CAKE & PIE Post (53rd RANZCO 2022 Edition) - Issue 3

by Matt

& Publisher

Spotlight at RANZCO

by Matt Herman

Standing

shoulders

A heartfelt tribute to Dame Ida Mann and her legacy saw Dr. Danesh-Meyer launch into her presentation, entitled An Eye on the Brain: Adding Insight to Injury Picking up the mantle of Dame Mann, Dr. Danesh-Meyer described the natural progression of her own work from the late, great trailblazer.

“In her pioneering studies in embryology, Ida identified the shared origins of the eye and the brain... This laid the foundation for a revolutionary new approach in clinical neuroscience that is the overarching theme of my lecture,” she began. “That is, the eye can serve as an accessible source of powerful insight into the brain because of the shared origins of the eye in the brain.”

The optic nerve, she explained, is the back of the eye and the front of the brain, and this powerful observation has led her to a gaggle of new discoveries and insights in neuro-ophthalmology.

Something wicked this way comes

The eye and optic nerve can be used as dynamic diagnostic tools, and Dr. DaneshMeyer gave a rundown of how her work and the work of others are capitalizing on this revelation.

Her early research in the mid 2000s found a clear relationship between optic nerve measurements and the retinal nerve fiber layer (RNFL) with cognitive function and risk of Alzheimer’s disease. Critically, these findings held true even in the absence of measurable optic nerve or visual dysfunction. This paved the way for more work on biomarkers that could be employed to sniff out other neurological diseases and injuries.

The advent of optical coherence tomography (OCT) more than a decade later confirmed these results and brought a bevy of new discoveries. For example, findings from former student Dr. Hannah Kirsten demonstrated a link between RNFL thinning, macular volume and the risk and severity of Huntington’s disease.

More probing from Danesh-Meyer acolytes has also led to the development of novel diagnostic equipment. Dr. Matthew McDonald, for example, has

developed a pair of 3D-printed eye tracking glasses. These were then used in a study on rugby players to illuminate brain-optic nerve disturbances and their role in concussion pathology. Diagnostic biomarker investigations continue today at a feverish pace, and Dr. Danesh-Meyer is just getting warmed up.

How long, how long?

Using the eye and optic nerve as a prognostic tool dates back to at least the late 1800s, but is only now picking up steam with the invention of new imaging tools. Research on fundus imaging in the late 1970s from Mats Lundström and Lars Frisén established a link between characteristic band atrophy and chiasmal damage. This would be confirmed using OCT 30 years later by Dr. Danesh-Meyer’s group and expanded to a structurefunction correlation between RNFL thinning and chiasmal compression.

After the surfacing of some problematic patients in this study and a publication rejection letter, more prognostic breakthroughs came through. “I always tell my fellows a rejection letter from an editor is an invitation for negotiation, so the negotiation started,” she mused.

Review of these cases led to the hypothesis that chiasmic compression was analogous to an arm falling asleep. And if this were true, chiasmic compression meant that structure remained despite function being lost.

In other words, if compression could be freed with pituitary surgery, function should improve, which would explain why a normal RNFL could be present with complete bitemporal loss. This set the stage for a host of prognostic breakthroughs that used RNFL thickness as a biomarker predicting degree of visual recovery after surgical intervention.

Another day, another notch on the belt for one of the world’s top neuroophthalmologists and her collaborators.

Leonhard Euler’s day on

Dr. Danesh-Meyer sewed it all up by saving the best for last and resurrecting the long-dead but ever-influential Swiss mathematician Leonhard Euler from the grave to do some heavy lifting in modern eye science.

Researchers at MIT used principles developed by Euler nearly three centuries ago to create Eulerian video magnification. This was then applied to magnetic resonance imaging (MRI), and amplified MRI (aMRI) was birthed by medical physicist Dr. Samantha Holdsworth of Stanford. The jaws of the audience (including your correspondent) in Great Hall 2 collectively hit the floor as Dr. Danesh-Meyer demonstrated the magnification of tiny movements in brain MRIs to make subtle movements in consecutive MRI scans visible to the naked eye.

