Spring has sprung in earnest, finally. But along with the blooming flowers and the warmer weather comes the risk of swooping magpies. Eye health experts are warning people to beware and to protect their eyes from these springtime pests. Parents of young children are being warned to be especially ware, as our research has found that spring, dubbed ‘magpie swooping season’, can be a dangerous time for children playing outdoors.
This was a lesson learned the hard way for one Western Australia mother and her young son. Around this time last year, two-year-old Will* was playing in a park near his home in WA , when a magpie attacked him, pecking at his left eye. It happened so quickly that, by the time the family were able to react, the damage had been done. Will was rushed to hospital with significant injuries to his eye.
Will was diagnosed with a corneal laceration and underwent emergency surgery. The injury was extensive and resulted in the onset of traumatic cataract and the loss of iris tissue. Approximately a month later, Will underwent a secondary procedure to implant an intraocular lens and remove corneal sutures. He now has significant corneal astigmatism and wears glasses to correct the refractive error in his injured eye. He has needed ongoing visual rehabilitation including patching , which works by covering the eye with normal vision so that the vision in the problematic eye improves. Will’s treating ophthalmologist describes patching therapy as “extremely challenging” in a child of his age because compliance can be such a problem.
A year later, Will’s vision is still poor in his injured eye and any further improvement will depend on the extent of his visual rehabilitation. It is expected that Will will suffer from lazy eye (amblyopia) and he will live with the impact and trauma of the injury all of his life.
Experts in the field of eye research estimate that each year approximately 250,000 children sustain serious eye injuries globally. Raising awareness through public education and by promoting simple protective behaviours and measures, such as using eye protection, can help prevent up to 90 per cent of eye injuries.1
*The patient’s name has been changed to protect his privacy.
1 Hoskin, A. (2014) Study to focus on children’s eye injuries. Medicus, May found at: https://search.informit.com.au/documentSummary;dn=585904964848706;res=IELHEA
Look at the sugar!
I have always felt very privileged to be an eye surgeon. The part of my job that I love the most is talking to patients the day after surgery and listening to their stories. Many of the stories are similar ‘I had no idea how dusty my house was’ or ‘I didn’t know I had so many wrinkles!’ People frequently remark on the brightness of colours, or the ability to see individual leaves on trees. They often say they had no idea how bad their sight had been and how much they had been missing. I never tire of hearing these stories no matter how often I have heard them.
One story, however, stands out in my mind. Some years ago, I operated on a young man in his 20’s. When I saw him the following day he didn’t say very much, and I wondered if he had noticed much of a difference in his vision. That’s when his wife spoke up and told me about their morning. While they sat at the table eating their breakfast he suddenly shouted ‘Look at the sugar! Look at the sugar!’ She had no idea what he meant and wondered if there might be ants or something in the bowl. He explained that he could see individual grains of sugar, instead of the usual vague hazy blob on the table. I myself, don’t recall when was the last time I became excited by something as simple as a grain of sugar, but this story has always reminded me just how precious the gift of sight is.
Dr Brian Kent-Smith
Worldwide, Retinopathy of Prematurity (ROP) continues to be a leading cause of childhood blindness. It is a potentially blinding eye disorder that primarily affects premature babies. This disorder, which usually develops in both eyes, is one of the most common causes of vision loss in childhood and can lead to lifelong vision impairment and blindness.
Recently, RANZCO teamed up with the University of Papua New Guinea and UNICEF to conduct a workshop on Retinopathy of Prematurity at the Port Moresby General Hospital. The workshop aims were to upskill eye care professionals, pediatricians and nursing staff in the identification and treatment of retinopathy of prematurity.
Through funding available from the Australian and New Zealand Eye Foundation (ANZEF), an indirect ophthalmoscope – the traditional standard of care for ROP, has been donated to the Hospital. The availability of this equipment enabled workshop participants to be upskilled in the use of indirect ophthalmoscopy to detect ROP. Special care nurses and neonatologists have also been upskilled in oxygen administration and resuscitation procedures for premature infants.
