WRITER Alan Saks

Challenged with a confronting topic, Rachel Callander (Perth), speaker, author, and artist, delivered an impactful RANZCO opening talk titled, ‘Seeing beyond sight: The power of language in patient-centred ophthalmic care’.

Ms Callander described the shock of discovering that her late daughter Evie was born with a rare genetic condition that doctors said was “incompatible with life”.

Over the ensuing two and a half challenging and traumatic years, doctors and bureaucrats continued to use complex medical jargon. Words like ‘retarded’, ‘abnormal’, ‘mutated’, ‘defective’ and ‘dysmorphic’ made her shut down and she frequently experienced feelings of hopelessness.

When asked in public “what’s wrong with your child”, she tried to explain using some of the complex jargon. People stared blankly at her and walked away. Ms Callander subsequently learned to tell people that her daughter had ‘superpowers’. This helped change attitudes and encouraged people to look at her daughter through a more positive lens. People saw a human – not a child with genetic abnormalities – and gained a bigger vision of humanity.

She subsequently published books – Super power baby project, and a follow-up Super power kids – featuring her own art and photos, along with considerate images of other children with genetic problems, to support other families in her situation and educate medical people and bureaucrats. Ms Callander reminded the audience of how important it is to consider the words we use; and to avoid destructive, patronising and confusing jargon. Focus on informing and empowering with softer language and terminology, and kind, respectful, honest and compassionate behaviour.

FRED HOLLOWS LECTURE

Dr Sandra Staffieri AO, (Melbourne), a clinical and research orthoptist with 40 years’ experience in paediatric ophthalmology, followed, delivering the Fred Hollows lecture, ‘Retinoblastoma awareness in Oceania – An odyssey’.

In his fight against trachoma, Prof Hollows promoted the importance of simple, clear messaging like “Clean faces, Strong eyes” and “It’s obscene to let people go blind when they don’t have to”; the latter a mantra she holds dear.

Dr Staffieri’s chosen topic was retinoblastoma, which is unfortunately, still regarded as ‘too rare’ for population-based screening: 25 children are diagnosed with the disease across the Australia/New Zealand region per year.

With timely diagnosis and access to treatment, retinoblastoma is the most survivable of all childhood cancers. She described retinoblastoma classification, staging and treatment strategies and said that with early detection, there’s a chance to save lives, eyes and sight, but as it advances through the stages, the chances of doing so lessen. She detailed management strategies, including intraocular treatment with focal therapy, laser, cryotherapy and intravitreal topotecan, adding chemotherapy as it advances, and in later stages enucleation with adjuvant chemotherapy is effectively curative. In the final extraocular stages, multimodal chemotherapy and radiation are used.

Dr Staffieri stressed that in all cases of strabismus, a cause must be determined to rule out retinoblastoma. There are strong drives for public education about retinoblastoma, strabismus, leukocoria and the red reflex. In some cases, patients presenting with retinoblastoma have multiple family photos where images show obvious leukocoria over the years, that were not acted on due to lack of knowledge and understanding. Studies in Oceania and further afield confirm the importance of raising awareness of retinoblastoma. Nearly 100% survival rates in affluent areas reduce to 50% in low-income areas. In Papua New Guinea, 87% of retinoblastoma patients die.

In closing, Dr Staffieri stated that “Every child’s eye could save their life”.

SUSTAINABILITY

Sustainability was a strong theme throughout RANZCO, as evidenced by the lack of congress satchels and printed programs, along with catering tweaks. It was also discussed in numerous sessions.

Dr Michael Loughnan (Melbourne) demonstrated that bagged surgical waste from one surgeon in one year, would fill a field. Solutions to this vast amount of waste include reusable tonometer tips, which are as safe as disposable versions. Additionally, he suggested avoiding unnecessary/excessive use of personal protective equipment, using multidose medications, minimising surgical packs/drapes, reusing as many items as possible, and avoiding post-op antibiotics. For more ideas, refer to the RANZCO Sustainable Practice Guide.1

Dr Sarah Welch (New Zealand) detailed initiatives that encourage clinics to reduce environmental impact. A clinic that developed a totally paperless, digitally integrated system reduced total carbon emissions by 74.25 kg CO2 per year. She also illustrated how reducing unnecessary and unused items from surgical packs can save half a million dollars.

