Interview with Ophthalmologist Dr Neil Murray

Interview with Ophthalmologist Dr Neil Murray
I have been a general ophthalmologist for 26 years. During this time, I have been privileged to work mainly in New Zealand, but also in Australia and a number of developing world countries as well. I have seen the burden of visual impairment and blindness firsthand in these countries. They are, in large part, preventable. I am passionate to see sustainable services delivering quality interventions, such as cataract surgery. I remain humbled by the life changing outcomes that can be obtained even in the most trying circumstances. To this end, I am involved in governance and eye care education with RANZCO, and continue to have developing world involvement with RANZCO, the International Agency for the Prevention of Blindness and The Fred Hollows Foundation NZ. My wife Tania and I have two adult children, both of whom work in public health, and two lively granddaughters. I enjoy hiking, and am currently working on my stand up paddle boarding skills (with some way to go yet!).

Why did you decide to make it your profession to help people with their eyes?
Why did I choose ophthalmology? Quite simple really. I am myopic. An ophthalmologist prescribed my first pair of contact lenses. I was intrigued. After finishing medical school, I was still interested enough to take up a rotation in ophthalmology. I found the unique mix of medicine and surgery refreshing. The rest, as they say, is history. I love my job.

Why do you believe vision is such an important sense to look after?
Eyes are so small, yet arguably the most critical sense we have. I have found this to be most apparent when people lose their sight, even more so when it can be restored.

What is one thing you want all people to know about looking after their eyes?
Have regular eye check-ups – schedule them in!

Why you should attend this year’s Annual Scientific Congress in Perth!

With less than one month to go until RANZCO’s 49th Annual Scientific Congress kicks off, we look at some of the top reasons you don’t want to miss out on one of the most exciting eye care events in the region!

1. Keep up to date with the latest news and developments in eye healthcare

Congress is a great excuse for you to socialise with your peers and discuss the latest and greatest innovations, techniques and advances in eye healthcare. You can be sure to walk away with some great memories and a wealth of knowledge!

2. An exciting line-up of international and local speakers not to be missed

This year, we have a fantastic line up of internationally renowned experts and distinguished local speakers who will be covering exciting developments in everything from glaucoma, cataract surgery, refractive surgery, international development, ophthalmic plastic and reconstructive surgery, and paediatric ophthalmology. To view this year’s complete list of speakers, visit RANZCO’s Congress website here: http://ranzco2017.com/speakers/

3. Participate in CPD accredited courses and seminars that will help your professional and personal development!

This year, we are pleased to present a number of activities, courses and opportunities to enhance your ophthalmic knowledge. Once again there will be a number of non-scientific courses and symposia taking place including ‘Ethics and Professionalism; Crossing the Line’ and ‘Stepping up to the Challenge of the Future’— an important session covering off workforce survey results; area of need; the changing face of medical records and CPD, audit and revalidation.

We’ve also brought together a number of facilitators to present the RANZCO Professional Development Workshop on Saturday 28 October. This CPD accredited session will include updates and information from experts exploring a broad range of topics including practice and personal investment strategies, working collaboratively with allied health, social media and advertising and more. Full program details are available on the ‘other meetings’ page of the congress website.

4. Mingle with industry in the exhibition hall

We have great line up of sponsors and exhibitors to showcase product advancements and industry trends. Don’t miss out on the inside scoop on new and upcoming products, equipment and technologies!

5. Catch-up with old colleagues at our exciting social functions

There will be plenty of opportunities for you to mingle and catch up with friends and colleagues with several exciting social functions planned during this year’s Congress. Some of the stand-out events include the Welcome Ceremony, Congress Dinner and, the Graduation and Awards Ceremony and President’s Reception. Take advantage by participating in as many social activities as you can. There’s bound to be a networking event to suit everyone­ – where you can engage and learn in a relaxed setting all while you enjoy some of the country’s best local food and produce!

6. Celebrate the achievements of your peers at the Graduation and Awards Ceremony

Help new Fellows celebrate as they embark on their ophthalmology careers by taking part in the Graduation and Awards Ceremony. The Graduation and Awards Ceremony is a great opportunity for experienced Fellows to share their wisdom and industry knowledge with new graduates.