“We had an amazing team from Australia – a specialist neonatal nurse from the Royal Children’s Hospital, Melissa Stewart, and a neonatologist from the Monash Children’s Hospital, Risha Bhatia, together with myself, an ophthalmologist at the Royal Children’s Hospital and Royal Victorian Eye and Ear Hospital in Melbourne. The medical and nursing staff in Port Moresby are passionate about providing the best possible care for their newborn patients and they were smart and keen to learn as much as possible. For my team, we were overwhelmed with their thirst for knowledge. The experience for us was tremendous and we hope to return to give a refresher course next year, and also to visit other provinces.” Says Associate Professor Susan Carden
“Preventing newborns from blindness is one of the most important things that we can do. Teaching ophthalmologists in developing countries, such as Papua New Guinea, how to examine newborns’ eyes is incredibly rewarding. It means that there is the potential for a sustainable management of newborn eye health and the prevention of lifetimes of blindness”.
This initial workshop was the first of a proposed wider program aimed at addressing the eye health of newborns in Papua New Guinea and the Pacific islands region.
The first workshop on Retinopathy of Prematurity held at the Port Moresby General Hospital.
Professor Helen Danesh-Meyer
The old maxim ‘behind every great man there’s a better woman’ might still have some truth in it – although now women are now also beside and ahead. But perhaps a better truism is ‘behind every great woman is her mother’.
FMHS Professor of Ophthalmology, Helen Danesh-Meyer is certainly one person who attributes her success to both her parents, particularly her mother.
“My mother inspired me to do medicine. As one of the first women to attend medical school in Iran, she was a trail-blazer. Her philosophy was that obstacles were only challenges waiting to be conquered! And to challenge the establishment she’d do things like wearing mini-skirts to classes.”
Helen, did her undergraduate studies at Otago and her fellowship training at the Wills Eye Hospital in Philadelphia. She then joined the University of Auckland and completed both a Doctorate of Medicine (MD) and Doctorate of Philosophy (PhD). She was appointed the youngest professor in the medical school in 2008 and the first female Professor of Ophthalmology in New Zealand. She divides her work time between eye surgery, research and teaching. And with her equally busy periodontal surgeon husband she’s parenting two daughters.
Getting the balance right can be a struggle.
“I thrive on multi-tasking, which helped enormously as I balanced raising a young family in parallel with pursuing a surgical and academic career,” she said.
“My young daughters would frequently join me in lectures and on post-operative ward rounds. Once, near the end of a lecture I was giving, my three-year old quietly got off her chair, came to the podium, pulled at the hem of my skirt, and said: ‘Mum, I think we have all had enough!’ She was probably right.”
Prioritizing parenting hasn’t always been easy. When one of her girls was small she had a relatively serious accident at school and needed to be taken to emergency.
“I know all she’ll have wanted was her mother. But I was operating. So I didn’t even know she was injured for several hours.”
Fortunately, there is more than one path available today she believes.
“Surgical training has traditionally been all-consuming: unusually prolonged and intense, and not amenable to part-time activity. However, attitudes and the configuration of training programmes are changing, reducing some of the challenges for both men and women who seek balanced lives.”
Helen says she is grateful for the support people like her Head of Department, Professor Charles McGhee have provided her.
“Professor McGhee prioritizes academic excellence it in a way that allows achievement by different individuals through different paths and in differing timeframes. Such imaginative excellence-led thinking should be at the core of solutions to achieve greater diversity in leadership at our institutions.”
And for the young women following in her footsteps including, perhaps, her daughters, Helen has this advice.
“Ignore people who attempt to set you limitations. Create your own path. And do it on your terms – embrace your feminine qualities on the way.”
This article first appeared in the September 2018 issue of the University of Auckland’s UniNews.
The team from Westmead Hospital with a Fundus camera that is sure to save many lives in the ED
A camera the size of a hairdryer can quickly identify symptoms that can threaten a person’s vision or life. Within the first two months of using Fundus photography in the emergency department, two people received lifesaving surgery as the camera made it possible to see what was going on inside the eye.
“It’s really important that we can diagnose problems in the brain by looking at the back of the eye,” Westmead Hospital head of ophthalmology Professor Andrew White said.
“Historically people haven’t been very good at that because it has been quite hard to put in place proper training and supervision. Having the camera in the emergency department lets us reliably look at the back of the eye in real time and transmit those images.”
This technology allows for images to be captured, uploaded to the eMR and reviewed by an ophthalmologist within 24 hours. This is a great leap forward in identifying life and vision threatening pathologies quickly in an emergency situation.
iFixPen prototype
A team led by Professor Gerard Sutton from the University of Sydney, the University of Wollongong and the NSW Organ and Tissue Donation Service has been awarded a $1.1M grant to develop the iFiX System, a novel invention for the treatment of corneal ulcers.
