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Tuesday / December 7.
HomemiophthalmologyTackling Clinical & Scientific Challenges RANZCO 2015

Tackling Clinical & Scientific Challenges RANZCO 2015

The mesmerising sight and sound of the New Zealand Haka indicated the start of the scientific program of the 46th annual RANZCO conference in Wellington.The excitement of the well-deserved All Black Rugby World Cup victory filtered through to the delegates and ophthalmic industry groups as the extensive academic program got underway.

The 46th annual RANZCO scientific program included an orthoptist’s program, practice management symposium, multiple plenary symposia, clinical courses and rapid fire sessions.

A welcome reception was held at the beautiful museum of New Zealand, Te Papa, which overlooks Wellington’s harbour. This was followed up in the early hours of Sunday morning by a spirited and well attended Rugby World Cup breakfast.

New fellows were inducted into the college and awards presented at the Graduation ceremony, which was held in the unique Michael Fowler Auditorium.

The annual general meetings of the Ophthalmic Research Institute of Australia (ORIA) and RANZCO were held on the first morning of the meeting. This was followed by the ASO (Australian Society of Ophthalmologists). Delegates were also introduced to the newly established “Eye Surgeons Foundation”, which replaces the “Eye Foundation” as the main fund-raising charity arm of the college, whose purpose is to continue to provide surgical guidance and training in the Asia-Pacific region.

Organisers included local and renowned international speakers in the academic program, who shared their academic and clinical expertise with delegates: Dr. John Grigg (Sydney Eye Hospital) delivered the ‘Council Lecture’, this year entitled Childhood vision impairment: helping children see the future. Professor Peter McCluskey (Sydney Eye Hospital) gave a review of Scleritis management in the ‘Sir Norman Gregg Lecture’.

Cataract

Dr. Randal Olsen (Utah, USA) discussed corneal considerations at the time of cataract surgery. He emphasised the need to prevent corneal oedema by avoiding endothelial trauma by swirling lens fragments at the time of quadrant extraction during phacoemulsification surgery. He also had some sound advice on the prevention and management of wound burn at the time of cataract surgery.

Dr. Ike Ahmed (Toronto, Canada) gave an inspirational lecture on complicated cataract surgery, including some amazing videos of difficult cases which he has performed. Dr. Ahmed is due to publish a recent meta-analysis of observational studies of Femtosecond Laser- Assisted Cataract Surgery (FLACS). According to Dr. Ahmed, there is no clear evidence that FLACS improves refractive outcomes when compared to conventional cataract surgery. However, the new technology is exciting and does have some advantages over conventional cataract surgery in there being slightly less phacoemulsification energy in the eye at the time of surgery with consequent decreased endothelial injury and loss leading to quicker post-operative recovery times. The strength and integrity of femtosecond laser produced capsulorhexis remains controversial. Some studies have also demonstrated an increased complication rate in FLACS when compared to conventional cataract surgery.

This perspective was also reflected by Dr. Randal Olsen who emphasised the need for prospective comparative studies to demonstrate any benefits with this new technology.

Glaucoma

Professor Tim Aung (Singapore) gave a comprehensive update on the pathophysiology and management of angle closure glaucoma. The lens is a major contributor in the pathophysiology of pupil block and angleclosure. Cataract surgery is a better treatment option than peripheral iridotomy alone, in the setting of angle closure and cataract.

The role of clear lens extraction in the setting of angle-closure glaucoma remains controversial, although should be considered as a treatment option in eyes with angle-closure glaucoma, high IOP and an anterior lens vault. Cataract surgery in the setting of angle closure remains difficult and risky. The benefits of clear lens extraction in this setting need to be measured against the risks of this potentially dangerous surgery. The current EAGLE trial is prospectively assessing quality of life outcomes of lens extractions in the setting of angle closure glaucoma, the results of which will hopefully address some of the unanswered questions in this divisive topic.

