OPTOMETRY PROFILE Nathan Efron Charismatic academic returns to Australia Clin Exp Optom 2005; 88: 6: 430-433 Barry L Cole levels of hypoxia beneath all forms of Professor Emeritus contact lenses in open and closed eye con- The University of Melbourne ditiom2This work formed an important part of the rationale for developing high Nathan Efron will take up an appointment oxygen performance silicone hydrogel as Research Professor in the School of lenses, which have become available in optometry at the Queensland University recent years and provide a much more of Technology in January 2006. He is satisfactory ocular response. returning to Australia after 16 years as After completing his PhD, Nathan held Professor of Clinical Optometry at the two 12-month postdoctoral appointments, University of Manchester Institute of one with Professor Ken Polse at the Uni- Science and Technology (UMIST) in the versity of California and the other with United Kingdom. Professor Brien Holden at the University of NSW. The highlight of this period was Early years at Melbourne co-authorship of the ‘Gothenburg Study’,’% Nathan Efron is a graduate in optometry which documented the long-term effects from The University of Melbourne. His un- of extended wear contact lenses on the dergraduate studies between 1973 and cornea and defined key requirements for 1976 coincided with the very early years the future development of contact lenses: of the commercial development of soft that they should be replaced regularly and contact lenses, an area that captured his made from materials of higher oxygen imagination and drew him into research Nathan Efron PhD DSc performance. The current dominance in as soon as he graduated. Professor Leo the marketplace of disposable contact Carney had just returned to Melbourne lenses and super oxygen-permeable sili- following post-doctoral studies with Pro- be applied to the human eye. cone hydrogel materials attests to the fessor Richard Hill at the Ohio State Uni- Nathan’s first refereed article,’ pub- prescience of the Gothenburg Study. versity in the USA and had established the lished in 1979 and co-authored with Leo Nathan returned to The University of Corneal Biophysics Laboratory. Nathan Carney, is one of his most cited works. It Melbourne in 1984 to take up an appoint- commenced PhD studies with Leo, work- defined the level of oxygen at the corneal ment as Lecturer in the Department of ing in the field of corneal oxygenation surface beneath the closed eyelid (it is Optometry where he established a fruit- during contact lens wear. This was an im- about one-third of that available to the ful and prolific collaboration with Dr Noel portant topic because it was the key to open eye). This was a critical finding for Brennan. Their work concentrated on the explaining the clinical performance of accurate modelling of corneal oxygena- hydration characteristics of soft lenses and rigid and soft contact lenses during open tion while wearing contact lenses over- methods for measuring contact lens gas and closed eye lens wear. Nathan adapted night, a topic that is still of considerable permeability. They developed an optical the ‘equivalent oxygen percentage’ (EOP) interest today. His doctoral studies also instrument for measuring the water con- technique-previously developed by Rich- resulted in the publication of a series of tent of hydrogel lenses, the Soft Contact ard Hill for use in rabbit eyes-so it could models that demonstrated significant Lens Refractometer, which was commer- Clinical and Experimental Optometry 88.6 November 2005 430 Profile: Nathan Efron Cole cially produced by Atago. They also puh- The move to Manchester highlighting a number of potential appli- lished an important series of papers on the In 1990, Nathan was appointed Professor cations for ocular thermography, includ- methodology for determining the oxygen of Clinical Optometry in the Department ing monitoring the pre-corneal tear film performance of contact lenses, which re- of Ophthalmic Optics (renamed in 1992 in dry eye, assessing post-herpetic neural- sulted in the contact lens industry adopt- as the ‘Department of Optometry and gia, quantifying the extent of ocular in- ing a more standardised approach to the Vision Sciences’ and renamed yet again in flammation in anterior eye disease and reporting of contact lens oxygen perme- 1997 as the ‘Department of Optometry assessing the thermal impact of various ability and transmissibility.