The year 2021 in hindSIGHT

Dr Maria Cabrera-Aguas chats with Prof Stephanie Watson, a corneal specialist and the head of the Corneal Research Group at the University of Sydney, Save Sight Institute, and the Head of the Corneal Unit at the Sydney Eye Hospital about the lessons dealing with the COVID-19 pandemic in our research group in 2021, and the challenges for corneal research and our research projects for 2022.

Interested in joining the Keratoconus and/or Dry eye registries? 

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The Transcript is available in the 'Transcript' tab on this page.
  
Don't forget to listen to our previous episodes -->
Ep8: The first international dry eye registry 
Ep7: The link between dry eye and breast cancer treatment
Ep6: Quality-of-life questionnaire in keratoconus
Ep5: A glimpse on a new technology for corneal surgery
Ep4: Eye injury registry
Ep3: Herpes Simplex Keratitis
Ep2: Antimicrobial resistance in corneal infections
Ep1: Corneal infection and contact lenses

Connect with us using #Sydeyepod

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• Instagram: @drmaria.cabrera 
• LinkedIn: https://www.linkedin.com/in/maria-cabrera-aguas/

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Transcript

Maria Cabrera (MC): I am glad that you are with me in the last episode of the Sydney Eye Podcast in 2021. In this episode, I will give a review of the year, what guests we had, what topics we discussed and what achievements we had in our research group and our plans for 2022. I will also chat with Prof Stephanie Watson, a corneal specialist and the head of the Corneal Research Group at the University of Sydney, Save Sight Institute, and the Head of the Corneal Unit at the Sydney Eye Hospital about the lessons from 2021 and the challenges for 2022.

 I am Maria Cabrera-Aguas. A Postdoc Researcher at the University of Sydney, Save Sight Institute. Welcome to the Sydney Eye podcast!

 Before we kick off our episode today, I want to say that I am very grateful to you for the amazing engagement that we have had in the last year. I released the first episode of this podcast in December 2020 as part of my Science Communication Fellowship from the Association for Research in Vision and Ophthalmology (ARVO). This organisation is the largest and most respected eye and vision research organization in the world with nearly 11,000 members from over 75 countries. This podcast was commended as an outstanding outreach event. 

 Please, keep sharing this podcast with family, friends, and colleagues and don’t forget to review the podcast or engage with us on Twitter or Instagram or send us an email to sydeyepodcast@gmail.com. 

 You can also subscribe to this podcast by clicking on subscribe and receive a notification when a new episode is released. You can find us on Spotify, Apple Podcasts, Google Podcasts, Stitcher and YouTube. 

 In the first episode of this podcast, I talked to Prof Stephanie Watson, about corneal infections. We talked about that this happens more in people wearing contact lenses, caused by a bacterium called “Pseudomonas aeruginosa”. Other causes are eye trauma, prior eye surgery and history of dry eye or blepharitis. Symptoms include red and sore eye, blurring vision, sensitivity to light, tearing, or discharge. You can also see an ulcer in your cornea and complications include loss of vision, scarring, infection of the whole eye, which is called endophthalmitis, corneal perforation or even the loss of the eye in severe cases. 

In another episode, we I again talked to Prof Stephanie Watson about corneal infections but caused by a virus called herpes simplex. It is one of the main causes of blindness in developed countries and individuals usually get it in the childhood but only 1% develop ocular infections. Children or adults can have this infection and it usually presents with a red eye associated with cold sores on the lips. If you also present pain in the eye or loss of vision, please see an eye doctor immediately. Recurrent episodes may cause scarring on the cornea leading to blindness. Check out our episode on this topic to learn how to prevent recurrent episodes.

I also talked in another episode about antimicrobial resistance in eye infections. This happens when a bacteria, virus, fungi, or parasites develop resistance to antibiotics that were commonly used to treat them. Some causes of this are overuse of antibiotics, incorrect antibiotic prescribing by clinicians, and lack of hygiene and infection control. The World Health Organisation has recommended surveillance programs to monitor antimicrobial resistance. Our research group established a surveillance program in 2016 which has reported that most of the patients with bacterial corneal infections are still susceptible to the most common antibiotics. On a positive note our group was awarded a grant from the Ophthalmic Research Institute of Australia to expand this program across Australia in 2022.

I also talked to Annette Hoskin a PhD student from our research group who has been working on an online eye trauma registry to document when and where eye injuries happen, and to better understand how those eye injuries are managed and can be prevented. From an initial analysis, Annette told us that boys are more likely to suffer an eye injury when playing sports due to the risk of collision with other players. Sports with more risk of eye injuries are basketball, squash, badminton, rugby and football. On the other hand, falls are the main mechanism of injury in elder women. Prevention strategies include hazard elimination, use of protection glasses and education related to falls in the elderly population.  

