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Australian Researchers Bridging the Gap

Australian academics make a significant contribution to global research and until 2020 it was commonplace to see local talent presenting their work at scientific conferences in all countries of the world.

Since early 2020, most Australian researchers have been forced to contribute to these meetings online, and, while many initially rejoiced at the opportunity to spend more time at home, a degree of ‘virtual conferencing fatigue’ has begun to creep in.

An innovative solution, implemented by University of New South Wales Sydney, has rekindled enthusiasm for conferencing, enabling researchers to fully engage and reap the benefits of participating in global scientific efforts, even from afar.

After 12 months of online clinical and scientific research conferences, we looked at the contribution of Australian Eye and Vision researchers to the recent online Association for Research in Vision and Ophthalmology (ARVO) conference. This longstanding annual meeting held in the United States is arguably the premier, and certainly the largest, international research meeting in this field.

students were able to absorb the content that was most relevant to them, in a space that was both comfortable and engaging

Before 2020, attendees would participate face-to-face in the conference, attending oral presentations and Q&A sessions, presentations with poster authors, special interest groups, section meetings and symposia. Beyond the formal sessions, there were numerous opportunities to interact with collaborators and industry partners, find jobs, seek mentors and meet exhibitors. Many Australian scientists, clinicians and students would use the trip to visit other labs or connect with collaborators.

With this year’s conference delivered online, on US Eastern Standard Time – a full 14 hours’ time difference to the eastern states of Australia – the opportunities for these informal yet highly valuable interactions were largely lost. Opportunities were limited to presenting virtually and to listening to pre-recorded presentations. As would be expected, over the last two virtual meetings, the number of Australian ‘attendees’ has reduced compared to face-to-face meetings.

UNSW ARVO LUNCHTIME SESSIONS: CREATING AN ACCESSIBLE EXPERIENCE ONLINE

The researchers who are probably most impacted, by virtual meetings or hybrid meetings held on overseas time, are early career researchers and higher degree students. The time difference between Australia, and particularly the US or Europe, forces them to either stay up all night to attend talks online or access their recordings at a more reasonable time, which means missing out on group discussions and questions. Younger researchers risk missing out on the face-to-face contact, networking opportunities and the chance to develop their international reputation.

While some of these drawbacks may be an inevitable feature of online conferences, others can be mitigated. This year at the UNSW School of Optometry and Vision Science, we held a series of ARVO lunchtime sessions, where higher students and early career researchers were encouraged to nominate their best rated topics of interest from the conference abstracts. Six themed talks per session were collated and accessed through the ARVO website at lunchtime on four separate days. Talks, posters, and paper sessions were replayed for the group and discussed among peers.

The benefit of this activity was that students were able to absorb the content that was most relevant to them, in a space that was both comfortable and engaging.

Researchers also benefitted from time spent in peer discussion, both learning about advances in their own fields, and also the wider picture of vision research internationally. Less often articulated, but equally important benefits, arose through social interactions, and through informal generation and exploration of ideas.

So, while we expect virtual or hybrid conferences to be the norm until the pandemic is brought under control and perhaps beyond, this does not mean we should not strive to improve our experience of them.

AUSTRALIAN RESEARCHERS STRONG AT ARVO

Impressively at ARVO 2021, 182 out of a total 3,731 abstracts presented had an Australian author.

Here are just some of the Australian highlights from the major fields of research that were nominated by UNSW researchers and students.

Retina 

The majority of the submissions from Australian scientists (n=83) were in studies of the retina. A paper from Dr Samantha Dando at University of Queensland, reported on Toxoplasma gondii, a parasite with a specific predilection for the retina and the brain.1 Humans can contract this parasite through consuming undercooked meat, contact with contaminated water, or it can be acquired congenitally. These parasites form cysts within the retina and brain and this can lead to chronic lifelong infections. In some people, especially those who are immunocompromised, this can present as retinal toxoplasmosis, posterior uveitis, and, if the parasite enters the central nervous system, cerebral toxoplasmosis. In mouse retina, Toxoplasma gondii cysts were exclusively localised in the ganglion cell layer and inner plexiform layer whereas in the brain, cysts were localised in the cortex. Despite the regional specificity of Toxoplasma gondii cysts, Tmem119+ microglia activation occurred throughout the retina and brain. Understanding the role of innate immunity in the control of Toxoplasma gondii replication in the CNS may lead to novel immunotherapeutic targets for toxoplasmosis.

Impressively at ARVO 2021, 182 out of a total 3,731 abstracts presented had an Australian author

Choroid 

In his virtual poster session, UNSW Scientia PhD candidate Stanley Wu, shared his study of the effects of visible light exposure on the choroidal microenvironment and its possible role in choroidal melanoma progression.2 Melanoma cells were grown in 96 well black plates and were then exposed to 32,000 lux light (LED, 400–700nm) for four hours. Unexposed control cells were grown in parallel conditions. Viability was reduced 10% to 15% immediately after light exposure but the effects on viability varied with cells from different tumour sources, possibly due to differences in their intrinsic melanin levels. There was no increase in the damage markers CCL2 or IL-8 production following light exposure in melanoma cells, however, the cumulative effects of light exposure (which is analogous to the in vivo scenario) remain unclear. Incidental light induced ARPE19 cell death, ameliorated with sodium pyruvate, indicates effects on metabolism and reduced oxidative stress. This is particularly important in relation to the effects of the Australian sun and lifetime exposure to ultraviolet light.

