University of Otago Dunedin School of Medicine Ophthalmology

Research

Ophthalmology has a very active research focus, major current research areas include:

Otago Glaucoma Surgery Outcome Study

The Otago Glaucoma Surgery Outcome Study was developed by Professor Molteno and is the world's longest ongoing follow-up study into surgery for glaucoma. Over 1015 cases of Molteno implant insertion and 1045 cases who had trabeculectomy at Dunedin Hospital since 1977 are being followed to determine their outcomes. The concentration of services in one hospital eye department and the stable population of this relatively isolated region has facilitated comprehensive long-term follow-up of most patients.

This study has focussed on:

  • The development and use of an effective draining implant for glaucoma, particularly previously untreatable cases of severe and complex glaucoma
  • The study of a glaucomatous eye with an implant to investigate the interaction between the glaucoma aqueous from the eye, the implant itself and the patient's tissues.
  • The application of drug regimes developed for use around implants in conventional glaucoma surgery to improve results.

The computerised database of over 2009 operations in the Otago Glaucoma Surgery Outcome Study now provides data for an increasing series of publications aimed at defining the long-term results of glaucoma drainage surgery.

Otago Glaucoma Surgery Outcome Study publications from the last 15 years

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Internet-based medical education

Ophthalmology has an interest in the development of the medical curricula and teaching delivery systems in response to changing educational needs and technological advances.

In 2002 the Postgraduate Diploma in Ophthalmic Basic Sciences was established in response to changed requirements for the FRANZCO. With over 20 years experience teaching ophthalmic basic sciences to Part I candidates for the RANZCO Part I examination, this postgraduate diploma was established. Four of the five papers offered are taught as distance learning papers on the internet while the fourth is taught as a three week residential course in Dunedin (PGDipOphthBS). Candidates must obtain a pass in any 4 of the 5 available papers. This course is now run jointly with the University of Sydney.

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UV photography of the cornea

A technique of ultraviolet (UV) photography of the rabbit cornea with a macro lens was developed in this department by Robert McMullan, Professor Molteno and WJ Sandle in 1991. Subsequently, an apparatus to enable UV macrophotography of the human cornea was built by Mr Giles Wynn-Williams (Department of Medical Physics, Dunedin Hospital) and Professor Molteno. Various human photos were taken over the years, but the intriguing patterns revealed remained unexplained.

In 2003 Dr Sean Every, Professor Anthony Molteno and Dr John Leader (Department of Physiology) further developed this research and UV photographs revealed the absorption prominence in the region of the Hudson-Stahli line and a pattern reminiscent of vortex keratopathy. On this basis the patterns were attributed to the epithelial layer. Sean Every aimed to catalogue absorption patterns of both normal and pathological corneas and to establish their physiological basis.

UV Biomicroscopy of the Cornea Powerpoint Presentation

Corneal iron lines and vortex keratopathies are common corneal phenomena which are considered indirect markers of epithelial cell migration. Because of the ability of UV corneal photography to unmask corneal epithelial iron and its whorl distribution, it was considered this project might be helpful in investigating corneal epithelial cell migration as part of maintenance of the epithelial population.

The current major directions of this research are:

  • UV photography of the normal human cornea
  • UV photography of the pathologic human cornea
  • Physiologic basis of ocular surface absorption lines

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Long-term follow-up of orbital implants

This long-term study is coordinated by Professor Anthony Molteno and follows over 160 cases who have had a bone derived hydroxyapatite orbital implant inserted at Dunedin Hospital since 1977.

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Other research areas

Ophthalmology researchers also combine with the vast expertise base at the University of Otago:

  • falls prevention in the visually impaired elderly in the Falls Prevention Study with the Medicine Department
  • cytology and immunohistochemistry of draining blebs around Molteno implants and trabeculectomies with the Physiology Department
  • the development of mathematical models for optical properties of the senile human lens with the Physics Department
  • Diabetic retinopathy - in particular the effectiveness and outcomes of retinal screening with the Edgar National Centre for Diabetes Research

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Recent research grants

  • 2014 Lotteries Health Translational Research Project Grant
    $94,283 for the Otago Glaucoma Surgery Outcome Study
  • 2012 Healthcare Otago Charitable Trust
    $43,064 for the Otago Glaucoma Surgery Outcome Study
  • 2011 Healthcare Otago Charitable Trust
    $57,220 for the Otago Glaucoma Surgery Outcome Study
  • 2010 Retina New Zealand
    $3,000 for A Retrospective Analysis of 10 years of Photoscreening Infants' Eyes
  • 2009 Health Research Council
    $103,030 for translational research into the effectiveness of the National Guidelines for the Diabetic Retinal Monitoring Programme
  • 2009 Ministry of Health
    $25,000 for development of an interactive CD-rom on diabetic retinal changes
  • 2008 University of Otago
    $12,000 for internationalization of the curriculum
  • 2008-2010 Healthcare Otago Charitable Trust
    $121,201 for the Otago Glaucoma Surgery Outcome Study
  • 2004-2007 Healthcare Otago Charitable Trust
    $93,309 for the Otago Glaucoma Surgery Outcome Study
  • 2003 Postgraduate Medical Education Trust
    $5,000 for interactive CD of human visual pathways
  • 2003 Centre for Advanced Learning Technologies
    $10,000 for e-ophthalmoscope
  • 2003 Postgraduate Medical Education Trust
    $5,000 for interactive CD of human visual pathways
  • 2003 Postgraduate Medical Education Trust
    $5,000 for encryption of CD for PGDipOphthBS
  • 2002-4 Healthcare Otago Charitable Trust
    $71,982 for the Otago Glaucoma Surgery Outcome Study
  • 2002 Health Research Council
    $999,000 for falls prevention in the elderly visually impaired
  • 2001 Centre for Advanced Learning Technologies
    $23,000 for slit lamp explorer

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