Research is just kicking off using this ingenious technology to study eye-brain connections. One such use is converting aMRI images into four minute sequences to accurately estimate intracranial pressure.

“We have used aMRI to create motion maps of brain deformation in response to a range of physiological dynamics,” Dr. Danesh-Meyer beamed, her voice tinged with barely-concealed excitement. “Motion maps from patients pre- and post-lumbar puncture are allowing us to build a computational model that predicts brain pressure. We’re also using this technology to help understand how microscopic movements impact different eyes with rare diseases.” Jaws remained firmly on the floor as she proceeded to rattle off the flurry of life-changing new research being conducted using aMRI in neuro-ophthalmology.

Much ground covered, much left to go

In the end, Dr. Danesh-Meyer left no doubt that there is a complex relationship between the eye and the brain that we are now only beginning to understand.

“I believe this relationship… extends to include late-stage neurodegenerative diseases, and is likely to have a clinical role in diagnosis, prognosis, and management,” she summarized.

And just as her lecture started, so it finished with a nod to the giant for whom the lecture is named, quoting Dame Ida Mann: “We use research to answer the age-old question – what makes you get what you get, when you get, and why.”

“And surely nothing could be more rewarding than that,” she concluded.

TECNIS Eyhance IOL

Advanced Monofocal IOL for Unprecedented Vision Quality

by Tan Sher Lynn

Thanks to intraocular lens (IOL) designs that are constantly evolving, today cataract patients who have their natural lenses removed have far more choices to achieve good vision and quality of life than ever before.

Superior intermediate vision

A game-changer in the industry is Johnson & Johnson Vision’s TECNIS Eyhance™ IOL, the first monofocal lens that is able to provide high-quality vision at both intermediate and far distances.

More than 500,000 TECNIS Eyhance™ and TECNIS Eyhance™ lenses have been implanted since it was first launched for the treatment of cataracts patients in Europe on February 2019.

Compared with a standard aspheric monofocal IOL, the TECNIS Eyhance™ IOL allows patients to achieve significantly improved intermediate vision, along with 20/20 distance vision. The great results and consistency of the TECNIS Eyhance™ IOL was attested by numerous clinical studies over the world.

For a start, a retrospective case-control study1 published in the European Journal of Ophthalmology in 2021 assessed 120 eyes of 60 patients who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (TECNIS PCB00), as a control group, or advanced monofocal IOLs (TECNIS Eyhance ICB00). The researchers found a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control

group, without compromising distance visual acuity – the average monocular uncorrected intermediate visual acuity (UIVA) was 20/32 in the ICB00 group and 20/40 in the control group (p<0.001); while the average binocular uncorrected distance visual acuity (UDVA) was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p=0.62). Patients in the ICB00 group also reported greater capability for intermediate distance activities (computer use and reading price tags).

At the other side of the world, a recent Korean study2 published in the Korean Journal of Ophthalmology also found that ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL. In the study, researchers viewed the medical

records of patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020, as well as data at 3 months. The ICB00 group showed significantly higher intermediate visual acuity (p < 0.001) and near visual acuity (p < 0.05) 3 months postoperatively.

A similar conclusion was achieved by a European multi-center study3 published in the Journal of Cataract and Refractive Surgery in 2021, which evaluated 139 patients bilaterally implanted with the enhanced monofocal IOL (n = 67) or standard monofocal IOL (n = 72) at 6 months. The researchers found that the enhanced monofocal IOL significantly improved mean monocular and binocular distance-corrected intermediate visual acuity (DCIVA) and UIVA by at least 1-line logarithm of the minimum angle of resolution versus the standard monofocal IOL (all P ≤ .0001). Meanwhile, distance vision for the enhanced monofocal IOL was 20/20 or better and comparable with that of the standard monofocal lens at 6 months.

