Congress Speakers
Anita Agarwal, MD
Retina Update Lecture
Dr Anita Agarwal MD
Dr. Anita Agarwal is a Vitreo-Retinal Consultant at West Coast Retina, San Francisco and adjoint Professor of Ophthalmology at the Vanderbilt Eye Institute and the Vanderbilt University School of Medicine, Nashville, TN. Dr. Agarwal specializes in medical and surgical diseases of the retina and uvea, and has a special interest in uncommon and inherited retinal diseases. She received her medical degree from Kasturba Medical College Mangalore and completed ophthalmology residency and fellowship trainings at the Postgraduate Institute of Medical Education & Research (PGIMER), University of Florida, Vanderbilt University and West Virginia University.
She is the author of the Fifth Edition of the Gass’ Atlas of Macular Disease, and has co-authored landmark research papers on the genetics of macular degeneration. Her clinical interests include a variety of infectious, inflammatory, degenerative and dystrophic medical retinal disorders and surgical vitreo-retinal disorders. She is a member of the Macula Society and Retina Society and has been recognized as one of America’s best doctors, Castle Connolly’s top doctors and top ophthalmologists. She is the recipient of the 2014 J. Donald M. Gass Medal for outstanding contributions in understanding Macular diseases awarded by the Macula Society and the 2015 Optic (UK) Lecture Medal awarded by the Royal college of Ophthalmology, UK. She has delivered several named lectures and also received honor awards from the American Academy of Ophthalmology and the American Society of Retina Specialists. She serves on the editorial board of journals – Ophthalmology, Ophthalmology-Retina, Retina Cases and Brief Reports, American Journal of Ophthalmology Case Reports and the Indian Journal of Ophthalmology.
Dr Anita Agarwal MD
Gene Testing Reveals New Insights into Retinal Dystrophies
With recent access to gene testing, the genotype phenotype correlation picture is evolving. Examples of novel gene mutations causing a particular phenotype, unexpected gene mutations of a known phenotype and extreme phenotype difference within family members will be discussed. Methods of confirming a disease-causing gene defect – Polyphen, SIFT, Muttaster will be explained.
Clinical examples of variable phenotypes in Peripherin/RDS(PRPH2), mitochondrial mutations and their phenotypic overlap with other non-inherited disorders, heterozygous ABCA4 and other diseases will be presented. Ancillary testing including electrophysiology and multimodal imaging features aid in the process. A reasonable combined clinical and genotyping approach towards arriving at a diagnosis of a given patient in a clinical setting will be summarised.
Prof Graham Barrett
Sir Norman McAlister Gregg Lecture
Prof Graham Barrett
Graham David Barrett is a Consultant Ophthalmologist at the Lions Eye Institute as well as Sir Charles Gairdner Hospital in Perth Western Australia and is a Clinical Professor in the University Department of Ophthalmology of Western Australia. His special areas of interest include cataract and implant surgery, as well as corneal and keratorefractive surgery.
Professor Barrett has been especially active in the field of small incision cataract surgery and phacoemulsification and has published many papers and is the author of several chapters in text books on related topics. He has produced several videos on cataract and refractive surgery, which have won awards at the ASCRS and ESCRS Annual Film Festivals. He is the recipient of the Harold Ridley Medal as well as the Binkhorst Medal.
His special areas of interests include, lens prediction formulae, new techniques in cataract surgery and intraocular lens implant surgery, intraocular lens implant design as well as refractive surgical techniques, including epikeratoplasty, synthetic refractive on-lays and in-lays and keratoscopic devices. He has developed innovative instruments for all cataract surgery as well as phacoemulsification equipment and intraocular implants, which are widely used by surgeons.
Professor Barrett has been on the Editorial Board of the Journal of Cataract and Refractive Surgery, European Journal of Implant and Refractive Surgery and past international representative for the Asia Pacific Region of the International Society of Refractive Keratoplasty. He is currently a board member of the International Society of Refractive Surgeons, past President of the International Intraocular Implant Club, Past President of the Asia Pacific Association of Cataract and Refractive Surgeons, Editor of the EyeWorld Asia Pacific publication and is also the current and founding President of the Australasian Society of Cataract and Refractive Surgeons.
