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April 2018

SPECIAL FEATURE: RANZCO

SPECIAL FEATURE: RANZCO 2018 ANZGS 2018 Toomac Ophthalmic Toomac Ophthalmic is proud to introduce the latest development in MIGS, the Glaukos iStent inject, a tiny surgical implant that can effectively lower IOP in adult patients with mild to moderate open-angle glaucoma. Trabecular micro-bypass technology developed by Glaukos has taken a leap forward with the new titanium microbypass stent that’s preloaded in a single-use sterile inserter. Come and see our stand at RANZCO NZ, where Ian and Mark together with the Glaukos representative will be happy to answer all your questions. Also new for RANZCO NZ is the MALOSA singleuse instrument range. See us for a bespoke surgical pack. Allergan – Xen The latest innovation in glaucoma management, the XEN Gel Implant, is now available in New Zealand for patients whose condition is not well managed with glaucoma drops. The unique technology is based on the same principle as trabeculectomy, creating a new outflow channel bypassing trabecular and scleral resistance forming a diffuse, low-lying bleb. As the technique becomes more familiar, the XEN procedure can offer a less intensive and less time-consuming alternative to the mainstay trabeculectomy. In the APEX clinical study, 70% of patients with XEN achieved an IOP of ≤ 15mmHg following the treatment with a significant reduction in glaucoma drop use. See the Allergan stand for more. BY DR GRAHAM REEVES* This was the first gathering of the group formerly known as ANZGIG, now the Australian and New Zealand Glaucoma Society (ANZGS), where glaucoma subspecialists from the region come together to meet colleagues, discuss difficult cases and gain insights from both local and international speakers. This year’s conference in Sydney from 23 to 24 February commenced with presentations on a variety of rare conditions and challenging cases with robust discussion about different approaches. The second session of paper presentations included two projects introducing new technology into patient testing. The first showed that an iPad-based perimetry programme could deliver similar results to a Humphrey visual field analyser. While there are some minor technical issues to fine tune, this is a promising development. The second looked at use of home tonometry to detect significant diurnal IOP variation in patients whose clinic IOPs had been unremarkable but whose glaucoma was progressing. The afternoon started with a fascinating nonophthalmic lecture by invited speaker Mr Peter Ellerton from the University of Queenslands’ Critical Thinking Project. He delivered a thoughtprovoking lecture on the nature of critical thinking and deliberate practice in gaining and maintaining skills or expertise. It highlighted the importance of contact with our peers to challenge biases that may influence our decision making. This was followed by Professor John Salmon, from Oxford University who shared his views on ‘Diagnosing glaucoma. The seven deadly sins’. These included the mistakes of not taking a good history, not doing gonioscopy, not using sufficient magnification to examine the optic disc (leading to disc haemorrhages being overlooked) and not correlating disc changes with visual field findings. These ‘sins’ were illustrated by cases from his vast clinical experience and even for those seeing glaucoma patients on a daily basis they were a timely reminder of possible pitfalls. Dr Shenton Chew from Auckland outlined the campaign he was involved in to try and highlight the burden of overdue follow-up patients and Drs Nicholas Johnston and Sonya Bennett at ANZGS showed how well-organised patient advocacy can achieve tangible results. A number of new treatment techniques were showcased at the meeting, including Associate Professor Paul Chew from the National University of Singapore who discussed the increasing use of micropulse diode laser in different clinical situations. Another promising new technique was the use of tissue glue in reducing the size of dysaesthesetic trabeculectomy blebs. Associate Professor Paul Healey from Sydney gave the Gillies lecture titled ‘100 years of progress in glaucoma’. This highlighted three paradigm shifts that have occurred over this time. The first was the move from using IOP as a defining feature to a risk factor in glaucoma. The second was to understand the chronic nature of glaucoma so that when we assess patients with glaucoma we are considering both the current state (determining how it may be affecting quality of life) and also the rate of progression (how the patient is likely to be affected in the future). Lastly, he presented data showing low rates of glaucoma medication adherence in Australia. This showed the importance of patient education and participation in treatment decisions given that for many patients their only symptoms are from the treatments we prescribe. Professor Salmons’ final talk detailed the seven Drs Jesse Gale and Graham Reeves at ANZGS types of