Ophthalmology Updates! Shaping Contemporary Care

OCULOPLASTICS AND ONCOLOGY

Professor Santosh Honavar (Hyderabad, India) was the first speaker to take to the stage, detailing key diagnostic signatures to differentiate benign lesions from aggressive malignancies in routine ophthalmic practice.

Eyelid Lesions and Malignancies

Squamous papilloma. Presents as a human papillomavirus (HPV)-induced benign epithelial proliferation with hyperkeratosis and finger-like projections. An increase in vascularity, base widening, or intralesional haemorrhage signals potential malignant transformation into squamous cell carcinoma.

Seborrhoeic keratosis. Appears as flat, placoid lesions in elderly patients; eruptive presentations may indicate underlying visceral adenocarcinoma.

Basal cell carcinoma (BCC). The most common eyelid malignancy in Western populations, including Australia, presenting with rolled edges and pearly borders. Morphoeic variants induce cicatricial ectropion. BCC can be linked to genetic conditions like xeroderma pigmentosum and Gorlin–Goltz syndrome, which respond to targeted Hedgehog pathway inhibitors, such as vismodegib.

Keratoacanthoma. Characterised by rapid growth, central keratin-filled umbilication, and eyelash loss, requiring complete excision when large due to pseudoepitheliomatous features.

Sebaceous gland carcinoma (SGC). Shows higher prevalence in Asian populations and frequently masquerades as recurrent chalazia or chronic blepharoconjunctivitis. Key signs distinguishing SGC from benign chalazia include loss /drop-off of meibomian gland orifices, localised madarosis, and posterior eyelid margin thickening. The insidious pagetoid/intraepithelial variant presents without a discrete nodule, requiring full-thickness map biopsies.

Conjunctival pigmented lesions. Benign naevi halt at the limbus and show pathognomonic microcysts on anterior segment optical coherence tomography (OCT). Unilateral primary acquired melanosis with atypia carries a 33% risk of transformation to conjunctival melanoma and is managed by map biopsy, cryotherapy, or topical mitomycin C / immunotherapy (nivolumab).

Vascular, lymphomatous, and inflammatory entities. Congenital capillary haemangiomas are unresponsive to propranolol, whereas infantile haemangiomas proliferate postnatally, carry PHACE(S) syndrome associations, and respond to oral propranolol (1–2 mg/kg) or intralesional triamcinolone. Eyelid lymphomas present as salmon-pink subconjunctival masses, while acute myeloid leukaemia in children classically presents as a preseptal infiltrate, marked by loss of the superior eyelid crease.

Thyroid eye disease. Emerging medical strategies beyond intravenous (IV) steroids include teprotumumab, tocilizumab, rituximab, and batoclimab to reduce proptosis and diplopia.

CATARACT AND ANTERIOR SEGMENT SURGERY

Associate Professor Clara Chan (University of Toronto, Canada) emphasised the need for meticulous preoperative ocular surface optimisation, discussed selection of advanced lens formulae, and presented an interesting case.

Surface optimisation. Ocular surface irregularities skew biometry. Salzmann nodular degeneration requires superficial keratectomy followed by a four- to six-week tapering course of topical steroid before biometry repetition. Large pterygia induce significant astigmatism and must be excised one to three months prior to intraocular lens (IOL) calculation.

Complex Corneal Cases

Keratoconus. Discontinue rigid gas permeable contact lenses prior to measurement. Formula selection favours the Kane formula (K values up to 65 D) or Barrett True K (up to 60 D). For extreme K values (>65 D), use manual SRK/T calculations targeting postoperative myopia (−1.5 to −2.5 D) to prevent hyperopic surprises. Neutral aspheric or pinhole (IC8) IOLs minimise higher-order aberrations.

Fuchs’ endothelial dystrophy. Morning visual blur indicates endothelial pump failure.  Pachymetry >600 μm warrants combined phacoemulsification with Descemet membrane endothelial keratoplasty (DMEK) or descemet stripping only (DSO).