Prof Graham Barrett
When and How to Treat Low Levels of Astigmatism
There are very few innovations that have had as significant an impact as the introduction of toric intraocular lenses. The ability to accurately predict astigmatic outcomes has improved and the threshold for considering a toric intraocular lens (IOL) has reduced. As a result, toric intraocular lenses are required in approximately 80% of cases undergoing cataract surgery if the desired outcome is less than a 0.5 D of residual astigmatism in all patients. A target of less than 0.5 D residual astigmatism in all patients requires accurate biometry, prediction and alignment as well as an understanding of the impact of surgically induced astigmatism.
The concept of combining multiple instruments to derive an integrated K value simplifies the interpretation of utilizing multiple instruments.
Astigmatic outcome prediction has improved with the availability of toric calculators that consider the impact of the posterior cornea.
Accurate alignment is facilitated by image-guided systems but similar accuracy can be achieved with inexpensive smart phone apps and associated markers.
The centroid value which encompasses both the magnitude and direction of the vector of surgically induced astigmatism is typically in the range of 0.12 D and should be utilized in toric calculators for optimum prediction.
Leaving a patient with significant astigmatism may have been acceptable in an era when extracapsular cataract surgery was widely practised but today with small incision cataract surgery and phacoemulsification an attempt to achieve a target of less than 0.5 D in all patients is preferable and could be considered a standard of care.
A/Prof Clare L Fraser
The Council Lecture
A/Prof Clare L Fraser
A/Prof Clare L Fraser
MBBS (Hons), MMed, FRANZCO
A/Prof Clare Fraser is an ophthalmologist specialising in neuro-ophthalmology, strabismus and visual electrodiagnostics. She is a consultant Visiting Medical Officer at both Sydney Eye Hospital and Liverpool Hospital, and is also in private practice in Sydney. At the University of Sydney, she holds the title of Associate Professor of Neuro-ophthalmology.
She completed ophthalmic training at Sydney Eye Hospital in 2006-2009 and went on to further Neuro-ophthalmic training at Moorfields Eye Hospital and the National Hospital for Neurology, London, England with Dr Gordon Plant for 18 months. In 2011 she completed a research fellowship at Emory Eye Centre, Atlanta, USA, with Drs Nancy Newman and Valerie Biousse.
A/Prof Clare Fraser is on the RANZCO board of directors and is the vice president of The Neuro-Ophthalmology Society of Australia. She is the chair of the North American Neuro-Ophthalmology Society International Committee and is on the committee for the Neuro-Ophthalmology Virtual Education Library. In 2018 she was chosen for the Asia Pacific Academy of Ophthalmology academic development mentor scheme. She serves on the editorial boards for Clinical and Experimental Ophthalmology, The Journal of Neuro-ophthalmology, and Neuro-ophthalmology.
A/Prof Clare Fraser has published over 120 articles in peer-reviewed journals, has written several book chapters including chapters on Optic Neuritis, Pituitary Tumours and Visual Snow. Her research has been awarded with an Ophthalmic Institute of Australia grant, and has won several international awards including the North American Neuro-Ophthalmology Society prize for the best research presentations in 2005, 2006, 2011 and their pilot grant award in 2018. Her work on optic disc drusen won a $1M European grant in collaboration with the University of Copenhagen.
A/Prof Clare L Fraser
Seeing Stars, Stones and Snow
Sometimes in Neuro-ophthalmology it is the patient who is not quite sure what they are seeing and sometimes it is the doctor. My neuro-ophthalmic research has always been driven by the curiosities and patient vignettes, particularly those rare conditions that have been overlooked by past research efforts. This lecture will explore recent advances in three areas of Neuro-ophthalmology from my own research.
A concussion is often colloquially referred to as “seeing stars” after a head injury. The visual pathways make up 30-50% of the brain substance, and therefore a diffuse brain injury like a concussion will often result in visual symptoms. These can be persistent and difficult for the patient to explain. Research is expanding on the diagnosis and management of acute concussion, post-concussion syndrome and Chronic Traumatic Encephalopathy.
