8 minute read
UPFRONT
Just as Insight went to print, THE
SAX INSTITUTE
published a new analysis by Australian research institutes that found cutting cataract surgery wait times to three months over a three-year period would result in 50,679 fewer falls. This would save around $20 million, resulting in an overall cost saving of $6.6 million, once the costs of bringing forward surgeries were included. The authors have called for more high-volume surgery services, standardised referral and triage processes, fast-tracked referrals when necessary, and prioritised surgery for Indigenous patients. IN OTHER NEWS, Melbourne biopharma company Opthea announced the first clinical trial sites in the Asia-Pacific region are recruiting into the OPT-302 Phase 3 trial for neovascular agerelated macular degeneration (AMD). The sites, located in Australia, are in addition to the US, Canada and Europe that are also recruiting patients. “This enables eligible patients to participate in the ShORe and COAST Phase 3 trials. We [also] anticipate opening sites in additional countries in the Asia Pacific region including South Korea and the Philippines,” Opthea CEO Dr Megan Baldwin said. FINALLY, Vision 2020 Australia and the Fred Hollows Foundation have each shared fresh statistics demonstrating that Australian’s are jeopardising their eye health amid the pandemic. As part of World Sight Day, Vision 2020’s analysis of the latest Medicare data showed almost half a million Australians missed an eye test over the past 18 months due to the pandemic. In a separate survey, Fred Hollows found one in two Australians aged 18 to 24 reported their eyes or vision have been negatively affected by more screen time. COVID has also delayed eye check-ups for 28% of people aged 18 to 24 and 31% aged 25 to 34, mainly because of lockdowns.
n WEIRD
The Ireland and Wales national rugby teams may need to change their respective green and red shirt colours when they face off to improve accessibility to the game for people with colour blindness. It also comes after affected fans had difficulty following the recent British & Irish Lions (red) series against South Africa (green).
n WONDERFUL
A legally blind Toronto home chef has a new, inclusive cooking show. Mary Mammoliti’s vision has progressively worsened with retinitis pigmentosa. With cooking providing therapeutic relief, she launched Dish with Mary that uses integrated described video. Key visual elements are incorporated into the production, making it inclusive for all viewers.
n WACKY
Actor Jason Momoa revealed a long list of injuries while performing stunts on the Aquaman set, including surgery for a hernia, serious rib injuries and a scratched cornea. “I messed up my eyes. I just got something in it that kind of cut it up, and then I’ve got to get surgery,” he said.
STAT
OPTICAL EXTRAS
Health funds collectively pay more than $966 million each year in member benefits for optical or eyecare services. Full report page 41.
WHAT’S ON
THIS MONTH APVRS CONGRESS
11 – 12 DECEMBER
The 14th Asia-Pacific Vitreoretina Society Congress will be held virtually, bringing the latest developments in the field. secretariat@apvrs.org
Complete calendar page 57.
NEXT MONTH 100% OPTICAL
22 – 24 JANUARY
The eighth edition of the show is taking place at the London ExCel, with around 9,500 visitors and more than 200 exhibitors expected. bethany.march@m10group.co.uk insightnews.com.au
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MORE GENE THERAPIES UNDER DEVELOPMENT
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0.3mL of Luxturna into this sub-retinal bleb via the same puncture site; with the injection pressure controlled by the assisting vitreoretinal surgeon, Dr Gaurav Bhardwaj.
“This requires clear communication and teamwork – the trick is to deliver the treatment slowly, watching for retinal stretch, which can lead to iatrogenic macula hole formation,” Simunovic added.
Simunovic is part of Ocular Gene and Cell Therapies Australia (OGCTA), a new Sydney-based collaborative to accelerate the development of novel genetic therapies and offer genomic diagnosis for patients who may benefit from Luxturna and investigational therapies. It brings together experts in ocular genomics, functional investigations, investigation of novel ocular genetic and stem cell therapies, drug delivery and clinical expertise in genomic and ophthalmic diagnoses. It involves the Genetic Eye Clinic at SCHN, the Eye Genetics Research Unit and Stem Cell Medicine Group at the Children’s Medical Research Institute (CMRI), and SSI at Sydney Eye Hospital and University of Sydney.
