April 2018

NZ hosts the world of retina
BY DR HANNAH KERSTEN*
The biennial Retina International World Congress was held
for the first time in Auckland on the 10 and 11 February.
With recent host cities including Taipei and Paris, Auckland
had a lot to live up to!
The Retina International Congress is a unique meeting,
bringing together the world’s foremost retinal scientists and
clinicians, patients and their families, health professionals and
patient advocates. The scientific programme, organised by local
retina specialist Associate Professor Andrea Vincent, boasted an
incredible line-up of 11 international speakers as well as many
local and national presenters. The speakers and delegates were
joined by a large group of volunteers, from the Blind Foundation
and the University of Auckland, to assist the many low-vision or
blind delegates.
Speaking to such a diverse audience was always going to be a
difficult task, but the speakers more than rose to the challenge.
The scientific programme was opened by Professor Elise Héon,
from the University and Hospital for Sick Kids in Toronto, who
gave a brilliant clinical overview of inherited retinal disease,
putting into context much of what was going to be discussed at
the meeting. This was followed by a presentation by Professor
Eric Pierce, from Harvard Medical School, summarising the
genetic causality of inherited retinal diseases and current
therapeutic approaches for treating these conditions. Both
opening speakers spoke of the difficulties associated with the
current inherited retinal disease nomenclature; many disease
names (for example, retinitis pigmentosa) cover a range of
genetic mutations and phenotypes.
The second session of the day covered the somewhat daunting
topic of Genetics and Gene Therapy. A/Prof Andrea Vincent,
outlined the clinical findings that can provide clues to the genetic
diagnosis in inherited retinal disease, while Associate Professor
Alex Hewitt (Tasmania) provided an overview of the advances
in genetic testing for retinal disease. He included a memorable
analogy, where each DNA nucleotide was a matchstick,
explaining how changes in the ‘matchstick’ configuration
can lead to genetic disease. Professor Jean Bennett, from the
University of Pennsylvania, then took to the stage to discuss the
enormous amount of work that goes into conducting a clinical
trial, and the phenomenal costs involved (up to US$1.8 billion if
conducted by a pharmaceutical company!).
In the afternoon, the meeting broke off into two parallel
sessions, ‘Retinal degenerations’ and ‘AMD and other
maculopathies’. I attended the AMD session and one of the
highlights was Professor Mark Gillies from Sydney discussing
the Australian Fight Retinal Blindness project and the role of big
data. He emphasised the importance of natural history disease
studies – by understanding the course of disease in individuals,
we are able to gather information that cannot be acquired
through clinical trials alone.
In this session, we also heard from a number of local speakers;
Drs Narme Deva, Rachel Barnes, David Squirell and Dianne
Sharp covered a range of topics including advances in treating
age-related macular degeneration (AMD) and diabetic eye
disease, and the latest in retinal imaging for AMD.
Claire Fitzgerald, Gary Williamson and Margaret McLeod from the Blind Foundation with
volunteer Nancy and Martine Able-Willamson
Diego Sonderegger, Drs David Squirrell, Graham Wilson and Angus Hatfield-Smith
Part III Optom students and volunteers Linda Zhou, Lusi Yu, Joyce Wong and Kate Lee
Speakers Dr Daniel Chung, Prof Elise Héon, A/Prof Andrea Vincent and Dr Thomas
Edwards
Blind Foundation’s Sue Emirali and Gail Mann (third left) with Jenny and Kyle Dobson
The final session of the day included presentations by Associate
Professors Alice Pébay, from Melbourne, and Alex Hewitt on using
stem cells to model eye disease, and CRISPR gene editing in retinal
disease. A/Prof Hewitt explained that although the possibilities for
CRISPR gene editing in humans are vast and exciting, it could be
many years before they are used in patients with retinal diseases.
Dr Kent Small then spoke about his work in North Carolina Macular
Dystrophy with patients from across the world.