Drusen is the German word for a geode or stone. Optic disc drusen are calcified areas in front of the lamina cribrosa within the disc substance. Drusen can cause difficulty for the ophthalmologist who needs to decide if the patient has papilloedema or true disc swelling. New diagnostic guidelines have been published, and there is increasing research into the nature of disc drusen, how they progress and the risks to a patient’s vision.
Finally, Visual Snow Syndrome is an increasingly recognised visual phenomenon which now has its own set of diagnostic criteria. While not being dangerous or progressive, it can cause very disabling symptoms for the patient. New research is providing insights into the neurological substrate of this phenomenon and will hopefully lead to better treatment options.
Dr Damien Gatinel
Refractive Update Lecture
Dr Damien Gatinel
Damien Gatinel, MD, PhD, has been the head of the Anterior and Refractive Surgery Department of the Rothschild Foundation, Paris, since 2007. His research is mainly focused on IOL optical design, mathematical modelling of laser refractive surgical procedures, astigmatism correction, and the detection of subclinical keratoconus. He holds a PhD in applied mathematics and devised a new classification for ocular optical aberrations. He owns several patents, including the first diffractive trifocal IOL design (e.g. FineVision IOL), for which he was discerned the title of Knight of the Order of the Crown from the Kingdom of Belgium. Dr Gatinel is a board member of the Executive Committee of the International Society of Refractive Surgery (ISRS) and of the Research Committee of the European Society of Cataract and Refractive Surgery (ESCRS). He serves on the Editorial Board of the Journal of Refractive Surgery. He has received more than 20 international awards, among which 14 Best Paper of Session won during ASCRS meetings. Dr. Gatinel was the first to win 3 Best Paper of Session during the same ASCRS edition (2018). Dr. Gatinel has published more than 100 articles in peer-reviewed journals and edited three books.
Dr Damien Gatinel
Artificial Intelligence: Applications for Pathologies of the Anterior Segment of the Eye
The use of artificial intelligence (AI) provides a better understanding of data collected through biometric and imaging techniques. It can increase the accuracy or the effectiveness of solutions intended to correct certain optical defects of the eye caused by structural alterations responsible for a reduction in the transparency of the ocular media and/or refractive errors.
This work has been mainly applied to the study of corneal topography and imaging, description of the ocular wavefront, ocular biometry and improving the accuracy of the power calculation of intraocular lenses.
We used AI techniques to carry out studies to characterise the alterations observed during the evolution of keratoconus as well as the spatial distribution of corneal oedema through the use of neural networks to tomographic image analysis.
Using artificial intelligence and the results from the description of the ocular wavefront on a new basis, we were able to estimate the real impact of high degree aberrations on subjective refraction.
From a thick lens paraxial eye model, we established an analytical formula to calculate the position of the principal planes of an implant based on its geometry and the main biometric constants. This work made it possible to train an algorithm to predict the effective position of an implant, taking into account its geometry and establishing an original biometric calculation formula combining principles of paraxial optics and artificial intelligence algorithms applied to an eye model made up of thick lenses.
Dr Lynn K Gordon
Neuro-Ophthalmology Update Lecture
Dr Lynn Gordon
Lynn K Gordon, MD, PhD is Professor of Ophthalmology and the Vernon O Underwood Family Chair at the Stein Eye Institute at UCLA, and the Senior Associate Dean for Equity and Diversity Inclusion at the David Geffen School of Medicine at UCLA. Dr. Gordon completed her M.D. and Ph.D. at Harvard Medical School, followed by residency in ophthalmology and fellowship training in neuro-ophthalmology at UCLA. She is an active clinician scientist and her work has resulted in multiple patents and more than 100 publications, book chapters, and reviews. She serves on the editorial boards for Ophthalmology Retina, Journal of Neuro-ophthalmology, and the Journal of Ocular Immunology and Inflammation. Dr. Gordon had held leadership positions in several state and national professional organizations including chair of the Council (2018-2019) and membership on the Board of Trustees (2016-2019) of the American Academy of Ophthalmology.