Glaucoma 

Glaucoma was another hot topic among Australian vision researchers, with 16 abstracts presented. Lachlan Knight and colleagues, from Flinders University in Adelaide, South Australia, reported the relative frequencies of childhood and early-onset glaucoma subtypes, and their genetic findings were reported in a large single cohort in Australia.3 In brief, 290 individuals with childhood glaucoma and 370 individuals with early-onset glaucoma were identified. Childhood and early-onset glaucoma are rare subtypes of glaucoma which begin before the age of 40 years and appear to often involve inherited genetic subtypes. The study found that primary glaucoma was most prevalent in both groups. In the childhood cohort, 57.6% of individuals (167/290) had primary congenital glaucoma and 19.3% (56/290) had juvenile open-angle glaucoma (JOAG). JOAG made up 73.2% of the early-onset glaucoma cohort (271/370). Pathogenic variants in 18 genes associated with childhood and early-onset glaucoma were identified.

the new topically applied selenium sulfide eye ointment (AZR-MD-001) has the potential to be the first effective drug treatment for meibomian gland dysfunction

Visual Function and Optics 

There were 26 abstracts in visual function and optics. Traumatic brain injury (TBI) and visual function was a topic of interest this year, with revised rules in Australian professional sports recently indicating the importance of managing concussions and head knocks. Revathy Mani and colleagues from UNSW, reported eye movement deficits, also called oculomotor dysfunctions, in mild TBI.4 Voluntary eye movements are directly related to highlevel cognitive functions such as sensory information processing, attention, working memory, and response inhibition, and have been investigated in neurological disorders and neurodegenerative diseases such as Parkinson’s and Alzheimer’s diseases. A group of 26 adults with TBI participated in the study that investigated antisaccades (eye movement opposite to target) and memory-guided pro- and antisaccades (eye movement towards or opposite to the target location from memory respectively). The study assessed delayed antisaccades and delayed memory-guided pro- and antisaccades with variable delays. The results of this study revealed that those with TBI had delayed reaction time, and increased unwanted eye movements towards the target during and after delay for antisaccades, compared to memory-guided saccades, indicating impaired responseinhibitory control. However, for memoryguided prosaccades, there was increased premature eye movement responses towards the target during the delay compared to antisaccade tasks, indicating impulsive behaviour. The study showed that people with TBI demonstrated response disinhibition and impulsive behaviour for voluntary eye movement tasks. Such findings may suggest potential oculomotor dysfunctions as markers for TBI.

Clinical Trials 

The Australian government offers significant support for companies undertaking trials locally, including the Research and Development Tax Incentive Program and the Therapeutic Goods Administration which streamlines the regulatory process for the approval of trials through their Clinical Trial Notification (CTN) scheme. With this support, it is no surprise that Australia is often a preferred location for the conduct of clinical trials research. Consequentially, a number of abstracts from Australia reporting clinical trials were presented at the ARVO meeting.

Dry Eye, Cornea and Ocular Surface 

Twenty eight abstracts reported studies in dry eye/cornea and ocular surface, including an early phase clinical trial presented by Laura Downie from the University of Melbourne.5 This multicentre, double-masked, vehiclecontrolled, randomised, parallel group clinical trial evaluated the safety and efficacy of a semi-solid ointment, (AZRMD- 001), as a novel meibomian gland dysfunction drug treatment. From baseline to three months, participants showed a statistically significant clinical improvement in dry eye symptoms and improvements in gland secretion scores. Abnormalities in the oil-secreting meibomian glands in the eyelids are implicated in up to 80% of dry eye cases, however, currently, management is limited by a lack of specific treatments. There were no major safety concerns found in the study. These findings are important as they indicate that the new topically applied selenium sulfide eye ointment (AZR-MD-001) has the potential to be the first effective drug treatment for meibomian gland dysfunction.

it is important to consider ways to maximise engagement – particularly for the career development of early career researchers and higher degree students

Epidemiological Research 

Epidemiological research by Australian researchers was well represented with 12 abstracts presented this year. A memorable epidemiology session featured a poster from Timothy Tang from Sydney Eye Hospital.6 The aim of this multicentre retrospective study was to review the outcomes of a large group of patients treated with systemic biologic therapy for uveitis. During follow-up, 35 patients (76.1%) were able to discontinue corticosteroids, while 10 patients (21.7%) were able to reduce corticosteroids to <7.5mg per day. The results of this study highlight the importance of beginning treatment early in patients with sight threatening uveitis to decrease complications and reduce prednisolone dosage.

