The power of AI and language were among top subjects discussed at the 2025 RANZCO Congress as leading ophthalmic figures from around Australia and the world gathered for the annual deep dive into industry innovations, issues and opportunities.
Organisers say RANZCO 2025 was the largest congress yet, a highly successful event with an “electric” atmosphere.
Much of that was generated by the more than 2800 attendees who made it to the Melbourne Convention and Exhibition Centre for the event between 14-17 November, most of whom attended in person, with close to 200 following the conference online.
Those in Melbourne for the four days experienced insightful sessions covering sector innovation and issues, plus a comprehensive look at new technology, products and techniques.
More than 90 exhibitors in the trade hall kept them across new products and technology.
The program at the Royal Australia and New Zealand College of Ophthalmologists event kicked off with the Global Eye Health Workshop and various CPD and RANZCO committee forums.
The official event started on Saturday with an emotional and insightful look into the power of language.
When award-winning speaker, author and artist Ms Rachel Callander steps on stage to address health professionals, her message is simple but profound: the language clinicians choose can either build a bridge with patients – or create an unnecessary chasm.
It’s a belief shaped by the short life of her daughter, Evie, and by countless encounters with medical professionals who, often unintentionally, conveyed fear instead of clarity.
Callander was a young wedding photographer living in New Zealand when she discovered she was pregnant.
It was news she admits “felt like an impending doom” for a young, wannabe artist not expecting or seeking out a life of structure and familial routine.
But when Evie was born, “all my fears melted away”.
However, those first moments of joy were soon replaced by medical crisis, confusion and, critically, damaging language.
Doctors delivered a diagnosis of chromosomal abnormalities using terms such as “incompatible with life”, “defective”, and even “retardation”.
Callander recalls feeling as if her beloved daughter had been reduced to “a collection of faulty body parts and big scary words”.
Evie’s early years were medically complex, and her life precarious, but she grew into a child of joy and “superpowers” as Callander affectionately reframed what others saw as faults or negatives.
“The reframe, says Callander, was necessary for her survival.”
Strangers often asked, “What’s wrong with your child?” and she realised that the narrative she chose could change the way others saw her daughter. Rather than focus on what others might perceive as disabilities, Callender recast them as in a more personal and positive light.
“In that moment,” she says, “they saw a human being, not a diagnosis.”
What she learned from healthcare interactions was equally defining.
Confusing jargon left her feeling isolated, inadequate and terrified to ask questions.
A specialist once offered an avalanche of technical explanations; the only words she grasped were “short arms”, which made no sense in relation to her daughter until a later clinician gently asked, “What do you know about chromosomes?” and drew a simple picture of a chromosome and its ‘arms’.
“In 10 seconds,” she says, “I learned more than in the previous hour.”
For Callendar, that moment became a benchmark for what good communication feels like: clear, calm, curious, and human.
And a catalyst to push for change.
Her experience has significant implications for medical specialists, including ophthalmologists and other eyecare professionals, who often deliver life-altering news.
“With eyes, you’re working with a whole person,” she says. Vision changes reshape daily life, identity and independence. Clinicians who ask grounding questions, including What’s your understanding of what’s happening? What matters most to you? Is there anything I’ve said that you’ll go home and Google?, help patients navigate fear and protect dignity.
Evie lived just two and a half years, but she inspired what Callander now describes as her life’s work: reframing medical language.
She has created photographic art books celebrating children with chromosomal and genetic conditions, capturing their “superpowers” rather than their labels.
Families repeatedly tell her how deeply diagnostic language has wounded them – words like “dysmorphic” or “abnormal” becoming damning identities rather than descriptions.
Today, Callander teaches a variety of communication strategies designed to reduce confusion and build trust.
Her message to clinicians is practical.
“I know you don’t go to work to intentionally cause harm,” she said.
“Communication is hard, and you cannot make decisions when you’re confused. But with clear, compassionate language, everything changes.
“With a few practical, human-centred tools and strategies, you as a clinician can share the knowledge you have, listen to the lived experience and expertise of the patient, and deliver the best care possible.”
Workforce pressures dominate
Following Callander, Dr Kristin Bell used her RANZCO Plenary address to lay out the forces reshaping the ophthalmology workforce – and the steps RANZCO is taking to shore up supply, distribution and sustainability.