She is passionate about education and teaches and lectures extensively on neuro-ophthalmology topics. In her role as senior associate dean for equity and diversity inclusion she helped develop programs on leadership development for mid-career women at the David Geffen School of Medicine and for the Association for Research in Vision and Ophthalmology. Her greatest passion is helping individuals realize their full career potential.
Dr Lynn Gordon MD, PhD
Neuro-ophthalmic Complications of Immune Checkpoint Inhibitor Therapy for Cancer: Lessons Learned through Case Reports and Big Data
Treatment of specific cancers was revolutionized through the use of immune checkpoint blockade (ICI) which unleashes the body’s own immune surveillance and mechanisms to kill tumor cells. This innovative treatment strategy induces remission for many patients with treatment-resistant cancers. Unintended consequences of ICI result from disrupting tolerance, therefore creating autoimmune consequences which can affect the eye and central nervous system. Following ICI therapy, case reports and series document dry eye, uveitis, and multiple neuro-ophthalmic complications involving the optic nerve, cranial nerves, neuromuscular junction, and extraocular muscles. The majority of patients with uveitis or optic nerve disease respond to discontinuing the ICI or to systemic or local corticosteroid therapy. Clinical improvement is however variable for patients with other types of neuro-ophthalmic sequelae. Case series provide insights about specific disease sequelae but do not help us understand the incidence or prevalence of complications following ICI therapy. Two big data studies provide additional complementary information, one using the IRIS database developed by the American Academy of Ophthalmology, and the other using the Kaiser Permanent Medical Record system. Using big data, cancer patients were identified to have a higher rate of uveitis and neuro-ophthalmic disease, even without the use of ICI. Patients with a prior history of immune-mediated ocular disease, uveitis or other, had a higher rate of recurrent disease following ICI therapy. Coordination of care between ophthalmologists and oncologists is suggested for patients in which ICI therapy is indicated.
A/Prof Catherine Green AO
The Fred Hollows Lecture
A/Prof Catherine Green AO
A/Prof Catherine Green, AO
MBChB, FRANZCO, MMedSc, MSurgEd
A/Prof Catherine Green is a glaucoma specialist and ophthalmic educator based in Melbourne, and is Head of the Glaucoma Unit at the Royal Victorian Eye and Ear Hospital., the largest specialist glaucoma service in Australia. Throughout her career Catherine has played an active role in education and training, clinical service improvement and international development.
Her contributions to RANZCO include serving as Chair of two examination boards, a board director from 2010-17 and as Dean of Education from 2017-19, as well as a member of several College committees. She is the founder of the RANZCO Leadership Development Program (LDP) and serves as director of the LDPs of both RANZCO and the Asia Pacific Academy of Ophthalmology (APAO).
Current international appointments include the Board of Governors of the International Council of Ophthalmology and the Council of the APAO. In 2017, she was recognised as an Officer of the Order of Australia for distinguished service to ophthalmology as a clinician, through executive roles with national and international professional groups, to research and education, and to eye health care programs in the Asia-Pacific.
A/Prof Catherine Green AO
Disruption and Innovation: Challenges and Opportunities in Ophthalmology
Two types of innovation, defined as “the use of a new idea or method”, have been described. The first, sustaining innovation, makes something bigger or better. The second is disruptive innovation, which disrupts the bigger-and-better cycle, bringing to market a product or service that is more affordable and easier to use, allowing a whole new population of consumers to access a product or service that was historically only accessible to consumers with more money or greater skill. The introduction of affordable intraocular lenses for patients in developing countries, as championed by Professor Fred Hollows, is an example of a disruptive innovation that has had a profound impact on eye health globally.
The year 2020 will be remembered for the global disruption caused by a pandemic that that will have ramifications for decades to come. 2020 also marked the culmination of a global initiative for the elimination of avoidable blindness, VISION 2020: The Right to Sight. Despite the global prevalence of blindness falling by 28% in the past 30 years, in 2020, 43.3 million people were blind and 553 million had vision impairment, with evidence of significant inequities. The COVID-19 pandemic has impacted eye health; however, innovations that address this disruption may present opportunities to improve eye health even after the pandemic is under control.
