VisionNewsISSUE 30 November 2011

Urine reveals blindness riskPioneering disease prediction technology launched Leading pharmacologist joins CERAA difference beyond a lifetimeA vision for Africa’s poor

Diabetic retinopathy through a

patient’s eyes

Urine reveals blindness risk

2 Centre for Eye Research Australia

discovery is exciting news for patients who are often unaware they have the disease until they experience symptoms. "The current practice of detecting AMD and monitoring its progression and the effectiveness of treatment is expensive and time consuming, requiring sophisticated equipment and clinical expertise," Professor Guymer said.

"Through the discovery of urinary biomarkers, we aim to develop a simple urine test to detect AMD at its early stages." she said. "The early detection of AMD can help patients seek treatment to prevent the irreversible vision loss that is associated with the late stages of the disease."

After being diagnosed with AMD at just 30-years-old, Michelle Kornberg (pictured) couldn't bring herself to tell anyone. "It was a complete shock. I saw an optometrist for a routine eye test and I was immediately referred to a retinal specialist who diagnosed me with AMD," Michelle said. "I was told that I could lose my sight. I was

distraught. I went home to my two children and tried to memorise everything about

them," she said. Fortunately for Michelle, being diagnosed early allowed her visit an ophthalmologist and seek treatment. "Like most people, I can't imagine life without my sight. The development of a sensitive, simple test to detect AMD before the onset of symptoms would be wonderful news for patients."

The discovery could pave the way for the first urine test to detect AMD, long before the disease can be identified through an eye test. Two urinary proteins were found to be associated with AMD.

Patients with early AMD were found to have significantly increased levels of the transforming growth factor-beta protein. While patients with both the early and late stages of AMD were found to have significantly increased levels of the protein macrophage chemoattractant protein-1. Recently, researchers have begun to view AMD as a chronic low grade inflammatory disease, leading scientists to look to the blood and urine for biomarkers to predict the disease. Study leader Professor Robyn Guymer said the

CERA researchers have discovered the potential of urine as a source of biomarkers for age-related macular degeneration (AMD).

Patient Michelle Kornberg is encouraged by research into urinary biomarkers for AMD.

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Vision

News November 2011

Loretta Bastian (pictured on the front page) works hard to keep her diabetes in check through regular exercise and a healthy diet. And while the positive 65-year-old is proof that the disease needn't be a life sentence, she has a strong warning for other diabetics - don't ignore your eye sight. Loretta was diagnosed with diabetic retinopathy five years ago after noticing black spots in her vision. Diabetic retinopathy is a common complication of diabetes. If left untreated, it can cause vision loss and blindness. Loretta is participating in a study that aims to measure the impact of the disease on a person's wellbeing. PhD student Eva Fenwick said that while diabetic retinopathy's impact on vision is well documented, its social and emotional impact is less understood. "From talking to patients, we know the disease can significantly impair participation in daily life," Ms Fenwick said. "It also causes emotional distress with participants frequently reporting fear of further vision loss and social isolation," she said. The results will help clinicians better understand the issues faced by patients and assess treatments from a patient's perspective, including symptom severity and treatment compliance.

"Vision loss in diabetics is often caused by poor diabetes management yet vision loss is a barrier to proper diabetes control," Ms Fenwick said. "We aim to prevent this harmful cycle from occurring."

For more information please contact Eva Fenwick on 03 9929 8363.

Diabetic retinopathythrough the patient’s eyesWith around 275 Australians developing the disease each day, the diabetes epidemic continues to worsen.

Facts about diabetic retinopathy

• Diabetic retinopathy occurs when the tiny blood vessels inside the retina at the back of the eye are damaged

• In its early stages, diabetic retinopathy doesn’t have any symptoms

• Patients can experience vision loss, blurred or distorted vision, increased sensitivity to glare and difficulty seeing at night

• Anyone with type 1 or 2 diabetes is at risk of developing diabetic retinopathy

• Regular eye exams and good diabetes management reduce the risk of diabetic retinopathy

• Vision loss from diabetic retinopathy is irreversible however laser therapy can help slow its progression and decrease the risk of vision loss.

4 Centre for Eye Research Australia

Professor Dusting is charged with overseeing CERA's research strategy and growing its basic science facilities and expertise. The appointment is key to

CERA's future growth and continued reputation as a leader in eye research. Recognised world-wide for his expertise in apply-ing pharmacology and tissue engineering to cardiovascular disease, Professor Dusting is eager to direct his skills to the prevention and treatment of eye disease.

"I intend to focus on two simple concepts - protection and regeneration," Professor Dust-ing said. "We know that cell damage in the eye can lead

Leading pharmacologist joins CERA

CERA honours eye health campaigner

CERA has welcomed Professor Dusting as its inaugural Executive Director of Research.

to a number of diseases including glau-coma and age-related macular degenera-tion. Our question is - how can we protect these cells from damage?"