Moreover, a Spanish study4 published in 2022 found that in patients undergoing cataract surgery, monofocal with enhanced intermediate vision IOL offered similar distance performance and contrast sensitivity along with perceived higher order aberrations (HOA) and halos compared with the standard monofocal IOLs tested.

induces against-the-rule-astigmatism. He also emphasized that every degree of rotation results in a loss of 3.3% of cylindrical power and misalignment of more than 10 degrees is considered an indication of surgical repositioning. Hence, he and his team conducted a study to evaluate the rotational stability of the TECNIS Eyhance™ Toric II IOL and found that TECNIS Eyhance™ Toric II IOL showed excellent rotational stability over 3 months where 96% of the IOLs are within 5 degrees, with a mean absolute IOL rotation of 1.35° ± 1.46°, with no re-rotations. The mean UCIVA at 66 cm was 0.17 LogMAR with 70% of the study patients had an intermediate visual acuity of ≤ 0.1 LogMAR.

Surgeon’s lens of choice

Australian cataract and vitreoretinal surgeon Dr. Lewis Lam has implanted numerous patients with TECNIS Eyhance™ and TECNIS Eyhance™ Toric II IOLs, and only have good things to say about these advanced monofocal lenses.

that should occur during a surgery should be due to a surgeon or patient factor, but never a product factor. I have dealt with some lenses in the past where the preloaders would jam and get stuck in the eye (it’s certainly not acceptable when it’s the patient’s only eye). I feel, with the Eyhance lens, that this is one thing less I need to worry about, and by far, it’s the simplest pre-loader to prepare and smoothest to inject. Always reproducible,” he said.

References

1. Lopes D, Loureiro T, Carreira R, et al. Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens. European Journal of Ophthalmology. 2022;32(1):229-234.

2. Kang KH, Song MY, Kim KY, et al. Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens. Korean Journal of Ophthalmology. 2021;35(2):112119.

3. Auffarth GU, Gerl M, Tsai L, Janakiraman DP, Jackson B, Alarcon A, Dick HB; Quantum Study Group. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. J Cataract Refract Surg. 2021;47(2):184-191.

Built on Toric II Platform for greater rotational stability

Cataract patients with astigmatism can also enjoy the benefits of the TECNIS Eyhance™ monofocal lens, thanks to the development of TECNIS Eyhance™ Toric II IOL – the latest innovation in the industry-leading TECNIS® family of IOLs that provides high-quality vision at both intermediate and far distances as well as superb rotational stability for astigmatism correction.

Prof. Dr. Oliver Findl from the Vienna Institute for Research in Ocular Surgery, during his presentation at the recently held ESCRS Congress in Milan Italy, noted that tilt and decentration of the IOL can lead to a negative effect on optical performance, and that horizontal tilt

“I have opted to use this as my routine monofocal IOL as it is marketed as the ‘IOL with more’. Supposedly, it is to give the patient some form of intermediate vision where functional everyday things like the car dashboard are clearer compared to a standard monofocal IOL. We are in the process of doing an audit to decipher a measurable outcome. At this point, when I counsel patients, I counsel them as if it is just a monofocal lens with no promise of unaided near vision – if there’s any, that’s a bonus. I have found however, noticed that a good proportion of patients who are hyperopic, +2 and beyond, do get a very good amount of near vision (unrelated to small pupil), with some of them even achieving N6 at approximately 50 cm. Anecdotally, I would say 50% of these hyperopes would be N10.

“What I also like about the lens is its reliability. In my opinion, the only ‘error’

4. Garzón N, Poyales F, Albarrán-Diego C, et al. Visual and optical quality of enhanced intermediate monofocal versus standard monofocal intraocular lens. Graefes Arch Clin Exp Ophthalmol. 2022;260:3617–3625.

Contributing Doctor

Dr. Lewis Lam is a subspecialty fellowship-trained vitreoretinal surgeon and a fellow of the Royal Australian and New Zealand College of Ophthalmology. Prior to his arrival on Gold Coast, Australia, he worked as a fulltime consultant vitreoretinal surgeon at Christchurch Public Hospital. Dr. Lam has a special interest in cataract and refractive lens surgery and stays updated with the advancements in intraocular lens technology. He undertook a postgraduate diploma in cataract and laser refractive surgery at the University of Sydney to refine his experience. As a vitreoretinal surgeon, he is able to access the back of the eye safely, meaning he can truly deal with complex cataract cases as well as complications that arise from routine cataract surgery or trauma.

