Western Australia is rapidly becoming known as a global centre for research excellence in ocular disease, thanks to a ‘trifecta’ collaboration between Lions Eye Institute (LEI), Curtin University, and University of Western Australia (UWA).
Established over 40 years ago, there’s no doubt that LEI has become a global centre for world-class medical research and its translation into clinical practice in metropolitan, rural and remote Western Australia.
At LEI, we have been focused on achieving excellence across three core areas – clinical services, research, and community – for almost 40 years
Ranked in the top 1% of universities worldwide, Curtin University is highly regarded for its strong connections with industry and high-impact research, including data analytics. Indeed, researchers in the University’s Centre for Data Linkage are contributing to the development of new technologies that aim to improve health outcomes at individual, community, and population levels.
And then there’s the newly established Doctor of Optometry program at UWA, which commenced in 2021 and is already attracting some of the country’s leading academics and clinicians. Led by Foundation Head Professor Garry Fitzpatrick and course director Khyber Alam (previously an academic at Deakin University), the school has recently attracted Pauline Xu from Centre for Eye Health (CFEH) in Sydney, Elisse Higginbotham from Australian College of Optometry, and Gavin Swartz – the owner of fi ve optometry practices in Western Australia and a PhD candidate under supervision of Mr Alam.
Cementing the state’s position as a global leader in the research and treatment of vision disorders, in April this year the appointment of Professor Allison McKendrick as the inaugural LEI UWA Chair in Optometry Research was announced. Prof McKendrick, a world leader in clinical vision sciences, will commence in the role on 1 November, bolstering the research capacity of UWA’s Optometry program and LEI’s translational research.
This was followed by the July appointment of Professor Andrew Turpin, as the inaugural Lions Curtin Chair in Ophthalmic Big Data. Prof Turpin, a global leader in data science and analytics, will undertake research, build new capacity in analytics across optometry and ophthalmology, and support research and eye care system development involving large and continuous related datasets. While his is an appointment of the LEI and Curtin University with support from the Lions Save-Sight Foundation WA Inc (LSSFWA), Prof Turpin will also contribute to the work of UWA through the University’s association with LEI.
FOUNDATIONS FOR THE FUTURE
Professor Morgan, Managing Director at LEI, believes this collaborative approach is analogous to new models of eye care delivery in Australia, involving ophthalmology and optometry using data transfer and analytics.
“At the LEI, we have been focused on achieving excellence across three core areas – clinical services, research, and community – for almost 40 years. The Doctor of Optometry program adds signifi cant capacity in all these streams and that is the reason we were so keen to be involved in collaborating with UWA.
“We are particularly excited that this initiative brings together the two complementary disciplines of optometry and ophthalmology. These are two professions that are quite reliant on each other, and there are many benefi ts to be gained when optometry and ophthalmology work closely together. These benefi ts relate to LEI’s common interest in providing quality eye care that is affordable and available to all sectors of the community. We believe that various models of collaboration will be needed to provide great eye care across the state. We are actually already doing this with Lions Outback Vision and look forward to learning more about implementing various forms of collaboration.”
Prof Morgan said the collaboration will enable LEI to explore the comanagement of patients by optometrists and ophthalmologists, through a process by which patients are triaged according to their condition and seen effi ciently and effectively by the most appropriate health professional.
“This is an uncommon model and one that we feel will become the way of the future in eye healthcare throughout Australia. Through this approach, we will be able to facilitate optometry student placements at our Midland clinic, as we will also be doing at our other clinics in Perth and through Lions Outback Vision at the Kimberley Hub in Broome.
“Another aspect of the Doctor of Optometry program that really excites us is the new Chair in Optometry Research that will be co-funded by the LEI and UWA. Translational research is in our DNA at the Institute, and we are delighted to be working with UWA to establish the new endowed Chair, an initiative that will help us to detect and manage ocular disease earlier, and develop new models for treating and managing eye health conditions,” Prof Morgan added.
WHY THE RUSH WEST?
Being a new school of optometry, the UWA Doctor of Optometry program doesn’t have a traditional academic pathway to draw on. This means it needs to attract academics who are passionate in key areas falling across optometry, such as posterior eye, anterior eye, glaucoma, low vision, paediatrics, contact lenses, public health etc.