"Our other important focus will be stem cells. Harnessing the power of stem cells and the body's ability to regenerate tissue will be central to stopping the progression of degenerative eye diseases and restoring sight." Professor Dusting is a Principal Research Fellow of the National Health & Medical Research Council and a Professor of Pharmacology and Surgery at the University of Melbourne. The appointment will be partly funded by the Eye Research Australia Foundation and the Ansell Ophthalmology Foundation.

David also chaired the Lions Eye Health Program and was a founding member on the CERA Board of Directors. His retirement concludes over 20 years of service to CERA and vision related causes. Established in 1991 as the Lions Eye Bank Melbourne, the Lions Eye Donation Service provides donor corneas to patients who have sight-threatening conditions and require a corneal transplant. CERA founder Professor Hugh Taylor said that during his 20 year tenure, David had shown exceptional commitment to CERA and the Service. “As an astute solicitor, David brought invalu-able legal expertise and wisdom to his posi-tions. He was always ready to provide advice and never failed to answer a call for help," Professor Taylor said. “The Service has helped to restore the sight of thousands of Australians.”

“Today, it supplies eye tissue for around 500 transplants annually and recently celebrated its 10,000th corneal donation. All of this has been achieved without any government funding." “David leaves the Service in a very strong position to continue its vital work.” David’s passion for eye research has been instrumental in generating more than $3 million from the Victorian Lions Foundation to support CERA and the University of Melbourne Department of Ophthalmology.

He is a founding member of the Frankston Lions Club and is approaching 50 years of Lions service.

This month, CERA farewells Lions Eye Donation Service Chair David Welsh AM.

News November 2011 5Vision

An example of a healthy retina.

CERA and its commercial partner, Medalytix, have launched a pioneering computer algorithm, iGradingCVD.

The iGradingCVD analyses changes in the eye to determine an individual's cardiovascular disease risk, years before symptoms arise. The technology uses automated retinal imaging analysis to predict a person's risk of developing diseases such as heart disease and stroke. CERA Operations Manager Dr Khay-Lin Teoh said that the current method of determining cardiovascular disease risk requires clinical expertise, and is invasive, costly, and time consuming. "Doctors look at many factors to assess a patient's risk of having a heart attack or stroke, including age, blood pressure, blood lipid levels, weight and individual and family medical history," Dr Teoh said.

"Through iGradingCVD, we aim to provide a simple, automated and non-invasive way to predict cardiovascular risk that is as effective as traditional screening methods," he said.

"Traditional screening methods are costly and time consuming when applied to a large population. If implemented, we predict the technology could lead to huge savings for the healthcare system."

CERA Principal Investigator Professor Tien Wong and his team developed the technology by analysing images and diagnostic informa-tion relating to more than 25,000 people. The iGradingCVD program recently won the National Health Service's Smart Solutions for Healthcare Competition in the UK. The iGradingCVD will initially be trialled by the UK’s National Health Service. Information will be collated and analysed to determine the feasibility of rolling out iGradingCVD in optometrist clinics across the United Kingdom.

Once implemented researchers hope to build a case for support to introduce the technology in Australia.

Pioneering disease prediction technology launched

6 Centre for Eye Research Australia

"Many people will never have access to eye care so they often go blind at a relatively young age and die blind. It's tragic. " "Having the opportunity to help this community and seeing people's sight restored was amazing. I cried with happiness many times." Eyes for Africa is a cataract project for people living in poverty in rural Ethiopia.

Photo by Ellen Smith.

Professor Hugh Taylor AC.

A vision for Africa’s poor Elizabeth Glatz has just returned from Africa on a trip she describes as “the experience of a liftetime.”

The CERA orthoptist joined other medical professionals traveling to a remote Ethiopian village where they provided free operations for people with eye disease.

"The town we visited, Mizan Teferi, is very isolated, the closest eye care facility

being more than 200km away via a dirt road," Elizabeth said.

"The conditions the people live in - harsh sunlight, poor hygiene and the absence of accessible medical care - contribute to the high rate of eye health issues in this commu-nity," she said. Elizabeth and the team were representing Eyes

for Africa, a project that aims to restore sight to impoverished Ethiopians. "Cataract was the most common condition we saw but we also treated bacterial infections like trachoma." Elizabeth says one of her fondest memories is of a woman who had been blind for many years and was completely reliant on her family for her care. "This patient had advanced cataracts in both eyes - something rarely seen in Australia" Elizabeth said. "After the surgery to remove the cataracts, we took off her bandages and the look on her face was priceless." "With a huge smile she raised her hands up to the sky and thanked God. It was the first time she'd seen anything in years." According to Elizabeth, it's common for people in poor, remote communities to go blind from conditions which are easily treated in Australia.

News in briefLaureate Professor appointment for CERA founder

CERA founder Professor Hugh Taylor AC has been appointed as a Melbourne Laureate Professor for his work in ophthalmology. CERA Managing Director Professor Jonathan Crowston said the appointment is testament to Professor Taylor's dedication to eye health, disease prevention and achieving Indigenous health equality. "The Melbourne Laureate Professorship represents a significant honour and the appointments are limited to distinguished professors, including Nobel Laureates," Professor Crowston said. "Professor Taylor's appointment is one of only ten such appointments in Melbourne and

the first of its kind in the field of ophthalmology," he said. "CERA and its staff congratulate Professor Taylor on his new appointment and on his outstanding career." Professor Hugh Taylor founded CERA in 1996 and served as its managing director for eleven years. He currently holds the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne.