Dr. Lam’s personal mantra is to always treat his patients how he would want his own family members to be treated.

Lewis.lam@eyespecialistinstitute. com.au

Hail the Winners

Best papers at RANZCO 2022

by Tan Sher Lynn

From reducing cataract surgery waste to predicting glaucoma worsening, here are some of the papers that won the Gerard Crock and John Parr Trophies during the 53rd Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO 2022).

Reducing the carbon footprint of cataract surgery waste

Cataract surgery is the most common surgical procedure worldwide, and 3,800 cataract operations were performed per 100,000 people in Australia in 2018. Such a high turnover rate means more surgical waste is produced. Dr. James Pietris from Queensland and colleagues investigated the waste produced by cataract surgery and how it impacts the world’s climate crisis.

Dr. Pietris and his team members conducted a bi-center evaluation of

phacoemulsification cataract removal procedures within the Gold Coast health sector (public and private hospitals) in 2021. Waste were segregated into 5 categories – soft plastics, hard plastics, metal and electrical, paper and cardboard, and textile (drapes and gowns) - and weighted. Annual surgeries performed were determined and yearly carbon emissions were calculated. They found that a total of 69.15 kg of waste were produced by 21 cataract procedures, with textiles being the biggest contributor (33.8% of total waste).

“An average of 1,655 cataract surgeries were performed at Gold Coast Hospitals and Health Service (GCHHS) annually. The total annual waste mass produced by cataract surgeries at GCHHS were calculated at 5,450 kg and the total annual carbon footprint as a result of these procedures was calculated at 7.52 tonnes CO2e-,” he said.

According to Dr. Pietris, the two issues that contribute to the cataract surgery

waste problem are: the inappropriate segregation of waste in the operating theater (clinical vs general waste), and practices of theater staff and environmental services that were sub-optimal regarding adequate waste disposal. “While primary concerns should always lie with the patient, we believe improvements to at least the base level of waste management is definitely achievable,” he shared.

Early Detection of keratoconus by AI

New Zealand has one of the highest prevalence rates of keratoconus (KC), with approximately 1 in 200 adolescents being affected by the disease. This condition disproportionately affects individuals of Maori and Pacific Islander ethnicities, occurring in about 1 in 45 Maori adolescents.

Dr. Rasha Altaie from New Zealand and colleagues set out to develop an artificial

intelligence (AI) platform that can detect KC and differentiate it from non-KC cases through evaluation of corneal topographic images.

A databank of corneal images has been downloaded from the corneal tomography (Pentacam). The dataset contains 12,000 images of 3000 New Zealander’s corneas captured between 2011 and 2021. These images were audited by two corneal specialists including Dr. Altaie herself, and divided into normal, KC, KC suspect and other diseases categories. The data is split by a ratio of 70/15/15 for training, validation and testing, respectively. A series of EfficientNet is trialled to identify the optimum AI design.

“The algorithm currently achieves 85% accuracy in differentiating between normal and KC, and 80% accuracy for identifying KC suspect from definite KC cases. The algorithm achieves this in less than 5 seconds per image. The AI engineers are currently working on more complex designs to achieve >90% sensitivity and specificity of the algorithm,” said Dr. Altaie.

Currently, Dr. Altaie and her team are taking images from both Medmont and Pentacam to train the AI on different devices. They are also trying to correlate the severity of KC with age and ethnicity as this will be of significant benefit for ethnicities that are known to have a greater risk of KC.

“Further work is in progress to use AI to identify KC from images taken with multiple different devices, which should make the technology more accessible for all optometrists and enable easier setup in the community and within schools to screen for KC,” she said.

Laissez-faire vs direct closure in lower lid reconstruction

Australia and New Zealand have one of the highest rates of non-melanoma skin cancers in the world, with around 10% of them occurring at the periorbital region, most commonly in the lower lid. While direct closure is the most common technique used to reconstruct the defect after lesion excision at the lower eyelid, the Laissez-faire (which literally means ‘leave it alone’) technique, which utilizes the natural wound healing process, may be comparable or even better.

