Many clinicians possess real-world solutions that would elevate the greater ophthalmic sector, but there have been few avenues to test their theories in a proper research environment. The Future Vision Foundation seeks to bridge this gap.
Since graduating 3.5 years ago, Ms Tram Nguyen has worked as a clinical orthoptist at Vision Eye Institute (VEI) Chatswood, Sydney. Alongside her core duties, she’s been involved in pharmaceutical trials as a clinical technician, whetting her appetite to pursue her own research project. But she faced a common challenge: finding the time, funding and guidance to get started.
Phacovitrectomy – combining cataract surgery with vitrectomy – was an area that she was particularly interested in investigating, so when the ophthalmology research-dedicated Future Vision Foundation (FVF) launched its inaugural round of funding in 2022, it provided the ideal chance to conduct a study of her own.
“Our project seeks to understand the phacovitrectomy patient and how we may be able improve pre- and post-operative information, discussion and general experience. Even if it is a subset of the ophthalmic surgery population, I believe this will make a difference,” she says.
“Patient protocols and processes have been studied across cataract surgery in general however there has been little to understand the patient journey within the combined procedure, which is increasingly an option.”
Nguyen says cataract surgery is a common procedure where clinicians can mostly focus on great visual outcomes, particularly with modern IOLs.
“Patients expect this but those with pre-existing retinal conditions are often restricted to the potential visual outcome post-surgery. This is an important discussion and providing the most appropriate information, and feedback, to the phacovitrectomy patient is essential to match expectations to possible outcomes to avoid disappointment.”
Projects like this – with potential real-world applications – are vital to address some of the biggest issues in eyecare, and are the motivation behind FVF, a new body launched by Vision Eye Institute (VEI) providing another avenue to support ophthalmic research.
In 2021, Australia’s largest private ophthalmology provider established the not-for-profit that features a board of prominent ophthalmic researchers and industry professionals, supporting the research efforts of VEI staff and associated clinicians or researchers. This includes those with little-to-no formal research experience but who are keen to improve diagnosis, treatments and/or healthcare experiences for patients with eye conditions.
Nguyen’s phacovitrectomy project was among 12 recipients awarded grants in FVF’s first funding round in 2022, which also included other intriguing studies such as the performance of EDOF IOLs with glaucoma surgical devices, why keratoconus patients suddenly progress long after cross-linking, and the role of music in reducing anxiety prior to refractive surgery.
FVF is now assessing applicants for the second round of funding for 2023, expected to be announced in July.
Nguyen is conducting the study with fellow clinical orthoptist Ms Opal Mai, and Dr Simon Chen, VEI Chatswood’s primary retinal surgeon. She says phacovitrectomy may offer several potential benefits such as faster visual recovery and possible reduction of complications – compared to separate surgeries – reduced costs and improved patient convenience.
“The team at VEI have helped guide me with respect to project development, understanding existing research options and how we may be able to optimise the practical outcomes of the research for our patients,” Nguyen says.
“Conducting the project within the VEI clinics has also allowed me to reach out across the clinics which potentially expands the sample. The FVF funding has helped me in a way where I can dedicate time to focus on doing the project, working outside of work hours and providing the flexibility to develop the project further.”
Participating in research and developing her own research idea was not something Nguyen expected upon graduating. However, she says FVF and the supporting environment has allowed her to develop the project.
“This is really important for a young researcher,” she says. “These opportunities can develop your own skills and interest and ultimately may be beneficial for patients and the community.”
The foundation’s inner workings
Dr Christopher Hodge is the clinical research coordinator at VEI, and was appointed chair of the FVF Advisory Committee that helps FVF applicants like Nguyen refine their proposals to ensure their relevance and maximum impact.
While larger studies seek lucrative grants from bodies such as the National Health and Medical Research Council (NHMRC), he says the FVF seeks to bridge the gap for smaller ophthalmic projects with more practical objectives.
“There are many good clinicians with great ideas to improve our industry, but they don’t necessarily have the time to go down the full postgraduate research pathway,” he says.
“They may also not understand what’s required to progress their ideas in a research context. If we’re able to facilitate that with the support of the Future Vision Foundation while they’re still performing their clinical duties, then we’re providing the chance to elevate ophthalmology as a whole.”