Corneal tattooing case. Debilitating dysphotopsia from peripheral iridotomies is managed by creating a 50%+ depth stromal corneal pocket and depositing sterile plant-based black tattoo ink to form an opaque barrier.

MEDICAL RETINA

Associate Professor Aleksandra Rachitskaya (Cleveland Clinic, United States) summarised advances in retinal vascular disease and macular therapeutics.

Retinal vein occlusion management. Pivotal trials demonstrated that early anti-VEGF therapy can secure visual gains unattainable if treatment is delayed.

Extended-interval therapeutics. Dual VEGF-A /Ang-2 inhibition (faricimab) and high-dose aflibercept 8 mg extend treatment intervals to every 12–16 weeks in 45–57% of patients.

Foveal avascular zone. Ischaemia predicts long-term treatment dependence, requiring six-monthly reviews to monitor for neovascular glaucoma.

Geographic atrophy (GA). Complement C3 (pegcetacoplan) and C5 (avacincaptad pegol) inhibitors reduce GA lesion expansion by approximately 20% over two years but require monitoring for secondary choroidal neovascularisation.

Biosimilars. Biosimilars offer equivalent clinical efficacy to reference biologics, demonstrated through comparative analytical testing and indication extrapolation. Global adoption (pioneered by India in 2015) is being accelerated by regulatory frameworks such as the United States Food and Drug Administration 2025 Guidelines and Australia’s Pharmaceutical Benefits Scheme, which reduced the price by 25% upon market entry.

NEURO-OPHTHALMOLOGY

Dr Benson Chen (Auckland) presented updates on ocular emergencies and hereditary neuropathies.

Central retinal artery occlusion. Manage as an acute ischaemic stroke emergency (“time is brain, retina is brain”). While IV tissue plasminogen activators (alteplase, tenecteplase/TNK) aim to dissolve fibrin clots within a 4.5-hour window, randomised trials failed to demonstrate statistically significant visual improvement over placebo/aspirin and posed severe risks, including fatal intracranial haemorrhage.

Optic Neuropathies

Leber hereditary optic neuropathy (LHON). The synthetic coenzyme Q10 analogue idebenone (300 mg three times daily) demonstrated a 43% clinically relevant vision improvement when initiated within the first months in the LEROS study. Gene therapy trials with Lumevoq remain ongoing.

Dominant optic atrophy (DOA). The RNA-targeted genetic medicine PYC-001 has been shown to increase OPA1 protein expression, delivering visual acuity improvements in clinical trials.

GLAUCOMA

Professor Ashish Agar (Sydney) reviewed surgical paradigms, personalised risk assessment, and presented a case.

Surgical spectrum. Minimally invasive glaucoma surgery bridges drop therapy and filtration surgery; however, trabeculectomy remains the gold standard for advanced disease requiring target intraocular pressure ≤10 mmHg.

Polygenic risk testing. The SightScore genetic test (Seonix Bio) evaluates single nucleotide polymorphisms via cheek swab to stratify individual glaucoma risk and need for surgery. Clinical validity was established in the PROGRESSA study led by Professor Jamie Craig from Flinders University.

Drug-induced angle closure case. Triptans (e.g. eletriptan) can induce bilateral secondary angle closure via ciliary body swelling and uveal effusion, requiring drug cessation, mannitol, and phacoemulsification with goniosynechialysis.

OPHTHALMOLOGY UPDATES! AWARD

The final session on day one, chaired by Professor Fung, honoured Professor Peter McCluskey, outgoing President of the Royal Australian and New Zealand College of Ophthalmologists and uveitis specialist, for his career achievements. Prof McCluskey reflected on his transition from engineering to medicine, his contributions to ocular inflammatory disease during the AIDS (acquired immunodeficiency syndrome) epidemic, and his leadership at the Save Sight Institute training the next generation of ophthalmologists. Finally, he shared perspectives on the evolving healthcare landscape in Australia and the enduring value of family support throughout his career. The session closed with the presentation of his medal.