Dr Bell, a comprehensive ophthalmologist, director of surgery at the Royal Hobart Hospital, and RANZCO’s regional education chair and lead of its regionally enhanced training network, said the eye health system was entering “a period of profound change”.
Demographic, economic and technological pressures continued to push demand for ophthalmology services higher, she said.
And rising obesity, chronic disease and an ageing population were also driving up costs, with healthcare spending “steadily rising as a portion of GDP”.
Yet despite three decades of national reports, she said there had been “very little change in the distribution of medical practitioners per 100,000 people” between 2013 and 2022.
Much of Dr Bell’s focus was on distribution – or the lack of it.
Around 29% of Australians live regionally, yet only 16% of the ophthalmology workforce is based outside major cities.
The imbalance is even starker for First Nations communities: while 59% of Aboriginal and Torres Strait Islander people live regionally, just 0.1% of ophthalmologists identify as indigenous.
“Regional background is the strongest predictor of future regional practice,” she noted, citing evidence across medical specialties.
Rural clinical school attendance also increases the likelihood of regional work, but students “lose interest in rural training as they move to the cities”, and one-year terms are too short to foster connection to place.
Longer placements, Dr Bell told the audience, “really do increase the likelihood of future regional practice”.
She also highlighted a trend towards narrowing scope post-training.
While more than 80% of trainees believe they finish with the required skills for comprehensive practice, fewer than 20% feel prepared to work broadly, and more than 90% intend to subspecialise.
She described this as partly driven by metropolitan oversupply: “As more people cluster in major cities, competition increases, and sub-specialisation becomes a point of difference”.
The structural challenge, Dr Bell argued, is that 87% of ophthalmology service delivery now occurs in the private sector, while specialist training is anchored in public hospitals.
Limited public capacity, combined with uneven distribution of public services, is “the single biggest barrier” to training enough ophthalmologists for the whole population.
Dr Bell outlined RANZCO’s recent actions under Vision 2030, of which she is the clinical lead, including revised curricula to ensure graduates are comprehensive generalists, parity in selection points for rural and First Nations applicants, and expansion of the Regional Enhanced Training Network.
The college was also “building strong relationships with government, other specialist colleges and health authorities”.
Looking ahead, RANZCO is calling for national governance measures, including jurisdictional KPIs for training distribution, better visibility of outpatient activity, and agreed access standards for public eyecare.
Workforce data will be critical: “It’s crucial we have the data we need when we go to government,” Dr Bell said, urging members to complete the perpetual workforce survey.
“Reform is not a choice – it is inevitable,” she concluded. “We are in a period where decades are happening in weeks, and we must take a united voice to government to ensure equitable eyecare for our patients.”
Reshaping care delivery
Dr Clare Bailey, consultant ophthalmologist and clinical lead of the retinal treatment and research unit at Bristol Eye Hospital, UK, gave an address about how medical retina services across the UK have been reshaped over the last few years to help deal with capacity pressures.
In her Retina Update Lecture, Dr Bailey outlined how the use of networked electronic patient records, enhanced roles within the multidisciplinary team, mobile treatment units, diagnostic hubs and closer links with community optometry were easing capacity pressures on the National Health Service (NHS).
She began by emphasising the scale of the challenge.
“The vast majority of patients with medical retina disorders are having their care under the National Health Service,” she said, noting that chronic conditions such as diabetic retinopathy and treatments for wet age-related macular degeneration (AMD) were not routinely covered by private insurers.
Combined with the UK’s relatively low ophthalmologist-to-population ratio compared with some other countries, the result has been long-standing capacity challenges. The Covid pandemic also resulted in additional challenges as routine work was postponed during the lockdowns.
To help to manage this demand, she described how Bristol Eye Hospital had developed a hub-and-spoke model of care built on a fully paperless electronic medical record system.
Among the most striking innovations is a mobile macular unit, located in a supermarket car park and fitted out with an OCT room, injection room and clinical spaces.
“It’s extremely popular with patients, who find it very convenient, and of course has very good parking!,” she said.
The unit, along with outreach injection clinics, means patients can access treatment closer to home.
That access was supported by an electronic patient records system that could be accessed by all appropriate medical professionals.
“It doesn’t specifically matter at which location the patient is seen, because we have one electronic patient record.”
Other units have developed similar systems for outreach treatment clinics.
Workforce innovation has also been important.
Nurses now deliver the vast majority of intravitreal injections nationwide, while shared-care optometrists undertake extended roles, including triage, grading and virtual clinic assessments.