Dr. Sarah (Jee Ah) Oh from New Zealand and her colleagues conducted a radonmized controlled trial to demonstrate that Laissez-faire is noninferior to direct closure in lower lid reconstruction, and may be even better in certain situations. The multi-center randomized controlled trial involved the Waikato and Nelson regions where 35 patients were randomly assigned to the Laissez-faire (LF) or direct closure (DC) groups.

Results showed that complication rates were similar in both groups, with the most notable complications being punctate epithelial erosions (31% in LF, 25% in DC) and trichiasis (19% in LF, 37% in DC). At 3 months, the LF and DC groups reported similarly high scores in the overall outcome (9.6, 9.5) and appearance (8.9, 9.5). A higher portion of LF patients reported improvement in their quality of life postoperatively (79% versus 61% in DC group). “Given that this is the preliminary result, it is possible that the difference may become statistically significant at the end of the study,” said Dr. Oh.

Predicting worsening of glaucoma

Glaucoma is highly inheritable and glaucoma polygenic risk scores (PRS) have been shown to be predictive of the risk of developing glaucoma and a greater likelihood of requiring more intensive treatment. Dr. Ayub Qassim from Flinders University, Adelaide, Australia, set out to investigate whether glaucoma PRS can be used to predict the likelihood of glaucoma worsening in early glaucoma cases or glaucoma suspect.

He used a prospective, longitudinal study of a cohort of individuals of European ancestry. The participants had characteristic optic nerve head changes suggestive of glaucoma, and were enrolled in the PROGRESSA (Progression Risk of Glaucoma: Relevant SNPs with Significant Association) study, monitored every 6 months. The main outcome is the association of glaucoma PRS with worsening of visual field. Using a scripted visual field grading algorithm, he graded 27,059 visual fields of 1,211 individuals, and found that the high-risk group had 50% greater risk of visual field worsening despite a higher number of treatments. Using an identical multi-variable model, he found that the top 5% PRS group were at 77% greater risk of visual field worsening.

“Polygenic risk can stratify risk of glaucoma worsening in early glaucoma and could be used to identify high-risk glaucoma patients. A clinically relevant risk prediction can be obtained using a blood or saliva sample, highlighting individuals who stand to benefit the most from more frequent surveillance, and earlier or more intensive treatment,” he concluded.

The ABCs of Gene Therapy for Retina

by Matt Herman

Dr. James Bainbridge gave RANZCO 2022 attendees a crash course on developments from the cutting edge of gene therapies.

therapy can cure some of the planet’s most menacing ailments.

Gene therapy challenges abound

While we’ve come a very long way in a short amount of time, Dr. Bainbridge noted, obstacles abound for the science behind gene therapy. Dosing, efficiency, and specificity remain difficult to pin down and fine tune.

The

anonymous-sounding Great Hall 2 at the 53rd Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO 2022) host venue Brisbane Convention & Exhibition Centre is not your average lecture space. Presenters speak from a pit to doctors from around the world lining the rafters of the cavernous conference hall. This epic fish-bowl feel has led your correspondent to refer to the hall as the “Thunderdome” from the Aussie post-apocalyptic Mad Max series of films.

But unlike the grim dystopian wasteland of Mad Max, Dr. James Bainbridge of the prestigious Moorfield’s Eye Hospital (London, United Kingdom) gave audiences a wildly utopian view of the future of retinal medicine with his overview of gene therapies on Day 2 of RANZCO 2022. And instead of gladiatorial battles to the death, aweinspiring glimpses of hope for some of ophthalmology’s most villainous diseases poured out of the Thunderdome pit.

Look what we can do!

Dr. Bainbridge’s lecture, entitled Gene

Therapy - Opportunities and Challenges, began with an overview of the current state of the retinal gene therapy space. Disease-causing gene defects, he explained, are currently approached in three ways – supplementation, silencing (or blocking), and editing.

