March 2017

dedication and work effort, having not
only studied optometry, being a dedicated
ophthalmology researcher and medical student,
but also a mum to two young children and wife to
Auckland ophthalmologist Dr Shanu Subbiah.
“I’m in awe of you and your dedication to
your career,” she said. “Not only have you been
awarded this and other accolades during your
medical studies, but you were also awarded the
senior prize in optometry during your optometry
degree for which you achieved first class honours
and then continued on to do your PhD. I couldn’t
be more proud…”
William MacKenzie Medal –
Jeremy Mathan
The newly appointed Professor Trevor Sherwin
kept the evening upbeat with an amusing look at
the William McKenzie Medal awardee, medical
student Jeremy Mathan’s rather casual email
pitch – “Hi Trevor” – to come and work in the
department.
Mathan is already an accomplished presenter
“with a David Attenborough tilt to him,” said
Professor Sherwin, having won a number of
awards for his presentations despite being
so early into his career. Mathan has already
published three papers: ‘Autonomous corneal
repair using autologous corneal repair using
In-vitro adult stem cell expansion’; ‘Analysis
of glaucoma subtypes and corresponding
demographics in a New Zealand population’;
and ‘Sphere-forming cells from peripheral
cornea demonstrate the ability to repopulate
the ocular surface’. He has also been involved in
the Aotearoa Research into Keratoconus (ARK)
study, looking at the epidemiologic, demographic
and basic clinical characteristics of people with
keratoconus managed by optometrists in New
Zealand.
The William MacKenzie Medal is awarded
annually for early excellence in eye research.
Arthur Thomas Paterson Scholarship –
Dr Divya Perumal
Dr Stephen Best presented the Arthur Thomas
Paterson Post-graduate Scholarship, noting every
one of the registrars who has won this prize since
it the first was awarded in 1994, has been one of
his registrars at some stage.
The award was established to assist newly
qualified Kiwi ophthalmologists to continue their
post-graduate studies overseas and thus return
to New Zealand with new skills to serve the
populace. Unfortunately this year’s award winner,
Dr Divya Perumal, had already left to take up a
glaucoma fellowship with Manchester Royal Eye
Hospital in the UK, so was not present to receive
her award on the night.
Summer Studentships
Associate Professor Jennifer Craig presented the
awards for the summer students:
Lise Angelo, whose study was titled:
‘Confirming a novel therapeutic target in human
retina for the treatment of chronic inflammatory
disease’ (Betty Bennett Summer Studentship)
William Cook: ‘Rocket science and ‘super’
vision’, which assessed the reproducibility and
comparability of ocular higher order and corneal
aberrations
Darina Khun: ‘The effect of semifluorinated
alkanes on tear fluid dynamics’
Joevy Lim and Ji Soo Kim: ‘Effects of pressure
and heat on corneal biomechanics’, to determine
if different modes of meibomian gland
dysfunction treatment using heat alters the
biomechanical parameters of the cornea (Eye
Insitute Summer Studentship)
Charisse Kuo: ‘Investigation of corneal
epithelium matrix production in healthy and
keratoconic corneas’
ANZGIG (now ANZGS) 2017
The Stamford Plaza on a sweltering Brisbane
summer weekend was the setting for the
2017 Australia and New Zealand Glaucoma
Interest Group (ANZGIG) meeting. This was
a great chance to catch up with colleagues,
discuss challenging cases, learn the latest results
from some high-quality glaucoma research
taking place in Australasia and hear about the
inspirational work of invited speaker Professor
Keith Martin from the Department of Clinical
Neurosciences at Cambridge University. It was
also timed to coincide with the Association for
Research in Vision and Ophthalmology (ARVO)
Asia conference across the river at the Brisbane
Convention Centre for those who wanted to get
their CPD points for the year off to a flying start!
Cases, driving and genetics
The two-day ANZGIG conference commenced on 4
February with a collection of cases. Dr Jo Koppens
from Auckland presented an interesting case of
normal tension glaucoma leading to a discussion
of the possible protective effect of statins in
glaucoma. Other cases included the challenges
of managing patients with nanophthalmic eyes
and raised IOP, highlighting the high-risk of
complications of any sort of ocular surgery.
The second session addressed an issue that
many ophthalmologists struggle with - glaucoma
and safety to drive. Given the ageing population
with many people still driving into their 80s this
is going to be an increasingly common situation.
Loss of a driving licence can have a severe
detrimental effect on quality-of-life through
loss of independence leading to isolation and
depression, with secondary effects on other
members of the family.
Dr Jim Stewart outlined the situation in New
Zealand, with our option to refer the decision to
the chief medical examiner of the Land Transport
Safety Authority if we feel a further opinion is
required, and the potential use of a practical
driving exam by an occupational therapist.
Professor Joanne Wood from the Queensland
University of Technology, a world expert on
driving and visual impairment, highlighted it was
unclear if current Australian visual standards
(which are similar to NZ) were suitable and the
Estermann visual field may not test the most vital
areas or in a way that is relevant to driving.
