March 2017

Meet the … bio-engineer
Dr Ehsan Vaghefi is known by friends and family as ‘the eye guy’, a
name given to him by his dad, who is also his inspiration. Jai Breitnauer
discovers the man behind the research
Dr Ehsan Vaghefi is a quietly spoken, very private, but
exceptionally passionate man. You get that from
the handshake alone. His office, tucked into a quiet
corner in the School of Optometry and Vision Science at the
University of Auckland, is well-ordered and punctuated with
personal photos – people are clearly important to him.
“My background is in bioengineering and I wanted to use a
novel, bioengineering approach to working with degenerative
eye diseases,” he explains, when asked about his research.
“I began imaging the eye using different modalities during
my PhD and became very passionate about this. It’s an area
where there is little research.”
The central tenant underpinning Dr Vaghefi’s work is the
idea of pre-diagnosis – that if you can find markers or model
the behaviour of parts of the eye under certain conditions, you
will be able to predict the likelihood of a patient developing
a particular eye problem and ultimately prevent potential
blindness.
“My dad went blind when he was five-years old,” explains Dr
Vaghefi. “He had congenital glaucoma, an ultimately treatable
disease that went undiagnosed. He’s a successful man in
his own right and a great dad – but my childhood was very
different from my friends. While they were play fighting with
their dads, I was helping mine with basic tasks like walking
around. It drives me mad that his blindness was preventable.”
When Dr Vaghefi went to university, his parents – both
lawyers – were surprised he chose bio-engineering.
“I said, ‘I want to help people like you, Dad.’ I knew he was
proud of me for wanting to make a difference in this area. He
calls me ‘the eye guy’.”
After he finished his PhD, Dr Vaghefi says the school of
Optometry and Vision Science was the natural place to go.
He felt there was a lot to be done from a bio-engineering
perspective. Clinicians, he says, are doing amazing work, but
there is room for a fresh look at the eye.
“We are seeing similar approaches for other systems in the
body, like cardiovascular. Medicine in this area is predictive
and preventative, but we can’t do this for vision right now.”
Using up-to-the-minute MRI technology, using the
University’s state-of-the-art MRI machine, Dr Vaghefi is
imaging the blood flood in patient’s eyes to find predictive
trends.
“MRI has many benefits. It’s non-invasive and has no depth
limitations, whereas most optical devices are limited to
looking at the surface. MRI can be fine-tuned to image the
same tissue in different ways looking at, for example, water
content then oxygen content.”
Looking at blood flow is a new area of development, which
has opened up MRI’s usefulness for the eye.
“Currently, ophthalmologists use angiography to look at
blood flow, but this has two problems,” explains Dr Vaghefi.
“Firstly, you have to inject a tracer into the blood stream, which
Dr Ehsan Vaghefi
makes this treatment invasive and perhaps not suitable for all.
Secondly, all you can see from this is one moment in the blood
flow, where the tracer enters that tissue. So, for example, you
can see if a leak is present, but you can’t see the quantity of the
leak or the speed of the blood flow.”
Dr Vaghefi has designed a system that solves these
problems. Using iron naturally present in the patient’s own
red blood cells as a marker, he tags them using a neutral
magnetic setup around the patient’s jaw bone area. The
magnetic tag lasts for just a few seconds and doesn’t interfere
with the patient at all, but it does allow Dr Vaghefi and his
team to monitor the blood flow for a few seconds using the
MRI machine, measuring the speed and quantity of the flow
and getting a really good look at where that blood is, and isn’t,
going in the eye. The full scan takes just seven minutes.
“It’s quite simple science really,” he says noting that the
possibility was always there, it just needed a sensitive enough
MRI machine and someone, like himself, to have the idea in
the first place.
“When people think of MRI, they always think of the brain.
But there’s a lot of applications for MRI technology if you think
broadly and from a bio-engineering perspective.”
So what’s the future for his research? Its potential knows
no bounds, says Dr Vaghefi. But for now the team are
concentrating on developing a model for pre-diagnosis of agerelated
macular degeneration (AMD) and have applied for an
HRC grant on the back of a successful pilot study to run a bigger
clinical study on people newly-diagnosed with AMD and in the
later stages of AMD. This study will
look at blood flow patterns to see what
the early warning signs of AMD could
be and also what the blood flow looks
like in later stages when patients are
receiving treatment. It will run for more
than three years.
