2022 Save Sight Society Symposium

Zealong Tea Estate in Hamilton was a picturesque venue for this year’s Save Sight Society Symposium. Three years in the making, conference organisers were rewarded with a turnout of more than 100 delegates, including university students, nurses, optometrists, ophthalmologists and vision scientists. It was refreshing to meet with colleagues in person once again, all while being entertained, educated and inspired by excellent talks from both seasoned and up-and-coming New Zealand ophthalmic researchers.

 

Conference committee chair Dr James McKelvie opened proceedings by providing an overview and update on advances in treatments for corneal diseases and cataracts. This was followed by an update by Nigel Brookes, technical officer at the New Zealand National Eye Bank, who said re-grafts have now supplanted keratoconus as the primary indication for corneal transplantation in New Zealand. This coincides with the increasing utility of corneal crosslinking (CXL) and represents the successful prevention of keratoconic corneas requiring transplantation.

 

Local Hamilton oculoplastic and orbital surgeon Dr Stephen Ng then introduced advances in non-operative ptosis and thyroid eye disease management options. Notably, the alpha-adrenergic agonist oxymetazoline, available as an eyedrop, received US Food and Drug Administration (FDA) approval for the management of acquired ptosis in July 2020. Although not yet compared head-to-head with blepharoplasty, oxymetazoline will likely become an important adjunct for future ptosis treatments. Alpha adrenergic agonists are the active ingredient in common nasal decongestants, which some of Dr Ng’s patients have reported as effective in improving their ptosis! The monoclonal antibody teprotumumab (Tepezza) was also introduced as a novel FDA-approved treatment for thyroid eye disease. “I could be out of a job,” joked Dr Ng. Finishing his talk on the sobering topic of practitioners’ self-care, Dr Ng recounted experiences that evoked self-doubt and advised us to silence our inner critic and be kind to oneself in the face of adversity.

 

Dr Stephen Ng

 

Optic nerve heads and paediatrics

Dr Ng’s heartfelt talk provided a neat segue into the next session, where practitioners frankly shared their experiences of complexities within eyecare. Auckland ophthalmologist Dr Taras Papchenko shared his insights on peripapillary hyperreflective ovoid mass-like structures (PHOMS) and differentiating them from optic nerve drusen. Differentiating benign causes of optic nerve head swelling from papilloedema can be difficult and may necessitate brain and orbital imaging, he said. Similarly, he said prevention of scarring in glaucoma surgery can be difficult. In his personal case series, Eye Doctors’ Dr Mark Donaldson presented results on the promising use of colchicine (Colcrys or Mitigare) in preventing scarring. The safety profile of colchicine has been studied by cardiologists, so Dr Donaldson said future studies should further explore its therapeutic efficacy in ophthalmology.

 

Challenges in retinopathy of prematurity screening, diagnosis of vision loss in children with severe autism disorder and diagnosis of optic nerve head swelling in children were presented by Auckland University senior lecturer and paediatric ophthalmologist Dr Sarah Hull and her team members, Emily Joe and Dr Glynis Hanrahan. The prevalence of premature eye disease has increased alongside survival rates of preterm infants. The increased work demands of early identification pose a challenge for paediatric ophthalmologists. Even in older children who are less verbal, such as those with severe autism spectrum disorder, identification of the cause of vision loss can be difficult. Vitamin A deficiency, which is suspected from a poor dietary history, needs consideration in such patients, said Dr Hull.

 

Precision medicine, retina and uveitis

We launched into the second part of the day with Christchurch-based vitreoretinal surgeon Dr Oliver Comyn sharing an interesting update on Susvimo (ranibizumab), a recently FDA-approved (2021) refillable anti-VEGF ocular implant for wet age-related macular degeneration (AMD) patients, which can last up to six months. Although promising, he said Susvimo is not without limitations, requiring theatre time and a specialist skillset for implantation (and, therefore, high initial costs), plus, more concerningly, the high risk of endophthalmitis.

 

Next, Auckland University’s Associate Professor Andrea Vincent shared a vision of a future where tailoring treatment to a patients’ genetic background could be the new normal, in the same way we adopted imaging advances to guide our practice. We then heard about a very interesting and rare case of ocular mucous membrane pemphigoid (MMP) from Dr Jane Shi, Taranaki Eye Centre’s pre-vocational registrar. Ocular MMP is an autoimmune conjunctivitis that can lead to severe scarring of the conjunctiva as well as limbal stem cell deficiency. In this patient, it was found to be triggered by gliptins, a group of medications used to treat type 2 diabetes.

 

Auckland uveitis specialist Dr Priya Samalia concluded the session by highlighting the high proportion of infectious causes in up to a third of paediatric patients presenting with uveitis, reminding us that early recognition is key to preserving visual outcomes in this population.

 

Waitlist elimination and equity

In our final session, we were inspired by Lyn Scott, clinical nurse specialist from Waikato Hospital, who shared the clinic’s growing demand for intravitreal injections and the strategies employed to eliminate the backlog of patients waiting for them – an impressive feat! We then heard various updates from up-and-coming young clinicians, with a specific focus on Māori health. Dr Dan Scott, Auckland neuro-ophthalmology junior fellow, delivered a harrowing reminder on the dangers and sight-threatening risks of cosmetic anterior chamber iris implants. Dr Lize Angelo, PhD candidate and CXL fellow, shared an update on Auckland’s CXL service, highlighting the higher proportion of requiring this service. Despite having less severe disease at presentation, Māori and Pasifika have worse vision at follow-up, attributed to the higher rates of non-attendance. This was followed by Auckland University registrar Dr Liam Walsh, who observed an increase in the proportion of Māori attending the acute service at Dunedin during the Covid-19 restrictions in 2020, which likely reflects the severity of cases in Māori at time of presentation. Finally, Isaac Samuels, fifth-year BMedSci (Hons) student at Auckland University, summarised the Māori health perspectives around eyecare and delivered tangible action points for our day-to-day practice.

 

Drs Lize Angelo and Jane Shi

 

All in all, this year’s Save Sight Society symposium provided a relaxing change in location, alongside myriad holistic talks, eloquently delivered. We look forward to the next symposium and the opportunity to catch up with our friends and colleagues again.

 

Dr Himanshu Wadhwa is a non-vocational registrar working in Waikato Hospital. He was a junior research and clinical fellow at the University of Auckland in 2021 and previously an awardee of the William MacKenzie Medal for early excellence in eye research.

 

Dr Joevy Lim is an HRC clinical research training fellow and PhD candidate studying the status of ocular melanoma in New Zealand, supervised by Prof Charles McGhee and Drs Stuti Misra and Akilesh Gokul.

 

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