The 41st Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Annual Scientific Congress was held last November in balmy Brisbane weather on the South Bank of the Brisbane River. We bring you some of the highlights of this years Congress.
“Grandma’s not Happy Mr Rudd” proclaimed a sign on a booth in the foyer of the Brisbane Convention and Exhibition centre where the RANZCO conference was in progress.
This piece of political protesting, part of a campaign by the Australian Society of Ophthalmologists against the federal government’s halving of the Medicare rebate for cataract surgery, was mainly preaching to the converted as more than 700 ophthalmologists filed past the booth on their way to attend lectures on subjects such as ‘Eyelid, Lacrimal and Orbital Disease’, ‘Glaucoma and The Aging Optic Nerve’ and ‘The Cape York Peninsula Eye Health Project’.
People attending the welcoming drinks were treated to champagne and sparkling evening river views from the upper level of the relatively newly opened GoMa, which stands for Gallery of Modern Art not “get out of my emergency room ” the acronym immortalised by Samuel Shem in his iconic book about hospitals, ‘House of God’.
…of those 117 severely vision-impaired adults in the cohort, 61 per cent would trade up to 40 per cent of their remaining life span to have their sight back.
The new gallery is an architectural gem designed by Architectus, and stands adjacent to the State Library in the fast-developing cultural hub on Brisbane River’s, previously industrial, left bank area opposite the CBD.
Brisbane-based ophthalmologist, and convener of the 2009 Congress, Associate Professor Tim Sullivan, spoke in his opening address, of how people “fear going blind almost as much as they fear getting dementia, cancer or losing partner.”
In fact, the results of a West Australian study, which were presented at the conference, titled ‘The Epidemiology of Blinding Eye Disease Study (EBEDS): Time Trade Off and quality of life assessments in the most severely vision impaired’ showed that of those 117 severely vision-impaired adults in the cohort, 61 per cent would trade up to 40 per cent of their remaining life span to have their sight back.
Julie Crew, Bill Morgan et al from Curtin University of Technology used the Time Trade Off method (TTO) to assess quality of life associated with severe vision impairment. The researchers found that TTO utility values for severe vision loss were comparable to those who had suffered severe strokes and who had become bedridden.
The scientific program on Sunday included the Council Lecture, titled ‘Eyelid, Lacrimal and Orbital Disease: Two Decades of Change’.
Delivered by the convener Associate Tim Professor Sullivan from the University of Queensland, the talk focussed on improvements in diagnostic aids and surgical approaches to malignancies and pathologies of the accessories of the eye – sockets, tear ducts and lids. One area of note has been the revolutionising of the classification methods for neoplasms such as lymphomas, from 1987 to 2009.
Over the years, various classification systems have been used to differentiate lymphomas; the one being used now by Australian ophthalmologists is the World Health Organization’s Revised European-American Classification of Lymphoid Neoplasms (REAL) classification.
According to Professor Sullivan, 20 years ago there were fairly rudimentary aids to diagnosis in the “arcane field of eyelid, lacrimal and orbital disease. History taking and physical examination were paramount, but since then there has been an explosion of ancillary tests to aid diagnosis and treat disease.”
Advances in computer imaging and pathology testing – 3D CT angiography, MR Angiography and Positron Emission Tomography (PET) and the discovery that glucose metabolism is a hallmark of malignant cellular activity – have improved outcomes.
“We also now know that immunosuppression is really important in the growth of tumours,” says Sullivan, and studies into the Hedgehog (Hh) pathway (a highly conserved system for regulating cell fate and self- renewal in metazoans) have shown it plays a major role in cancer by sustaining the growth of tumour stem cells, such as in Basal Cell Carcinomas (BCCs).
Such research is of major benefit in Australia where we continue to have a very high rate of sun-exposure related malignancies and neoplasms, often affecting the surrounds of the eye and even the eye itself.
The conference heard that in sunny Queensland there is a higher incidence of pterygium than other states. Pterygium is caused by ultraviolet-light (UV) exposure.
Professor Lawrence Hirst from Queensland Eye Hospital was convener of a course outlining research which assessed the rate of recurrence, complications, and cosmesis after recurrent pterygium removal in Queensland with P.E.R.F.E.C.T. (Pterygium Extended Removal Followed by Extended Conjunctival Transplant).
Earlier research in 2007 by Dr Hirst and his colleagues had found, via a survey completed by ophthalmologists in Queensland, that in their current methods of treatment of pterygia there was no consensus on the best way to treat pterygia in Queensland.
“This probably reflected the lack of scientific proof for one method being superior to another,” the researchers said.
The current research on P.E.R.F.E.C.T. for PTERYGIUM showed that “there were no patients with recurrence in 111 consecutive patients, and all but two patients were followed for at least one year. One patient developed an exotropia that required no treatment, and one patient lost four lines of vision as a result of a corneal ulcer.