challenging patients who require glaucoma surgery. Most in the audience could think of patients who fell into at least one of these categories. These included “the patient who has researched the options on the internet”, “the patient at risk of visual loss from the surgery” and the “the patient no one else will do”. The final session covered minimally-invasive glaucoma surgery (MIGS) with a collection of experts sharing their experience with different devices including the iStent inject and the Cypass supraciliary stent and offering advice on patient selection and technical tips. Associate Professor Michael Coote from Melbourne gave a salient talk about the costs involved with adding these new techniques to our armamentarium, both in terms of the financial costs and the risk of losing skills needed for traditional glaucoma surgery. Overall this was a very interesting meeting and I look forward to next year when it will be timed to coincide with the World Glaucoma Congress in Melbourne. *Dr Graham Reeves is a glaucoma subspecialist practicing at Manukau Superclinic and the Eye Institute. Rethink glaucoma management The power of simplicity 1 Reference: 1. Allergan XEN directions for use. The XEN ® Gel Implant is intended to reduce intraocular pressure in patients with primary open angle glaucoma where previous medical treatments have failed. Always refer to full instructions before use. Adverse events should be reported to your local Allergan office, Australia 1800 252 224 or New Zealand 0800 659 912. XEN ® is a registered trademark of AqueSys, Inc., an Allergan affiliate. Trademark of Allergan, Inc. ©2017 Allergan. All rights reserved. Allergan Australia Pty Ltd, 810 Pacific Highway, Gordon NSW 2072. ABN 85 000 612 831. Allergan New Zealand Limited, Auckland. NZBN 9429 0321 20141. ANZ/0016/2017e. DA1731CB. Date of Preparation: October 2017. 16 NEW ZEALAND OPTICS April 2018

ANZCS 2018 BY DR JENNIFER COURT* This year’s annual Australia and New Zealand Cornea Society (ANZCS) meeting was held in Sydney in February and was organised by Drs Con Petsoglou, Noni Lewis and Chameen Samarawickrama and Jane Treloggen from the NSW Tissue Bank. The well attended meeting, originally developed by Professor Douglas Coster in the 1980s, is now in its 35th year. The venue for this year’s gathering was the InterContinental Hotel, set back from the bustling Circular Quay which had been wonderfully decorated for the ‘Year of the Dog’ Chinese New Year Festival. In the first session, entitled ’Cutting Edge’, invited guest speaker Associate Professor Jod Metha of the Singapore National Eye Centre kicked off proceedings with an interesting talk on developing nonsurgical therapies for TGFBI (transforming growth factor beta-induced gene) dystrophies by identifying peptide targets to reduce corneal opacity formation. Dr Greg Moloney then described his experiences introducing a successful keratoprosthesis service in Sydney, using the osteo-odonto keratoprosthesis (OOKP) technique, with his colleague and friend Dr Shannon Webber who provides maxillofacial expertise. Professor Gerard Sutton from the Save Sight Institute introduced the iFix pen and iFix bio-ink, which was the winner of the inaugural ‘Big Idea’ research funding challenge last year. His 3D-printed technology promises the exciting prospect of a biocompatible transparent ‘ink’ delivered by a handheld device that actually facilitates cell proliferation and thus ulcer repair. Dr Petsoglou and microbiologist Professor Wieland Meyer provided a detailed account of the recent ‘therapeutic goods recall’ by the Lions NSW Eye Bank following an apparent cluster of cases of candida endophthalmitis in DSAEK cases with pre-cut tissue. The honest and detailed account of the course of events and thorough investigation provided reassurance to surgeons of the quality and safety of service strived for. The annual report from the Australian Corneal Graft Registry was received with interest, as usual. The number of DMEK cases continues to rise with good visual outcomes, but reduced survival compared with penetrating keratoplasty and Descemet’s stripping endothelial keratoplasty (DSEK) in-keeping with results from around the world. But the numbers remain small and the follow-up short for now. Professor Stephanie Watson presented the Keratitis Antimicrobial Resistance Surveillance Program (KARSP) update. Resistance remains low and is stable; others were encouraged to join the programme. The first day concluded with a debate on whether femtosecondassisted pterygium surgery was a ‘welcome application of new knowledge’ (W.A.N.K.) or not. The fiercely argued cases for and against reflected the scientific but still humorous tone of the meeting! For now, at least, the audience was not swayed towards the femtosecond technique. The relaxed and informal meeting dinner, hosted in The Pavilion in the Royal Botanical Gardens, was a welcome opportunity to catch up with colleagues and meet new friends, and was very well attended. It was a particularly pleasure