"Many people will never have access to eye care so they often go blind at a relatively young age and die blind. It's tragic. " "Having the opportunity to help this community and seeing people's sight restored was amazing. I cried with happiness many times." Eyes for Africa is a cataract project for people living in poverty in rural Ethiopia.

The Governor of Victoria and CERA Managing Director Professor Jonathan Crowston.

News November 2011 Vision 7

The CERA orthoptist joined other medical professionals traveling to a remote Ethiopian village where they provided free operations for people with eye disease.

"The town we visited, Mizan Teferi, is very isolated, the closest eye care facility

being more than 200km away via a dirt road," Elizabeth said.

"The conditions the people live in - harsh sunlight, poor hygiene and the absence of accessible medical care - contribute to the high rate of eye health issues in this commu-nity," she said. Elizabeth and the team were representing Eyes

for Africa, a project that aims to restore sight to impoverished Ethiopians.

"Cataract was the most common condition we saw but we also treated bacterial infections like trachoma."

Elizabeth says one of her fondest memories is of a woman who had been blind for many years and was completely reliant on her family for her care.

"This patient had advanced cataracts in both eyes - something rarely seen in Australia" Elizabeth said.

"After the surgery to remove the cataracts, we took off her bandages and the look on her face was priceless."

"With a huge smile she raised her hands up to the sky and thanked God. It was the first time she'd seen anything in years."

According to Elizabeth, it's common for people in poor, remote communities to go blind from conditions which are easily treated in Australia.

News in brief (contd)

CERA founder Professor Hugh Taylor AC has been appointed as a Melbourne Laureate Professor for his work in ophthalmology. CERA Managing Director Professor Jonathan Crowston said the appointment is testament to Professor Taylor's dedication to eye health, disease prevention and achieving Indigenous health equality. "The Melbourne Laureate Professorship represents a significant honour and the appointments are limited to distinguished professors, including Nobel Laureates," Professor Crowston said. "Professor Taylor's appointment is one of only ten such appointments in Melbourne and

CERA is honoured to announce the Governor of Victoria, the Honourable Alex Chernov AO QC as its Patron. The patronage continues the support CERA has enjoyed under previous governors, John Landy and Professor David de Kretser. Speaking at CERA's 2011 Gerard Crock

the first of its kind in the field of ophthalmology," he said. "CERA and its staff congratulate Professor Taylor on his new appointment and on his outstanding career." Professor Hugh Taylor founded CERA in 1996 and served as its managing director for eleven years. He currently holds the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne.

Lecture, the Governor commented on his interest in the mechanics of the eye and the importance of sight. "The intricacies and complexities of the human eye have always been a fascination to just about everyone," the Governor said. "One intriguing aspect to a layman is its funda-mental importance to human functionality - its elaborate mechanisms give us the privilege of vision, the ability to differentiate colours and perceive depth," he said. "Sadly, those without sight are deprived of this experience." The Honourable Alex Chernov, AO, QC is the current Governor of Victoria. He has a distin-guished legal career and a long association with the University of Melbourne.

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The Governor of Victoria and CERA Managing Director Professor Jonathan Crowston.

News in brief (contd)

Victorian Governor announced as CERA patron

For more information about CERA’s bequest program or for a copy of our bequest information brochure, please contact 03 9929 8426 or visit www.cera.org.au.

Royal Victorian Eye and Ear HospitalLevel 1, 32 Gisborne Street, East Melbourne VIC 3002Telephone: 1300 737 757 Email: cera-info@unimelb.edu.au

www.cera.org.au

Making a differencebeyond a lifetimeJane Borton has always supported medical research. But it wasn't until her vision was threatened by age-related macular degeneration (AMD), that her interest in eye research was ignited. Diagnosed with the wet form of the disease in 2001, Jane lost the central vision in her right eye and her outlook was bleak. At the time there were no effective treatments for the disease, which is usually characterised by rapid vision loss. Jane's prognosis improved dramatically however with the introduction of Lucentis, a drug trialled by CERA researchers, that slows and in some cases, stops, vision loss in patients with wet AMD. Jane has been receiving injections of the drug since it became available in 2007. She continues to receive injections every four weeks. "I've noticed a tremendous difference. Before the injections, my vision was very poor and I was on the brink of losing the central vision in my left eye completely," Jane said.

In planning her will, Jane wanted to give something back to the research community that changed her life. "Research is so important. And the more money that can be invested in research, the quicker we'll find a cure," Jane said.

Jane has chosen to support a PhD scholarship or a Research Fellowship within the Macular Research Unit at CERA. "It's great to think the research resulting from my bequest could benefit members of my family and others for generations to come," she said. "I would strongly encourage anyone thinking about leaving a bequest to research to do so."