, doctors who have been denied the right to apply for If you look down the screen the articles assist in clinics, screening, assist with operations and the Occasional Practice Category, when the LROP that you can access go back to Volume more. There is a wealth of wisdom and experience out was closed. 1 Issue 1 in 1973. there. We are the grandparents of the extended ophthalmic family. Use it. Don’t waste it. A grave injustice is being perpetrated on more It is essential that as many Senior Doctors as possible than 1800 Australian doctors, who will be thrown image 1 image 2 image 3 are encouraged to stay connected with RANZCO and the out of their profession from 1 July 2013 when the Profession. The vast majority of Senior Ophthalmologists registration category will end. are keen to maintain their ties with the College. We The result will be hundreds of senior doctors not attend State Branch Meetings, RANZCO Congress and being able to use their medical knowledge in any International Meetings, and still have an active interesting way, since to do so would breach the regulations Ophthalmology and in medicine in general. of unregistered practice. This is an absolute waste Some of the senior Ophthalmologists attending RANZCO of some of the most exceptional talent in Australian have been eminent doctors, eg Past Presidents who had medicine. been actively involved in steering RANZCO to where it is The cost of training a doctor is very expensive, today. it is not possible to calculate the cost of training The Senior and Retired Fellows Committee has had 1800 doctors with some having 40 plus years of meetings with RANZCO CE Susi Tegen and the CPD experience. Amongst this group is undoubtedly Committee (chaired by Dr Peter Macken). A very some of the best medical minds in the country. satisfactory outcome has been reached. It was recently announced that to support our Senior Fellows RANZCO We are calling on the support of the AMA both We hope that all Fellows and trainees are able to take advantage of this resource made available to you as a member has revised its CPD requirements to exempt Retired State and Federal, all Doctors Societies and service. Colleges, as well as State, Federal and Territory Fellows from the audit requirements. All Retired Fellows A further range of journals is also available to you through the ONE Network. These are accessible from your dashboard government health ministers to support the right to still on an active Medical register are now only to report when you first login to the RANZCO website. support their right to continue to participate in their 50 CPD points. profession. If you need any help accessing this then please either email [email protected] or phone us on + 61 2 9690 1001 and This has been an excellent outcome, one that has ask for either Sarah, Eden, Barry or Peter who will assist you. been noted by other Colleges, as a way of helping their One day you will retire. senior and Retired members, remain involved with the Dr Frank Cheok Colleges and the medical workforce, thus extending their Chair Senior and Retired professional life and usefulness to the community. Committee

46- RANZCO NEWS JUNE 2012 RANZCORANZCO NEWS NewsJUNE June2012 2012-47 47 eye surgeons and surgery in NZ eye surgeons and surgery from his hotel room for a few days, and then he’d move on About the author elsewhere. He was clearly a clever man but an advertising man, and he wasn’t alone in doing that in those days; there Associate Professor Bruce Hadden graduated from the Eye Surgeons and Surgery were several itinerant medicos who brazenly advertised University of Otago Medical School in 1967, trained in cures they couldn’t deliver on.” ophthalmology in Auckland and in the United States, and practised in Auckland in both the public and private sectors. One of the memorable characters from the 1900s was Sir Randal Elliott. “He was born into a prestigious and He led the amalgamation of the Ophthalmological Society of wealthy medical family in Wellington. He started medical New Zealand with the Australian College, to form The Royal in New Zealand Australian and New Zealand College of Ophthalmologists. school at the outbreak of World War II, and after the war he travelled to Moorfields Eye Hospital in the UK to specialise He was New Zealand’s first chairman of the board of in ophthalmology. He returned to Wellington, where his examiners of the College, and New Zealand’s first College influence quickly extended well past ophthalmology; he President. He was involved in establishing the foundation A/Prof Bruce Hadden went into medical politics and he became the President of chair in ophthalmology in Auckland and, with his wife the NZ Medical Association. He was prominent in the Order Wendy, endowed a chair in ophthalmic research at the of St John, and was also reputedly shortlisted to be the University of Auckland. Governor-General of NZ in the 1980s.” He was made an honorary Doctor of Laws by the University of Auckland in 2007, and a Companion of the New Zealand New Zealand finally has a readily accessible The first thing I did was visit senior Order of Merit (CNZM) in 2012. history of ophthalmology thanks to a new ophthalmologists across the country. To order a copy of the book, contact A/Prof Hadden via: book by RANZCO Fellow A/Prof Bruce ‘‘ Ph: +64 21 497 191, email: [email protected] Hadden, of Auckland. They all had interesting stories and readily shared information and A/Prof Hadden spent two years researching and writing the book, Eye Surgeons and Surgery in New personal archives with me. That was Zealand, which was launched during the New Zealand Branch Meeting in Hamilton in May. 1 the most enjoyable part of the whole “I wanted to have New Zealand’s ophthalmology history remembered in some way,” says A/Prof Hadden. “I was book-writing process. concerned that sooner or later much of the early history would be forgotten. Prof Charles McGhee, the Head Prof McGhee wrote the foreword to the book. The following of the Department of Ophthalmology at the University is an extract of his comments: ” Book of Auckland, said ‘Let’s make it happen’ and kindly organised me a desk and computer in his department at “[New Zealand] ophthalmology grew from itinerant Review the University. Prof McGhee has a keen sense of history, practitioners, occasionally more like ‘snake-oil quacks’ than and Drs Thiran Jayasundera and Tracey Wong in his serious medical men, to a highly specialised profession Cutting for Stone department had made a tentative start [on this process] employing cutting edge technology and exploring the

