RANZCO NZ 2026: Reflections from Queenstown

Bascom Palmer Eye Institute’s Professor Carol Karp delivered several of the meeting’s most elegant clinical lectures. Her talk on ‘the ABCs of anterior segment OCT’ for ocular surface pathology was immediately practical, particularly in recognising and monitoring ocular surface squamous neoplasia. Across her later talks on ocular surface masqueraders, cataract surgery in eyes with corneal and ocular surface lesions and in the Molteno Lecture, she presented a coherent diagnostic philosophy: look carefully, image intelligently and remain alert to diseases that do not behave as expected. Her framing of OCT as an “optical biopsy” was especially powerful.

Paediatric ophthalmology was brought vividly to life by the Netherlands’ Dr Jan-Tjeerd de Faber. His lecture on anterior segment surgery in congenital eye anomalies combined deep surgical experience with humour, warmth and evident affection for patients and families. His aphorism that “paediatric ophthalmology is 50% parentology” was cheeky yet precise. One of his four lectures, the fascinating ‘Gorillas out of the mist’, recounted his adventures as a visiting ophthalmologist at Rotterdam Zoo, including YAG capsulotomy in a mouse lemur, cataract surgery in gorillas, horses and codfish, plus a memorable pearl: never give atropine to birds!

Efficiency and sustainability in cataract surgery

The University of Sydney’s Associate Professor Tim Roberts, a cataract and glaucoma expert, took us on a panoramic tour of intraocular lens (IOL) technology. Understanding the defocus curve remains fundamental to interpreting presbyopia-correcting lenses, yet its clinical value depends on the ability to translate this information to patients and manage expectations. His observation that “successful surgery is outcome minus expectations” captured the centrality of expectation-setting in modern cataract practice.

Despite being unable to attend the conference in person due to ongoing tensions in the Middle East, Dr John Ellis, an innovative cataract specialist from Scotland, gave one of the meeting’s most memorable recorded lectures. Discussing maximising cataract surgery efficiency in the NHS, he offered a thoughtful critique of the misuse of “symbolic capital”: the professional and institutional habits that preserve inertia rather than enable progress. His words resonated with those of Dr Brian Kent-Smith, who analysed New Zealand Government healthcare funding and argued that current spending trajectories are unlikely to be sustainable without a more informed public debate about priorities, eligibility, public-private contributions and the limits of comprehensive care within fiscal reality.

Sustainability was further examined from several angles. Ophthalmology New Zealand’s chair Dr Sonya Bennett and executive officer Associate Professor Moira McInerney shifted the focus to practice infrastructure, outlining how non-clinical benchmarking of administrative and business measures may support more efficient, evidence-based management. Dr Miswan Mahyudin, a guest speaker from Malaysia, presented results from the Asia-Pacific Academy of Ophthalmology sustainability survey, placing ophthalmology within the wider environmental responsibilities of healthcare.

A strong equity thread ran through the programme, with talks from RANZCO policy officer Laura Ferreira and Dr Alistair Papali’i-Curtin from RANZCO charity arm ANZEF (the Australian and New Zealand Eye Foundation) on the college’s progress in implementing Te Tiriti o Waitangi Action Plan and Pacific Peoples Action Plan. Dr Justin Mora highlighted work by RANZCO, Eye Health Aotearoa (EHA) and the Eye Health National Clinical Network towards improving eye health equity. EHA co-chair Chrissie Cowan ONZM later presented key statistics and insights on Māori children’s attendance rates for paediatric ophthalmology appointments, outlining the need for a national effort to better understand non-attendance patterns and identify barriers and facilitators with whānau Māori and community partners.

A highlight was Esmeralda Lo Tam’s three presentations. A University of Auckland doctoral student supervised by Prof McGhee, she presented her major community projects focusing on improving keratoconus detection and access to care for Māori and Pacific People’s youth – research that has already attracted close to $1m in funding from the Health Research Council, among others. Her work combines targeted high-school vision screening with Pacific People’s research methodologies, including talanoa, to create a model of screening that is relational, culturally grounded and community-led.