A NEW DAY DAWNS

The Sunday plenary sessions kicked off with Associate Professor Andrea Vincent, New Zealand’s first molecular ophthalmologist clinician-scientist. She delivered the Dame Ida Mann memorial lecture, ‘Navigating the genetic basis for eye disease in Māori and Pacific peoples – a journey through Polynesia’.

Assoc Prof Vincent observed how far we have come since Dame Ida, who in her 1937 textbook, Developmental abnormalities of the eye, stated that “It remains now only to consider the problems of genetics, possibly the most important of all, in their relation to anomalies”. Dame Ida’s foresight and expertise was again evidenced in a 1966 text, Culture, race, climate, and eye disease, an introduction to the study of geographical ophthalmology, which had a strong influence on Assoc Prof Vincent’s chosen speciality.

She went on to detail the migratory pathways and genetic influences on NZ Māori, citing Dr Oliver Sacks’ book The island of the colourblind, explaining how genetic drift and the founder effect led to the concentration of achromatopsia (CNGB3) among the Pingalepese.

Assoc Prof Vincent discussed inherited retinal disease (retinal dystrophy/optic atrophy) among Māori as well as ectopia lentis and other genetic conditions, complex DNA and protein level genetics. The different migratory subsets among Māori populations were also detailed, as was ethnicity, geographical area, common variants in cases, phenotype-genotype variability, and implementation of targeted diagnostic and therapeutic strategies. Advanced disease at presentation emphasises the need for earlier diagnosis and regular review.

OCULAR ONCOLOGY

Next up, Professor Mandeep Sagoo (United Kingdom) delivered ‘Ocular oncology in the digital age – from telemedicine to 3D printed ocular prosthetics’. In 2021, he led the clinical team that fitted a world-first digitally engineered, three-dimensional printed ocular prosthetic for a patient. He reiterated that the goal in ocular oncology is to save the patient’s life, save the eye, and then to save vision. He elaborated on multimodal imaging to distinguish small melanoma from naevus, virtual clinics, artificial intelligence (AI), large language models (LLMs) and international registries. Numerous other speakers throughout RANZCO 2025 detailed the evolving use of AI and LLMs in their respective specialities.

Prof Sagoo compared TFSOM and MOLES systems for melanoma diagnosis:

TFSOM

Thickness

Fluid

Symptoms

Orange pigment,

Melanoma (hollow on ultrasound)

Heidelberg Engineering’s stand celebrated retiring ophthalmologist Dr Bruce Munro from Geelong, who at the young age of 75, purchased his first SPECTRALIS OCT, and a few years later, acquired the ANTERION. In 2024, he upgraded once again to Heidelberg’s latest technology, the SPECTRALIS SHIFT. A second painting acknowledged Heidelberg's contribution to monitoring the eye health of astronauts on the International Space Station. Artwork by Damian Cazaly.

MOLES The main advantage of the MOLES scoring system is that it can be used by non-experts (and experts alike) to estimate the likelihood of malignancy.

Mushroom shape

Orange pigment

Large size

Enlargement

Subretinal fluid

Various studies demonstrate near 100% accuracy of such models. Evolving AI and LLMs are improving levels of detection and survival prediction but are not yet up to the standard of expert humans. He presented current and evolving treatment options for the various stages of uveal melanoma. Despite progress, enucleation is still required in some cases of melanoma/retinoblastoma: The process and detail, including the 3D prosthesis project, can be seen in the referenced video.2

The day’s proceedings closed with a social sunset poster session, film festival, and prize giving.

MONDAY PLENARIES

Professor Celia Chen (Adelaide), opened the Monday plenary talks, presenting the Council Lecture, ‘Central retinal artery occlusion: What’s new? Evidence from updated meta-analysis’.

Central retinal artery occlusion (CRAO) presents as painless monocular visual loss with an incidence of 1/100,000 per year. She detailed the spectrum of acute retinal ischaemia and its pathogenesis, being thromboembolic, arteritic and transient, and discussed cilioretinal artery sparing/involving.

