Dec 2015

SPECIAL FEATURE: RANZCO Congress
Notes from the lecture hall
BY KALIOPY MATHEOS*
The 47th RANZCO Annual Scientific Congress offered an
action-packed scientific programme with an amazing array of
international speakers and local experts.
The calibre of speakers at this year’s event testifies to RANZCO’s
success year after year, attracting leading overseas ophthalmologists
from Australia, the UK, the US and Canada, who presented the latest
in eye research and developments in cataract surgery, glaucoma and
uveitis, to name but a few topics.
Day one: Sunday
The congress commenced on November 1, with several speakers
presenting as part of an Ophthalmic Research Institute of Australia
(ORIA) session. This covered recent progress in understanding the
genetic basis of corneal dystrophies, corneal cross-linking, RPE stem
cell development and applications and new techniques for genetic
manipulations.
Keynote speaker Dr Randall Olson, chair of the department of
ophthalmology and visual science at the University of Utah School
of Medicine, gave the Cornea Update Lecture. A vibrant and practical
presentation, demonstrating how to respect the corneal endothelium
in cataract surgery.
Next Associate Professor John Grigg, head of the Discipline of
Ophthalmology at The University of Sydney’s Save Sight Institute,
gave an insightful overview of the challenges posed by childhood
visual impairment in the annual Council Lecture. Grigg illustrated the
importance of an effective screening programme to detect childhood
Ashton Lindsay, Courteney Lindsay, Drs Jessica and Alistair Papali’i-Curtin
refractive error, and how it rated amongst the most common causes
of childhood disability. He went on to discuss other childhood visual
problems such as cataract, paediatric glaucoma and uveitis reminding
the audience these rare eye diseases are more common than childhood
cancers and cystic fibrosis. Delegates were also given a taste of
emerging new technologies, such as gene-splicing, that potentially will
change the future of diagnostic and therapeutic treatment options.
Day two: Monday
The Best Paper presentations demonstrated the high standard of
research within the ophthalmological community, from the most
junior medical students through to the most senior experts within
each specialty.
Dr Nitin Verma, Suzie Tegan and Drs Stephen Best and Iain Dunlop
Dr Mike O’Rourke, Chantel Burton and Dr Andrew Thompson
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The John Parr Trophy was awarded to Jessica Trollip for her
presentation on New Zealand laser treatment for retinopathy
of prematurity in the era of ETROP: a ten year outcome. Trollip
presented a retrospective review of 143 patients treated with laser
for ROP from 2005 to 2015, showing the long-term outcomes for
these children appeared more successful compared to international
data, with favourable ROP regression rates.
The Gerard Crock Trophy was awarded to Professor Mark Gillies
for his presentation titled Long-term outcomes of treatment of
neovascular age-related macular degeneration: data from an
observational study, focusing on outcomes of treatment-naïve eyes
with neovascular ARMD using anti-VEGF. Gillies concluded that the
long-term outcome in terms of change in visual acuity appeared
good with a mean improvement of approximately 6.3 letters after six
months of treatment. Visual acuity also appeared to remain better
than pre-treatment acuity for at least a six-year period.
Professor Tin Aung, executive director of the Singapore Eye
Research Institute, presented an update on angle closure glaucoma.
Aung asserted that glaucoma is not a simple disease, as viewed
traditionally. For Angle Closure Glaucoma (ACG), there are many
and variable mechanisms by which the angle can close and there
are many genetic factors associated with ACG. Aung discussed
the increasing evidence clinicians can rely on in choosing an ACG
treatment approach, specifically Selective Laser Trabeculoplasty and
lens removal.
The Sir Norman Gregg lecture was given by Professor Peter
McCluskey, director of the Save Sight Institute at Sydney University,
who presented delegates with an overview of scleritis and a review of
clinical and research-based perspectives from the last 30 years.
The current system of classifying scleritis as nodular or diffuse, he
said, is still valid and useful. Identifying and adequately treating the
underlying systemic disease has improved over the decades, to the
point that complications from scleromalacia perforans, for example,
are rarely seen today.
The Plenary Symposium on Cataract Surgery in 2015 was a novel
and well-executed session with Clinical Associate Professor Michael
Lawless, of Sydney University, leading an “interrogation” of experts
including Drs Ike Ahmed and David Kent and Professors Charles
McGhee and Randall Olsen.
The panel compared their preferences in the management of
various problems commonly encountered clinically and in surgery.
It was refreshing for those of us on the bottom rungs of the surgical
ladder that more than one “correct” and safe approach exists to
manage problems arising in anterior segment surgery.
That afternoon Professors Stuart Graham of Macquarie University
and Jonathan Crowston of Melbourne University chaired a Diagnostic
Dilemmas in Glaucoma discussion. Professor Helen Danesh-Meyer
of Auckland University discussed when to suspect a patient has
more than a “typical glaucomatous progression”. She illustrated the
clinical features that would favour a glaucoma diagnosis compared
to those that would not, reminding all to correlate clinical findings
with the nerve appearance. If progression appears inconsistent with
the vision, visual field or colour vision, neuroimaging is required to
exclude a non-glaucomatous optic neuropathy. Sydney University
Associate Professor Paul Healey undertook a journey through
iridology demonstrating that trauma, inflammation and proliferative
disease can induce iris changes which can help tell a story of
glaucomatous pathology if the clinician is in tune to interpret the
changes demonstrated.
Later in the afternoon delegates had the opportunity to view the
posters and films while being treated to craft beer and dumplings.
This year’s winner of the Community Ophthalmology film was Dr
Angus Turner, McCusker Director of Lions Outback Vision, with Beat
that Sugar. While the winner of the surgical technique section,
and overall winner, was specialist cataract surgeon Professor Rasik
Vajpayee of the Vision Eye Institute with Intrastromal fluid drainage
with air tamponade: anterior segment optical coherence guided
technique for the management of acute corneal hydrops.
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