In another episode, I talked to another of our PhDs students, Dr Jackie Tan about his project on a new surgical technique where a patch is stuck very strongly to the cornea upon laser activation, sealing full thickness corneal wounds up to 6 mm in size with possible applications in closing leaking, penetrating corneal wounds after routine cataract surgeries, closing traumatic corneal lacerations from battlefield injuries and replacing sutures during corneal transplantations. 

I also talked to Dr Himal Kandel about keratoconus in another episode and with  Dr Pauline Khoo about dry eye disease. Keratoconus is an eye condition in which the cornea has a cone-like shape as a result of thinning of the cornea. Normally it is diagnosed in the adolescence and is progressive until the age of 40. In early stages, glasses or contact lenses can correct the distortion in vision and surgeries such as crosslinking or corneal transplantation may be needed in severe cases. The progression of the disease and its treatments affect the quality of life of the patient. The Keratoconus Outcomes Research Questionnaire has been used to measure quality of life in patients with keratoconus. It is a short and self-administered questionnaire available in clinics enrolled in the Save Sight Keratoconus registry for example Sydney Eye Hospital. 

Dry eye disease is a common condition that happens when your tears are not able to lubricate your eyes. It occurs more in women and in advancing age, when you have inflammation of the eye lids, prolonged computer use, or systemic diseases such as Sjogren syndrome, lupus, rheumatoid arthritis, or use of medications for high blood pressure, depression, allergies or for hormone replacement among others. 

I also talked to them about the keratoconus and dry eye registries. These registries are part of The Save Sight Registries which is one of the most advanced ophthalmic registries in the world. The Save Sight Dry Eye Registry will allow clinicians to enter information into the registry for example the treatments used, individual patient-reported outcomes and adverse reactions. This information will have positive outcomes for patients, clinicians, government health institutions and industry. Specifically in the case of dry eye, because usually once drugs are approved for treatment, there is usually no post-market surveillance

 If you are an eye health professional and would like to enrol in the keratoconus or dry eye registry, please request access into savesightregistries.org or send us a email and our staff will contact you. 

More on our year in review up next…

Now, let’s welcome Prof Watson, a corneal specialist and the head of the Corneal Research Group at the University of Sydney, Save Sight Institute, and the Head of the Corneal Unit at the Sydney Eye Hospital. Today, we are going to chat about lessons we learnt in 2021 and the challenges ahead for 2022.

MC: Thank you, Stephanie for join joining me again in the show today. Welcome again!

Stephanie Watson (SW): Thank you, Maria. Glad to be here

MC: Well, it is incredible how fast this year passed by and I suppose to move forward to next year, it is important to stop and reflect on what we learnt this year. Of course, we need to talk about the COVID-19 pandemic and the restrictions we faced here in Sydney this year and the restrictions we carried from 2020. So I wanted to ask you, what were the challenges you think we had as a research group and how we dealt with them?

SW: Look, yeah, there was a number of challenges, I think finding new ways to work because we spent a lot of time in lockdown. But we still had important sort of research work that we wanted to do. Uh, and you know people around the world are still losing sight from corneal blindness. So we wanted to really continue to publish our work and to find new answers. We found ourselves moving more to online in terms of meetings, but also webinars, meeting other groups across the globe. That maybe became a little bit easier. Yeah. 

MC: Yeah, actually, that's true, because we we had, for example, the Keraclub, because before we had face to face at the institute and now we move it to to a webinar, no? So what? What was your thought about it? 

SW: Yes, but we had about over 300 people registering for the Keraclub and they came from all across Australia. When we did Keraclub in person, we'd have about 30 people that would turn up on the night. I mean, it was nice to see people and meet and chat, but grab to reach a far larger audience this year using the Webinar. Next year we think we might do a hybrid so you could have some people still in the webinar and others still able to meet in person. 

MC: Yeah, that that that was a really exciting project with the Keraclub. So I suppose for next year we're gonna do something similar for dry eye for the dry eye registry? 

SW: Yeah, that's been something I'm looking forward to planning for a while is to have a group or discussion chat for patients with dry eye to have, you know, our researchers and clinicians given a little bit of an update on the latest research, what's available and provide a little bit support because it is a condition that causes a lot of suffering around the globe.

MC: Yeah, we also, um well, we started with this podcast as a project for my ARVO science Communication Fellowship. And then I'm very grateful for your support when we started the episodes last year, and then we continued with the other projects this year, so that was really exciting to to look, to keep doing this. So also as a recap for for our audience, what projects were we able to complete this year? 