Professor Dao Yi-Yu’s (Perth) presented the “Ida Mann Lecture” on Developing a New Glaucoma Filtration Surgery. As we know, trabeculectomy remains the gold-standard drainage procedure in glaucoma management. Success of this surgery is limited by fibrosis of the conjunctiva and surrounding tissues leading to unpredictable outcomes. This inspired Prof. Yi-Yu to develop an ab-interno micro-filtration drainage device. Prof. Yi-Yu discussed the process of developing the appropriate bioengineered materials needed to develop the stent and the implantation device. Working out the exact depth of implantation required to successfully drain aqueous into the conjunctival lymphatic system was complex and Prof. Yi-Yu produced some fantastic demonstrations of dyes within the conjunctival lymphatic drainage system.

The device has now evolved and is currently undergoing a multi-centre international clinical trial. The entire process has taken in excess of 20 dedicated years to date.

Epidemiology

Dr. Neil Murray (Rotorua, NZ) delivered the ‘Hollows Lecture’. His lecture was inspired by the “disruptive, innovative” legacy of Fred Hollows. He discussed the global fight to treat world blindness. Nepal is a stand-out example of an enduring and accessible solution to manage blindness in the developing world. This strategy is being implemented with help of the College of Ophthalmology in providing surgery and training in the Pacific region where the number of trained ophthalmologists and number of locally performed cataract surgeries has increased substantially.

Dr. Murray also discussed the looming ‘diabesity’ epidemic in regions of the developing world, such as the Pacific where a cultural shift in diet has led to a dramatic increase in the consumption of fizzy, sugary drinks and has led to a dramatic increase in the incidence of diabetes and, subsequently, diabetic related eye disease. Dr. Murray suggested the possibility of implementing a ‘cheap’ intravitreal anti-VEGF program in the region if feasible, however, challenged delegates at the conference to come up with innovative solutions to these avoidable blinding conditions.

Uveitis

Dr. Douglas Jabs (New York, USA) gave an update on the long-term outcomes of systemic treatment in posterior uveitides. The four and a half year results of the MUST study have been released, which surprisingly, show no difference in systemic side-effects in patients having systemic immunosuppression vs. local Fluocinolone implant for the treatment of macular oedema associated with posterior uveitis. The patients treated with local steroids predictably developed glaucoma/ocular hypertension and cataract, while patients treated with well-managed, appropriate systemic immunosuppression had similar visual outcomes with similar systemic side-effects.

He concluded that well managed and appropriate systemic immunosuppression was better at controlling complicated inflammatory eye disease than local therapies and that these systemic treatments were generally safe. He pointed out that there is an association with alkylating agents and increased rates of neoplasia and an Australian study showed an association of long-term immunosuppression with increased rates of skin cancers and lymphoma.

Biologic agents are rapidly becoming more popular and have proven to be highly effective in treating some ocular inflammatory diseases, especially Bechets disease.

Entertaining, Educational, Enjoyable

The academic program was both educational and enlightening. The organisers invited a fantastic mix of international speakers who covered many different fields in ophthalmology. International speakers have different perspectives and opinions on topics, which we, as fellows of RANZCO, may take for granted.

There was an interesting mix of academic and innovative topics which kept delegates engaged throughout the conference.

Wellington is a beautiful city. Our hosts organised an imaginative program of social events which were well attended and enjoyed by all delegates.

In summary, this year’s RANZCO conference was an entertaining, educational and enjoyable experience. Wellington and its world-cup winning hosts provided the perfect back-drop for a successful meeting.

Dr. Anton Van Heerden is a cataract surgeon, retina sub-specialist and comprehensive general ophthalmologist. He provides a general ophthalmic service, which includes laser-assisted cataract surgery and has a sub-specialist interest in medical retina conditions which include age-related macular degeneration and diabetic retinopathy.

Dr Van Heerden practises at Armadale Eye Clinic and is the Head of Unit of one of the surgical units at the Royal Victorian Eye and Ear Hospital. He also consults at the Alfred Hospital and in Shepparton at the Goulburn Valley Eye Clinic.

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