A systems approach is required, with innovation not only in eye care delivery, but in policy, workforce planning, and education. Of course, we should promote sustaining innovations, but also be looking for truly transformative (disruptive) innovations that provide opportunities for improving eye health in ways not previously considered.
Prof Alex Hewitt
The Dame Ida Mann Memorial Lecture
Prof Alex Hewitt
Professor Alex Hewitt completed his Ophthalmology training at the Royal Victorian Eye and Ear Hospital in Melbourne. In 2012 he was the Novartis Fellow at the Lions Eye Institute in Perth and was awarded a WA Tall Poppy Award from the Australian Institute of Policy & Science. He was also awarded a Peter Doherty Biomedical Fellowship from the Australian National Health and Medical Research Council and is currently supported by a Practitioner Fellowship.
During medical training he completed a B.Med.Sci.(Hons) degree investigating the outcomes of cataract surgery for people living in remote areas of the Northern Territory with Clinical Associate Professor Nitin Verma AM, and in 2001 he completed his undergraduate medical degree at the University of Tasmania. He obtained a PhD investigating the genetics of glaucoma through Flinders University of South Australia, under the supervision of Professors Jamie Craig and David Mackey.
Professor Hewitt has a major interest in translational research – scientific research that helps to make findings from basic science useful for practical applications that enhance human health and well-being.
He has been involved with work relating to the identification of genes and risk variants in glaucoma and myopia, as well as quantitative traits such as central corneal thickness, optic nerve size and the retinal microvascular circulation. This work has resulted in publications in leading journals such as Nature Genetics, Human Molecular Genetics, PLoS Genetics and Ophthalmology. To date he has co-authored over 200 peer-reviewed publications.
He has worked with major research projects including the Glaucoma Inheritance Study in Tasmania, the Norfolk Island Eye Study, the Twins Eye Study in Tasmania, the Australian and New Zealand Registry of Advanced Glaucoma. Professor Hewitt is part of the International Glaucoma Genetics Consortium, and the global Consortium for Refractive Error and Myopia. Additionally, he has recently help establish independent research projects in China, Uganda, Nepal and Indonesia.
Prof Alex Hewitt
The Dawn of Precision Ophthalmology in the Asia-Pacific.
Heralded as the most significant breakthrough in biology since PCR, the adaptation of the “CRISPR/Cas” system to mammalian cells is set to revolutionise treatments for inherited disease. The CRISPR/Cas system, used by bacteria to counter viral intrusion, can cut or edit DNA at specific sites, and the clinical application of this technology opens the very real prospect of anticipatory cures to well-defined inherited diseases. Whilst ocular blinding conditions will be at the forefront of these, a transformative shift in the Australian biotechnology and healthcare delivery sectors must occur to ensure this becomes reality. Many of the steps for a safe therapeutic pipeline for in vivo CRISPR/Cas therapy, such as accredited mutation detection and patient-specific profiling (e.g. with patient-specific stem cells) are well-established, and a clear-pathway of how this technology would be incorporated into clinical care has been developed. With ongoing advances and enhanced manufacturing capabilities, the end of blinding monogenic retinal diseases is in sight.
Dr David Lockington
Cataract Update Lecture
Dr David Lockington
David Lockington MB BCh BAO (Hons) FRCOphth PhD
Originally from Northern Ireland, David Lockington has been a Consultant Ophthalmologist at Tennent Institute of Ophthalmology, Glasgow, Scotland since January 2014, with sub-specialist training in Cornea, Cataract and Anterior Segment. Following 2 years of SHO training in the Northern Ireland ophthalmic rotation, he moved to Glasgow in 2007 for his Registrar ophthalmology training throughout the West of Scotland. From 2012-13 he undertook a 1-year Cornea and Anterior Segment fellowship with Professor Charles McGhee at the University of Auckland in New Zealand, where he remains an honorary clinical senior lecturer.