SW: Yeah, we had a couple of exciting projects, one which I just mentioned, which has been the dry eye registry. This is a global registry able to collect information on patients with dry eye and their outcomes from everyday practise. So normally, when you see a clinician and they write their notes paper notes on a computer, and that's where they stay in their use to manage the patient. But with with our registry were able to facilitate clinicians actually putting that data into something useful, something that they can use for their own audit and something we can use to answer key questions that remain unanswered in dry eye, such as What's the natural history, which treatments are better Also, what benefits are there of the treatments to patients, because the registry collects patient reported outcomes. Some other wins this year have been with our Keratoconus Registry. We've been able to find out the best ways to collect patient reported outcomes so we can see the benefits of treatment. We've also published on the best way to perform treatments such as corneal cross linking in adult and paediatric age groups. We've done further work looking at the natural history of Keratoconus. This is important because it sounds simple. It sounds, well, what does happen in a condition, But people might assume that that's well known. But it's not for all conditions, and it's not for keratoconus. Patients with keratoconus, if their eyes are getting worse, you can have a procedure called Cross linking. But without knowing who's going to get worse, it's hard to say who needs the treatment.

MC: Well, that's true. We have advanced so much with the keratoconus, and now with the dry eye registry. So, what do you think were the achievements for this year in our group? Apart from completing, these two projects.

SW: We also got some really exciting working corneal infection and the students who have been supervising. So we've been working on herpes simplex and finding out whether the clinicians are treating patients as they should be, according to the guidelines we wrote a few years ago and providing clinicians information on corneal infection. And Maria, that's something you have been quite involved in and leading, which has been great. And that's because many eyes are still lost from infection. One of our recent publications has just come out documents, eyes that have been the lost due to infection in order to sort of highlight whether we can do things better to stop it happening.

 MC: Yeah, that's true. I've been very involved in the herpes simplex keratitis guidelines and in the microbial keratitis, in the BOSS, uh, surveillance programme for antimicrobial resistance. And particularly, we got an invitation from from a university in Colombia to talk about it. And then we are kind of expanding the guidelines internationally so that that was very exciting as well. And also, um, well, this podcast, it was well received from in ARVO. Yeah, they really like it. And And it was an incentive to keep going.

SW: Yeah, very popular at ARVO, uh, you know, being here, we also had some ARVO webinars on stem cells, and that was great to put together. So we have been working closely with ARVO this year, and I'm pleased to support their advocacy efforts, as their chair of the Advocacy and Outreach Committee. Um, they do a lot of good work for eye research.

MC: Well, we're almost getting into two years into the pandemic. How do you think I Research has changed during this time?

Look, I think there's probably been some changes for the for the good and then some changes for the worse. I think it's been much harder to get laboratory, it's been much harder to get laboratory work done because of the lockdown. We've been locked out of the labs for a large time now, and it's hard to get continuity of projects when the labs keep opening and shutting. But I hope we passed that. In terms of good things, there's probably been increased connectivity internationally because it's much easier to arrange meetings at different time zones at the moment, which used to just happen at conferences, so less travel means more work being done on the ground. But sadly, there's also been a little bit less, Uh, well, I guess, uh, we're not collaboration, but just meeting of the minds and and people getting together to share ideas, Uh, in sort of more informal settings that might help eye research. 

MC: Yeah, that that's true because we've been in quite a few conferences this year. Well, virtual because we weren't able to to leave the country. But then when you are not there in person, it's really hard to keep up with the timing zone for us here in Australia. So it's a shame. So looking forward to maybe travelling this next year, Yeah, yeah, for example, what changes do you think it will remain going forward from all this from the pandemic?

SW: I think there will always be this use of the online forum for meetings. Uh, not necessarily conferences, but particularly for arranging research collaborations. I think that people will be more interested in collecting data to understand diseases I think people have moved toward. It's been moving that way with the use of artificial intelligence, but people have spent a lot more time working on the data they got from their research when they couldn't get into the labs. Um and, um, I think it's also given us time to stop and pause and recognise how important our own health is and how important the health of everyone is and why we need to continue our work to save sight

MC: Yeah, because mainly the researchers have been focused on, of course, Covid 19 pandemic. But then we cannot forget the other diseases.