“In this series, P.E.R.F.E.C.T. for PTERYGIUM resulted in a zero recurrence rate (two patients lost to follow-up) with few complications and a good cosmetic appearance,” said Professor Hirst.
It’s not just in older Australians who are affected by malignancies of the eye or damage from sun exposure. Children’s vision and lives are being put at risk due to delays, of sometimes up to six months, in correctly identifying symptoms of cancer of the eye in young people and health messages are needed to encourage parents to get their kids to wear sunglasses to protect their eyes from UV rays.
There was also some good news for Australian kids in that genetic testing can now determine if children are at risk of retinoblastoma – the most common eye cancer in children.
Babies who are born with cataracts will now benefit from new surgical techniques. In a study undertaken at the West England Eye Unit in Exeter, in the U.K. and presented by Dr. Anthony Quinn, refraction (spherical equivalent), of 68 operated eyes of 45 babies were plotted over time. Acrysof intraocular lens implant, anterior chamber maintainer and Healon 5 were used in the majority of cases. The results showed “excellent visual outcomes were obtained with significant improvement in monocular and binocular visual acuity and reduction mean refraction.”
Current Queensland -based paediatric eye research made front page headlines during the proceedings, with Brisbane’s Sunday Mail (15th November 2009) featuring an article on an “Australia first technology to stop blindness” in premature babies.
Neonatal nurses at Brisbane’s Mater Mothers’ Hospital are using hi-tech camera equipment to photograph the eyes of premature infants to identify Retinopathy of Prematurity (ROP). If detected early enough, medical intervention can prevent these children from going blind and even achieve normal sight.
The initiative has been developed by Mater’s neonatal and ophthalmology team, and is led by Dr Michael Forrest from the Queensland Eye Hospital who was co author of a film abstract at the conference titled “What Is The Incidence and Interocular Stage Difference of Asymmetrical Retinopathy of Prematurity?”
“The only way that ROP can be identified and assessed is by examining the retina, either with indirect ophthalmoscopy or by digital imaging using a RetcamTM,” Dr Forrest said.
“Early detection is essential so that intervention can prevent blindness.
“With a shortage of paediatric ophthalmologists, and an increase in their workload, it is hoped that this extension of neonatal nursing clinical practice will have considerable impact on the provision of care to premmies, and allow the screening program to be maintained.”
New research reported since June 2008 has shown that a drug normally used in cardiology, Propanolol, also shrinks ocular haemangioma in kids, with no side effects. Current treatments for this disfiguring and potentially amblyogenic condition, while affective, may be associated with side effect including vision loss.
In some cases lesions treated with Propanolol were found to grow back when treatment was ceased.
The Ageing Eye
Going from the young to the elderly eye the Ida Mann lecture focussed on ‘Glaucoma and the Aging Optic Nerve’. Professor Jonathon Crowston gave an interesting overview on how the mechanisms that predispose the ageing optic nerve to neurodegenerative changes remains unclear.
“By 2050 the world population over 65 will reach 2 billion people. A third of people aged over 60 are in Oceania and Japan and Australia is at the head of the curve,” said Professor Crowston.
Adding that, this situation will lead to a dramatic impact on the delivery of health.
“Glaucoma is the leading cause of irreversible blindness and incidence increases exponentially with age,” Professor Crowston went on to say.
He spoke of research into the ageing optic nerve which looked at calorie restriction as a means of prolonging life by 30 to 60 per cent and lowering the rates of development of neurodegenerative diseases. Results published in Science journal 10 July 2009 of a study titled ‘Caloric Restriction Delays Disease Onset and Mortality in Rhesus Monkeys’, showed marked difference in the rate of aging and onset of diseases in rhesus monkeys who had been severely calorie restricted without malnutrition.
“The hypothesis is that ageing and mitochondrial dysfunction render the optic nerve more vulnerable to injury,” said Crowston.
Those of us old enough to remember the Six Million Dollar Man TV series will recall the main character had a bionic eye amongst other things. This was the stuff of science fiction in the 1970s but is now nearing reality. A trial of a bionic eye device is underway in animals, as a prelude to human studies. Australian research has focused on two approaches to bionic eye research, both building on the idea of stimulating the optic nerve with electrical signals created from images collected by an externally worn camera.
The fun part of the event was the black tie conference dinner which was held on the Tuesday evening in the elegant, gothic revival style surrounds of St. John’s Cathedral in the heart of Brisbane.
The 42nd RANZCO Annual General Meeting and Scientific Congress will be held in from 20 to 24 November, in the Adelaide Convention Centre, Adelaide, Australia. For details go to www.ranzco.edu/congresses.
Laura Macfarlane is a trained ophthalmic nurse, professional journalist and member of the Australasian Medical Writers’ Association.