back in 2002” Ey E Surg on S and ry boundaries of eye research. In this book, Bruce Hadden - by Abraham Verghese

Eye Surgeons and Surgery in New Zealand throws new light on eye chronicles that intriguing story with enlivening anecdote and surgery and its many colourful practitioners, from our colonial days to the EyE SurgEonS present. Some early surgeons were itinerants who operated in hotel rooms, and advertised like snake-oil salesmen. In contrast, others, such as Sir Lindo A/Prof Hadden says writing the bookFerguson in the early was 1900s, were at thea top of thebig specialty and were huge and SurgEry the insightful perspective that can only come from a lifetime “I have just finished reading contributors to medical education in New Zealand and Australia. Since the in nEw ZEaland late 1990s there has been a remarkable ascent of academic ophthalmology, resulting in New Zealand ophthalmologists and ophthalmic researchers exercise for someone whose worstbecoming recognisedsubject internationally. Controversies at in the popular press spent in the pursuit of ophthalmology…” Cutting For Stone by have not always been favourable to ophthalmology, but beyond that school was history. “I had no interestcoverage it is a specialty in which history is serving New Zealanders superbly.at all Bruce Hadden Abraham Verghese, which “Ophthalmology has changed exponentially in the last fifty when I was young. I was more interested in maths was one of the best books years, and a surgeon from the mid-twentieth century would and physics, so I was really starting with a handicap in I have ever read. It tells the nE w Z E aland Associate Professor Bruce Hadden graduated from the University of Otago Medical barely recognise the equipment used to diagnose and treat School in 1967, trained in ophthalmology in Auckland and in the United States, and captivating and colourful but we got there!” practised in Auckland in both the public and private sectors. He led the amalgamation of the Ophthalmological Society of New Zealand with the Australian college, to form the Royal Australian and New Zealand College of Ophthalmologists. He was New Zealand’s first chairman of the board of examiners of the college, and New Zealand’s first college eye disease in the twenty-first century… Thus from the president. He was involved in establishing the foundation chair in ophthalmology in story of a medical family Auckland, and with his wife Wendy endowed a chair in ophthalmic research at the University of Auckland. He was made an honorary Doctor of Laws by the University of To research the book, A/Prof HaddenAuckland in 2007, and a Companioninterviewed of the New Zealand Order of Merit (CNZM) in 2012. most humble beginnings in a small country in the midst of a of Indian descent, living in ophthalmologists, sifted through old newspaper mighty ocean a dynamic, vibrant culture of ophthalmology ISBN 978-1-927158-03-6 Bruce Ethiopia at the turbulent clippings and records and photos of individuals, as Hadden and eye research has arisen which exercises influence far 9 781927 158036 time of independence. well as official archives. beyond its borders – this is its story.” Every delicious paragraph The first thing I did was visit senior ophthalmologists As for what’s next on the horizon, A/Prof Hadden says he’s is to be savoured and his across the country. They all had interesting stories and Photograph: Dr Neil Murray gets his copy signed by not sure there’s another book in him. However he’s currently descriptions of surgical readily shared information and personal archives with me. A/Prof Hadden at the NZ Branch meeting, Hamilton. Photo in the process of converting this “history book into a more procedures are unique and That was the most enjoyable part of the whole book-writing courtesy of Maryanne Dransfield, NZ Optics. academic document in the hope of making it a thesis for a perfect. I’d recommend this process, he says. Doctor of Medicine degree”. book to all surgeons, in fact He came across a number of unforgettable stories of to anybody at all, as it is so A/Prof Hadden also accessed the ‘Oral Archives’ of the ophthalmologists while putting the book together. One That’s being done purely for occupational therapy in my beautifully written!” Ophthalmological Society of New Zealand. “The OSNZ was of the more colourful characters was Dr John Wilkins. semi-retirement. I can’t hit a golf ball to save myself and our national ophthalmology body before we amalgamated “Wilkins started his practice in Melbourne in the late I’m not interesting in boats, so it’s either doing something Dr James Muecke with the Australian College and became RANZCO. In the 1800’s. However, he advertised his services improperly stimulating like this – or pulling out weeds! RANZCO Fellow 1990s, the OSNZ had the foresight to arrange for official and was asked to leave the Medical Association of oral archives to be recorded from senior ophthalmologists. Victoria. He moved to NZ and practiced ophthalmology in I accessed those and they had some great tales to tell.” Christchurch, Dunedin, and Auckland. He was a peripatetic ophthalmologist – he would advertise himself as consulting

48- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -49 44TH ANNUAL SCIENTIFIC CONGRESS MELBOURNE 24 – 28 Obituaries NOVEMBER 2012 MELBOURNE CONVENTION AND EXHIBITION CENTRE WWW.RANZCO2012.COM.AU Further memoirs of Clement J Walter

As the unacknowledged co-author of the obituary published in the last issue of RANZCO News and Clem’s friend for over 70 years, I would like to detail a little more of his life before he was forced to retire from his city practice. I met Clem in 1941 when we were digging slit trenches in front of the old medical school as first year medical students. I met his wife, Sue, a telephonist at about the same time. We became close friends when I was appointed to the honorary staff of the Royal Newcastle Hospital and Clem was the permanent head of the eye clinic. When the latter went into private practice he suggested that my wife and I join him to form a retino-strabismus group – he was ahead of the field in retinal work and he was aware that my wife had graduated as Dux of the British school of Orthoptics and that we were in close contact with the San Francisco research unit which later allowed Dr Pittar and I to introduce Botulinum ocular muscle injections to Australia. We had also joined Professor Fenelon’s multidisciplinary group which received top NHMRC grants for 17 consecutive years. Clem’s move to Sydney and his exceptional success with the new Yag laser defused these partnership plans but we visited him quite often and our daughter Catherine attended his rooms on Thursday and Fridays, at first to learn and later to help reduce the constant pressure. Years later Clem became critically ill while travelling through Rome. He decided to fly home for surgery, a decision which almost cost him his life. Dr Catherine took up residence in his clinic and relayed instructions from his hospital bedside to his clinic in Park Regis. Gradually he seemed to recover and to work as hard as ever, but recurrent small strokes became more severe and eventually he was forced to retire, at first to the Burwood suburban practice and eventually, with his very disabled wife, to his daughter Michele’s home in Victoria. He visited his wife every day until she died in 2005. I wrote to him telling him about his old friends in Newcastle and Michele wrote back telling me how much he had enjoyed these letters and how he had tried to write back but could not quite manage it. He needed the comfort of old pals, especially when Sue passed away.

- Dr Donald B. Dunlop

50 RANZCO50- RANZCO News NEWS June 2011 JUNE 2012 RANZCO NEWS JUNE 2012 -51 obituaries obituaries

Dr Andrew John Kelly 10 April 1925 – 23 November 2011

Andrew John Kelly passed away on 23 enabled Andrew and Clem to move to Noosaville where David, and grandchildren Aemon and Celeste. Andrew’s he continued to practice and serve the Sunshine Coast large circle of friends filled the church to overflowing. The November 2011 after a long fight with community. hymns sung at the requiem mass were hymns Andrew loved to sing for others at his church. cancer. He was the only son of Andrew and Andrew gave up surgery in the 1990’s and finally retired Christina Marie Kelly. Andrew’s mother died from all practice in 2004. He regularly attended RANZCO The Noosa Rotary Club turned out in force to form a meetings and visited Greenslopes Repatriation Hospital to guard of honour for one of their past Presidents and fellow of complications following his birth, and keep current with the latest advances in ophthalmology. Rotarian. Andrew will be greatly missed by his beloved Clem and beautiful family, his large circle of friends, and Andrew was raised by his father (who never He was always involved in community service through his patients he cared for during his 86 years. remarried) and his uncle Michael and his church, St John Ambulance and Rotary. Andrew joined Rotary in 1974. An extract from the Noosa Rotary Bulletin Andrew is survived by his wife Clem, sons Paul, Michael grandmother. reads: and David, five grandchildren (Stephanie, Siobhan, Aemon, Celeste and Rhys) and a great grand-daughter Violet. Andrew attended primary school at St James Coorparoo and then Andrew immediately engaged himself in Club activities and went to the Christian Brothers St Laurence’s South Brisbane to lead the way in such projects as the blood pressure clinic, - Dr Gary Lillicrap AM (FRANZCO) grade 10. He completed his secondary studies at St Joseph’s and made all varieties of pancakes in the Club caravan at (Dr Lillicrap is a friend and colleague of Dr Kelly and College Nudgee, before studying medicine at the University of outside functions such as the King of the Mountain. Clem) Queensland in 1947. In 1984 Andrew was elected Club President for the 1984- In 1954 Andrew married Clem (nee Ferris). It was a wonderful 85 year. In 1992 he was made a Paul Harris Fellow of marriage in which Clem always supported Andrew. Together their Rotary International for his service to the community – not raised a beautiful family. only through Rotary, but for the work he did of this own accord; some of which will never be known. He regularly Following their marriage, Clem and Andrew moved to visited the nursing homes and retirement villages to sing At the time, he was the only Maryborough in 1955 where he was in general practice for 10 and entertain, to the joy of his audiences. years. In 1965 Andrew applied, and was accepted, for the position ophthalmologist between Brisbane as Eye Registrar at the Princess Alexandra Hospital. With his fine voice, Andrew loved entertaining his fellow Rotarians and friends. At the club’s last changeover, ‘‘ After completing his registrar training in Brisbane, and further Andrew – although in poor health and some pain – sang and Rockhampton. From Maryborough, study at the Royal Victorian Eye and Ear Hospital (Melbourne), ‘Tie a Yellow Ribbon Round the Old Oak Tree’ and Andrew provided a fortnightly Andrew returned to Maryborough to specialise in ophthalmology encouraged all club members to join in. practice. Andrew loved fishing. In his early years as a specialist in ophthalmology service to Bundaberg. At the time, he was the only ophthalmologist between Brisbane Maryborough, he would appear in Townsville at short notice and Rockhampton. From Maryborough, Andrew provided a with his latest CD (which he produced for charity) on one fortnightly ophthalmology service to Bundaberg. of his many trips north to catch the elusive barramundi. ” Andrew not only served the private sector, he provided public Andrew was a three-times member of the ‘Barramundi outpatient and surgical services to both Maryborough and 100 Club’ – and honour bestowed on those who caught Bundaberg Hospital Districts. His days were very long. Barramundi of more than 100cms on three separate trips. In retirement Andrew spent many happy hours fishing the Andrew encouraged Dr Neil McDermott to move to Bundaberg Noosa River for flathead and whiting. to provide a full-time ophthalmic service and care for patients in the Bundaberg region. In 1979, Andrew invited Dr Laurie A Requiem Mass to celebrate Andrew’s life of was held at Russell to take over his ophthalmic practice in Maryborough. This his local church, Our Lady of Perpetual Succour, Tewantin. Eulogies were read by his three sons Paul, Michael and

52- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012 -53 obituaries obituaries

Dr Sam W Scargill 21 May 1928 – 27 October 2011

Sam Scargill was born in Keighley, York, in Unfortunately, before Sam could move to his new property Ivan Goldberg: As testified by his ophthalmic colleagues in York, several cerebral vascular accidents made farm with whom he shared patient care, Sam was a dedicated, the United Kingdom on 21 May 1928. He was work somewhat difficult. However, he enjoyed very much caring and skilled ophthalmologist. He left a lasting legacy educated at Bootham School and graduated the picturesque setting and time spent on the front veranda of compassionate professional service. looking at the dams, pasture and stock. in 1945. He studied medicine at Leeds - Adrienne Scargill, Dr Jean Calcutt (FRANZCO), University, qualifying in 1952. When not working, he could be seen on his yellow 6x4 ATV Prof Ian McAllister (FRANZCO) and Ivan Goldberg (an all-terrain vehicle he fondly called ‘the yellow peril’) (FRANZCO). checking fence lines, wind mill and dams. He would be (Adrienne Scargill is Dr Scargill’s wife. Dr Calcutt, Prof During his national service, he served in the Royal Army accompanied by his dogs, with the Airedale sitting up on McAllister and A/Prof Goldberg are friends and colleagues Medical Corps in the Malayan Emergency, and was ‘Mentioned the passenger seat and the Ridgeback covering four times of Dr Scargill) in Dispatches’ in the London Gazette on 25 October 1955 for the distance in its quest for kangaroos. distinguished service. Upon discharge, he went into general practice in Bradford, Sam practiced part-time in Midland until his reluctant where he met and married Deborah in 1957. They subsequently retirement in 2009 at age 81 yrs. Following a period of moved to Tasmania to a general practice in Richmond and later, declining health, Sam released his tenuous grip on life on Launceston. 27 October 2011. It was his time. Sam is survived by son Tim and second wife Adrienne. In 1962, with Deborah and son Timothy, Sam travelled to the UK where he studied ophthalmology and performed post-graduate The following are tributes from some of Sam’s colleagues: work in Glasgow. While in Glasgow, he gained his private pilot’s license and also enjoyed time in the Territorial Army – although Jean Calcutt: Sam was one of the people I trained with the parachuting component, less so! in ophthalmology in Glasgow in 1963. A special bond develops between people who train together. It was a On their return to Australia, Sam went into ophthalmology practice delight to catch up with him at conferences in Sydney and in Sydney and continued to enjoy flying to see patients in Taree, there emerged a long-distance relationship by phone. I Port Macquarie and Kempsey. He also enjoyed farming and found it very helpful to discuss cases and especially to ask The Australian Medical breeding Hereford cattle near Kempsey. his opinion about general medical problems – drawing from In 1992 Sam flew to Perth, Western Australia, in his Cessna 310 his experience as a GP in Tasmania. He would also regale Association recognised a and stayed to build a successful practice in Midland and, later, me with his funny stories from his extensive repertoire. ‘‘ in Wanneroo. He developed a very successful practice in these valued member in 2001 areas of Perth that were very under-serviced by ophthalmology at Ian McAllister: Sam was a dedicated ophthalmologist. and elevated him to that time. He was much loved by his patients; not only for his considerable skill as an ophthalmologist but for his honorary membership. In 1998 he bought Meedo Station (362,000 acres) where he bred repertoire of amusing anecdotes from his life as a rural GP. Boer goats and ran sheep. This was successful until lack of rain He would often ring me about a difficult or rare case. As per in the Gascoyne Region made farming of sheep and goats non usual, he would have had it all worked out before he rang – cost-effective. Sam later settled for 500 acres in York, inland from ” having come to the correct conclusion about the diagnosis Perth. and management. Our conversation would be simply to The Australian Medical Association recognised a valued member confirm that he was correct and to bounce a few ideas in 2001 and elevated him to honorary membership. about, but rarely would I have to contribute anything that Sam had not already considered and dismissed.

54- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012- 55 obituaries obituaries

Dr William ‘Roy’ Holmes 1 December 1928 – 22 April 2012

A leading ophthalmologist and prominent national President of the Association in 2000. Roy retired secure. He had a statesman-like ability to look beyond the from his public hospital appointment in 1993 at the age of horizon and cast petty issues aside. Christchurch (New Zealand) personality, 65, and retired from private practice a few years later. Roy will be remembered for being an amazingly patient Dr William ‘Roy’ Holmes, died on 22 April Early on Roy became involved in both local body and and erudite teacher, and the medical students loved his following a short illness. He was 83 years old. medical politics. He was always a keen spectator of tutorials. Roy was an excellent speaker with a great turn of cricket. This led him to a second and parallel career in phrase and he loved debating. He will also be remembered Roy was born in Oamaru, an only child, and after the family local politics; first as a member of the Victory Park Board for being his own man. He seldom heeded the beat of moved to Christchurch, he attended St Andrews on a scholarship. supervising Lancaster Park, then as a member of the North others’ drums; he marched to the beat of his own, doing At Canterbury University College he took Medical Intermediate, Canterbury Catchment Board to which he was elected in what he knew to be right. He also was a traveller – he and he started second year medicine in Dunedin in 1946, having 1962. He was a member of the Catchment Board for 18 visited Japan for a glaucoma meeting at a time when just turned 17. He was the youngest in his class and one of the years and he chaired it from 1970 to 1980. For those ten very few westerners went there. One of his many highlights youngest students the school had had. years he also served as a member of the National Water was flying on Concorde from New York to London. He graduated in 1950 and, after house registrar jobs at and Soil Conservation Authority, and was president of the Roy grew into the role of grandfather. He began to Christchurch Hospital, he returned to Dunedin as an anatomy NZ Catchment Authorities Association from 1978 to 1980. appreciate his grandchildren increasingly as they became demonstrator. He decided he wanted to do something in the ‘head He also served a three-year term from 1968 as a Waimari old enough to engage in philosophical discussions with and neck’ area, but wasn’t sure quite what, so he applied for a post County Councillor. From there he was nominated to the him. In his retirement, Roy continued with some of his as house surgeon at Queen’s Square, the London neurological Riccarton Bush Trust Board where he was a trustee for committee duties, and he became a devotee of the hospital. about 20 years. A little known fact was that he was also an University of the Third Age which he continued to attend honorary Riccarton Bush Ranger. He worked at Queen’s Square for a year. After he had decided up to his final illness. neurosurgery was not his vocation, the family moved to Edinburgh Roy was a big man who filled a doorframe and filled Three weeks before his death, Roy had a fall and broke his where he trained in ophthalmology, qualifying with the Diploma in a room, and he was known to ride his bicycle around hip. The fracture was operatively fixed, but Roy was not. Ophthalmology and FRCS(Edin). Christchurch on gloomy nights. This too was an indication He developed postoperative pneumonia and, after battling of the way in which he was ahead of his time. Not for him The Holmes’ family roots were in Ireland, so he and his wife and it for two weeks, died. Lycra and a trendy helmet – he cycled in an overcoat and their two children spent some time there while Roy gained an Irish A memorial service was held for Roy. He donated his a deerstalker hat that he wore as a pun on Conan Doyle’s Diploma in Ophthalmology. After returning to New Zealand, he also body to Otago Medical School so he can help to teach yet great detective. became a Fellow of the Royal Australasian College of Surgeons. another generation of young doctors. From conservation, Roy’s extra-medical interests turned The family returned to Christchurch in 1956 where Roy established Roy is survived by his third wife Gloria (his previous to more academic pursuits. He joined the Royal Society an ophthalmology practice. Once a week he visited Ashburton, two wives having pre-deceased him), and his children where he served on the Canterbury Branch Committee, and he was also the visiting ophthalmic specialist to the public Rosheen, Shevaun, Deirdre and Charles. Roy had 10 and he was very proud of his appointment to the Council hospitals in both centres. The Ashburton Chronicle noted on his grandchildren and 11 great-grandchildren. of the University of Canterbury, of which he was a member retirement that he had served the town for 43 years. from 1978 for about 20 years. His interests were nothing - This is an extract of an obituary written by Maryanne He established the first glaucoma clinic in New Zealand at if not eclectic: he was the Founder President of Birthright Dransfield of NZ Optics, with material provided by Christchurch hospital, and glaucoma remained a major interest Christchurch, an inaugural member of the NZ Nursing Dr Ross Boswell and RANZCO Fellow A/Prof Bruce throughout his professional career. In due course he became Council, and an enthusiastic member of the Skeptics Hadden, CNZM. recognised as one of NZ’s senior ophthalmologists. He served Association. For 25 years he was involved with Lions as president of the Ophthalmological Society of New Zealand International and was one-time President of the Lions from 1983-84 and was Head of the Department of Ophthalmology Club of Christchurch. He established the first glaucoma at Christchurch Hospital for nine years. He was instrumental Roy read widely both within ophthalmology and throughout in establishing a Senior Lectureship in Ophthalmology in English literature. He was an excellent and powerful clinic in New Zealand at Christchurch in the 1960s. He held office in the New Zealand communicator. He had a clever wit, and that, together with Medical Association as Canterbury Division Chairman, and as ‘‘ his large stature, rendered him intimidating to those less Christchurch hospital.