Dr Bailey described them as “an absolutely integral and outstanding part of our team”.
During COVID-19, Moorfields Eye Hospital and Bristol Eye Hospital established large diagnostic imaging hubs that have since become permanent and now handle the majority of medical retina follow-ups.
Technicians at each hub take images with OCT, widefield colour and autofluorescence imaging.
The imaging appointment takes about 15-20 minutes, with subsequent grading of the images by the clinical team.
Patients would receive tele-consultations with consultants based on clinical need after the initial grading.
Dr Bailey said their service audit had shown that over 99% of images were of sufficient quality for grading.
A major recent advance in Bristol has been a new electronic referral pathway directly to the hospital from community optometrists, enabling them to send full-resolution DICOM OCT scans and colour images directly into the hospital system.
She said this had saved a hospital appointment in 73.4% of cases, significantly reducing travel burden for patients while boosting treatment timeliness.
She described a scheme from Gloucestershire whereby the hospital ophthalmic scans, visual fields and GP letters could be reviewed by community optometrists, which had led to a significant reduction in unnecessary referrals and avoided duplication.
Dr Bailey said these changes in the supported research participation and real-world data collection. The UK experience had shown that digitally enabled triage, multidisciplinary working, diagnostic hubs and community-aligned care could deliver faster, more efficient outcomes for patients and the health system.
Myth, magic or monster?
In his Glaucoma Update Lecture, Professor Gus Gazzard confronted the promise and the pitfalls behind “interventional glaucoma”, a term that has gained traction since around 2010 and generally refers to earlier, non-pharmacological interventions aimed at lowering intraocular pressure (IOP).
This mainly includes procedures like selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgeries (MIGS), but in some cases early trabeculectomy or lens extraction.
The idea is to reduce or eliminate dependence on long-term eye drops, offering a more proactive, procedure-focused pathway for managing glaucoma.
Prof Gazzard, director of the glaucoma service at Moorfields Eye Hospital in the UK and one of the world’s most cited glaucoma researchers, acknowledged the hype surrounding the term.
“I think there’s an awful lot of jargon that some individuals are hiding behind,” he said.
His aim was to separate hype from hope, and to propose “non-incisional glaucoma care” as the logical entry point into any interventional pathway.
He contrasted the historical “drops, drops and more drops – then trab” sequence with today’s reality. “Seventy-five per cent of glaucoma specialists in the US now use SLT as primary treatment,” he noted, with medications and surgery used only as required.
This shift was supported by several landmark trials: the EAGLE (Effectiveness in Angle-closure Glaucoma of Lens Extraction) trial confirming clear lens extraction in primary angle closure disease; the TAGS (Treatment of Advanced Glaucoma Study) research revisiting primary trabeculectomy for advanced glaucoma; and the LiGHT (Laser in Glaucoma and Ocular Hypertension) trial, which has become the cornerstone of the SLT-first approach.
Among newly diagnosed mild-to-
moderate patients, SLT delivered 70% drop-free control at six years, alongside a 30% slower rate of visual field deterioration compared with medication.
“The medication group did worse, even though they were treated to the same target pressure,” he said.
Emerging horizon data suggested similar effects with phaco-MIGS combinations, with five-year results showing a three-fold reduction in the need for future incisional surgery compared with cataract surgery alone.
These visual-field differences, though numerically small, matter, Prof Gazzard argued, citing work linking even modest mean deviation losses to impaired driving, reading speed, falls and reduced physical activity.
But he also issued strong cautions. Not all MIGS are equal – or even truly “minimal”.
Some devices and procedures carry under-reported risks, he said, from 90% hyphaema rates in certain trials to hypotony risk with supraciliary approaches.
“We have to be clear-eyed about the balance of safety and risk,” he said.
Medications are not benign either: non-adherence, BAK (benzalkonium chloride) toxicity, goblet cell loss and long-term conjunctival changes carry their own harms.
His conclusion: interventional glaucoma is not a myth – the evidence for non-pharmacological care is now substantial; it is not magic – advanced disease still demands “proper surgery for proper pressures”; and there is “some monster in the detail”, particularly around unacknowledged complications, confirmation bias, and the cost implications of a “MIGS-for-most” approach.
“Getting people away from medications is a good thing, but we must be very careful that enthusiasm doesn’t outstrip evidence.”