CRAO is a condition not to be trivialised; the mortality rate is 56% versus 27% for age-matched controls. Life expectancy is 5.5 years and 15.4 years, respectively.4 Management of acute CRAO includes early reperfusion strategies, treatment of local ocular complications, and management of systemic vascular risk factors. Although various strategies have been tried, Prof Chen noted they did not have much effect on outcomes. That said, she reported higher recovery rates with the thrombolytic agent alteplase, and earlier treatment. As with any stroke, the earlier it is treated, the better. In cases of non-arteritic CRAO, if there are no systemic contraindications, intravenous (IV) thrombolysis and/ or IV tissue plasminogen activator (tPA) should be considered within 4.5 hours. For IV thrombolysis, a patient should be seen at a capable stroke centre within six hours from onset for potential intra-arterial tPA. Urgent action is essential, and the stars need to align to tick all boxes. Awareness of the FAST acronym is essential:

Face (drooping)

Arm (weakness)

Speech (difficulty)

Time (call emergency services).

ENDOSCOPE AND THE ORBIT

Prof Dinesh Selva (Adelaide) delivered the Norman McAlister Gregg Lecture, ‘To the orbit and beyond: The story of the endoscope and the orbit’. In this ‘eye-opening’ talk, he explained transorbital neuroendoscopic surgery (TONES), endonasal endoscopic approaches to the orbit, and the transorbital endoscopic approach.

By its nature, surgery in general has an evidence gap with <10% of surgical procedures evaluated by high-quality randomised control trials.

Prof Selva described a history of evolving procedures since the so-called transorbital ‘ice pick’ lobotomy, first performed in 1937 in Italy by Amarro Fiamberti. This was adapted and popularised in the USA from 1946 by Walter Freeman II, who inserted an orbitoclast (ice pick-like instrument) via the orbital roof to sever frontal lobe connections. It was a rapid procedure with no operating theatre/ anaesthesia. The emergence of Thorazine and surgical complications saw to its demise, but it was, nevertheless, pioneering surgery.

Cadaveric dissections confirmed access to the anterior and middle cranial fossae, cavernous sinus, and Meckel's cave, post fossa.

An increasing number of peer-reviewed studies have now been published: From 2010-2024 TONES reviews went from zero to over 35, and studies on endonasal endoscopic surgery of the orbit went from zero in 1999 to over 60 studies by 2025.

The Australian Vision Research Plenary session covered a variety of topics including MIGs, visual field testing, novel peptide-based glaucoma treatment, and Save Sight Registry outcomes. Additionally, we heard about the value of RETFound – a Moorfield’s developed AI-driven retinal foundation model trained on 1.6 million retinal images – and its application to an Australian Aboriginal population.

A session on ‘Global frontiers in AI and ophthalmology’ examined aspects of reasoning, LLMs and diagnostics, and AI in diabetes now and in the future. Oculomics, (an emerging field utilising non-invasive imaging to find biomarkers and detect and monitor systemic disease) as well as evolution from in-silico to in-vivo AI deployment in ophthalmology, were also covered.

Delegates and suppliers in the exhibition area and at the poster displays.

IN CLOSING

RANZCO 2025 rounded off with ‘The eye and systemic diseases 2025 update’. Professor Stephanie Watson (Sydney) provided an in-depth presentation on the eye and the skin, covering allergic conjunctivitis and hypersensitivity disorders, atopia, vernal keratoconjunctivitis (rare, but most commonly found in young boys in hot climates), and rosacea. Additionally, she explored ocular surface disease, dry eye, shield ulcers, keratoconus, eye rubbing, corneal grafts and rejection, sclerokeratitis, microbial keratitis, and more. She detailed treatments and side effects (like glaucoma and preservative toxicity) with related ocular discomfort risk as high as 78%.

Using complex case studies, Professor Radhika Tandon (India) discussed peripheral ulcerative keratitis typically associated with systemic disease. Topical and systemic treatments were covered, along with surgical management in complex cases, including full and patch grafts. The complex nature of such cases with multifaceted conditions, high risk behavior, alcoholism, and underlying conditions such as tuberculosis, syphilis, and Sweets syndrome was detailed.

Dr Ngozi Chidi Egboka (Sydney) elaborated on the need for awareness of ocular surface complications from new chemotherapy agents, stressing the need for further evidence from real-world clinical research. She spoke about the ocular surface storm that is created by increasingly powerful anticancer therapies and tabulated the various drugs, discussed the benefit of autologous serum eye drops and provided useful resources.