56- RANZCO NEWS JUNE 2012 RANZCO NEWS” JUNE 2012- 57 upcoming events upcoming events

Paediatric Special Queensland Branch Australian Society 3rd EuCornea NOSA Annual WCOPS – 2nd Interest Group Meeting 3-4 of Cataracts Congress Milan Clinical and world congress 27-28 Jul 2012 August 2012 and Refractive Italy Scientific Meeting of Paediatric The Annual Conference of the 6-8 Sept 2012 6-7 September Paediatric Special Interest (PSIG) The Queensland Branch Scientific Surgeons (AUSCRS Ophthalmology and will be held at the Sheraton Resort Meeting will be held on the Gold 2012 (NeuroVision Noosa, Queensland, from 27-28 Coast from 3-4 August. The main The 3rd Congress of the European July. focus of the meeting is ‘Retina’ 2012) 9-12 August Society of Cornea and Ocular Strabismus 7-9 and sessions will cover the most Disease Specialists (EuCornea) course on 8-9 Paediatric ophthalmologists and up-to-date aspects of this rapidly will be held in Milan, Italy, from 6-8 ophthalmologists with an interest in evolving sub-specialty. 2012 September 2012. September) September 2012 paediatric ophthalmology are invited The dates are set, the venue The 2nd World Congress of The program is structured to The EuCornea Congress will be The Neuro Ophthalmology to attend. is confirmed, the snow’s been Paediatric Ophthalmology and give you ample time to catch up held in the same venue as the Society of Australia (NOSA) will ordered and it’s full steam ahead Strabismus will be held in Milan, For further information: with friends and enjoy the warm European Society of Cataract and hold its 28th Annual Clinical for AUSCRS – Thursday August Italy from 7 – 9 September 2012. Email: [email protected] Queensland winter sunshine in 5 Refractive Surgeons’ Congress; the and Scientific Meeting from the 9 to Sunday August 12 2012 – in Ph: +61 7 34204899 star luxury at the Sheraton Mirage 12th EuRetina Congress; and the 6-7 September, 2012 with the The 2nd WCPOS features an Queenstown New Zealand! Fax: +61 7 33497260 on the Gold Coast. 2nd World Congress of Paediatric NeuroVision Course being held exceptional scientific program There is a fantastic line up of local on 8-9 September (predominantly including scientific symposia, Alongside local and national Ophthalmology and Strabismus. and overseas guest speakers in the afferent Neuro Ophthalmology) at free paper sessions, a video speakers, keynote guests include One of the meeting highlights is pipeline, some great functions and, the conveniently located Sofitel session, workshops, wetlabs and Sydney Alumni Prof Carmen Puliafito (Professor of the joint symposium on Corneal of course, plenty of down time to Hotel Melbourne. joint symposia with high profile Ophthalmology Dean Keck School Neovascularisation hosted by allow you to head for the hills and Ophthalmic societies including of Medicine, USA), A/Prof Sophie EuCornea and ESCRS. Speakers include: Jason J S Barton, Association take advantage of one of the world’s ESCRS, EuRetina and EuCornea Bakri (Associate Professor Mayo Director Neuro-ophthalmology/ best ski fields. and much more. Clinic, USA), and A/Prof Philip Congress organisers remind Human Vision and Eye Movement Biennial Meeting delegates to book accommodation Polkinghorne (Associate Professor, Visit http://bit.ly/LVD7tq for more Laboratory, UBC, Jonathan For more information please visit early, as the Italian Grand Prix is University of Auckland, NZ). information. D. Trobe, M.D. Professor, www.wcpos.org 28 July 2012 being held in Milan at the same time. Ophthalmology and Visual With topics ranging from macular The 9th Biennial Sydney Eye Sciences Professor, Department degeneration and diabetic For further Congress information, Hospital Alumni Association of Neurology, The University of retinopathy to retinal considerations visit the website: www.eucornea.org Meeting will be held at the Sofitel Michigan, Mike Burdon Consultant in cataract surgery, organisers aim Wentworth Hotel, Sydney, on 28 Ophthalmologist University to make the meeting relevant and July. Hospitals, Birmingham. Prof beneficial for sub-specialists and Catriona McLean Neuropathologist Contact Meredith Damon comprehensive ophthalmologists Alfred Hospital and Prof Brian Tress MD Events: alike. Neuroradiologist Royal Melbourne Email: [email protected] For further information, contact Hospital. Ph: +61 2 8006 1775 or Shan Fleming For more information please contact +61 414 474 042 Email: [email protected] Isla Williams Fax: +61 2 8324 6472 Ph: +61 7 3851 4298 Email: [email protected] RANZCO Fellow, Dr Diana Ph: +61 3 9650 1606 Semmonds, can be contacted via email: [email protected]

58- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012- 59 upcoming

XXX ESCRS Meeting Retina Australia APGC 2012 – Asia Prague Congress Sydney Pacific Glaucoma 8-12 Sept 2012 19-21 Oct 2012 Congress Ophthalmic The European Society of Cataract The triennial Retina Australia December 7-9 2012 Congress will be held at and Refractive Surgeons (ESCRS) The 1st Asia-Pacific Glaucoma the Sebel Parramatta Hotel, will hold its Congress in Milan, Congress (APGC 2012) will be Parramatta from 19-21 October, Italy, from 8-12 September 2012. held on 7-9 December 2012 in 2012. Workshop The Congress venue is MiCo, Bali, Indonesia. The Keynote speaker will be Prof. Milano Congressi (formerly Fiera The South East Asia Glaucoma Robin Ali who is Professor of Milano City). The ESCRS Congress Interest Group (SEAGIG), the Asia- Human Molecular Genetics at the will be held in parallel with three Oceanic Glaucoma Society (AOGS) other ophthalmology meetings: UCL Institute of Ophthalmology, Invitation and the Asian Angle Closure London where he is also Head of the EuCornea; EuRetina Congress; and Glaucoma Club (AACGC) have Department of Genetics. He holds the World Congress of Paediatric joined forces to form the Asia-Pacific faculty positions at the UCL Institute Ophthalmology and Strabismus. Glaucoma Society (APGS), securing of Child Health and the Biomedical Ophthalmic Supervisors Workshop the future of glaucoma research Delegates are encouraged to book Research Centre for Ophthalmology, and development in the Asia Pacific accommodation early, as the Italian Moorfields Eye Hospital, London. Grand Prix will be held in Milan at region. Other well known researchers will the same time. Tailored for ophthalmologists, The training, and where required, be presenting papers including Following a highly Attendance will attract 7 eye surgeons, vision scientists economy air travel and one night’s For further information about the Dr. Lauren Ayton, Bionic Eye and other professionals with an successful Supervision accommodation, will be covered by the CPD points! ESCRS Congress, contact the hosts: Research Coordinator, Centre for interest in glaucoma, APGC 2012 Workshop held in December College through the Commonwealth Ph: +353 1 209 1100 Eye Research, Melbourne covering To secure your place, please email will serve as a natural gathering Government’s Specialist Training Email: [email protected] progress with development of the 2011, the College will be Adam Kiernan at akiernan@ranzco. point for both experienced and Program (STP). Web: www.escrs.org bionic eye. There will also be a edu by 16 July 2012 nominating which young professionals to present their offering 3 similar Workshops Scientific Panel led by Prof. Ali The Workshops will be facilitated by Workshop date you prefer. Places are research, take part in hands-on throughout 2012. during the course of the Congress. Professor Stewart Dunn and Dr Paul limited. instructional courses, and network The College invites supervisors in the Heinrich of the Pam McLean Centre Persons involved in the area of with the best and brightest minds in Vocational Training Program (VTP) to (affiliated with the University of Sydney). ophthalmology and optometry etc the field today. All workshops will be held at: attend one of the Workshops as they There will be a focus on term evaluations are invited to register their interest Venue: The Royal North For more information please visit will particularly target supervision issues and appropriate terminology, and in receiving information on the www.apgc2012.org identified by you and your colleagues. effective strategies for remediation. Shore Hospital, Pam McLean Congress as it becomes available by They will be highly interactive. Communication Centre, sending an email with their contact Some of the topics to be covered are: Although compulsory attendance is details to [email protected] not required, the College urges you to Sydney • being an effective trainer and seriously consider attending as it will Time: 8:30am to 5:30pm supervisor allow you to develop your skills and • providing meaningful feedback in effectiveness as a supervisor as well as Dates: clinical and non-clinical areas providing an opportunity to raise issues • 28 July 2012 For more upcoming events and College meetings go to www.ranzco.edu and click onto • dealing with a poorly performing and discuss them with your peers. • 8 December 2012 the Events Calendar trainee