The interesting topics continued on day two of the
programme, with ‘Scientific Breaking News’. Professor Bennett,
who conducted the first gene therapy treatment trial for
patients with inherited retinal disease, spoke about the recent
FDA approval of Luxturna (or voretigene neparvovec-rzyl to use
its proper name) for the treatment of patients with mutations
in the RPE65 gene. Professor Pierce gave an update on the
ReNeuron clinical trial of human retinal progenitor cells for
patients with advanced retinitis pigmentosa. Dr Sharp discussed
treatment difficulties in patients with polypoidal choroidopathy
and retinal angiomatous proliferation. Professor Gillies gave an
overview of AMD clinical trial results, including brolucizumab
as a potentially longer-lasting treatment for neovascular AMD
and lampalizumab, trialled for the treatment of geographic
atrophy. Finally, Dr Tom Edwards from Melbourne, gave an
overview of the safety and efficacy of a robot-assisted retinal
surgery system. The robot is able to make very fine movements,
particularly important in patients with fragile retinas (including
patients with inherited retinal disease). In the video, ‘Robot
vs. Surgeon’, the robot was much steadier, with slower, more
deliberate movements.
The futuristic theme continued, with a session on artificial
vision. Dr Edwards discussed the first attempt at artificial vision
(back in 1968!) and the considerable progress that has been
made since then. Artificial vision requires an intact inner retina,
so retinitis pigmentosa is often a good target. Dr Penny Allen
from the Royal Victorian Eye and Ear Hospital, talked about
Bionic Vision Australia’s suprachoroidal retinal prosthesis, and
presented the results of a prototype clinical trial, where all
three patients showed improvement in navigational ability
following the surgery. Dr Thiran Jayasundera, a New Zealandtrained
retinal specialist now working in the USA, was the first
to implant the Argus II over a decade ago. Today, there have
now been over 350 Argus II implant surgeries. He discussed the
Argus II’s surgical procedure and clinical journey. Because the
implant only provides very basic vision, pre-operative vision
needs to be light perception or worse, he said.
The afternoon was again split into parallel sessions, with
separate sessions for patients and professionals. I chaired one of
the patient sessions, which included an illuminating presentation
by ophthalmic nurses Sandy Grant and Olga Brocher on the
services offered by the Auckland District Health Board’s low
vision clinics. Blindness consultant Jonathan Mosen, blind since
birth, talked about why it is the best time in history to be a blind
person. Technology was also the focus of the Blind Foundation’s
adaptive technology trainer Matthew Rudland, who turned our
attention to the Seeing AI app for those with visual impairment,
while the Blind Foundation’s Sandra Budd detailed some of the
Foundation’s services.
Following the parallel sessions, Professor Gerald Chader from
the Doheny Institute in the USA, gave the closing keynote
presentation, summarising the decades of laboratory and
clinical work that have led to clinical trials and better outcomes
for patients with retinal disease.
Feedback about the conference was positive, with attendees
commenting on the high quality of the speakers and the fantastic
networking opportunities available. The next Retina International
World Congress will be held in Reykjavik, Iceland, in 2020; the
perfect excuse to organise a trip to the Northern Hemisphere. ▀
*Dr Hannah Kersten is a lecturer in the School of Optometry and Vision Science at
the University of Auckland and a member of the local organising committee for the
2018 Retina International World Congress.
Focus on
Eye Research
Retinal detachment,
epiretinal membranes
and anti-VEGF for DMO
VISUAL RECOVERY AFTER RETINAL
DETACHMENT WITH MACULA-
OFF: IS SURGERY IN THE FIRST 72H
BETTER?
Frings A, Markau N, Katz T et al
British Journal of Ophthalmology.
2016;100:1466 -1469
Unlike macula-on retinal detachment,
which is often treated as an
“ophthalmic emergency” and repaired
swiftly before the macula detaches,
macula-off retinal detachment
is usually considered less of an
emergency. However, determining
the ideal time for repair of maculaoff
retinal detachment before
compromising the visual prognosis
can be difficult. The purpose of this
study was to evaluate the influence
of lag-time between the onset of
central visual acuity loss and surgical
intervention of macula-off retinal
detachment.
A retrospective review of 1727 patients
was undertaken, with 89 patients
meeting the inclusion criteria. The
main outcome measure was final
visual acuity as a function of symptom
duration of macula-off detachment.
Symptom duration was defined as the
time from the onset of loss of central
vision (macula detachment) to surgical
intervention.
The results showed there was no
clinically significant difference in
final visual acuity in those operated
within 10 to 30 days of macula-off
retinal detachment. But patients with
symptom duration of three days or
less achieved best final visual acuity
(p