The opening address at this year’s Graduation and Awards Ceremony will be delivered by Professor Fiona Wood, a world leading plastic surgeon, burns specialist and researcher, who also spearheads the Fiona Wood Foundation – a not-for-profit organisation dedicated to ground breaking scientific and clinical research into pioneering new treatments for healing burns and minimising scarring.

Registration is still open. To register, please visit: http://ranzco2017.com/registration/

World Orthoptic Day 2017

To mark this year’s World Orthoptic Day (5 June), we spoke to Sandra Staffieri on her role as a Clinical and Research Orthoptist at the Centre for Eye Research Australia.

1. What role do orthoptists play in treating eye problems in kids?
Orthoptists undertake specific training to examine, diagnose, manage and treat a variety of childhood eye conditions, most commonly this includes strabismus (turned eye) and refractive error (glasses). A child’s vision develops from birth until around seven or eight years of age and any condition that affects the eyes can significantly affect vision development. Less commonly, a child can develop eye problems that are usually associated with adults – like cataract and glaucoma. These conditions can be quite devastating to the child’s vision development and treatment is not as straightforward, particularly in the case of cataract, as it would be in an adult.

2. How closely do you work with ophthalmologists on a day to day basis?
Orthoptists usually work in public hospital clinics or private practices with an ophthalmologist. Orthoptists are very much an integral part of the eye health care team, performing all the preliminary examinations and assessments prior to the examination by the ophthalmologist. Orthoptists and ophthalmologists will often discuss difficult cases and formulate the best management plan for that individual child or family.
In some cases, orthoptists will work in their own private practice with paediatric patients being referred for assessment or management of eye movement problems (strabismus) and vision loss (amblyopia). Orthoptists are also active in the area of paediatric low vision. Through organisations such as the Royal Institute for Deaf and Blind Children and Vision Australia, an orthoptist can assess children with significant vision impairment in their own home environment or school setting and then provide a report to assist parents or teachers to provide a safe environment for the child as well as suggest ways to best optimise their vision for learning.

3. Can you tell us about your work with the Centre for Eye Research Australia as a research orthoptist?
I have been extremely fortunate to have spent the last 10 years at the Centre for Eye Research Australia as a research orthoptist in the Clinical Genetics Unit. I have had the opportunity to work on many projects that involved assessing adults and children with different eye diseases or disorders, such as strabismus, cataract and glaucoma and then collect DNA samples to be sent for analysis. In this way, we are able to compare each individual’s eye problems – or lack of – with their genetic make-up and try to uncover the gene changes that result in their eye disease. We often look closely at families with hereditary eye disease as this gives us vital clues as to the possible gene changes that cause these conditions. This knowledge helps us better understand how these conditions occur and perhaps develop better treatments or strategies for earlier diagnosis to limit vision loss. It has been exciting to marry my clinical skills with research skills and be given the opportunity to be at the forefront of gene discovery, cutting-edge technology and gene-therapy which is on the horizon. After so many years looking after children with irreversible vision loss I can see the hope that research can provide for future generations.

4. You’ve done quite a bit of work in retinoblastoma care, can you tell us a bit about that?
I have been the Retinoblastoma Care Coordinator at the Royal Children’s Hospital in Melbourne for 23 years. What started out as essentially an administrative role, it has become much more than that. I coordinate all the care of children with retinoblastoma as there are many doctors, nurses, allied health personnel and teachers involved in each child’s care and treatment over many, many years. I also spend time counselling parents, providing information and assistance as required. With the support of a Centres of Research Excellence grant from the National Health and Medical Research Council (NHMRC), I was able to start looking at causes of delayed diagnosis for retinoblastoma in Victoria. The findings of this research paved the way for me to undertake a PhD to develop and evaluate an awareness program for parents to recognise and respond to the very earliest signs of the disease. I have been fortunate enough to be supported for my studies by an NHMRC public health Postgraduate Scholarship.