Since May 2025, more than 700 youth have been screened across Auckland, many of whom required further assessment for possible keratoconus or other conditions. I have been fortunate to work with the team on this programme, an experience that has introduced me to the warmth, openness and generosity of Pacific Peoples and Māori communities.

Lo Tam’s persistence and courage in building this programme through schools, churches and community partnerships have been outstanding and it was a fitting recognition that she was awarded the RANZCO best presentation prize.

Retinal screening in preterm infants was a particular focus within the paediatric sessions. In her review of routine retinopathy of prematurity (ROP) screening cases at Auckland City Hospital NICU, paediatric fellow Dr Corina Chilibeck identified that small mid-peripheral retinal white dots may be an early ocular sign of cytomegalovirus infection in preterm infants, in some cases preceding systemic diagnosis. Dr Chilibeck was awarded the RANZCO second presentation prize for this original work.

Dr Helen Kearns’ eight-year review of ROP screening in the Auckland NICU also provided important service-level context, showing increasing screening volumes, rising rates of stage 3 ROP and increasing treatment rates over time, likely reflecting improved survival of extremely premature infants and a growing neonatal ophthalmology workload. Dr Isaac Samuels, ophthalmology registrar at Greenlane Clinical Centre, complemented these talks with a review of follow-up after spontaneously regressed ROP, suggesting there are opportunities to reduce low-yield visits and improve clinic capacity at Greenlane Eye Clinic.

Tackling tumours

In addition to Prof Karp’s four keynote lectures on ocular surface tumours, Dr Joevy Lim, a vocational registrar in Auckland, presented on conjunctival and uveal melanoma in New Zealand. Comprising part of her recently awarded PhD, this epidemiological work is foundational for service planning, referral awareness and future research in Aotearoa.

Prof McGhee then presented on anterior segment tumours – “observe, biopsy, repair” – summarising multiple biopsy and excision techniques for iris tumours, as well as medium-term outcomes from minimal iris touch excision (MITE), a minimally invasive biopsy technique he developed. The results suggest diagnostic promise with a low complication profile. Using a two-stage approach with an intracapsular artificial iris and IOL, the team has found that most patients regain their previous vision. I am pleased, as a research fellow, to be contributing to this evolving body of research.

With two decades of ocular oncology experience, Dr Peter Hadden offered highly practical clinical pearls in managing choroidal tumours via myriad clinical photographs and diagnostic imaging.

Oncologist and vitreoretinal surgeon Dr Riyaz Bhikoo reminded the audience that not all iris tumours are managed surgically and presented a wide-ranging review of choroidal tumours, including missed and late diagnoses, ocular cancer pathways and emerging systemic treatments for metastatic disease.

The Molteno and other named lectures at the RANZCO branch meetings have always been a highlight and this year we were taken on a philosophical journey by Dr Keith Small. His Dorothy Potter Medal Lecture on ‘trust in an ophthalmological context’ was an apt theme for a meeting that had repeatedly touched on patient expectation, misinformation, cultural safety, donation systems and the social contract underpinning healthcare.

Dr Heather Machin, the nursing keynote speaker from Australia, spoke on the changing landscape of eye and tissue donation, including corneal allogeneic intrastromal rings and the challenges of healthcare fatigue and donor trust. Her lecture placed corneal transplantation within the wider ecology of public confidence and the often-unseen work of eye-bank teams.

By the end of the meeting, Remarkable Insight had extended beyond its clinical remit. I was reminded of how much eyecare can be an art, supported by advanced surgical innovation and practised within a rapidly improving yet imperfect health system. Like the magnificent mountains surrounding Lake Wakatipu, the meeting offered a broader vantage point: a reminder that progress in ophthalmology is not only measured by the heights we reach, but by the clarity with which we see the landscape around us, including the inequities that often remain in shadow.

Additional reporting

I would like to acknowledge Dr Joevy Lim for her contributions to this article.

Dr Jabelle (Siyuan) Lu is the current Maurice and Phyllis Paykel corneal and anterior segment clinical research fellow at the University of Auckland, supervised by Professor Charles McGhee. She completed her BSc and Doctor of Medicine at the University of Queensland, and Master of Medicine (Ophthalmic Science) at the University of Sydney.