Another study, by Professor Konrad Pesudovs from UNSW, described findings of a study on the global burden of eye disease.7 In 2020, an estimated 15.2 million people aged 50+ were blind, and a further 78.8 million had moderate to severe vision impairment due to cataracts. There has been an increase of 29.7% in cases of cataract blindness and 93.1% in cases of moderate to severe vision impairment since 2000. Between 2000 and 2020, the age-standardised prevalence of cataract blindness in males decreased more than in females (-31.8% vs -24.8%); similarly, the increase in cataract-related moderate to severe vision impairment was higher for females (+8.9%) than males (+4.7%). The most reductions in cataract blindness rates worldwide, between 2000 and 2020, occurred in Southeast Asia, East Asia and Oceania (-43.0%), North Africa and the Middle East (-40.0%), and South Asia (-36.5%). This study is significant because the World Health Assembly Global Action Plan set a target of a 25% reduction in avoidable vision impairment from 2010 to 2019, and despite availability of treatment for cataracts, the rate of cataract-related blindness between 2000-2020 has risen. It reminds us of how much work is still to be done, and the importance of collaborative efforts across countries.

SUMMARY

The annual ARVO conference featured posters, talks and symposia from Australian vision and eye scientists and researchers. While the virtual conference has enabled some research connectivity in a world of closed borders and bans on international travel, it is important to consider ways to maximise engagement – particularly for the career development of early career researchers and higher degree students.

References 

  1. Dando, S., Lee, D., Tonkin, C. & McMenamin, P. (2021) Region-specific cyst localisation and widespread innate immune activation in the retina and brain in a mouse model of toxoplasmosis, Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  2. Wu, C., Cioanca, V., Zhu, L., Chen, Y., Natoli, R., Conway, M., Madigan, M. (2021). Does bright light exposure affect in vitro choroid melanoma viability and secretion of proinflammatory chemokines? Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  3. Knight, L., Ruddle, B., Taranath, D., Goldberg, I., Smith, J., Gole, G., Chiang, M., Mullany, S., Elder, J., Vincent, A., Staffieri, S., Mackey, D., Luu, S., Siggs, O., Souzeau, E., Craig, J. (2021) Childhood and Early-Onset Glaucoma Classification and Genetic Profile in a Large Australasian Disease Registry, Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  4. Mani, R., Asper, L., Arunachalam, V., Khuu, S. (2021) The impact of traumatic brain injury on delayed antisaccades and memory-guided pro- and antisaccades, Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  5. Downie, L., Watson, S., Tan, J., Stapleton, F., Bosworth, C. (2021) A multicenter, double-masked, vehiclecontrolled, randomized, parallel group clinical trial of AZR-MD-001 (AZR) in individuals with meibomian gland dysfunction, Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  6. Tang Lee Say , T., Yang, V., Fingret, J., Zagora, S., Symes, R., Younan, C., Cornish, E., Sammel , A., Wakefield, D., Speden , D., McCluskey, P. (2021) Adalimumab therapy in patients with vision threatening uveitis Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 
  7. Pesudovs, K., Lansingh, V., Kempen, J., Steinmetz, J., Briant, P., Varma, R., Wang, N., Jonas, J., Resnikoff , S., Taylor , H., Braithwaite , T., Cicinelli , M., Vos, T., Bourne, R. (2021) Cataract-related blindness and vision impairment in 2020 and trends over time in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study, Annual Association for Research in Vision and Ophthalmology Meeting (ARVO). 

Ashleigh Chandra is a PhD candidate in the School of Optometry and Vision Science at University of New South Wales Sydney (UNSW SOVS) working in conjunction with the George Institute for Global Health, Injury Division. Her main research interests include vision and neuroscience. She spent three years working on projects at the Save Sight Institute in Sydney Eye Hospital, where she earned her Masters by Research. 

Dr Revathy Mani is post doctoral fellow at UNSW SOVS. Her area of research is to understand the relationship of visual, oculomotor and cognitive deficits in Traumatic Brain Injury. She received her Bachelors (2002) and MPhil degree (2011) in Optometry from Elite School of Optometry, affiliated to Birla Institute of Technology and Science (BITS), Pilani India. Joining Sankara Nethralaya, a tertiary eye care centre in India in 2002 as an optometrist, she was the Head of Department of Binocular Vision and Vision Therapy from 2009 to 2016. She is a Fellow of the Neuro-optometric Rehabilitation Association, USA (2018) and the recipient of the 2019 William C Ezell Fellowship Award from American Academy of Optometry Foundation. She was awarded her PhD from UNSW in 2021. 

Fiona Stapleton is Scientia Professor, School of Optometry and Vision Science, Faculty of Medicine and Health at University of New South Wales Sydney. 

Awarded her PhD from City University and Moorfields Eye Hospital in London, she completed a post-doctoral fellowship at University College London. She is a clinical scientist with expertise in epidemiology and clinical research in the fields of corneal infection, dry eye and contact lens related disease. 

Professor Stapleton holds numerous memberships and executive affiliations with scientific organisations, is a regular reviewer for a range of journals, belongs to the international editorial board of three journals, has over 270 peerreviewed publications, has contributed 20 chapters to textbooks and published one book. 

She is President of the International Society for Contact Lens Research. 

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