The iFix System consists of a proprietary iFixInk which is printed onto the cornea with the iFixPen. It has specific qualities that allows printability as a liquid but sets within two minutes as a transparent gel. The ink has been shown in vitro to accelerate epithelialisation. It also has sufficient mechanical properties to seal a full thickness wound and still remain transparent.
There are 55,000 cases of corneal ulceration presenting to accident and emergency departments in Australia each year and the iFix System could be used to reduce pain, protect from infection and speed up recovery. In addition, the iFix System may have a role in photorefractive keratectomy (PRK), providing pain relief and lessening the time to full healing. The bio-ink itself can be customised depending on the type of injury and can carry antibiotics and corneal cells.
The $1.1M grant from NSW Medical Device Fund is the result of a unique collaboration between the team at the Save Sight Institute; Sydney University; Wollongong University Intelligent Polymer Institute, led by NSW Scientist of the year Professor Gordon Wallace; and the team at the Lions NSW Eye Bank (NSW Organ & Tissue Donation Service).
The iFix System is one of a number of innovations being developed through the corneal bio-engineering programme. Ultimately the team hopes to be able to 3D bio-print an entire cornea. This is just the beginning.
iFixInk is transparent and printable
What inspired you to pursue a career in ophthalmology?
During my rotation in ophthalmology when I was a fourth-year medical student, I decided this is what I wanted to do. What inspired me to pursue ophthalmology was the exactness of the speciality – everyone else was talking in inches and feet, centimeters and meters yet ophthalmologists were talking in microns and millimeters.
The other thing I liked about ophthalmology was the fact that, unlike other departments and branches where you needed a big team to work, an ophthalmologist could quite easily be the physician, the anesthetist, the surgeon or the refractionist, because we are trained to do all of this.
What are some of the biggest challenges you’ve faced when it comes to getting to where you are now in ophthalmology? What have you personally had to overcome?
I think the major difference is in the training. When I was a registrar, we were all trained to be general ophthalmologists. We were able to do cataract surgery, corneal surgery, plastic surgery and so on. Once you finished your six years of training one could then go and train towards a subspecialty. In our exam, we had to operate as part of the exam. This is not done anywhere now. The challenge really has been that everything has developed so much that the learning never “ended”. For us, everything changed rather rapidly from 1980 to now and so much new stuff came out that you either kept pace with it or you got left behind.
How did you keep up with all the changes?
I think the first thing is to be interested in what’s going on. When the College talks about CPD and so on, it is extremely relevant. Back then, it wasn’t so formalized. One went to conferences to learn. Before starting a new procedure, you would have to find someone to be trained by and be guided through the process. One surgeon who helped train me was in Germany and I was in India, he would post me his videos and books for me to learn from. I knew his video off by heart. The day before carrying out for the fist time, I often couldn’t sleep because I would be revisiting it in my mind. Today that is not needed because there are so many people to teach you. Now when someone asks me for advice I am so willing to give it because nothing belongs to me. Someone taught me so I am happy to teach someone who wants to learn.
How do you balance work, life, research and learning?
There is a lot to fit into my day and I do what I enjoy but the problem is I am interested in a lot of stuff. Besides my profession (which always comes first) I have commitments with the College and several other organizations – but they are all connected to ophthalmology. Because everything is a spin off from ophthalmology, it makes it easier for me to translate my skills and transfer my contacts and experience into any of these directions.
How do you balance the world of ophthalmology with your personal life; your family and friends?
I am not sure that I have a good work life balance, but I must say that I have an acceptable work life balance in that my family accepts it. I think that it is perhaps because I have an understanding wife and, while I was doing my ophthalmology, she was doing her engineering and studying and working was something that we both grew into together. We didn’t know it any other way. I would study for my exams and she would be doing the same when she was writing her PhD, and we were just busy all the time. It has worked for me because my family is involved in everything that I do, and I am involved in some things that they do.
Do you think medicine is more accommodating now than when you started out?
Yes – we didn’t have so much maternity leave –in our time things were not so generous back then. There was no such thing as paternity leave. We didn’t really have baby sitters either – the only way we could get a baby sitter was if we left the baby with our parents, a relative or friend. But friendships don’t last too long if you keep leaving your baby with them. But now the system makes allowances and I think it has really brought attention to proper work life balance. I see that in my children and their partners who share the responsibility of parenting with each other more than what we used to. Things have now changed for the better.
Do you ever experience feeling stressed? How do you deal with it?
