![Pancakes and glaucoma. A tasty insight into a blinding disease]()
Researchers at University College London have turned to a basic cooking staple, the pancake, to glean insights into possible new treatments for the disease that is often called the sneak thief of sight.
The connection may not be immediately apparent to most of us but it relates to how water and air escape from batter mixtures. It seems there are similarities between the layers of the eye and pancake batter as it heats.
Glaucoma is a condition caused by a build-up of liquid in the eye and any subsequent visual impairment is irreversible. It is hoped that better understanding the properties of a pancake will improve surgical methods for treating the disease.
Researchers examined a range of pancakes of differing thicknesses and diameters and discovered the thinner and smaller the pancake, the more evenly the surface cooks. This is because water vapour is released more smoothly, avoiding the “craters” that form in thicker pancakes when water is trapped.
Cooking conditions were kept constant while observing the behaviour of steam as each pancake firmed up. Thicker batters formed larger, irregular pockets of steam on the bottom. Thinner batters allowed a more even release of steam.
Renowned ophthalmologist, Sir Peng Khaw, a co-author of the research paper said treatment of glaucoma is dependent on mastering surgical techniques that can best alleviate the pressure caused by trapped water vapour in the eye.
“To treat this, surgeons create an escape route for the fluid by carefully cutting the flexible sheets of the sclera,” he said. “We are improving this technique by working with engineers and mathematicians. It’s a wonderful example of how the science of everyday activities can help us with the medical treatments of the future.”
Thursday 17 March 2016 marked the 10th anniversary of the Close the Gap campaign – an initiative that aims to close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by 2030.
RANZCO has always supported the Close the Gap campaign, and this year was no different. On National Close the Gap Day, RANZCO staff members showed their commitment to reconciliation and achieving equity in health outcomes by gathering together for an informative lunch as well as signing the Close the Gap organizational pledge.
Although Australians enjoy one of the highest life expectancies of any country in the world, RANZCO Manager for E-Learning and Indigenous, Adam Kiernan, explained that the same cannot be said for Indigenous Australians. Aboriginal and Torres Strait Islander people live 10–17 years less than other Australians and experience higher rates of preventable illness such as heart disease, kidney disease and diabetes. In addition, Babies born to Aboriginal mothers die at more than twice the rate of other Australian babies.
WHAT ABOUT EYE HEALTH?
Vision loss causes 11% of the health gap between Indigenous and non-Indigenous Australians. It is behind cardiovascular and diabetes, equal with trauma but ahead of alcoholism and stroke. The 2008 National Indigenous Eye Health Survey found blindness rates in Indigenous adults to be 6 times the rate in mainstream. While 94% of vision loss is caused by preventable or treatable conditions such as cataract, refractive error, optic atrophy and diabetic retinopathy, 35% of Indigenous adults have never had an eye exam.
WHY THE DIFFERENCES?
There are a number of factors contributing to the health gap between Indigenous and non-Indigenous Australians but lack of access to health services, particularly for remote, Aboriginal communities as well as lack of cultural sensitivity and understanding among health professionals are some of the main reasons.
RANZCO’S COMMITMENT TO CLOSING THE GAP
RANZCO Fellows have been involved in striving to improve the eye health of Indigenous Australians over many decades in rural, urban and more remote practices and clinics. RANZCO has also participated in initiatives to survey the eye health of Indigenous Australians. Recently a cultural awareness booklet has been produced which aims to educate Fellows on issues surrounding Aboriginal and Torres Strait Islander culture as it relates to ophthalmology. In addition to this, a flyer has been produced which outlines some of the historical achievements of Fellows as well as outlining advocacy and training opportunities. RANZCO’s Indigenous Committee is also actively involved in advocacy and regular service provision aimed at delivering the highest possible standards of eye care to Indigenous communities.
See our flyer for more information.
1. Close the Gap
2. The Roadmap to Close the Gap for Vision
3. Closing the Gap Prime Minister’s Report 2015
The Close the Gap Coalition — a grouping of Indigenous and non-Indigenous health and community organisations — together with nearly 200,000 Australians is calling on governments to take real, measurable action to achieve Indigenous health equality by 2030.
The rates of blindness in Indigenous adults are six times the rate in mainstream Australia. While 94% of vision loss is caused by preventable or treatable conditions (refractive error, cataract, diabetes and trachoma), only 35% of Indigenous adults have ever had an eye examination (2008 National Indigenous Eye Health Survey).