‘ Nathan’s two and Neuroscience’) at UMIST in Manches- forms of laser refractive surgery on the PhD students at Melbourne, Suzanne ter in the United Kingdom. His formal cornea. Dr Morgan became Research Man- Fleiszig” andJohn Ang,b have gone on to interview for the Professorial Chair was ager of Eurolens Research and has re- develop their own distinguished careers in held immediately following the annual mained Nathan’s closest research collabo- academia and industry, respectively. meeting of the British Contact Lens Asso- rator; together they have co-authored While at Melbourne, Nathan won an ciation, which Nathan attended. At that more than 40 refereed scientific papers. Academic Exchange Award from the Brit- meeting, he was introduced to an engag- Professor Efron’s arrival in the UK cor- ish Council to travel to London for six ing and attractive young woman, Suzanne responded with the introduction of dispos- months to undertake historical research Bloore, who had previously graduated in able contact lenses. One of his first papers with Dr Richard Pearson in the Depart- Optometry from UMIST, by a mutual on this subject focused on the question- ment of Optometry at the City University. friend, the editor of the Optician, Alison able quality of these mass-produced The year 1988 marked the centenary cel- Ewbank, ostensibly so that Nathan would lenses? This was hugely controversial and ebration of Fick’s Line Contactbrilk, which be better informed about UMIST prior to was reported and debated internationally was the first published paper on contact his interview. The ‘ploy’ worked; two years in both the ophthalmic and lay press. Al- lenses. The following year was the 100th later Suzanne became Nathan’s wife and though causing great upheaval at the time, anniversary of August Miiller’s inaugural a further 12 years later she was a research that work is now recognised as a landmark dissertation on contact lenses, which was collaborator and co-author. paper that drew the attention of the con- the first reported attempt to correct myo- The professorial chair at UMIST to tact lens industry to the importance of pia with contact lenses. Nathan and Rich- which Nathan was appointed was spon- contact lens quality and led to significant ard published historical reviews of each of sored by a major contact lens company, improvements in contact lens design and these pioneering works in prominent in- Bausch & Lomb, with the expectation that manufacture. ternational oph thalmicjournalsg~6that pro- the incumbent would engage in research Professor Efron makes a habit of con- vided a nostalgic retrospective analysis of relating to contact lenses and provide gen- troversial pronouncements, such as his 100 years of development of the contact eral support for the UK contact lens in- predictions of the demise of rigid contact lens industry and corrected a number of dustry. Professor Efron had bigger ideas, lensesg and his outspoken criticism of misinterpretations of previous historians. and quickly established a European-wide orthokeratology and fitting rigid lenses to About 15 years after their paper on Muller contact lens research and consultancy arrest the progression of myopia.“’Despite was published-and with the aid of the group known as Eurolens Research (short drawing fire from many quarters, Profes- internet which did not exist at the time of for the European Centre for Contact Lens sor Efron’s arguments are always based on their earlier work in the 1980s-they un- Research). Realising that single-company well marshalled evidence and cogently earthed additional historical material sponsorship of his chair could compro- expressed. It is unlikely that he will he about the optician Otto Himmler, who mise the potential of this venture, Profes- deterred from expressing controversial made the glass lenses used by Miiller and sor Efron sought and obtained ongoing opinions, however politically incorrect who can he credited as being the first sponsorship from 11 other contact lens they may seem; the more politically manufacturer of a contact lens of speci- companies. This provided a support vehi- incorrect the view, the more he enjoys fied dimension and power. They published cle for fundamental research into the espousing it. a short account of thisin Survqr nJOphtha1- cornea and contact lenses in addition to The mid-1990s heralded the clinical molngy.7 commercially-negotiated industrial con- development of the corneal confocal mi- sulting work. croscope, which allows the human cornea One of the first of Professor Efron’s 19 to he imaged in vivo at about 700x magni- PhD students in Manchester was Philip fication and enables the cornea to be Morgan. Together they embarked on a viewed in vivo at a cellular level. Professor a. Suzanne Fleiszig is Professor of Optometry and Vision Science and Associate Dean for Basic research project that had received little Efron acquired an early-generation instru- Sciences in the School of Optometry at the prior attention, the mapping of ocular ment and embarked on a wide-ranging University of California, Berkeley, USA. temperature of the eye using highly sensi- series of studies, elucidating the response b. John Ang is Vice-President, Asia-Pacific Pro- tive infra-red thermal imaging. A series of of the cornea to contact lens wear and fessional and Regulatory Af‘Fairs, Johnson and Johnson Vision Care. important papers on this topic followed, refractive surgery, and developing a Clinical and Experimental Optometry 88.6 November 2005 431 Profile: Nathan Efron Cole greater understanding of the normal and able output by ordinary standards.