The first day concluded with the conference dinner, held at Taronga Zoo, which provided a chance to catch up properly, share a few laughs, and enjoy a very Sydney backdrop of the harbour.

SURGICAL RETINA

Assoc Prof Rachitskaya, on day two, highlighted surgical choices and sustained delivery technology.

Scleral buckling vs vitrectomy. Primary scleral buckling achieves >90% single-surgery anatomical success and superior visual outcomes in phakic young myopes with atrophic holes, and in eyes with retinal dialysis, peripheral traction associated with a history of premature birth, and rhegmatogenous retinal detachment secondary to degenerative retinoschisis.

Port delivery system. Susvimo’s refillable pars plana implant delivers customised ranibizumab across 24–36-week intervals. Pivotal trials demonstrated non-inferiority to monthly injections, with over 93% patient preference.

UVEITIS

Associate Professor Rachel Niederer (Auckland) presented data on zoster and systemic uveitis triggers.

Herpes zoster ophthalmicus (HZO). HZO can cause neurotrophic keratopathy (29% corneal melt risk), secondary glaucoma, and vasculopathy. Cataract surgery in post-zoster eyes carries a 40% recurrence rate of HZO and 50% risk of vision loss; prophylactic oral valaciclovir (1 g daily) should be given on the day of surgery and continued for three to 12 months. Zoster vaccination reduces stroke risk by 22% and seven-year dementia risk by 20%.

Lifestyle Modulators in Uveitis

• Smoking: Elevates odds of anterior (1.7×), intermediate (2.7×), posterior (3.2×), and panuveitis (3.9×).
• Obesity: Is associated with a 60% higher rate of anti-tumour necrosis factor treatment failure.
• Sleep and stress: Sleeping less than seven hours per night increases anterior uveitis recurrence odds by 12×, while severe stress increases recurrence odds by 9×.
• Vitamin D deficiency: Affects 32% of HLAB27-positive patients. Low sunlight exposure correlates with winter disease spikes.

PAEDIATRIC OPHTHALMOLOGY

Dr Cam Loveridge-Easther (Wollongong) summarised treatments for retinoblastoma.

Targeted therapies. Transpupillary thermotherapy (TTT), enhanced by indocyanine green (ICG) for lesions accessible through the pupil, notch plaque brachytherapy for juxtapapillary lesions, and intravenous chemoreduction (+TTT) remain the standard of care in Asia because of cost.

Refractory vitreous seeds are managed via intravitreal high-dose topotecan (100 μg) or melphalan injections. Multimodal therapy (neoadjuvant chemotherapy, stereotactic radiation, enucleation) is used for orbital extension.

AI FOR DOCTORS

Associate Professor Sriram Rao, a Melbourne cardiologist and co-founder of AI for Doctors, discussed generative artificial intelligence integration into the clinical workflow.

Structured prompting. Clinical outputs require a five-step framework: role, context, task, format, and constraints.

Data hygiene. Strict adherence to the Australian Health Practitioner Regulation Agency (Ahpra) guidance and privacy laws governing AI tools is necessary to prevent entering patient-identifiable data into public AI models.

Source-grounded AI. Tools like Gemini Notebook / NotebookLM operate strictly on uploaded clinical guidelines and literature, minimising hallucinations by grounding all summaries, flashcards, and analytical outputs directly in source text.

CONFERENCE CONCLUSIONS

The clinical perspectives presented across varied domains emphasised the transition toward targeted, minimally invasive, and personalised medicine. Finally, whether through early detection of carcinoma margin signatures, the extrapolation of biosimilars, precision intra-arterial thrombolysis, or source-grounded AI synthesis, grounding clinical decisions in robust evidence remains paramount to optimising patient outcomes.

Ophthalmology Updates! returns to Sydney in August 2027 with specific dates to be confirmed.