Gonin Medal

40
Gonin Medal Alan Bird Moorfields Eye Hospital Institute of Ophthalmology University College London

description

Gonin Medal. Alan Bird Moorfields Eye Hospital Institute of Ophthalmology University College London. Teachers and Colleagues. R Ali J Anderson G Arden N Ashton R Black D Bok S Bhattacharya A Brannon C Bunce I Chisholm P Coffey C Ernst F Fitzke J Flannery M Friedlander - PowerPoint PPT Presentation

Transcript of Gonin Medal

Page 1: Gonin Medal

Gonin Medal

Alan Bird

Moorfields Eye Hospital

Institute of Ophthalmology

University College London

Page 2: Gonin Medal

R AliJ AndersonG ArdenN AshtonR BlackD BokS BhattacharyaA BrannonC BunceI ChisholmP CoffeyC ErnstF FitzkeJ FlanneryM FriedlanderH FuglsangZ GregorC Gregory

J GreenwoodA HardcastleP Hamilton G Hageman C HammondE HèonG HolderD HuntC InglehearnM Jay B JayB JonesC KempE KohnerI LengyelP Luthert S LightmanWI McDonald

J MarshallA MilamD MinassianS MossA MooreS OnoT PetoA RobsonG RubenK SehmiG SheriadahG SerjeantE StoneJ VingerlingR WealeA WebsterA WrightJ Yates

Teachers and Colleagues

Page 3: Gonin Medal

R AhujaA AmbresinI AudoR Barnes M BarondesS BeateyC BellmanT BerningerD BessantP BetancourtJ BowbyesS BoydC BlytheJ BowbyesR BrecherM BrantleyR BraunsteinA CalcagniM CaponA CasswellG ChaineC CheeJ ChenI ChisholmV ChongV ChristopoulosE ChuangP ClearyR ClemmetR Coco

J CosgroveN CoxJ R CocoCosgroveN CoxR CocoJ Cosgrove N CoxL Da CruzS DandekarH DollfusS DownesS DubovyC EganA EksteinK EvansJ FanD FarnworthG FishC FlaxelT GillowT GinB GodleyM GoldsteinM GorinZ GregorM GrossR GreyE GurwinR Guymer

R HaimoviciP HamiltonR HamptonN HarperE HayF HolzJ HopkinsD HornanA HoskinH JacksonS Kabanarou S Kaushall H KlassenJ KeisR KimA KohD KohenF v KuijkM KurzC LaneN LanselN LoisB LeroyA LuckieL LynessM McGibbonI MantelA MarinescuJ Marks

J McKibbinM MichaelidesA MooreP NgD NewmanR OberA OkuboS OwenS PagliariniI PalmvangD PauleikhoffM PerksL PelosiniT PetoP PolkinghorneB PiguetS QureshiS RansomeP RathA ReckD RosenA v RückmannP RushR RosaJ SandbachD SarrafR SchlingermanS SchwartzG Schoepner

H SchollD SharpeG SilvestriS Schmitz-Valckenberg J van SoellenA SmithP StangaR SteinmetzT StoutJ SungD SwansonH TabandehJ TalbotJ TalksV TannerV TeetersT TsangG TurnerA UllisV VaclavikE VankuijkJ VingerlingM VortrubaS VujosevicD WagnerA WebsterJ WellsT WolfensbergerB WrightJ WroblewskiN Young

Fellows

Page 4: Gonin Medal

World blindness 1972

Trachoma

Onchocerciasis

Nutritional

Infective keratitis

Cataract

Page 5: Gonin Medal

Onchocerciasis – world distribution

Page 6: Gonin Medal

Onchocerciasis

Vector – black fly

Page 7: Gonin Medal
Page 8: Gonin Medal

Onchocerciasis

adult worms

Page 9: Gonin Medal

Onchocerciasismicrofilariae

Page 10: Gonin Medal

Onchocerciasis

Adult worms live for 20 years

Produce 1,000 mfs. each day

Microfilariae live for 2 years

Infected early in life - anergy

Disease due to reaction of dead mfs.

Page 11: Gonin Medal

Onchocerciasis

French / Belgianblindness largely cornealother lesions:

retinal optic nerve - peripheral loss

Britishsurface disease – skin and cornearetinal lesions genetic

Savannah worse than rain forest

Page 12: Gonin Medal

John Anderson

Harald Fuglsang

MRC fillaraisis unit, Douala

Brian Duke

Page 13: Gonin Medal

Clinic - Tcholire

Page 14: Gonin Medal

OnchocerciasisAge Savannah Rain Forest

5-9 4 1

10-19 48 11

20-29 43 20

30-39 29 25

40-49 13 31

50+ 3 16

Total 140 104

Page 15: Gonin Medal

Onchocerciasisretinal disease:temporal lesions over insertion of long cilliary

arteries into choroid

Anderson J, et al Trans R Soc Trop Med 1976; 70: 378-95.

Page 16: Gonin Medal

Onchocerciasis

optic nerve diseaseperipheral VF loss

Page 17: Gonin Medal

OnchocerciasisPattern of optic nerve disease

as percentage of population

Savannah Rain Forest

Swelling 27 12

Atrophy 56 67

Total 83 79

Page 18: Gonin Medal

Onchocerciasis

Of those blind from posterior segment

involvement: 80% due to optic nerve disease

Bird AC, et al Br J Ophthalmol 1976; 60: 2-20.