While many applications in the first-round cohort had links to well-established researchers, the FVF aims to support emerging researchers and those new to the academic field. It’s not limited to ophthalmologists and orthoptists either, with grants supporting optometrists, allied health nurses and administrative staff.
A key function of FVF’s Advisory Committee is to provide feedback to the FVF Board comprising several prominent ophthalmic industry professionals, including UNSW’s Professor Fiona Stapleton, Mr Tim Grant, an executive with broad experience in the ophthalmic sector, former long-serving senior manager of ZEISS Mr Joe Redner, and ophthalmologist Associate Professor Tim Roberts (chair).
“It’s a highly impressive board, and from a research perspective they have unimpeachable credentials,” Hodge says.
“We also have industry representatives who offer a different perspective. In addition to making decisions around which projects are successful, they’re also there to provide feedback on how we can evolve the foundation – their experience and knowledge has helped significantly.”
The FVF will soon announce the recipients of its second round, using criteria based on current NHMRC guidelines. Hodge says there were around 18 applications this year, with projects focusing on topics such as optimised protocols around post-operative patient care, the role of computation to improve imaging and diagnosis, and the potential impact of microplastics in the eye.
A little more than half of these are expected to become successful 2023 recipients.
Support helps progress bioengineered cornea
For people struck by corneal endothelial pathologies from injury, inflammation, infection, or diseases like Fuch’s dystrophy, there’s sometimes only one option: surgery involving donated corneal tissue. The problems is, there’s a shortage globally, but imagine if patients could overcome this with a man-made biomaterial.
It might sound like a concept from an ophthalmological era decades from now, but a team of scientists, clinicians and orthoptists in Sydney are bringing this concept to life, assisted by FVF support.
In essence, they are investigating the use of surgically discarded lens capsule discs as a platform to grow primary corneal endothelial cells obtained from donors. The resulting construct will then be compared to a normal corneal endothelium and tested for its potential as a substrate for clinical and surgical use.
If successful, it could ease demand on eye banks globally, including Australia which receives around 1,400 donations a year for around 2,400 corneal transplants.
Postdoctoral researcher Dr Sheng Hua, from the University of Sydney, has been involved in the study. So far, support from the FVF – as well as the NSW Organ Tissue Donation Service – has enabled the use of discarded lens capsules to generate a bioengineered corneal endothelial layer.
This layer is exhibiting favourable endothelial characteristics, relative physical properties – such as thickness, size, and mechanical strength – and excellent optical clarity. Currently, the product is awaiting testing in a mock-surgery trial by surgeons.
“Human donor tissues are a valuable and limited resource, particularly in the context of corneal transplantation, which is currently considered the gold standard of care. The current practice relies on accessing end-of-life (deceased) donations of corneal tissue, which are retrieved, prepared, and provided to surgeons through Australian eye banks. Unfortunately, there is a global shortage of donors, with 53% of the world’s population lacking direct access to the required tissue,” Hua says.
“Our project focuses on developing alternative approaches that utilise surgically discarded tissue for clinical applications. For instance, we explore the use of such tissue as surgical materials for endokeratoplasty.
“Additionally, we will develop bioinks containing human type I and IV collagen using our patented formulae, which will be derived from discarded stromal and lens capsules. Bioinks have the potential for treating ocular tissue wounds, including those in the cornea, retina, or brain. The combination of this bioink and the novel corneal endothelium will enable the exploration of advanced cornea prototypes for in vitro testing.”
Supporting Hua in the study is the Save Sight Institute’s Professor Gerard Sutton, a VEI ophthalmologist and renowned cataract surgeon, the University of Sydney’s Dr Jingjing You, orthoptist Ms Michelle Phung and Hodge.
Hua says support from the FVF has provided resources that are otherwise difficult to obtain. Bioengineering research on human tissue faces particular challenges, including the production cost of biomaterials, biocompatibility issues, and the need to achieve optimal physical properties.
“The availability of biocompatible tissues resolves half of these challenges, simplifying and streamlining subsequent research. It is remarkable that these valuable (FVF) resources can be utilised for research, and I am hopeful that they will be applied for greater medical purposes in the future,” he says.