Celebrating International Women’s Day 2018 – interview with Dr Genevieve Oliver

Dr Genevieve Oliver is an ophthalmologist and retinal surgeon, working at Flinders Medical Centre in Adelaide. Dr Oliver is also currently doing a PhD researching neglected and emerging retinal infections such as dengue, Ebola and toxoplasma

What made you interested in becoming an ophthalmologist?
When I was a kid, the only doctor I knew of was Fred Hollows, then a living Kiwi legend. I was inspired to do medicine, but it wasn’t until fourth year at med school that I fell for ophthalmology. I found myself in this insanely busy medical diabetic clinic in Auckland, and some nurse stuck me in the very dark clinic of an ophthalmologist who handed me an ophthalmoscope and put me to work. As I examined the retina, she described what I was seeing. That was my Epiphany. Since then, I have never looked away from ophthalmology or from the retina.

What has been the most rewarding aspect of your career?
It’s mundane, but I love discharging patients from clinic… it’s great when they no longer need my care! Having the opportunity to do research is deeply rewarding but also confirmed for me how much I enjoy clinical medicine and just how satisfying ophthalmology is.

What is the biggest challenge you have had to overcome to get where you are today?
It is a long, long road to becoming an ophthalmologist. I used to find it hard looking sideways at my friends who spent the best years of their lives not studying and not vitamin D deficient.

What do you know now that you wish you had known starting out?
I think life would have been easier if I’d had more self-belief when I was starting out. As a registrar, I had very encouraging and supportive consultants and mentors, but a pretty bad case of impostor syndrome. It was only when I was preparing for the RACE that I realized that if I had any hope of passing, I had to back myself. I wish I had seen Amy Cuddy’s TED talk back then: fake it ’til you become it!

What do you think needs to happen in order to press for progress in ophthalmology today?
As ophthalmologists, we are facing an ever-expanding workload and increasing demands on our time and resources. As a collective, we have a powerful voice to advocate for our patients in terms of funding, research and better health outcomes. Collaboration also inspires diversity, innovation and success.

Celebrating International Women’s Day 2018 – interview with Dr Christine Younan

Please tell us a little about yourself and the work you do?
I am an ophthalmologist in Sydney. I work in two public hospitals (Sydney Eye Hospital and Westmead Hospital), as well as in private practice. I am a big believer in access to eye care for all Australians, which is why I commit to working in the public hospital system. The hours are long, often unpaid, and the clinics are tough (my Wednesday morning Sydney Eye Hospital clinic, manned by several doctors, routinely has 80 – 90 patients), but without this service people would go blind. There is a lot of bad publicity out there about doctors, often portraying them as greedy, but anyone at the coalface knows that this is wrong. A lot of us work really hard in a chronically underfunded public system to ensure people don’t suffer unnecessarily. A lot of us do these hours while juggling young families and multiple other commitments.

What made you interested in becoming an ophthalmologist?
Ophthalmology is a brilliant mix of both physician and surgeon, something difficult to obtain in other medical specialties. Ophthalmologists have the ability to restore or maintain vision, something that keeps people independent and working. In addition to Australia and New Zealand, RANZCO takes a particular interest in the eye health of those in the Asia Pacific region. We have highly trained and experienced doctors that regularly give their time to help those less fortunate and unable to access any eye care in their own countries.

What has been the most rewarding aspect of your career?
Giving back. Whether it is in Australia or overseas, having the skill and expertise to restore vision is incredible rewarding. One of the first overseas trips I was involved in was in East Timor and we had 900 patients turn up on the first day (now that is a busy clinic!) It is incredible satisfying (and does give me a warm, fuzzy feeling) to be able to give people back their vision and independence.

What is the biggest challenge you have had to overcome to get where you are today?
For reasons I don’t fully understand, women often don’t get the same encouragement to succeed. Finding the confidence and belief in myself to know I can achieve was an important step, and I was lucky to be mentored by both men and women along the way who believed in me. As a junior doctor I was told by an eye registrar I did not have what it took to be an ophthalmologist, and that I would never get into the training program, but I did my part one entry exams and got in anyway (it was incredibly satisfying to subsequently see him in a café in Surry Hills and tell him so). As a junior registrar I was told that I couldn’t operate, and that I would never be as good as the male ophthalmologists (because I was a girl), but I went ahead and qualified anyway. I am now the Chair of the Annual Scientific Meeting for Australia and New Zealand, and sit on the RANZCO Board, all while raising a toddler.

What do you know now that you wish you had known starting out?
When you are training to be an ophthalmologist, you are surrounded by colleagues and supervised by consultants, so there is always someone around to help you through difficult situations. As a new ophthalmologist I felt rather isolated, though over time I came to discover a rich network of people whom I could ask for advice or help if the need arose. It’s just knowing where to look and who to ask. It would be useful to link young ophthalmologists into these networks earlier.