Closing the Gap Prime Minister’s Report 2015– Outlines the progress being made in each of the Close the Gap targets.
On Thursday 17 March, National Close the Gap Day, RANZCO staff members show their commitment to reconciliation and achieving equity in health outcomes by signing the close the gap pledge and sharing lunch in the park for to show thier support.
This World Glaucoma Week, Dr Andrew White, RANZCO Fellow and Consultant Ophthalmologist at Westmead Hospital is celebrating. The new Community Eye Care Centre which Andrew has been lobbying for, opens its doors mid-year.
“It’s the first time in Western Sydney that the right people will be seen by the right health professional, that is, the severity and complexity of the eye condition will be matched to the expertise of the provider. This will ensure the best utilisation of resources and that people don’t slip through the cracks,” said Dr White.
The new clinic based at West Point Shopping Town in Blacktown will screen and assess for glaucoma and diabetic retinopathy and then refer to a local optometrist or to Westmead Eye Clinic depending on the severity of the condition. All patients seen in the clinic will have the benefit of oversight from Westmead ophthalmologists and a multidisciplinary team.
“Glaucoma is a group of diseases that can damage the eye’s optic nerve and result in blindness. It is a significant issue in our community because it’s asymptomatic and 50% don’t know they have it. Added to this, we currently can’t treat the patients we do have. Patients are having to wait so long, they might have advanced stage glaucoma before we see them.
“What we are seeing is a tsunami of patients, the numbers of patients needing eye treatment is growing and is expected to grow by 150% in Western Sydney. This means we need to do things differently. By introducing a new model of care, we can become more efficient and hopefully prevent unnecessary and irreversible vision loss – which is life changing,” said Dr White.
There were many stakeholders involved in making this clinic a reality, in particular, Dr White would like to thank Western Sydney Local Health District, Western Sydney Diabetes Initiative, NSW Agency for Clinical Innovation, Glaucoma Australia, Diabetes NSW, Optometry Australia and RANZCO NSW.
RANZCO staff gathered together for the Beat Invisible Glaucoma Breakfast in support of this year’s World Glaucoma Week 6-12 March. With everyone bringing an array of delicious and healthy food, it was a great opportunity to come together and help raise awareness about what’s known as the ‘silent thief of sight’.
RANZCO staff member, Adam Kiernan, gave an insightful presentation on how Glaucoma affects our vision and how it can lead to blindness if left untreated. The damage to our vision progresses slowly and gradually and, because one eye covers for the other, we remain unaware of any problem until significant vision is lost.
With Glaucoma being an inherited disease affecting over 300,000 Australians and more than 7 million people worldwide, it is important to have the conversation with our families and get our eyes checked regularly.
Visit the bigbreakfast.org.au to learn about how you can protect your family’s sight and help beat Invisible Glaucoma.
You can find additional information about Glaucoma on the RANZCO website, facebook and twitter
![Pancakes and glaucoma. A tasty insight into a blinding disease]()
DO I REALLY NEED A SUPPLEMENT FOR MY MACULA?
Macular degeneration is the commonest cause of significant vision loss in Australia. Being diagnosed with age-related macular degeneration (AMD) can be life altering. Patients often ask if there is anything they can do to stop vision loss.
The good news is that there are things you can do to slow down the progression of AMD, such as changes to your diet, not smoking, and in some cases by taking certain vitamin supplements.
Released today under the Choosing Wisely campaign the Royal Australian and New Zealand College of Ophthalmologists is advising patients to talk to their eye doctors as to whether they need vitamin supplements for their macular disease.
“Patients can ‘choose wisely’ by only taking vitamin supplements if they are at risk of their macular degeneration causing significant loss of vision. Looking at a patient’s macula can determine if their macular degeneration is likely to get worse”, said Professor Stephanie Watson, chair of the Royal Australia and New Zealand College of Ophthalmologists Public Health Committee.
“By talking to their eye doctor, patients will be able to understand if they need supplements. Clinical studies have not shown a benefit from supplementation at the early stages of AMD or where there is no AMD.
People with early AMD can obtain the necessary vitamins and minerals from a healthy diet that includes fruit, dark green leafy vegetables, fish and nuts. For these patients, Choosing Wisely means that they will not have the inconvenience of having to take supplements in addition to their usual medications”, said Professor Watson.