It is about getting things done rather than doing everything yourself. You need to be able to delegate. In this whole sphere of activities, the only way you can delegate is if you surround yourself with like-minded people. You need to link with people who find the kind of stuff you do interesting and who will help you. A lot of my work is really having ideas and discussing with people how to move the cause forward. I know what is going on and I help out where needed but I do not do everything myself. I make sure to create a team who will help get things done. If you have the right network then you have a better chance of being able to delegate appropriately. Sure, there is stress and you have difficulties but, in general, if you are surrounded by people you trust you can share the achievements with them and also share the stress.
When you are working with registrars, what advice do you give them in dealing with stress?
I think the main thing to reduce stress is to communicate. You will know yourself that sometimes you work yourself up when things are not going right – the relief you get by discussing it with someone is often enough to bring you back to a level where you are not agitated and not angry. I think the major problems come when there is not enough good, clear communication. It is important to talk and let people know that you are on their side. Once you have that link, everyone’s stress levels go down.
Professor Alex Hewitt.
There are some things in life we can’t control – genes are one of them. You can’t change your genetic makeup, your family medical history or your predisposition to certain diseases, including glaucoma. But, a better understanding of the genetics that cause eye disease to emerge will help us to diagnose and treat conditions like glaucoma.
In his blog for RANZCO, Professor Alex Hewitt, a senior author on work recently published in Nature Genetics and a clinical researcher at the Menzies Institute for Medical Research and the Centre for Eye Research Australia, explains a revolutionary discovery that could transform the diagnosis and treatment of glaucoma.
I’m excited to be part of the team of clinicians and researchers from across Australia that has just identified over 50 new gene markers that increase a person’s risk of developing glaucoma – one of the leading causes of irreversible blindness globally. Our discovery is ground breaking because it could lead to earlier diagnosis and intervention and moves us one step closer to preventative treatment that could stop people from losing their sight as they age.
This discovery is based on data from the UK Biobank, the International Glaucoma Genetics Consortium and the Australian and New Zealand Registry of Advanced Glaucoma which was established by Professor Jamie Craig from Flinders University and involves ophthalmologists from across Australia & New Zealand. Research grants from organisations like ORIA have been crucial in progressing our work and reaching this point.
Up until now, glaucoma treatments have focussed on reducing the pressure in the eye. This new work is important because we have identified a number of new genes that could be targeted in the development of new drugs.
Glaucoma has long been described as ‘the sneak thief of sight’ because it is generally asymptotic in the early stages of the disease and early treatment is vital because, once a person experiences vision loss, it is impossible to reverse.
Although a predictive test for glaucoma is not available yet, our new research will dramatically improve our ability to identify people at risk of developing glaucoma and, potentially, stop the disease in its tracks. This is a really exciting time to be involved in eye research, knowing that each discovery is taking us closer and closer to eradicating preventable blindness.
Professor Alex Hewitt was one of the recipients of the 2016 ORIA Grant to advance studies on using stem cells to understand glaucoma.
In supporting organisations like the ORIA, it’s remarkable what you can help to achieve.
Link to paper: https://rdcu.be/3CTh
A stem cell sphere colonizing the corneal surface.
In 2014, my research team at the University of Auckland was awarded a grant from RANZCO/Save Sight Society NZ which would help advance our work in corneal wound healing.
Since then, we have been working on establishing whether tissue engineering can be used to permanently restructure and stabilise the cornea of the eye, providing treatment for defects in corneal wound repair due to limbal stem cell deficiency (LCSD). LCSD is a devastating corneal condition which often leads to severe vision loss, significantly affecting the patient’s independence and quality of life.
Our research in this area is crucial as treatment for LSCD patients has long been frustrating with many patients having a poor prognosis. Recent advances in therapeutic options for these patients have come in the form of an autologous graft of the patient’s own limbal cells following expansion in the laboratory. However, this form of autologous transplant is highly undefined in that what is transplanted back into the patient is a heterogenous mixture of cell types that is applied to the whole of the ocular surface in the hope of success. The efficacy of this technique is unknown, and success is variable with the largest study of patients so far reporting failure in 21 eyes out of 88, with a further 10 eyes lost to follow up. Thus, although recent advances have improved treatment options for LSCD there are still significant improvements to be made for these patients.