But while the need for academics provides opportunity, it doesn’t necessarily create the magnet necessary to attract the best.
According to Prof Fitzpatrick, this magnet for UWA’s optometry program is “its clean slate, free of history and politics, coupled with a strong alliance with the LEI”. Together, these factors have enabled his team to create a progressive culture that is attractive to passionate, world-class optometric clinicians and academics.
“When defi ned by history, culture can be a barrier. However, because there has never been an optometry program at UWA before, we have had the opportunity to set the culture – to draw on the best of what’s available at universities on the east coast of Australia and around the world to shape our culture.
“This has enabled us to create a unique and exciting environment where young, ambitious academics have opportunities to lead the way at one of Australia’s Group of Eight Universities; and to collaborate with the incredible research at LEI, much of which aligns with optometry of the future.”
Echoing Prof Morgan’s sentiment he said the optometry school’s strategic partnership with LEI brings ophthalmology and optometry together, providing unique opportunities for students to be involved in research as well as local and outreach clinics.
“Research informs education and education informs research. Our close working relationship with ophthalmologists and researchers at LEI is enabling us to explore population-based needs for eye care – particularly in rural and remote areas – and how we can train a future eye care workforce to meet those needs in Australia and New Zealand,” Prof Fitzpatrick explained.
“Together, we’re developing research streams to align with the population’s need for high quality treatment and management of avoidable blindness in the community.”
TAKING A RISK
Indeed, these were the ‘magnets’ that attracted Professor Allison McKendrick to the role of LEI UWA Chair in Optometry Research. Since 2005, Prof McKendrick has been a teaching and research academic at the University of Melbourne, during which time she led a team of postdoctoral and PhD researchers interested in solving problems in clinical visual assessment. From 2014 to March 2021, Prof McKendrick was Head of Department of Optometry and Vision Sciences.
“I am excited by the opportunity to work within a framework of worldclass institutions, coupled with a unique opportunity to work with the team at LEI/ UWA and Curtin University to establish and grow a new program of research excellence in primary eye care,” she explained to mivision.
Acknowledging that some may consider the move to a new institution high risk, she said, “Some risk is important in order to challenge thinking. It also assists in building excitement! However, LEI is a world-renowned ophthalmology centre of clinical and research excellence, which provides an excellent framework to build upon and contribute to.”
Similarly, Pauline Xu was enticed by the opportunity to contribute to something new.
“Who doesn’t want an adventure in the wild, wild west? The UWA program is the second Doctor of Optometry program and the newest Optometry School in Australia. Being new means there is ample opportunity to design, create, and innovate to lead the changes that we want to see for the future generation of optometrists. This is the cause that I am passionate about.
“What I am also excited about is the setup of a new public facing optometry clinic, which will be a total game changer. It’s not very often that you get involved in setting up a brand-new state-of-the-art clinic from the ground up, and I am humbled to be given the opportunity, and to be working with an amazing team to see it through.”
While she experienced the inevitable selfdoubt that comes with any major career move, Ms Xu said accepting the fears and committing to take a small step forward every day, has made it all less terrifying.
“Focussing on the upsides, such as the supportive team and great collaboration with ophthalmologists in LEI, and envisioning the future and the positive changes we could potentially make, often takes my mind away from fears,” she said.
Those upsides are incredible opportunities to build on an already impressive career.
“I’ve had diverse careers within optometry in the past – clinical optometry in metro and regional practices, research in BHVI, clinical supervision in UNSW and the recent one being a lead clinician in Centre for Eye Health. I think it is important to enjoy the process while you are on the job rather than focusing too much on the career path. The skills and experience we built on previous jobs lay the foundation for the next one.
“How this opportunity will shape my career path, time will tell,” Ms Xu continued.
“Already I’m learning and adding to my experience because the nature of the work is different. As a clinician, we focus a lot on our clinical and communication skills to provide optimal care to our patients. But having clinical expertise alone does not guarantee effective teaching, we also need excellent pedagogy. Learning pedagogy is something new for me at the school, just as learning protocol writing was new when working in BHVI and learning advanced ocular imaging was when working in CFEH.”