Page 19: Gonin Medal

WHO recommendations:

Head nodule

15 mfs/ snip near eye

Remove head nodule

Give: Banacide (DEC)

Suramin

BUT

Treatment of Onchocerciasis

Page 20: Gonin Medal
Page 21: Gonin Medal

DEC treatment of OnchocerciasisBird AC et al, Lancet 1979; 46-7.

18 moderately to heavily infected

(mf counts – buttock > 100 / snip

outer canthus > 15 / snip)

9 with and 9 without visual field loss

All had itching

14 had vertigo

12 had headaches

10 had arthalgia

Page 22: Gonin Medal

DEC treatment of Onchocerciasis

10 day: observation

Visual field loss 5 of 18, 1 bilateral

OD swelling: new in 9

worse in 3

New RP lesions in 7

Compression of 2 years disease into 10 days

Page 23: Gonin Medal

DEC treatment of Onchocerciasis

Page 24: Gonin Medal

DEC treatment of Onchocerciasis

visual field loss

Day 0

Day 4

Day 8

Page 25: Gonin Medal

Treatment of OnchocerciasisDEC - makes them blindSuramin - kills them

Ivermectin - infertility in female adult worms

Vector control

Page 26: Gonin Medal

   

Ivermectin causes diminution of microfilaria without inflammation

Aziz et al . Lancet 1982; 2: 171-3.

Dadzie et al. Trop Med Parasitol 1989; 40: 355-60

Ivermectin treatment does not cause optic neuritis

Murdoch I et al. Eye 1994; 8: 456-61.

Ivermectin causes diminution of the weight of infection

Taylor H et al. Science 1990; 250: 116-8.

Treatment has had a major effect on ocular morbidity although elimination of the disease has yet to be achieved

Treatment of Onchocerciasis

Page 27: Gonin Medal

Retinal dystrophies

1969: Known to be genetic – dominant and recessive

More that one disease

Variable phenotype: sine pigmento, sector, unilateral

Can be associated with multi-system disease

Involvement of rods

Cause unknown: vitamin A deficiency simulates RP

No Treatment

Page 28: Gonin Medal

Nettleship: On retinitis pigmentosa and allied diseases.

The Royal London Ophthalmic Hospital. Reports.

I 1907;7:1-56.

II 1908;7:152-166.

III 1908; 7:333-439.

Page 29: Gonin Medal
Page 30: Gonin Medal

Retinal dystrophies

Identify prevalence of different genetic forms

Identify sequence of photoreceptor loss

Identify genes involved

Relate phenotype to mutation

Identify disease mechanisms

Initiate treatment

Page 31: Gonin Medal

Potential biological therapy for retinal dystrophies

Growth factorsGene therapyCell transplantation

Page 32: Gonin Medal

CNV in age-related macular diseaseResponsible for over 50% of blindness in Western Society

Physical treatments disappointing:

Laser photocoagulation

Photodynamic therapy

Transpupillary thermo-therapy

Ionising radiation

Page 33: Gonin Medal

Biological treatment CNV

Based on an understanding:

of the physical changes

of the biological processes

initiating of biological treatment

Page 34: Gonin Medal

RAP

PEDF/VEGF

CNV

Neovascularisation

Page 35: Gonin Medal

Secondary Endpoint:Mean Change in Visual Acuity Over Time

17.7 letter benefit *

17.0 letter benefit *

* P < 0.0001

1 2 3 4 5 6 7 8 9 10 11 12

Visit (months)

-10

-8

-6

-4

-2

0

2

4

6

8

10

ET

DR

S le

tter

s

Sham (n=238)

Ranibizumab 0.3 mg (n=238)

Ranibizumab 0.5 mg (n=240)

-10.5

+6.5+7.2

Page 36: Gonin Medal

InstitutionsTherapeutic advances resulted from importation of

knowledge from the laboratory to clinical management

Institute of ophthalmology Moorfields Eye Hospital

Page 37: Gonin Medal

A.A. Milne; Winnie-the-Pooh, 1926

Page 38: Gonin Medal

A.A. Milne; Winnie-the-Pooh, 1926On Monday, when the sun is hot I wonder to myself a lot:“Now is it true or is it not, That what is which, and which is what?”

On Tuesday, when it hails and snows, The feeling on me grows and growsThat hardly anybody knowsIf those are these and these are those.

Page 39: Gonin Medal

A.A. Milne; Winnie-the-Pooh, 1926On Wednesday, when the sky is blue,And I have nothing else to doI sometimes wonder if it’s trueThat who is what and what is who?

On Thursday, when it starts to freezeAnd hoar-frost twinkles on the trees,How very readily one seesThat these are whose but whose are these?

Page 40: Gonin Medal

A.A. Milne; Winnie-the-Pooh, 1926On Wednesday, when the sky is blue,And I have nothing else to doI sometimes wonder if it’s trueThat who is what and what is who?

On Thursday, when it starts to freezeAnd hoar-frost twinkles on the trees,How very readily one seesThat these are whose but whose are these?

On Friday.…………………….