The Sydney team has now treated four people with Luxturna, including two adults in their 40s. For patients to ultimately receive Luxturna, Simunovic said it involved a significant team effort, including identifying suitable patients and ordering the medication with a minimum 12-month lead time, through to surgery planning and follow-up. Suitable patients must also have proven mutations to both of their RPE65 genes – responsible for recycling vitamin A in the retina – and deemed likely to benefit from treatment through testing.
“Generally, a treatment effect is noticed one month following treatment,” he said.
“Improvements following Luxturna gene therapy are probably best quantified by full-field stimulus testing (FST). The improvements correspond to – on average – a 100-fold improvement in sensitivity. This translates to improved function in real life. For example, Rylee stopped using a cane to navigate by streetlight about a month following treatment. When we caught up [recently], Rylee also reported having seen stars for the first time.”
A MOMENTOUS MILESTONE OGCTA lead Professor Robyn Jamieson – also head of the Eye Genetics Research Unit at SCHN and CMRI, and head of Specialty of Genomic Medicine at the University of Sydney – said it was remarkable to now see gene therapies used in the real world: “When I started in the field 20 years ago, we couldn’t even offer these people a hint of a genetic diagnosis."
She said the OGCTA builds on decades of work in Sydney, with one of
“WHEN I STARTED IN THE FIELD 20 YEARS AGO, WE COULDN’T EVEN OFFER THESE PEOPLE A HINT OF A GENETIC DIAGNOSIS"
ROBYN JAMIESON, OGCTA AND CMRI its important functions bringing together a multi-disciplinary panel of expert ophthalmologists, geneticists, genetic counsellors and researchers who can determine eligible Luxturna recipients, as well as other diagnoses.
In some cases, patients may have a “variant of uncertain significance” – meaning the case is not clear cut. Here, the OGCTA can perform functional genomics where a blood sample is taken from the patient and grown into retinal organoids or RPE where researchers can then assess the mutation more closely and hopefully determine a diagnosis and eligibility for approved and/or pre-clinical treatments.
If confirmed to have the mutation, she said they need viable photoreceptor cells to clear the next hurdle towards treatment. This is where her husband and genetic eye disease expert Professor John Grigg, also part of OGCTA, performs retinal testing to determine if the patient will benefit.
The OGCTA’s activities also include developing gene and stem cell therapies, and clinical trials, with a focus on diseases groups like retinitis pigmentosa, conerod dystrophy and Usher syndrome. For Stargardt disease – a gene too large for viral vectors – the OGCTA is conducting trials for an oral therapy that works at the enzyme level, and is also looking at potential gene editing techniques. n
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second-eye surgery some weeks after the first operation, which may avoid unnecessary delays for patients, particularly those for whom refractive differences may be considerable after the first-eye surgery. In others, it may be the patient’s decision to wait and see.
“The standard clearly leaves this assessment to the treating clinician and suggests that they offer informed consent to the patient about the options suitable in their individual circumstances,” Picone said.
The commission also responded to the ASO’s comment that it “falsely claims” to be consultative and RANZCO’s statement that it has not “listened to the experts”.
Picone said the ACSQHC consulted extensively with both RANZCO and the ASO and has met with their representatives several times to discuss their feedback, including before, during and after public consultation.
“Both organisations provided feedback as part of the public consultation process after which the document was revised taking all feedback into account. Changes proposed by RANZCO during public consultation to Quality Statement 4: Indications for cataract surgery, were accepted verbatim by the commission,” she said.
“Both RANZCO and ASO initially endorsed the standard but withdrew endorsement some months later, despite no changes having been made in the interim and with no change in the evidence base. The commission remains perplexed as to the basis for changes in endorsement
The cataract standard is Australia’s first. without a change in clinical practice recommendations.”
Ultimately, however, Picone said clinical care standards describe best practice care and priorities for quality improvement and don’t aim to describe current practice, “which may be in need of improvement”.
“Best practice and current practice can differ, as in the case of post-operative prophylactic antibiotic eye drops, routinely prescribed by ophthalmologists against current recommendations,” she said.
“Similarly, prioritisation for non-urgent elective cataract surgery based on clinical need is not currently widespread and it is surprising that ophthalmologists do not support such a model for improving equity of care.”
RANZCO and the ASO said they had nothing further to add at the time of print. n