Khyber Alam is no stranger to change or taking risks. Since arriving in Australia as a refugee from Afghanistan in 2007, he has grown up, studied, and worked as an academic and optometrist in Victoria, and practised optometry in Tasmania. Two years ago, Mr Alam “took a big career risk”, giving up his position as an academic at Deakin University to join the fledgling UWA as it prepared to take on its first student cohort.
“Any change for any human is not easy. I’d been at Deakin for a long time, and I was very comfortable there but UWA, as one of Australia’s top eight institutions for research delivery and societal impact, presented a lot of great opportunities. The offer was too enticing to let go and once I arrived, I met Garry (Fitzpatrick) who took me under his wing. He taught me the importance of self-awareness, sound strategic leadership, collaborations, and effective communication skills. I was off and running.”
FILLING THE GAPS IN CARE
Western Australia has acknowledged shortfalls when it comes to delivering health care across its vast state, which places a huge weight of responsibility on the shoulders of leaders like those paving the way in Western Australia’s ophthalmic institutions.
To fill gaps in eye care, Prof Fitzpatrick believes optometry of the future will include upskilling optometrists to work more collaboratively with ophthalmology, enabling the provision of services that ophthalmologists are no longer resourced to deliver due the increasing complexities of their own areas of practise.
This is in line with the Western Australia Government’s sustainable health review,1 which identified two opportunities particularly relevant to eye care:
The first is to improve timely access to outpatient services through moving routine, non-urgent and less complex specialist outpatient services out of hospital settings, in partnership with primary care.
The second is to implement contemporary workforce roles and scope of practise where there is a proven record of supporting better health outcomes and sustainability.
To encourage more young optometrists to provide primary care in rural Western Australia, where unmet eye care is particularly prevalent, Prof Fitzpatrick’s team has developed a placement program that will see third year students spend significant time working in clinics and on research programs from ‘hub and spoke’ health care models in Broome and Geraldton. Students will gain experience working alongside optometrists and ophthalmologists on outreach programs, with local Aboriginal Community Controlled Health Organisations (ACCHOs) and in other community allied health settings.
Prof Fitzpatrick hopes the placement program will provide students with a “very real experience” that increases their awareness of rural and remote eye care needs. As he explained, evidence shows students who are exposed and trained in rural settings are more likely to return to practise in these settings.
The rotational placement program, which begins in 2023, is financially supported by the University Departments of Rural Health – academic centres based in rural and remote Australia focused on health education and research. Additionally, the UWA will fund academic optometrists on the ground at Broome and Geraldton to provide support for student well-being. This is a ‘win-win’ for all as the academic in Broome will spend half of their time with the students and the other half supporting the work of Professor Angus Turner. In Geraldton, the academic’s time will be split between student support and working with community optometrists, ACCHOs, and the visiting optometrist scheme.
“There has been a lot of structural work involved in getting this program up and running, but once we’ve attracted the right people it will provide invaluable opportunities for students to gain clinical experience, participate in research and lead the development of optometric care in the future,” Prof Fitzpatrick said.
BRINGING IT ALL TOGETHER
There’s no doubt that once Prof McKendrick and Professor Turpin arrive in Western Australia later this year, the WA collaboration will really dial up a notch.
As Prof McKendrick told mivision, “It’s my intention to develop a centre of excellence for primary eye care research that delivers meaningful outcomes for people in need of eye care, leading to improved diagnosis, management, and improved self-reported patient outcomes.
“There will be unique opportunities for PhD students and early-career researchers to really build a research career that will help solve important problems in eye care. Modern eye care generates a lot of data (from imaging, visual fields as a start) so the vision of LEI to also create the Lions Curtin Chair in Ophthalmic Big Data is very forward-looking and will also create a really interesting, and rather unique, collaborative research environment. The intersection between optometry and ophthalmology, using data intelligently, is key to ensure great patient outcomes and is the future of eye care.”
For Mr Alam, UWA’s success in building a team and, most recently, attracting the likes of Professor McKendrick and Professor Andrew Turpin, is exciting both from an academic and a personal perspective.
“I love the process of gaining new knowledge – and with fine people around me, it’s almost impossible not to grow. Together we’re contributing to the development of our students and the profession. That means, as a collective, we will make a true impact on academia in the communities of Western Australia, and in other states and territories of Australia, and in communities overseas. To me this is the most exciting outcome.”