WHAT CAN I DO?
TO PREVENT, SUPPORT EARLY DETECTION OR REDUCE THE PROGRESSION OF AMD:
- Have a comprehensive eye examination at least every two years. This should include a check of the macula.
- Tell your eye doctor if there is a history of AMD in the family
- Check for symptoms of AMD daily, using an Amsler grid – if you find symptoms or notice a sudden change in vision, request an urgent review by an ophthalmologist
- Balance your diet with a daily intake of fruit and green leafy vegetables, fish two to three times per week, a handful of nuts per week, and low glycaemic index (“low GI”) carbohydrates in preference to high GI. Limit the intake of fats and oils.
- Talk to your doctor to understand the nature of your eye condition and whether an AREDS or AREDS2 vitamin supplement would be beneficial
- If you are a smoker, quit smoking
- Keep your weight at a healthy level and exercise regularly.
WHERE CAN I OBTAIN FURTHER INFORMATION?
TESTS, TREATMENTS AND PROCEDURES TO QUESTION – PUBLIC INFORMATION SHEET
WHAT IS CHOOSING WISELY AUSTRALIA?
Choosing Wisely Australia is a campaign that seeks to promote conversations between doctors and their patients on avoiding wasteful or unnecessary medical tests and treatments. Not all tests add value for the patient and some can be costly or harmful.
WHO IS RANZCO?
The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) mission is to drive improvements in eye healthcare in Australia, New Zealand and the Asia-Pacific region through the provision of continuing exceptional training, education, research and advocacy. We provide the training for medical doctors who undertake another 5 years of study to become an eye specialist. Committed to supporting the best possible outcomes for patients, RANZCO is proud to be participating in Choosing Wisely Australia.
The Choosing Wisely messages have been developed by RANZCO ophthalmologists and are highly technical in nature. This Public Information Sheet aims to help patients understand these same messages and what they can do to choose wisely.
TESTS, TREATMENTS AND PROCEDURES TO QUESTION
EYE TESTING
Message 1: In the absence of relevant history, symptoms and signs, ‘routine’ automated visual fields and optical coherence tomography are not indicated.
Explanation for patients: Advances in technology have resulted in the development of many sophisticated instruments to aid in the diagnosis and treatment of eye disease. However, in many cases, a medical history and a clinical examination are all that is required.
Automated visual field testing and optical coherence tomography (OCT) are commonly performed investigations that often provide invaluable information for diagnosis and treatment. They are, however, often an additional cost for the patient and are only necessary if the patient’s history and examination suggest they are needed.
What can patients do? Ask your health professional what tests are being conducted and why, especially if just going for a “routine check-up”. If you have diabetes or eye disease such as glaucoma in the family it is important to let your health professional know when you have a routine eye check-up.
VITAMIN SUPPLEMENTS
Message 2: AREDS-based vitamin supplements only have a proven benefit for patients with certain subtypes of age-related macular degeneration. There is no evidence to prescribe these supplements for other retinal conditions, or for patients with no retinal disease.
Explanation for patients: Age-related macular degeneration (AMD) can be a very debilitating disease and most patients want to do everything they can to keep it at bay. Treatment options, especially for “dry” AMD, include dietary changes, not smoking and in some instances taking vitamin supplements.
The Age-related Eye Disease Studies (AREDS) show there is good, long term evidence that vitamin supplements can reduce the risk of progression of AMD.
However, the evidence exists only for those patients whose disease has reached a certain level of severity. For earlier stages of the disease, or when taken as a preventative measure in patients with no macular degeneration, there is no proven benefit. Moreover, high doses can be harmful and are an added cost and inconvenience to the patient.
What can patients do? Talk with your eye doctor to find out if you need a vitamin supplement. Check the label of the vitamin supplement to see if the formula is based on the AREDS study#2. For more information on vitamin supplements and AMD visit www.ranzcodev.dev.nucleoserver.com or www.mdfoundation.com.au
CATARACT SURGERY AND MEDICATIONS
Message 3: Don’t prescribe tamsulosin or other alpha-1 adrenergic blockers without first asking the patient about a history of cataract or impending cataract surgery.
