Collaboration, collegiality and cricket
NZ ophthalmologists Drs Aaron Wong, Anmar Abdul-Rahman and Rahul Dwivedi

Collaboration, collegiality and cricket

April 8, 2020 Dr Rahul Dwivedi

This year’s Australia & New Zealand Glaucoma Society (ANZGS) meeting was held in the South Australian city of Adelaide. The magnificent Adelaide Oval Stadium was a much-approved choice of venue for the conference, particularly for those cricket fans among us, as it is the ‘home’ of the legendary Sir Donald Bradman. It was also refreshing to be at the Adelaide Oval and not have to witness a crushing English defeat!

 

Adelaide is also known as ‘The City of Churches’ and the beautiful buildings along the cultural boulevards of North Terrace and King William Street formed a perfect backdrop for the welcome drinks reception held on the eve of the conference. This allowed delegates and speakers to meet each other in an informal setting, providing a personal feel to the conference sessions that would follow. It is often in these informal settings where new ideas are fomented and perspectives on work are shared but, more importantly, global relationships are formed that can promote future collaboration aimed at reducing the disease burden from glaucoma.

 

Attending this sub-specialty meeting for the first time, I found it achieved the perfect blend of delivering a high-calibre scientific programme in a welcoming environment for delegates that encouraged interaction. This was particularly beneficial when discussing management of challenging cases and how to overcome difficult surgical situations.

 

There was a strong genetics theme to the meeting, with distinguished speakers from both Australia and abroad presenting their latest research. The focus on ‘big data’ and personalised medicine formed another central feature of the conference, with identification of particular genes responsible for glaucoma helping to create novel risk stratification tools. These themes were eloquently covered during the Lowe Lecture and the Gillies Lecture, delivered by keynote speakers Dr Anthony Khwaja (Moorfields Eye Hospital) and Professor Alex Hewitt (Hobart) respectively.

 

Minimally invasive glaucoma surgery (MIGS) was discussed at length, with promising real-world long-term results presented for trabecular-meshwork bypass stents such as iStents and the Hydrus micro-stent. I presented three-year post-operative outcomes for the latter, as part of work conducted by Drs Dean Corbett and Jay Meyer in Auckland. Some interesting data on xen-related endophthalmitis from Melbourne added to discussions about challenges faced by clinicians when using this MIGS device. The dosage of the anti-fibrotic agent mitomycin C (MMC) and positioning/orientation of the stent were proposed as key factors for localised conjunctival defects and subsequent infection. Data from newer devices such as PreserFlo showed good early post-operative results with regards to intraocular pressure reduction, but more long-term data is required to achieve a better understanding of its efficacy.

 

Other work presented by New Zealand-based ophthalmologists included a fascinating talk from Dr Anmar Abdul-Rahman (ophthalmology consultant, Counties Manukau) on measurement of normal retinal vascular pulse wave attenuation using modified photoplethesmography, as well as a case of lens calcification post-transcleral diode laser used to treat a cyclodialysis cleft. Dr Aaron Wong (ophthalmology registrar, Auckland) presented a poster evaluating the long-term risk of glaucoma in uveitis and scleritis patients.

 

One of the most inspiring presentations at the meeting demonstrated the collaboration between Professor William Morgan in Perth and ophthalmologists in Jakarta to create a low-cost glaucoma drainage device tailored for the local population of Indonesia. The effort and resourcefulness required to develop this device emphasised the importance of appreciating the relationships between various key public health tenets. These include understanding local healthcare economics and delivery models, disease burden and socio-cultural factors, as well as acknowledgment of the strengths/weaknesses of existing training infrastructure for local ophthalmologists. Having overcome these challenges, this new glaucoma drainage device is now being used extensively throughout Indonesia and South-East Asia.

 

Overall, the 2020 ANZGS meeting has paved the way for a better understanding and appreciation of the role of genetics in the diagnosis, progression and management of glaucoma. Thanks to the input of scientists and clinicians, this advancing field of ophthalmology is making giant strides in translating laboratory-based research, in the era of big data, to the clinical environment.

 

Witnessing high levels of collaboration and collegiality at the meeting was another big positive, with clinicians of all ranks willing to learn together from shared experiences to achieve the best results for their patients. It was a privilege to attend and present work at this meeting. Leaving Adelaide behind, I feel we are living in exciting times in our fight against glaucoma-related blindness.

 

Dr Rahul Dwivedi is currently the glaucoma fellow at the University of Auckland and works with Auckland District Health Board. He studied medicine at the University of Manchester and completed his ophthalmology specialist training in Liverpool, UK. Maintaining a sub-specialist interest in glaucoma, he has presented work at numerous international conferences and published research in peer-reviewed journals.