Dr Nicholas Toalster (Brisbane) addressed the question, ‘Should I change my practice based on the Zoster Eye Disease Study?’. Drawing on the results of the recent Zoster Eye Disease Study (ZEDS), he detailed the myriad complications of herpes zoster ophthalmicus. Overall, it seemed that one year of suppressive valaciclovir had some benefit. In acute herpes zoster ophthalmicus (HZO), carry on as usual with valaciclovir 1 g three times a day for seven days. If ocular disease remains within 12 months, then 1 g daily reduces ocular sequelae and pain duration. The best results occur if treated early. Doctors should still consider topical steroids and discuss vaccination.

In the final talk of RANZCO 2025, Associate Professor Samantha Fraser Bell (Sydney) asked ‘As ophthalmologists, do we need to know about weight loss medications?’. She opened with a quote from Robbie Williams, who had stated on social media that “Fat jabs are making me go blind”. She detailed some of the United States Food and Drug Administration (FDA) approved weight loss/diabetes drugs – that are certainly trendy – and detailed eye-related issues.

Despite being prescribed for weight loss and diabetes, these drugs can potentially increase risk of diabetic retinopathy. In a diabetes control and complications study,5 13.1% of patients in an intensive glucose control group had early worsening of retinopathy versus 7.6% in a conventional treatment group. The worsening occurred at six to twelve months after rapid HbA1c reduction. Close coordination with endocrinologists and GPs – targeting a gradual reduction in hyperglycaemia, with diabetic retinopathy grading before intensive treatment – followed by frequent dilated fundus exams/wide field photography and OCT in high-risk individuals, and prompt treatment of worsening diabetic retinopathy, is advised. Author’s note: The 1998 study was published before glucagon-like peptide-1 (GLP-1) receptor agonists were available to manage type 2 diabetes and obesity. Further studies are needed to confirm the relationship between GLP-1 and DR.

Assoc Prof Fraser Bell detailed non-arteritic anterior ischaemic optic neuropathy (NAION). In a study, over 16,000 patients (with no NAION before treatment), were broken down into Type 2 diabetes (T2D) and overweight/obese groups, then further grouped into NAION with or without GLP-1 drugs. The GLP-1 groups had a higher incidence of NAION: The NAION incidence in the T2D cohort at 36 months was 8.9% (GLP-1) vs 1.8% (not on semaglutide). In the obesity cohort, NAION incidence at 36 months was 6.7% vs 0.8% respectively.6 The use of semaglutide for managing T2D is associated with an increased risk of NAION compared with the use of sodium-glucose co-transporter 2 inhibitors, however, the absolute risk remains low.

RANZCO 2026

The 56th RANZCO Congress took place from 14-17 November. The next opportunity to acquire such world-leading education will be at RANZCO 2026 in Auckland from 6-9 November, at the flagship New Zealand International Convention Centre. With ten renowned keynote speakers already confirmed, this will be a great excuse to visit NZ. See you there!

References
1. RANZCO Sustainable practice guide on reducing waste in cataract surgery. Available at: ranzco.edu/wp-content/uploads/2022/08/RANZCO-Sustainable-Practice-Guide-Reducing-waste-in-cataract-surgery.pdf [accessed Dec 2025].
2. 3D printing in eye tumour treatment. Available at: ted.com/talks/mandeep_sagoo_3d_printing_in_eye_tumour_treatment [accessed Dec 2025].
3. Cohen EJ, Troxel AB, ZEDS Trial Research Group, et al. Low-dose valacyclovir in herpes zoster ophthalmicus: The Zoster eye disease randomized clinical trial. JAMA Ophthalmol. 2025 Apr 1;143(4):269-276. doi: 10.1001/jamaophthalmol.2024.6114.
4. Wang JJ, Cugati S, Mitchell P, et al. Retinal arteriolar emboli and long-term mortality: pooled data analysis from two older populations. Stroke. 2006 Jul;37(7):1833-6. doi: 10.1161/01.STR.0000226929.23297.75.
5. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998 Jul;116(7):874-86. doi: 10.1001/archopht.116.7.874.
6. Hathaway JT, Shah, Hathaway DB, et al. Risk of nonarteritic anterior ischemic optic neuropathy in patients prescribed semaglutide JAMA Ophthalmol. 2024 Aug 1;142(8):732-739. doi: 10.1001/jamaophthalmol.2024.2296.