What do you think needs to happen in order to press for progress in ophthalmology today?
It needs to start with the right culture. In the last few years the College has worked hard to set standards that let people know unethical and unfair behaviour won’t be tolerated. The next step is to see it put into practice. I have been an ophthalmologist for ten years now, and I believe the vast majority of ophthalmologists are decent people who want to work in a fair system. It is not easy to challenge the status quo, but each and every one of us needs to take responsibility for what we see. I have heard from countless colleagues who have sat in a meeting, seen a significant injustice occur, and rave on about it afterwards, but never call it out at the time. We need people to speak up when they see something wrong, and take responsibility for being part of the solution, rather than waiting for someone else to sort it out, because who knows when that “someone else” will come.

Eye2Eye 2018 Autumn preview – Profile on A/Prof Penny Allen

This article will be published in the 2018 Autumn issue of RANZCO’s magazine Eye2Eye.

Hope for restoring optic nerve damage from glaucoma

A potential scientific breakthrough holds the possibility of being able to restore some visual function in people blinded by glaucoma. Mice with similar optic nerve damage to that caused by glaucoma were able to regenerate nerves that conduct impulses from the eye to the brain that enable sight.

Two factors were involved in the breakthrough: gene therapy to get the nerves to regenerate and, most vitally, a channel-blocking drug cocktail to help the nerve transmit the impulses.

It has to be stressed that no human trials have been conducted and the results may not translate from mice to people. What is creating most optimism, though, is that gene therapy – which has been successful in sight-restoration previously – can only be done in a laboratory whereas drugs can be administered elsewhere. The researchers are hopeful that, eventually, drugs alone can be used to achieve similar results.

The technique of genetic modification carries the risk of causing cancer because it deletes or blocks tumour-suppression genes to stimulate nerve regeneration. The drug approach does not interfere with the tumour-suppression genes.

The breakthrough of this research was getting regenerated nerve fibres (axons) to not only form working connections with brain cells but to also carry impulses (action potentials) all the way from the eye to the brain. Previous experiments have achieved nerve regrowth but the fibres grew without the insulating sheath known as myelin which helps propagate nerve signals over comparatively long distances.

Earlier efforts were unable to achieve the necessary speed for nerve signals to reach the brain quickly enough to enable vision. But a review of medical literature revealed a potassium channel-blocker, 4-aminopyridine, that strengthens nerves signals when myelin is absent. This blocker is used to treat multiple sclerosis which also involves a loss of myelin.

The scientists – from Boston Children’s Hospital – believe suitable drugs can be identified to achieve further advances, even if they have to be teamed with visual training to facilitate recovery. Relief for glaucoma patients is not close but this new discovery does offer some hope.

Source: Boston Children’s Hospital

Eye2Eye Winter 2017 Feature Article

Highlights from RANZCO’s 49th Annual Scientific Congress 2017

RANZCO’s 49th Annual Scientific Congress held in Perth was a great success!

Here is a sneak peak look at an article from the Summer edition of EYE2EYE, wrapping up the highlights of 2017 Congress. See more in the full Summer edition coming soon!

Interview with Ophthalmologist Dr Shuan Dai

I am vocationally trained in ophthalmology in Beijing, China and again in Auckland, New Zealand. I am a consultant ophthalmologist specialising in paediatric ophthalmology and strabismus. I spend two thirds of my time working in the Eye Department of Greenlane Clinic Centre and Starship Children’s Hospital of Auckland District Health Board, the tertiary eye care centre for Auckland and New Zealand. I am the clinical lead in paediatric ophthalmology and strabismus and principal supervisor for the paediatric ophthalmology fellowship program. I am the chair of New Zealand Paediatric Ophthalmology Interest Group. I am the visiting paediatric ophthalmologist for the Blind and Low Vision Education Network of New Zealand (BLENNZ) which is the national centre for children with severe visual disability. BLENNZ is recognised as one of the world’s best facilities for children with special needs and low vision. I am very proud of being part of their team and contributing to their success. I have an honorary senior lecturer appointment in the Department of Ophthalmology, University of Auckland. I have been a supervisor for PhD, MD, junior research fellows, registrars and medical students. I enjoy clinical research and have published over 40 peer reviewed journal articles. I spend a third of my time in my private practice through Eye Doctors, Ascot Hospital in Auckland.

Why did you decide to make it your profession to help people with their eyes?
I decided to become an ophthalmologist when I was age 10, when one of my distant relatives lost vision in one of his eyes due to cornea infection. Seeing him struggle with getting employment, marriage etc. made me want to become an eye doctor so I can help people like him. I went to medical school, once I completed the internship, then got direct entry into three years’ vocational ophthalmology training in Beijing. During my ophthalmology resident training in Beijing, I developed a strong interest in paediatric ophthalmology which led me to a clinical research fellowship job in England. My interest in helping people in need took me to Lebanon where I worked as a volunteer ophthalmologist for Lebanese and Palestinian refugees. In 1995, I moved to New Zealand with my wife, Hong Duan, a GP specialising in children and women’s health.