60- RANZCO NEWS JUNE 2012 RANZCO NEWS JUNE 2012- 61 classifieds positions vacant for lease or sale Glaucoma Fellowship in UK Macquarie Street Following items are for sale. Glaucoma Fellowship available Newly refurbished consulting rooms • Tango Ellex laser for yag at the West of England Eye Unit, available for lease in small building capsulotomy and slt) hardly used Exeter, UK. This 12 month fellowship in Macquarie St. About 45 sq m, • Welch alyn ophthalmoscope and is available from August 2012 and flexible layout, new A/C. retinoscope offers training in all aspects of adult • Lenses glaucoma management. The Fellow Contact Phil, 0402 550 913. • A5 filing cabinet from optiplan 8 drawers grey will gain extensive experience in laser Ophthalmic practice for sale and surgical treatment including SLT, Ph: 0411 155 442 MMC trabeculectomy, tube surgery, For sale Macquarie St Sydney non-penetrating surgery and ECP. ophthalmic practice. Contact Mr Michael Smith, Contact: Peter Duke Items for Sale Email: [email protected] Ph: 0431 332 092 60 inch Television Monitor, please Phone: +44 1392 406316 Fax: +61 2 9247 3559 Fax: +44 1392 402798 make an offer Books • Contemporary Ophthalmology Opportunity for sessional or fulltime equipment for sale Honouring Sir Stuart Duke Elder. Ophthalmologist • Stereoscopic Atlas of Macular Equipment for sale Diseases. Gass .Second Edition, Knox Surgicentre/Knox Specialist with Stereo Reels. Medical Centre • 1 x Haag Streit 800 Slit Lamp on wind-up table - $2,000 Contact Karin Monday to Friday 9am • 303 Mountain Highway Wantirna to 5pm P 0400 417 796 • Dorset Consulting Centre 282 • 1 x Haag Streit R-style Dorset Road Boronia Tonometer - $500 We are equipped with Ellex Tang, • 1 x Rayner C-Range Trial Lens wanted Ellex Integra, Lens star, Heidelberg Set including Trial Frame - OCT and angiography. Fully $2,000 equipped Day Surgery facilities on • 1 x 4 sided rotating visual Acuity Wanted to Buy site. system - $500 Contact Luneau Stand L105 Series 9001 • 1 x Nikon Projection Lensmeter Dr Woodward on 0425 765 112 or In working condition.This is older - $400 Dr John Sutton on 0412 107 137 style • 1 x Nikon 20D Lens - $100 Luneau Stand. Wanted - Locum for a busy solo • 1 x Set of Clement clark Loose Contact Ian Dinihan Prisms to 30D - $200 Ph: 0416 183218 or ophthalmology practice in Western +61 2 9579 4004 Sydney. • 1 x Set of Prism Bars - $100 Fax: +61 2 9570 1377 • 1 x Welch Allyn Ophthalmoscope Plenty of opportunity for surgery, with recharging system - $300 person should be ready to start operating straight away on both Also available smaller items of little or Old style Javal keratometer, and private and public lists. Fully no commercial value, phone Dr Pittar A scanner, for the John Fawcett equipped surgery for general +61 2 9416 2722 Foundation (www.balieye.org ). ophthalmology work, friendly doctor Phaco Machine and reception staff. Doctor wishes to Please contact Peter Graham travel for a few months in near future Bausch & Lomb Millenium in good Phone: +61 8 93863097; and is planning retirement. Would working order. fax: +61 8 9386 9154 or like to start locum with a few sessions Modular Design Email: [email protected] and then assess future work. Reliable Service Contact: Purnima Roy Venturi Pump Email: [email protected] Please call: Jenny 0407 621 585 Email: [email protected]

62- RANZCO NEWS JUNE 2012

Clinical & Experimental Ophthalmology Experimental & Clinical Ophthalmology Experimental & Clinical Clinical & Experimental Ophthalmology Experimental & Clinical

Clinical & Experimental Clinical & Experimental

Ophthalmology Ophthalmology

Volume 40, Number 4, May/June 2012 Pages 337–000 Pages 2012 May/June 4, Number 40, Volume 337–000 Pages 2012 May/June 4, Number 40, Volume

Clinical & Experimental

Ophthalmology

Volume 40, Number 4, May/June 2012 Pages 337–000 Pages 2012 May/June 4, Number 40, Volume Clinical & Experimental Ugitaturistis excerferatis se et omnis rest erem Ugitaturistis excerferatis se et omnis rest erem

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