5. It must be hard working with children affected by serious eye conditions, such as retinoblastoma. What role does the orthoptist play in helping parents cope with the situation?
I spend a lot of time with parents not only at the acute stage – at first diagnosis and during treatment – but also in the months and years that follow to review the information they have been given and help them navigate their way through the health system. Not only does their child have cancer, they will also likely have a vision impairment of some kind. In addition, I support the survivors of retinoblastoma (many of whom we looked after a generation ago!) who then have their own children with the same disease. I spend considerable time answering questions they might have after they have been to see the genetic counsellor.
All parents and survivors are provided with a lot of information that is often complex and difficult to understand, at a time when they are very anxious and distressed. My role is very much one of counselling and explaining the disease again, the treatment options and prognosis. In the acute stage, parents can be very worried about a red eye or some new sign or symptom. I like to think they can call me at any time and together we can decide if they need to be seen urgently, and if so, I can facilitate that. Yes, it is hard sometimes, because you do develop a relationship with the child and the family over time but I guess I am only doing what think I would want someone to do for me if I were in their shoes. I cannot begin to imagine, even after all these years, how it must feel to be told your child has eye cancer – because usually, they are not even sick.

6. What’s the most challenging part of your role?
It is my privilege to care for children with retinoblastoma and their families, but the most challenging thing is feeling helpless. Sometimes there is nothing more that can be done and the child needs to have their affected eye removed. They might have gone through many months of invasive treatments including chemotherapy, and we still lose the war. Sometimes we lose the war for both eyes.
I guess the other difficulty is wondering if the child might have been able to be diagnosed earlier, the outcome might have been different. The two most common signs of retinoblastoma are a white pupil or an eye turn. The child will be otherwise well, so it is common for these early signs to be overlooked simply because parents don’t know any different. In developed countries, the child will lose their eye and might need chemotherapy, but they will survive. In developing countries though, they will likely lose their life. It is challenging for me to think that the majority of children in a developing country with retinoblastoma will die because of delayed diagnosis when really it is the most survivable paediatric cancer in a developed country.
I look forward to my research perhaps developing a sustainable and cost-effective program to raise awareness of these early signs of retinoblastoma. Looking further ahead I hope to be able to examine how such a program might be adapted and implemented in developing countries to save lives.

ANZAC Day – the work of a consultant ophthalmologist in the Australian Army

To mark ANZAC Day this year, we interviewed Dr William Glasson on what it’s like working as a consultant ophthalmologist in the Australian Army.

1. Can you tell us a bit about your role as a consultant ophthalmologist to the Australian Army?
I’ve been part of the medical side of the Australian military for approximately 35 years. I was a 5th-year medical student when I first joined. During school, I was a cadet so having experience in the military, I saw it as a great opportunity to work as a doctor in the military force. I’m still an active Reservist. I’m a Lieutenant Colonel in the army and I was a medical officer for an artillery unit based in Southeast Queensland for 10-15 years. Now I work at a consultant level at the military base where I provide eye services and advice to the Department of Defence around the list of medical conditions people can/can’t have in the army and what we’ve agreed to accept in terms of visual limits, visual acuity, colour vision, etc. My role involves a lot of advice around policy to the Australian Defence Force for both soldiers working on the frontline as well as those working in the rear aspects of the military force.

2. What are the most common eye injuries you see working on the frontline?
I like to think of eye injuries in terms of military or non-military related. Obviously, non-military related eye problems are similar to those of the general community such as conjunctivitis, vision problems, etc. For the most part, we’re dealing with a group of young and healthy individuals needing glasses or contact lenses. They usually present with general complaints or refractive errors but there are some cases where there is trauma to the eye – blunt injuries to the eye, some even penetrating the eye, although we do make sure there are preventative measures in place such as wearing protective glasses where it’s needed.
In terms of the back of the eye, we don’t see too many problems because they are a younger generation. We do get some who have diabetes so we need to keep a check on them and follow up on any treatment plans.
In terms of those that are on the frontline or those injuries that occur during military operations, the big one would be explosive injuries and IEDs that send pieces of sharp shrapnel through the air which can penetrate one or both eyes. In the worst-case scenario, this can lead to blindness or losing your eyes. Injuries from IEDs was one of the major issues during operations in Afghanistan and the Middle East particularly.
Also, laser is used a lot these days in terms of military equipment so people that are exposed to laser beam injuries need to be assessed and treated according to whether the damage is to the front or the back of the eye.
Troops on the ground are exposed to extremely harsh conditions – dust is a major issue and they get dust and dirt in their eyes. They’re exposed to extreme heat, high wind and high UV conditions which put the eyes at risk. There’s also the potential to be exposed to chemical injuries so it’s very important to ensure that the eyes are adequately protected in these tough conditions.