Our study explores the corneal stem cell sphere as a new unit of tissue for transplantation that will provide a highly defined transplantable entity for implantation at a defined site (the limbus) that may have the potential to restore the limbus – the border of the cornea and the sclera (the white of the eye) – to near pre-LSCD condition. Achievement of this will not only correct the current wound healing defect for patients but may also provide the eye with restored long-term ability to heal itself.
Our preliminary data is highly indicative of success within this project and the use of human tissue will ensure the translatability of any findings into clinical practice as early as possible.
Research such as ours is essential in furthering eye research and the realm of ophthalmology in delivering innovative treatments to save people’s sight. Without the support of organisations like Save Sight Society NZ, we would not be where we are today, or where we hope to be tomorrow.
Prof Trevor Sherwin
The 2018 Save Sight Society Conference will be held at Rutherford Hotel, Nelson on 10 August. The theme of the meeting is Challenging Eye Care: Beyond Major Urban Centres.
Earlier this week, we celebrated the work of the women and men who participated in the on-the-ground service delivery of the groundbreaking National Trachoma and Eye Health Program. The article focused on the work of two women, Jilpia Nappaljari Jones and Rose Murray, who worked in one of the multidisciplinary teams that methodically covered most of Australia, for screening and treatment of trachoma and other eye conditions.
Today, RANZCO is celebrating the work of Naomi Mayers OAM, a leader and advocate of Aboriginal and Torres Strait Islander people’s rights, whose contributions to health, including eye health, are immeasurable.
In 1957, as a teenager, Mayers started working for the Aborigines Advancement League, one of the earliest Aboriginal organisations, which advocated for equal rights in Australia.
After moving to Sydney, Mayers was active in a number of breakthrough projects in the Aboriginal community in Redfern. Mayers joined the Redfern Aboriginal Medical Service in 1972, the first Aboriginal Community-Controlled Health Service in Australia, following its establishment in the previous year.
In 1976, Mayers co-founded and became the convenor of the National Aboriginal and Islander Health Organisation (NAIHO), an umbrella organisation of Aboriginal Community-Controlled Health Services throughout Australia, the predecessor of the National Aboriginal Community Controlled Health Organisation (NACCHO).
Mayers’ vision for the Community-Controlled Health Services model has shaped the movement in its development, and from the early days of Redfern, emphasised the importance of genuine grassroots control over external administration. These principles were at the heart of establishing the NSW Aboriginal Health and Medical Research Council (AHMRC) in 1983, and when she Chaired the committee developing the National Aboriginal Health Strategy (1989).
In her capacity as the convenor of NAIHO, Mayers was heavily involved with coordinating the involvement of AMSs around the country in the National Trachoma and Eye Health Program. From November 1981 to January 1982, Mayers was employed by the Royal Australian College of Ophthalmologists (RACO, a predecessor to RANZCO) as an Aboriginal Advisor to the Trachoma and Eye Health Committee of the College, in a 10-week contract. In her role, Mayers travelled throughout the country to meet with AMSs and other local organisations about the Trachoma Program, and wrote a detailed report with recommendations for the next phase of the Program.
In the report, Mayers write under the Statement of Principle section:
“The past ten years have seen the establishment and consolidation of the basic principle in Aboriginal Affairs, as being the fundamental necessity for Aboriginal people to assume control of any programmes which are intended to be of benefit to their community.
“In the area of Aboriginal health, the application of this principle has been most dramatically illustrated with the development and proliferation of “community controlled” Aboriginal Medical Services.
“The success of A.M.S.’s is living prof that, given the opportunity, Aboriginal people are not only perfectly capable of controlling their own affairs, but, given adequate resources, are capable of radically omproving their own health situation to a far greater extent that has yet been achieved by “white” initiated and controlled programmes. There is extensive evidence available which proves that aboriginal people will respond more positively to an Aboriginal controlled health programme than one which is run by white people. Indeed, this is recognised by the present Federal Government, the Prime Minister of which [Malcolm Fraser] has stated, “the Government is determined to see a substantial improvement in the health status of Aboriginals. To this end, we are totally determined to se a substantial and increasing degree of Aboriginal involvement in, and control of, the design, control, management, delivery and evaluation of health services provided to them.
Consequently, the same principle must be applied to any programme which is intended to “focus” on the eye health of Aboriginal people.”
Naomi Mayers’ work had deep, long-lasting impact in shaping Aboriginal health policy and practice over the past 50 years. Her influence and dedication to the model of community-control and grassroots ownership continues to resonate today.
Because of her, we can!
Guy Gillor
RANZCO Policy Manager