Explanation for patients: There is a group of drugs known as “alpha-1 adrenergic blockers” that are being increasingly prescribed by GPs and urologists to patients, usually men, for urinary retention and urinary flow problems. The commonest trade names for these drugs are “FlomaxTM”, “FlomaxtraTM” and “DuodartTM” but there are others.
These drugs have been used very successfully but they do have side effects. Even one or two doses can mean the irises within your eyes are irreversibly weakened. This has no effect on your vision but if you need cataract surgery, there is a much greater chance your surgery will be more complicated with the possibility of iris damage and permanent glare after the operation. In fact, there is an increased rate of all cataract surgical complications in patients on these drugs
What can patients do? Tell your GPs or urologist if you are due to have cataract surgery as it may be possible to find an alternative drug therapy or delay treatment. If you are needing cataract surgery, inform your ophthalmologist if you are taking or have ever taken alpha-1 adrenergic blockers. Steps can be taken to reduce the risks of surgery in patients on these medications.
DAY SURGERY AND HOSPITAL CARE
Message 4: Intravitreal injections may be safely performed on an outpatient basis. Don’t perform routine intravitreal injections in a hospital or day surgery setting unless there is a valid clinical indication.
Explanation for patients: It is now very common for patients with the “wet” form of macular degeneration, retinal vein occlusions and diabetic eye disease to have injections of drugs into their eyes. These relatively new treatments have had a significant impact on reducing vision loss and blindness.
Most eye doctors give these injections to patients in their consulting rooms. Some doctors believe that admission to a hospital or day surgery facility is safer
However, studies on thousands of patients all over the world have shown that if standard antiseptic protocols are followed, the rate of complications is no greater for injections done in the doctor’s rooms than they are if done in an operating theatre.
Even so, a patient with private health insurance might still reasonably prefer to have the injection in the operating theatre as the cost is often covered by their insurance with no gaps, a situation that may not be the case for injections given in the doctor’s rooms. The problem is that the overall cost borne by private health insurance for an injection given in an operating theatre is up to five times higher than the average price charged by ophthalmologists for conducting the procedure in their rooms.
Whilst a minority of ophthalmologists give their injections in the operating theatre, the additional cost of this practice to health insurance companies is many millions of dollars each year. These costs have to be recouped by other means and hence a flow-on effect is being seen through higher premiums, reduced insurance benefits or no cover at all for patients who require other eye procedures. There is understandable concern that private health insurance premiums are continuing to increase at very high levels, out of proportion with other cost increases in medicine. There should not be any additional “excuses” for premium increases, which continue to reduce the affordability of private health insurance and its value to patients. RANZCO is committed to working with patient organisations, and with Government and the Health Funds, to find sustainable solutions which deliver affordable, high value care to patients.
In short, the practice of injecting eyes in operating theatres is too expensive for our health system to sustain, and research shows it is not associated with a lower rate of complications.
What can patients do? This is not an issue for patients to act upon. It is hoped that changes in health policy will allow more affordable and equitable access to injection treatments for all patients, whether they have private health insurance or not. In the meantime RANZCO trusts that its doctor members will provide affordable treatment for patients, and the overall health care system.
RETINAL LASER
Message 5: In general there is no indication to perform prophylactic retinal laser or cryotherapy to asymptomatic conditions such as lattice degeneration (with or without atrophic holes), for which there is no proven benefit.
Information for patients: This recommendation is highly technical in nature, and is directed at ophthalmologists who may still be advocating laser treatment where there are no symptoms of retinal change. In such instances this treatment has not been shown to be of benefit.
What can patients do? Ask your ophthalmologist to clarify the reason for treatment.
Prof Minas Theodore Coroneo has been made an Officer of the Order of Australia in this year’s Australia Day honours, for his distinguished service to ophthalmology, to the research and development of innovative surgical technologies and devices, and to eye health in regional and Indigenous communities.
Listen to Prof Coroneo’s interview with SBS (interview in English and Greek).
Congratulations to the Honourable Dr Brendan John Nelson who received an Officer of the Order of Australia (AO) in the General Division at the Australia Day Honours this year. Dr Nelson received this honour for his distinguished service to the Parliament of Australia, to the community, to the advancement of Australia’s international relations, and to major cultural institutions. Dr Nelson is the Chair of the RANZCO Benevolent Fund.
![Pancakes and glaucoma. A tasty insight into a blinding disease]()