3. What would a typical day look like for medical corps? What’s involved?
A typical day in the medical corp can be quite similar to running a general clinic. You’re dealing with the typical things that the younger generation would present with such as conjunctivitis, pterygium, sore eyes, red eyes – those common conditions that we see in the mainstream community and those you would see in a typical eye clinic. You’ll also see people who wear glasses that will come in because their glasses are broken or their scripts are wrong or they wear contact lenses and they’ve developed an infection. So, contact lens related injuries and issues are not uncommon.
Not that we want contact lenses worn frontline. In fact, only those in non-frontline positions can wear contact lenses so we have a range of issues related to that.

4. How is working as a military ophthalmologist different to working in a clinical setting?
The pathology you see is very similar. But, generally, you are working with young, healthy people and what they present with is usually very different to what you’d see in your day-to-day ophthalmology clinics where you’re mainly dealing with older patients who have cataracts, macular degeneration, etc. This would take up 90% of your time in general ophthalmology.
Whereas, in the military, you’re working with young people and you’d mostly be dealing with refractive errors. Occasionally, you’ll come across those with a family history of glaucoma or another condition which you might treat.
Given the extreme conditions troops are exposed to, you also need to educate them on maintaining their eye health – wearing sunglasses, how to treat blepharitis and keeping dust out of their eyes.

5. How did you spend ANZAC Day this year?
One of my family members was an ex-prisoner of war. He was taken in Singapore and fought in the Borneo campaign. When he was captured, he was taken to Sandakan, which is in Borneo, and he was brutalised for five years while he was imprisoned. He eventually came back to Australia, went on to study medicine and became a very successful doctor. So in honour of him and to commemorate fallen ANZACs, my wife and I help to organise a formal service at the Sandakan memorial in New Farm, Queensland.

ANZAC Day – the role of ophthalmology in the military

To mark ANZAC Day this year, we interviewed RANZCO Fellow and Colonel, Dr Viki Andersons AM RFD, on what it’s like working as a consultant in the Army Reserves.

Dr Viki Andersons
1. Can you tell us a bit about your role as Colonel in the Army Reserves?
I am currently serving as a Consultant in the Reserves but have in the past been Commanding Officer of the 3rd Field Ambulance (the unit of Private John Simpson Kirkpatrick) and later 3rd Health Support Battalion. That unit was deployed to East Timor where I served as the Commanding Officer of the United Nations Military Hospital.

2. What are the most common eye injuries you see working on the frontline?
The types of injuries encountered on the ground would be penetration of foreign bodies and chemical burns to major penetrating eye injuries. Recently there have been soldiers that have lost eyes in blast injuries. There is also some evidence that the shock waves from nearby blasts can have a detrimental effect on retinal ganglion cells similar to the concussive effect on brain cells.

3. What would a typical day look like for medical corps? What’s involved?
Basically, the army medical corps exists to look after those soldiers that put themselves in harm’s way for us. It is a privilege to be able to do that. All of the army’s medical specialists are in the reserve and are deployed when their particular skill set is required. It is felt by our military that eye injuries should be dealt with at high-level facilities so ophthalmologists are not deployed as such. I do often provide medical advice over the phone.

4. How is working as a military ophthalmologist different to working in a clinical setting?
While it is rare, I have performed eye surgery in the military setting and here it was essentially the same as at home except that it was in a tent.

5. How did you spend ANZAC Day this year?
On Anzac Day I attended the Dawn Service at my unit’s barracks then had breakfast there with the unit. After that, the unit travelled to the Adelaide CBD and marched as a unit in the ANZAC Day march. The 3rd Health Support Battalion has subunits in several states and provides a large number of medical specialists, nursing officers, pharmacists and combat medics for a range of deployments around the world.

I am very proud of the fact that our military deeply considers moral and ethical questions in all of our military interventions and always endeavours to treat local populations with respect and dignity. This makes our job as medicos a humbling experience and as I said earlier a distinct privilege.