In celebration of Macula Month, Dr Narme Deva joins us on the RANZCO blog to share some important advice about macula health. Dr Deva is a Consultant Ophthalmologist in New Zealand and a Medical Retinal Sub-Specialist. Following completion of her training in New Zealand, she spent several years at the prestigious Moorfields Eye Hospital in London. She also holds a Doctorate of Medicine from the University of Auckland for research into ocular wound healing modification.
This month RANZCO is celebrating Macula Month. Can you start by telling us why the macula is such an important part of a person’s sight?
The macula is part of the back of your eye that is responsible for your central vision, your colour vision and what allows you to perform fine detailed visual tasks. This is an important part of the eye as the macula is what allows you to recognise your family and friend’s faces.
What diseases commonly affect the macula?
The diseases that most commonly affect the macula include diseases that are inherited. Often a problem with the macula is one that you are born with. The most common condition that affects the macula is Age Related Macular Degeneration (AMD), and as the name suggests, this is a condition that increases in incidence as you get older. If left untreated, AMD can have devastating consequences for your vision. The other group of conditions that commonly affect the macula are due to blood vessel problems in the back of the eye from conditions like diabetes or high blood pressure. These can cause leakage of fluid at the macula and can also cause vision loss or blindness.
When you first started out in medicine what inspired you to lean towards macula and retina related ophthalmology?
The macula is rather beautiful to look at. There is also a vast array of problems that can happen to the macula and retina. Many diseases that affect the body manifest in the retina and indicate a larger problem. It is quite an intellectual sub-speciality and we can manage a lot of problems now that we couldn’t before! I find the work very rewarding.
Why is raising awareness during macula month so important?
It is crucial that conditions of the macula are caught early as many can be treated and the treatments are considerably more effective if the condition is recognised in its early stages. A small amount of pathology at the macula can have a big impact on vision. It is important to spread the word about good macula health, talk to your family and friends about their experiences and be aware of family history of any diseases that particularly affect the eyes.
What is the most important advice that you give to your patients about macula health?
It’s never too early to be concerned about looking after your health. The most important advice I can give my patients about macula health is please don’t smoke, try to eat a diet that is rich in green leafy vegetables and regularly wear sun protection for your eyes.
When in a person’s life should someone start considering the health of their macula?
It is particularly important from your 50s onwards and if you have a family history of macula problems to be looking after your eye health. Additionally, if you have any other general health issues like diabetes or blood pressure it’s also important to consider your macula health and have regular eye checks.
What are the most important signs that a person needs to have their macula checked by an eye care professional?
If you notice any distortion with straight lines or letters in a word appearing slightly tilted, it’s very important to get your vision checked. Also, dark grey patches in your central vision is another important symptom that should prompt you to get your macula checked by an eye professional.
Today (Tuesday 27/05/2019) the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) officially celebrates 50 years as a college.
The College in Australia was formed in order to bring together the numerous and varied ophthalmology qualifications that were available at the time into a single, high quality, training program and examinations system. With this is mind, the College’s predecessor organisation, the Ophthalmological Society of Australia, was disbanded and reformed, being officially incorporated on the 27 May 1969 as the Australian College of Ophthalmologists.
The College was granted the title of Royal College, becoming the Royal Australian College of Ophthalmologists (RACO), in 1977.
While negotiations had been going on for a number of years, it was not until 1997 that the Ophthalmological Society of New Zealand amalgamated with RAZCO to form a trans-Tasman college for ophthalmologists. For the next few years, the College was known as the Royal Australian College of Ophthalmology incorporating the Ophthalmological Society of New Zealand.
Finally, in 2000, the College moved to fully properly recognise New Zealand in its and the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) came into being.
RANZCO CEO Dr David Andrews states that “While RANZCO is one of the smaller specialty colleges in Australia and New Zealand, over 50 years we have had an enormous impact in the region. Ophthalmologists undoubtably change people’s lives for the better and RANZCO is proud of our history in training, education and across all areas of eye care. We look forward exciting developments in the future.”
While there have been a number of significant dates in the formation of the College, the 27 May 1969 is particularly notable. Today we celebrate 50 years of being a College. Later in the year, on 8 October, we will celebrate 50 years since the first official meeting of the College. Through 1969 and the 50 following years there have been a large number of notable moments for the College – when New Zealand joined being a particularly important one – and we will aim to celebrate the anniversaries of these dates in the future, as well as look ahead to what the next 50 years of the College and of ophthalmology will bring. Please continue to look out for interesting events and information celebrating our 50th year, including an e-publication history of the College.
A/Prof Adrian Fung joins us on the RANZCO blog to look at why macula health is so important
This May is Macula Month run by Macular Disease Foundation Australia. Macular disease is currently the leading cause of blindness and severe vision loss in Australia. Macula Month focuses on urging people to learn about their risk and take action to protect their sight. A/Prof Adrian Fung joins us on the RANZCO blog to look at why macula health is so important.
Can you start by telling us why the macula is such an important part of a person’s sight?
The macula is the centre of the retina, the nerve tissue that lines the inside of the eye. It acts like the “film” in the camera and is one of the most important structures in the eye for sight. It’s particularly important for central, reading and colour vision under lighted conditions.
What diseases commonly affect the macula?
The most common cause of visual loss in elderly patients is Age-related Macular Degeneration (AMD). This disease specifically affects the macula. There are two forms: a “dry” form which is a wearing down of the macula with loss of cells and a “wet” form where there is bleeding underneath the retina. Other than AMD, there are many other diseases that affect the macula. The most common of these would include swelling of the macula caused by diabetes (diabetic macular oedema) or blockages (occlusions) of the retinal veins.
When you first started out in medicine what inspired you to lean towards macular and retina related ophthalmology?