Supplementation, he explained, is currently the most widely-used gene therapy.

This therapy involves providing synthetic gene copies to the cells that need it. Silencing is the opposite of supplementation, Dr. Bainbridge continued. In this strategy, toxic protein production that induces harmful gains of function is ‘silenced’ by blocking translation via RNA interference.

The final, and by far most complex and novel of the three, is gene editing. CRISPR-Cas, developed by Drs. Jennifer Doudna and Emmanuelle Chapentier, is the most common form of this gene therapy subtype. Gene editing involves actually fixing the underlying defect by directly editing DNA, and is the most promising type for one simple and powerful reason. Successful gene editing

Delivery vectors are also problematic. Immunogenicity issues like inflammation and atrophy are inevitable when introducing any foreign substance into the body. Inflammations can be sidestepped using immunosuppression, but the risk of harm is still great. Atrophy is another hazard lurking in the shadows, and the potential for resultant long-term harm must be addressed.

The safety and scalability of delivery is also a key field in need of improvement. Intravitreal injection, subretinal injections via various approaches like transvitreal/ transretinal, transscleral/transchoroidal, and suproachoroidal/transchoroidal all have their positives and negatives, and further investigation is needed to ensure safe and scalable efficacy.

Beyond the medical nitty gritty, efforts also must be made to optimize gene therapy trial design. Dr. Bainbridge concluded his talk by pointing out specific areas of improvement here, including the identification of relevant and reliable outcome measures, establishing valid comparators, and improving efficiency for more timely outcomes.

anti-cancer properties. They found that a lead molecule, which they called novel molecule 2 (NM2), remarkably reduces cell viability, significantly impacts mitochondrial function, induces cell necrosis and possesses anti-metastatic effect. “Our future work will identify its molecular target(s), explore its cell-killing mechanism and investigate its in vivo effect,” she said.

Corneal blindness, the third most common cause of blindness, is irreversible and affects all ages. In Australia, bacteria are the leading cause of microbial keratitis (80-92%), a major cause of corneal blindness. Prof. Stephanie Watson talked about the Bacterial Ocular Surveillance System (BOSS) research grant, which aims to establish a national surveillance system for antimicrobial resistance in bacterial keratitis in order to review and report on the trends in bacteria distribution and antibiotic susceptibility profiles from patients clinically diagnosed with bacterial keratitis.

by Tan Sher Lynn

Pioneering Research to Battle Debilitating Eye Diseases

The Australian Vision Research (AVR) plenary session, held on Day 1 of the 53rd Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO 2022), showcases successful AVR grants that aid research in retinal biomarkers, developing new therapy for uveal melanoma, establishing a national antimicrobial resistance surveillance system for antimicrobial bacterial keratitis, and more.

Firstto present was Dr. Vivek Gupta who spoke on tau-targeting to protect retinal ganglion cells and the optic nerve in glaucoma. According to him, tau is essential for normal ganglion cell function. In glaucoma, tau hyperphosphorylation is increased in the inner retina. Adeno-associated virus vector (AAV9), a promising gene transfer vehicle, can modulate tau expression in the retinal ganglion cells (RGCs) exacerbating the effects of glaucoma in over expression whilst mediating the effects with partial knockdown. AAV9 gene therapy can therefore provide some functional and

structural protection in the glaucoma model. “Our findings provide strong incentive to further explore Tau as a retinal biomarker for detection and drug targeting in glaucoma,” shared Dr. Gupta.

Although rare, uveal melanoma (UM) is a highly metastatic deadly disease, accounting to a median survival of 5.2 months. A/Prof. Fan Fan Zhou and colleagues set out to develop a novel therapy for UM with high efficacy and manageable toxicity. The team designed and synthesized a group of epoxy fatty acid derivatives in order to study their

“Corneal scrapes were done with local protocols, and a positive culture means any bacterial and/or fungal growth present on solid media. The bacteria were identified via the MALDI-TOF mass spectrometry using an Ultraflex LT with v3.0 software, and antibiotic susceptibilities were determined by the Calibrated Dichotomous Sensitivity (CDS) method,” she explained.