to chat to invited guest speaker Dr Mike Straiko, from the Devers Eye Institute in Portland, Oregan, prior to his informative and instructive talk which began the DMEK session on Saturday morning. His presentation was full of videos and pearls of wisdom for those starting out with this often tricky to master technique for replacing Descemet’s membrane and the corneal endothelium with a true anatomical likeness. The significantly lower rejection risk of DMEK versus DSEK and PK and the improved quality of vision remains the significant attraction for mastering this technique. There were more tips to come the following day too, for those attending the Sydney DMEK course, organised by Dr Moloney, where Dr Straiko was joined by A/Prof Mehta and Drs John Males and Andrew Apel. Later on the Saturday, Professor Minas Coroneo presented cases of ocular surface squamous neoplasia (OSSN) treated medically with retinoic acid and interferon, and topical cidofovir for refractory cases, with very promising success. This year’s Blandford Lecture was given by Professor Gordon Wallace of the University of Wollongong who provided a fascinating look at 3D bio-printing and its exciting potential applications in medicine and ophthalmology. The next session focused on crosslinking with talks covering the use of a soft contact lens to allow treatment of thin corneas; iontophoresis; combining the treatment with intra-stromal corneal ring segments in anisometropic patients from asymmetric disease with clear corneas; and Professors Gordon Wallace and Charles McGhee the effective treatment of children. Attention was drawn to the potential for rapid progression in children with need for close monitoring. The Doug Coster lecture titled ‘Corneal endothelial cell engineering – it’s not just culture’ was given by A/Prof Mehta. The afternoon then split into concurrent sessions on eye banking and ‘News from the lab’ focusing on dry eye, which included Auckland’s own Associate Professor Jennifer Craig as one of the speakers. Topics discussed in this session included how a poor blink can lead to ‘drop-out’ and atrophy of the meibomian glands and how blink exercises can be helpful; how intense pulsed light (IPL) can restore meibomian gland function with an accumulative effect; and how the cholesterol-lowering agent, atorvastatin, is being investigated as a novel treatment for evaporative dry eye. Dr Tom Cuneen then shared how patients with Stevens Johnson Syndrome, the rare blistering skin reaction that can devastate the LEAVE A LEGACY OF VISUAL FREEDOM. Professors Laurie Hirst and Minas Coroneo, A/Prof Jod Mehta and Dr Jacqueline Beltz who led the femtosecond laser-assisted pterygium debate ocular surface, can benefit from early amniotic membrane transplant. He described his effective surgical technique that can be performed outside the operating theatre, if necessary. The conference then ended with an interesting interactive complex case presentation and video session. Overall the meeting provided open, in-depth discussion with informative and entertaining speakers in a friendly and informal manner. There is a lot of exciting research in the field of cornea and I, for one, am looking forward to seeing where bio-printing, corneal endothelial regeneration and novel treatments for previous ‘surgical’ diseases will take us next. *Dr Jennifer Court is a senior corneal fellow at the Department of Ophthalmology at the University of Auckland OptiMed Optopol REVO NX, the world’s fastest OCT will be on display at RANZCO NZ 2018. Come and visit the OptiMed NZ booth to view our latest technology. Be sure to check out the Eidon Ultra-Wide Field Confocal Scanner for high-resolution fundus imaging as well as other innovations and diagnostic equipment. OptiMed NZ will have product specialists available to answer all your queries. Robert, Craig and Richard invite you to come and discuss your interests, have a chat or just “hang out”. TECNIS ® PRESBYOPIA-CORRECTING IOLs Optos Optos ultra-widefield retinal imaging devices deliver detailed 200-degree, high-resolution Optomap images in a single capture, something no other device is capable of doing. Optomap can image past the equator, helping you find pathology sooner. Optomap images are a proven tool for effective clinical decision making with over 400 peer-reviewed studies showing the importance of Optomap imaging in diagnosis and treatment planning. Visit us at this year’s RANZCO NZ branch meeting to find out more about the latest technology from Optos. See ad on p10 for more details. TECNIS is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. All other trademarks are the intellectual property of their respective owners. AMO Australia Pty. Limited. Level 3, 299 Lane Cove Road, Macquarie Park, NSW 2113. AMO Australia Pty. Limited (Incorporated in Australia) PO Box 401, Shortland Street, Auckland, 1140. © 2017 Abbott Medical Optics Inc. | www.vision.abbott | PP2016CT1775 AMO20530 Tecnis PICOLs Adv_A4.indd 1 April 2018 NEW ZEALAND OPTICS 14/3/17 10:00 am 17