The first time I ever saw the retina I was struck by its beauty! A structure that is not much thicker than a piece of paper can capture all the images, memories and emotions that we see over a lifetime. Here is an organ that we can see in microscopic detail with the aid of only some lenses and a light source. Although there are many diseases that affect the retina, many of these are treatable with new medications and surgical techniques. This is perhaps the most rewarding part of being a retinal physician; restoring sight to patients and seeing how it can transform their lives.
Why is raising awareness during macula month so important?
In general, there is a poor awareness in the community of what the macula is and the consequences to vision that diseases to the macular can cause. Vision is a major determinant of quality of life, and currently there are good treatments for many macular diseases. The earlier that patients present, the better the final prognosis will be.
What is the most important advice that you give to your patients about macula health?
1. Don’t smoke
2. If you have diabetes look after your blood sugar levels and blood pressure.
3. If you notice blurring of vision, don’t delay seeing an eyecare professional.
When in a person’s life should someone start considering the health of their macula?
People of all ages can develop diseases of the macula from newborns to patients over 100 years old, so everyone should seek professional advice if they notice a deterioration in their vision. Patients who are diabetic should have an eye check when first diagnosed with diabetes and then at least every 1-2 years thereafter. AMD (“macular degeneration”) occurs in older people over the age of 50 years.
What are the most important signs that a person needs to have their macular checked by an eye care professional?
Blurred vision, difficulty reading, distortion (straight lines becoming wavy) and difficulty judging distances.
If there anything else that you would like to add or tell us about?
Contrary to popular belief, reading or watching the TV does not harm your eyes!
By Prof Nitin Verma
Ophthalmology has changed dramatically over the past 50 years. Ophthalmologists are now treating and managing conditions proactively rather than reactively, as was the case in the past. A prime example was the timing of cataract surgery. A few decades ago cataract surgery was performed only when the patient was severely visually disabled, with the philosophy being that it was best to intervene surgically only when the patient would have nothing to lose if the cataract surgery went wrong. Techniques for intracapsular cataract extraction included “tumbling”, the Smith Indian technique, instrument assisted extraction with the erysiphake, capsule forceps or cryotherapy with or without the use of zonulysis. Even when cataract surgery was performed, it was very often without the use of a microscope using 8-0 silk sutures to close the wound and leaving the patient aphakic. By today’s standards, the visual results were often poor and the complication rates were high.
With the advent of intraocular lenses, small incision cataract surgery with phacoemulsification, better intraocular lens power calculation formulae, cataract surgery has evolved into refractive surgery, which is being offered earlier and earlier to patients once they start complaining of visual disability. Cataracts are often in much earlier stages in their development when surgical intervention is planned.
As you would expect, looking more broadly we can see that, in every area of ophthalmology, the treatments and methods we use today produce significantly better results than were achieved 50 years ago.
The ophthalmic therapeutic armament was very limited and most of the drugs that ophthalmologists used had serious side-effects. An example of this was the use of topical Pilocarpine and Eserine in the management of glaucoma. These were often made in hospital pharmacies. Surgical techniques in the earlier days included cyclodialysis, iridenclesis and sector iridectomy. The complications of these medical and surgical therapies were very serious and were well known.
Screening programs for diseases such as glaucoma, diabetic retinopathy and childhood eye disorders were limited and very often by the time disease was detected, it was fairly advanced. In addition, blindness from infectious diseases such as tuberculosis, syphilis and leprosy were common.
Over the years a lot of disruptive medical technologies have come in (“disruptive” is a word used to define a technology that radically changes the way we do things; in this instance the way we practice ophthalmology). Examples of disruptive ophthalmic technologies include Optical Coherence Tomography, phacoemulsification and the use of intravitreal anti-VEGF agents for the management of ocular diseases. The YAG and Argon lasers are other examples of disruptive technologies that have come into common use over the past few decades.
From being a specialty that not many people were interested in and being low on the “scale” of popular medical disciplines, ophthalmology now is a sought after field of specialisation.
To enter the training program today is a very competitive process simply because the specialty has evolved to a very precise art and the results that we can achieve today are nothing short of spectacular.
With the advent and incorporation of artificial intelligence in an ophthalmologist’s day-to-day work, this will only make things better for patients, the profession and, of course, the community at large. A/Prof Nitin
Prof Nitin Verma will be further exploring this topic, including looking ahead to what the next 50 years of ophthalmology might bring, in RANZCO’s member magazine, Eye2Eye , later in the year.
Recently, RANZCO made two submissions to the Therapeutic Goods Administration (TGA) proposing changes that would help to improve eye health care. The submissions included the following:
RANZCO submission to consultation: Proposed changes to the classification of active implantable medical devices and their accessories – RANZCO recently made a submission to TGA supporting the re-classification of active implantable medical devices and their accessories in a category called Class III (Medical devices). Changing this classification would mean that active implantable medical devices (AIMD) is defined as Class III and RANZCO is therefore in agreement to re-classify AIMD and their accessories.
RANZCO submission to consultation: Proposed new medical device classification for substances introduced into the body via a body orifice or applied to the skin – RANZCO recently made a submission to TGA advising of appropriate emergency eye irrigation solution use. The appropriate emergency eye irrigation solution at the time and place of chemical eye injury, usually before transfer to a healthcare facility, is tap water which of course does not require TGA classification. Should proprietary eye irrigation solutions be necessary at other times and places for chemical injury and any other indication, RANZCO believes they should remain as “Class I sterile” since they are not intended for absorption into the body, the particular feature that would require reclassification.
For more information please contact Stephanie Mulholland via smulholland@ranzcodev.dev.nucleoserver.com or on +61 2 9690 1001.