Why do you believe vision is such an important sense to look after?
Over 90% of our information is acquired through the visual system and it gives people the ability to see his/her world and the world of others. It gives us the joy of appreciating the beauty of life and the universe. Observing the suffering of many of my patients over the years in my ophthalmology practice I became even more appreciative of the value of “being able to see”. I feel very privileged to be in a position where I can make some difference, however small or large that might be, to other’s vision needs.

What is one thing you want all people to know about looking after their eyes?
With advances in knowledge and technology most eye diseases can be treated effectively if they are identified early. We need to empower everyone in our community to become a champion for raising awareness of eye diseases in our world to prevent unnecessary visual loss, especially visual loss in younger children from congenital cataract and vitamin deficiency where delayed diagnosis is still common.

Interview with Ophthalmologist Dr Nicholas Toalster

I am an eye doctor at Sydney Eye Hospital where I work as the Corneal Fellow. I look after patients from across New South Wales and Australia with problems of the front of their eyes, performing operations such as corneal transplants. I have worked in eye healthcare since 1999, having completed degrees in optometry, medicine and ophthalmology surgical training. My passion is training the next generation of healthcare professionals.

Why did you choose ophthalmology as a profession?
Starting my career in eye care was more luck than choice, but once I began helping patients on a daily basis I was hooked. Because of the profound effect eye disease had on my patients and the dramatic improvements they achieved with modern therapies, I derived a great sense of satisfaction from my work and decided to further my training and medical specialisation.

Why do you believe vision is such an important sense to look after?
My patients invariably tell me they could lose any of their senses but not their vision. Ours is a visual world, with more and more of what we do dominated by the need to see. More importantly I think that our eyes are more closely connected with our emotional selves than just about any other part of our body. We understand and interact with those around us by seeing and people connect to us through our eyes.

What would you like people to know about looking after their eyes?
I would like everyone to know that treatments for eye conditions these days are, for the most part, amazingly effective. So much so, even I am amazed quite often. You can’t go wrong having regular eye checks and, at the first sign of problems, make sure you see an eye care professional.

Interview with Ophthalmologist Dr Robert Griffits

Interview with Ophthalmologist Dr Robert Griffits
I have been practicing ophthalmology at Lake Macquarie since 1994. Located 120 kilometres north of Sydney, Lake Macquarie adjoins the City of Newcastle, and is classed as regional.
The scope of regional practice has some elements of both capital city and rural practice. I am a general ophthalmologist, meaning that I treat a spectrum of eye disorders by medical and surgical modalities. Most ophthalmologists in rural and regional centres tend to be generalists in contrast to capital city practice where there seems to be a much more entrenched sub-specialisation model prevailing.

Life is good both professionally and in lifestyle. Whilst I was educated and grew up in Sydney, I have never regretted leaving the big smoke. The community is socially cohesive and friendly, with an enduring sense of community. Patients are appreciative and thankful of medical practitioners. I live and work within my community of patients.
Referral to the practice is still largely on the basis of word of mouth rather than advertising or a need to go out and chat up the referrers. A medical reputation and competency is a common subject of discussion at the local bowling club, and my hairdresser generally can give me a fair indication about how I am tracking. My ophthalmology colleagues in the area are generally collegial, and we work well and constructively together.

Why did I choose Ophthalmology?
Well, a few years out of medical school, I decided that I would like to become a specialist, and the choice was either anaesthetics or ophthalmology.
Fortunately, I choose Ophthalmology, and I have never regretted it. I don’t think that I am neurotic enough in the form of obsessive compulsive behaviour to be an anaesthetist. A few of my friends are anaesthetists, and a look in any of their clothes draws will reveal neatly bundled paired socks, carefully iron handkerchiefs and all manner of ritualistic behaviours. There is a clear role for the obsessive compulsives in the professions, and that is for anaesthetists and airline pilots.

Ophthalmology is about careful attention to detail, even minutiae, be it in the nuances of the eye examination, or in the execution of fine ophthalmic surgery. I like doing things with my hands, either when making things in my shed, or when at work in the operating room. In particular, I like fine careful strokes, rather than the broad course strokes such as when cutting open someone’s belly. The rewards of ophthalmology are immense.

Why do you believe vision is such an important sense to look after?
Sight is arguably the most important of the senses. Sight is required for so many aspects of everyday life. We need it for ease of navigation and awareness of proximity. We need it for occupation and recreation. Most of all we need it to fully appreciate the wonderful beauty of the amazing life on earth. The current ophthalmology techniques and technologies are just so effective at restoring and maintaining sight. Ophthalmology just keeps on getting better.

Can you tell us about the benefits of eye surgery?
Cataract surgery is incredibly successful and cost beneficial. Since I started practice the procedure has evolved from one which patients approached with trepidation to one that is considered passé. Cataract surgery results are really significantly better, it is safer, and involves less inconvenience. Let’s not forget the people whom have made it so: the pioneers in new surgical techniques, the research scientists, as well as the engineers whom have given us such amazing technologies and instrumentation.

Advances in therapeutics have meant that we can successfully treat the wet form of macular degeneration, diabetic retinopathy, and retinal vein occlusion. We now have many drugs to treat glaucoma. There has never been a better time to practice ophthalmology.