“It’s very exciting,” says Dr Vaghefi,
who is aiming to launch the research
trial later this year. “I believe the
outcome of this trial will be informative
and unique. As far as I know, we are
the only research group in the world
who has this perspective on AMD. We
are aiming to get in a couple of steps
before vision starts to degrade and if
we can spot AMD here, then maybe we
can prevent it.”
This pre-diagnosis would involve a
simple scan of people with certain risk
factors and allow ophthalmologists to
prescribe preventative lifestyle changes
and medication before AMD damage
has set in. The research will also look
at the relationship between AMD
progression, treatment and blood flow,
giving medical practitioners the ability
to fine tune the way they prescribe and
treat patients suffering AMD related
vision loss.
The same technology can be applied
to other vision damaging conditions as
well, Dr Vasghefi adds. “Imagine going
to a clinic and being told a couple of
years beforehand that you were at risk
of losing your sight for some reason
and then being told what you can do
now to prevent that from becoming a
reality rather than just what they will
do once the symptoms set in. If you
can predict you can prevent. Predicting
pathologies is my big drive. Preventing
eye disease, not just managing it, is the
next big thing.” ▀
It’s green for
glaucoma
World Glaucoma Week (WGW) from 12-18
March kicks off this year with an all-day event
in Times Square, New York, which will be followed
by a host of other inventive events around the globe.
Across Japan, 34 landmark buildings will be illuminated in green with the
‘Light Up in Green for Glaucoma’ campaign to help spread awareness. This will
be complemented by special lectures in Tajimi by Dr Tadahi Nakano and a host
of screening events.
Closer to home, Glaucoma Australia is inviting everyone to ‘Beat Invisible
Glaucoma’ (BIG) by hosting a BIG breakfast to raise funds for glaucoma
awareness and education; the Department of Ophthalmology at the University
of Auckland is hosting a fundraising morning tea; and Glaucoma New Zealand
has been contacting numerous organisations to help drum up awareness.
Thousands of glaucoma awareness initiatives have been held since the first
World Glaucoma Week in 2010. The World Health Organization has identified
glaucoma as the second
leading cause of blindness
in the world with 79.6
million people expected
to have lost their sight
from glaucoma by 2020.
“Enormous efforts will
be needed in the next
decade to overcome
the impact of glaucoma
around the world. New
strategies concerning
glaucoma screening,
diagnosis, treatment
and rehabilitation are
mandatory,” said Maria
Carrasco, WGW managing
director.
In other glaucoma news,
registrations are now
open for the 7th World
Glaucoma Congress
from 28 June to 1 July in
Helsinki, Finland. In 2019
the event will be held
in Melbourne. For more
information, visit: www.
worldglaucoma.org. ▀
For more on the latest
research on glaucoma, see
our story on ANZGIG 2017
on p23.
Light Up in Green for glaucoma in Japan
Partnership reduces
cataract costs
Eye Institute has partnered with Southern Cross to reduce the cost of
cataract procedures.
The Auckland-based Eye Institute has committed to incrementally
decrease the cost of a cataract procedure for Southern Cross members by almost
30% to help make cataract surgery more affordable, both organisations said in a
joint statement at the end of January.
“With a significantly ageing population and stretched health dollars, we have
entered into a long-term agreement with Southern Cross Health Society,” said
Dr David Fitzpatrick-Cockram, Eye Institute CEO. “They wanted to ensure great
value with the best possible outcomes and treatment experiences for their
825,000 plus members. This marries with our commitments to provide high
quality clinical care and exceptional patient service and in doing so maintain a
sustainable sector.”
Southern Cross’ main vehicle for providing members with cost certainty is its
Affiliated Provider programme, where specialists provide procedures at agreed
prices and streamline prior approval and claims processes for members. But this
is contracting, said Geoff
Searle, Southern Cross’
head of provider networks.
“With our increasing
senior population, the
number of cataract
operations is increasing
each year, [so] we need
to be getting the best
possible deal for our
members. Eye Institute
are definitely supporting
us in this by providing
exceptional patient
experience at lower cost
to the patient and in doing
so, helping to keep the
private healthcare sector
affordable for a significant
number of Kiwis.”
Southern Cross Health
Society currently funds
around 9,000 cataract
procedures each year. ▀
Eye Institute CEO, Dr David Fitzpatrick-Cockram and Southern Cross’
Geoff Searle
10 NEW ZEALAND OPTICS March 2017