Professor Wood undertook some very
interesting research comparing patients with
moderate to severe glaucoma with age-matched
controls using an on-road assessment with a
trained instructor in a dual-control car. She found
the patients with glaucoma had only slightly
lower overall safety scores than the controls,
but had twice as many critical errors where the
instructor had to intervene. None of the standard
visual field measures were strongly correlated
with driving safety. She suggested tests involving
motion sensitivity may have better predictive
value. In her research, combining visual field
scores with tests of cognition and strength
showed a better correlation to the driving score.
The other factor making it difficult to determine
the effect of glaucoma on driving was that the
“normal” controls made a high number of driving
errors!
The biggest discussion at the AGM of ANZGIG
was changing the name as there was a feeling
that we should transition from being a “Group” to
a “Society” (having started out as a “Club”!). After
a near unanimous vote it was decided that in
future this group will be known as the Australia
New Zealand Glaucoma Society (ANZGS).
The Lowe Lecture was delivered by Professor
Martin of the University of Cambridge and was
titled ‘Beyond IOP’. He discussed the ongoing
need to develop better ways to protect patients
heading towards significant visual loss. He
outlined the early use of stem cells and the
growth factors they release which were found
to be protective but cause reactive gliosis. He
described newer techniques whereby genes are
introduced into retinal ganglion cells (RGCs) using
viral vectors. This research has reached human
clinical trials, initially testing technique safety
on blind eyes. Further trials on neuroprotective
agents are likely and in the future we may be
combining strategies to replace and regenerate
RGCs.
Professor Martin was followed by Professor
Jamie Craig from Melbourne who updated us
on advances in glaucoma genetics. He broadly
grouped the glaucoma phenotypes into those
where there was a single gene mutation causing
severe disease such as myocilin, which makes up
a very small proportion of glaucoma cases, and
compared this with the more common situation
BY DR GRAHAM REEVES*
Drs Jay Meyer, Nicholas Johnston and Graham Reeves at ANZGIG in
Brisbane
where individuals are born with a “bad hand” of
genes that individually only increase the risk of
glaucoma slightly, but together contribute a risk
up to five times greater. Professor Craig said he
sees a future where genetic analysis may allow us
to better understand an individuals’ risk profile
so we can better personalise their treatment.
Already through The Australian and New Zealand
Registry of Advanced Glaucoma, researchers
are using genetic profiles to help screen family
members of those patients with severe glaucoma.
False irides, vascular factors and MIGS
The second day started with another set of
challenging cases, the most notable being a
patient who had undergone surgery in India
of angle-supported iris implants to change the
colour of her eyes and then suffered recurrent
episodes of anterior uveitis with raised intraocular
pressure. She refused treatment for a
Ye Li: ‘Is keratoconus a stem cell disorder?’
TECNIS ®
Sunny Li: ‘The cornea: wound healing and
changes after cataract surgery’ (Tom Cat Summer
Studentship)
Micah Rapata (absent): ‘Characterisation of the
inherited maculopathies from the NZ Inherited
Retinal Disease Database’ (Ombler Trust Summer
Studentship)
Michael Wang (last year’s William MacKenzie
Medal winner): ‘Clinical and microbiological
profile of Pseudomonas aeruginosa keratitis at
Greenlane Clinical Centre’ (NZAO Education and
Research Fund)
Kenny Wu (absent): ‘Quantification of laserinduced
choroidal neovascular lesions in a mouse
model of AMD’ ▀
LEAVE A LEGACY
OF VISUAL FREEDOM.
PRESBYOPIA-CORRECTING IOLs
long period before finally consenting to having
one explanted. Audience members shared their
experiences with similar patients and advised it
may be necessary to enlist a psychiatrist to help
engage with these patients as there is often an
element of body dysmorphic disorder that makes
rational discussion of the implant risks very
difficult.
Professor Stuart Graham from Sydney gave
the Gillies Lecture discussing the importance of
vascular factors in glaucoma, including research
into patients with nocturnal blood pressure drops.
So-called “big dippers”, whose blood pressure
drops more than 10% overnight, have a three
times greater risk of glaucoma progression.
The only recommended remedy is to make sure
any systemic hypertension is not over-treated
and avoid beta-blocker use, which may further
compromise optic nerve head perfusion. Professor
Graham also discussed the controversy about
whether obstructive sleep apnoea is relevant in
glaucoma. His conclusion was there are probably
several different disease processes involved in the
pathophysiology of glaucoma and postulated that
future genetic testing may allow better distinction
of phenotypes and so guide us in individualising
treatment.
Professor Bill Morgan from Perth added to the
vascular discussion with his work on venous
pulsation and disc haemorrhages, providing
further evidence of the importance of looking
for haemorrhages to identify patients who are
progressing.
The final session covered minimally invasive
glaucoma surgery (MIGS) with a collection of
experts sharing their experience with different
devices and offering advice in terms of patient
selection and technical tips. This was finished with
some very informative and entertaining videos
from Dr Graham Lee of Brisbane, complete with
music appropriate for the sticky situations he
demonstrated!
Overall this was a great conference with
enlightening and entertaining speakers and I look
forward to next years’ instalment in Sydney. ▀
* Dr Graham Reeves is based at the Manukau Superclinic and
Eye Institute and has a special interest in the diagnosis and
management of glaucoma.
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