SW: Yeah,

MC: and then, yeah, also, what do you think are the trends in corneal research for next year? Like, kind of focus on disease prevention, treatment or, as you said, artificial intelligence? Maybe

SW: Yeah, look particularly in terms of trauma. I mean, 90% of trauma, um, more than 80% of eye diseases. Sorry is preventable. And eye trauma is the leading cause of corneal infection and corneal scarring. And so that's an area that really needs more done with prevention. And some of our research has been looking at what's happening internationally in terms of eye trauma. We've written about potential injuries from fireworks during celebrations, and we're using a platform called IGates, which is an international registry to collect data to find out more about how we can prevent trauma. We also need to ensure that treatment is correct. So once treatments get through randomised trials, they then go into the clinic and then when they're in the clinic, they used in different ways and we don't always know the outcomes. And so I think registries and um and then using the data from the registries to form guidelines for be an important part of how we improved care in the future. Artificial intelligence has been growing, and there's increasing opportunities to use it for diagnosing conditions and understanding the natural history of disease. Um, also, people are interested very much in regenerating the cornea in using stem cells to find new ways to do things. And one way we may achieve that is through nano medicine. And I've been involved in recent initiatives where we're looking at how we can actually use nano biotechnology to harness the potential of stem cells to treat corneal disease, which is pretty exciting.

MC: Wow, that that sounds very futuristic with the nanotechnology. So, uh, so what are your projects in the store for next year? For for the group. 

SW: Yes. So next year Look, I think it's going to be a great year. I think we really managed to keep things going despite all the challenges, and were sort of ready to really launch further into what we build the base of over the last two years. And that's improving outcomes for people with corneal disease broadly speaking. We're going to have natural national surveillance data for corneal infection. We're going to have really great data from our registries that will inform natural history and treatments and treatment outcomes, and some of that data will be able to use for artificial intelligence. We are going to continue our work with stem cells and with nano biotechnology, and I think that could lead to really exciting new ideas for further investigation. But most importantly, we're going to continue to train and teach the next generation of our researchers. Um, Maria, you've been supervising some students recently as well, and you probably recognise the importance of building up those skills so they can go on and continue with the eye research after we are gone. But I’ll be gone sooner than you.

MC: Yeah, uh, it's a great experience supervising other students now, with the dry registry with the herpes simplex keratitis audit. So it's a great skill to build over the years, for sure. So and finally, um, now that we're getting into the Australian summer, do you have any advice for our audience and how to look after their their eye health during the Christmas period and the Australian summer?

SW: Yes, I think they have to look out for sun and sand and so sunglasses, wear them as much as you can when you're outside and the wraparound sunglasses the best because they will keep the wind off to stop drying, keep sand out of your eyes and protect your eyes from the sun. Look, sometimes at Christmas time, people can think that they're ready to do a lot of their DIY around the house. We've found eye injuries can occur with that. So remember to wear your protective eyewear, whether whenever you're going to be doing something that might risk your eyesight. Um, and contact lenses don't leave them for too long, and best not just swimming in them. That way you will reduce the risk of getting an infection. 

MC: Yeah, well said, because people are wearing more and more contact lenses, and sometimes they forget to take them off when swimming or something like that.

SW: Yeah, yeah. That's right. I always say it's important to have a good pair of glasses. I mean, people, sometimes they get infections. Don't actually own glasses. So as well as the contact lenses, you know, have a nice pair of glasses with nice frame. So you feel like you wear them. 

MC: Exactly. So Well, thank you, Stephanie again to join joining me in the show after some months. The last time was in March, but then it has been an exciting journey this year with the Sydney Eye podcast and looking forward to continuing next year. So we wish all the audience a good Christmas break. And then for sure, we'll see you next year, Stephanie.

SW: And thanks again, Maria. It's been great. I've been listening to the podcast this year, and I think it's been really great. And I wish everyone a happy holidays. 

MC: Thank you so much. 

SW: Thank you.

Before I closing this episode, I would like to congratulate Dr Himal Kandel for his Early Career Alumn Award from Flinders University in Adelaide and to Dr Pauline Khoo for completing her PhD. 

 We will come back in January with new episodes on new techniques for treating eye injuries, updates on our registries, clinical trials for conjunctivitis and much more. Please stay tuned!

 I am Maria Cabrera-Aguas, thanks for listening to the Sydney Eye Podcast in 2021. If you haven’t yet subscribed to this podcast you are invited to do so, to receive a notification when a new episode is released. Please, keep sharing this podcast with family, friends, and colleagues.

 If you have any questions, comments or suggestions please send them to sydeyepodcast@gmail.com and connect with us on Twitter @CabreraMarie, it’s C-A-B-R-E-R-A-M-A-R-I-E or @cornealresearch using the hashtag S-Y-D-E-Y-E-P-O-D or on Instagram at drmaria.cabrera.  

 Will see you next time. Have a good one! Bye