According to Prof. Watson, initial data from across Sydney found that there are 75% gram-positives, 46% coagulase-negative staphylococci and 19% coagulase-negative staphylococci resistant to cefalotin, which is quite high and a matter of concern. They also noticed increasing resistance of methicillin-resistant staphylococcus aureus (MRSA) to ciprofloxacin and gentamicin. “In treating keratitis, we need epidemiology to inform our drug choice, which is critical, and this is where the BOSS fits in,” she said, adding that all national centers are welcome to join the project.

Other topics presented that day were Hyperspectral Retinal Imaging Perfusion Maps for Retinal Vascular Diseases by A/ Prof. Peter van Wijngaarden and Genetic Indicators of Treatment Response to AntiVEGF Intraocular Injections for Diabetic Macular Edema by Dr. Kathryn Burdon.

Vision and Beyond

As the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) 53rd Annual Scientific Congress kicked off, RANZCO president Prof. Nitin Verma launched RANZCO’s Vision for Australia’s Eye Healthcare to 2030 and Beyond - Vision 2030 and Beyond - during the RANZCO Plenary session on Day 1.

“There is considerable inequity in the delivery of eye healthcare across Australia. The resultant visual loss is often irreversible, unnecessary, and preventable. The loss of sight to an individual and their family is devastating and the flow on increased healthcare and community costs have adverse economic consequences for the whole country,” said Prof. Verma. “As a leader in collaborative eye care, RANZCO has the responsibilities for reviewing the problems that we currently see in eye healthcare delivery and exploring potential solutions to ensure equitable access to eye health care,” he said.

Prof. Verma further noted that RANZCO’s strategy aims to eliminate avoidable blindness in Australia and close the gap in eye care for indigenous Australians.

“This is to be achieved through enhanced equitable service provision across Australia, advocating changes to Australian healthcare system, meeting increasing demands for eye healthcare services, sustainable healthcare delivery, and developing and maintaining a

sustainable ophthalmology workforce,” he explained.

“The development of Vision 2030 is a long journey that we started in March 2021 despite COVID-19, when we met with the former health minister to raise concerns about inequity to access eye care. As a nation, we were not adequately prepared to face the challenges in the future in this regard. We were then challenged and asked to develop a plan to eliminate avoidable blindness in Australia by 2030 and close the gap in eye care for indigenous Australians by 2025,” he shared.

Vision 2030 focuses on six key areas: workforce and training, service delivery, closing the gap, preventative health, sustainability and global eye health.

According to Prof. Verma, in order to have a sustainable workforce into the future, more training positions are needed in public hospitals. To increase regional training posts, the Regionally Enhanced Training Network was inaugurated in 2023 where the trainers are regionally based for 60% of their training.

“Existing public ophthalmology services across Australia have long waits, and more than half outpatient services available do not offer comprehensive care, and delays in access to pediatric ophthalmology services are particularly problematic,” Prof. Verma said.

“So we need to advocate for more public ophthalmology services particularly in rural, remote and outer urban areas, with comprehensive ophthalmology services,” he added.

In terms of closing the gap of inequity, there’s the need to ensure that aboriginal and Torres Strait Islander people share in decision making, and develop special measures that facilitate their access to healthcare services. In terms of preventable health, the idea is to resource the implementation of a national children’s vision screening program, and invest in vision research to develop key technologies and treatments.

Meanwhile, efforts towards sustainability involves advocating for healthy futures and clean energy use by 2030 through joint colleges’ initiatives, and research to reduce practitioner carbon footprint and waste. A coordinated strategy for global eye health involving multiple stakeholders will also be developed.

Moving forward, he said that the next steps are to prioritize key areas within the plan, to continue to engage and collaborate with stakeholders, to seek new partners to develop solutions to inequitable access to eye healthcare, and to have further engagement with the Fellow of the Royal Australian and New Zealand College of Ophthalmologists (FRANZCO).

RANZCO’s vision for the future, where equity and sustainability take center stage by Tan Sher Lynn