He has an active interest in research and teaching, achieving over 90 peer-reviewed publications and leading to a recent PhD by publication entitled “First do no harm! Safer management of ophthalmic anterior segment conditions”. David has received 9 awards at national and international conferences for his research and multiple oral presentations. He recently graduated from the 2017-19 SOE European Leadership Development programme as the UK representative, and used these skills to coordinate a renovation project to create a bespoke “Teach and Train simulation Hub” for ophthalmic trainees in Glasgow to promote safer surgical training. He is now the national UK ophthalmology simulation lead for the Royal College of Ophthalmologists.
David is actively involved in cataract and corneal education via organisations such as ESASO, and is a UKISCRS council member, a Member with Thesis of The Cornea Society and a Fellow of the Royal College of Ophthalmologists.
Dr David Lockington
Ensuring a safe cataract experience for all through embracing the role of simulation
The COVID19 pandemic has disrupted medical education and surgical opportunities. Surgical simulation has partly filled some of the training gaps, but it should have been central prior to this disruption. In this Cataract Update Lecture, I will look at the historic methods of teaching and training and show why they were inadequate, demonstrated through the perils of the “Beyonce method”. I will then discuss the established and new simulation equipment options and methods. Proactive use of these novel training techniques will ensure that trainees have the knowledge and the experience required to perform surgical tasks safely prior to live surgery. Ensuring competence will improve confidence, which is relevant to the subsequent handling of greater surgical complexity and/or complications. These principles are not unique to new trainees, as the whole surgical team (including consultants) can always benefit from refinement of their skills. Expanding and engaging with ophthalmic simulation offers that opportunity. Embracing this attitude of constant learning and ensuring a better educational culture will result in a safer cataract experience for the trainer, the trainee and the patient (most importantly).
These issues will be discussed and illustrated within a lively and contemporary presentation, with concepts made memorable through surgical videos and tenuous links to popular music culture.
Dr David Lockington
Dr Pradeep Yammanuru Ramulu
Glaucoma Update Lecture
Dr Pradeep Yammanuru Ramulu
Using a variety of tools including patient reported outcomes, observation of task performance, and real-world behavioral monitoring, Dr. Pradeep Ramulu has helped define when, how, and why visual impairment results in disability. His current work is focused on the possible protective role of physical activity against eye disease, developing methods to assess/prevent falls in older adults, particularly those with visual impairment, and the use of ocular imaging to identify persons at risk for cognitive impairment.
Dr. Ramulu’s work has resulted in over 180 peer-reviewed publications, 10 book chapters, and 2 books. Because of his expertise, he has helped various agencies including the Federal Bureau of Investigation to set vision standards for work. He also holds leadership positions in various national and international ophthalmic societies, including Program Chair for the American Glaucoma Society Director of the Education Committee for the World Glaucoma Association. He has mentored numerous medical students, MPH students, residents and fellows clinically and in research projects. He twice won the resident teaching award and, in a model that has now become the standard for Wilmer, reorganized glaucoma teaching by placing lectures on-line and using in-class time for interactive sessions using game-based learning and small-group interactive case review. On top of caring for his patients’ needs, he now serves as Director of the Wilmer Glaucoma service, consisting of 10 faculty and over 20 research, clinical, and administrative staff members. Dr. Ramulu has received continuous NIH funding since 2007 and has received the Secretariat, Achievement, and Senior Awards from the American Academy of Ophthalmology and the Pisart Award for Vision Science. He was also named to Newsweek’s list of “America’s Best Eye Doctors” in 2021.
Dr Pradeep Yammanuru Ramulu
Novel concepts in evaluating functional damage in glaucoma
Functional testing in glaucoma has heavily relied on testing of the visual field in the central 24-30 degrees. However, glaucoma should be understood as a disease which affects a wide range of visual measures beyond visual field damage, many of which can be useful in understanding the impact of the disease. Of course, visual field damage remains a mainstay for the clinical diagnosis of glaucoma and for assessment of progression. But new concepts are emerging regarding visual field testing. This lecture will present data on the strengths and pitfalls of new algorithms for more rapid field testing and offer evidence-based insights on how to better integrate visual field reliability data into clinical decision making. New emerging technologies to capture visual field testing using novel platforms will also be discussed as well all the methods to assess the quality of life impact of glaucoma on the individual within the daily flow of clinical care.