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Top-Four of the Scientific Meeting of the Australian and New Zealand Glaucoma Interest Group
Brisbane, Queensland, Australia, February 6-7, 2015

Anne Brooks

1. Intraocular pressure – Complexities and clinical relevance
   IOP is a dynamic parameter that undergoes constant variation, along with a circadian rhythm in which IOP is higher at night than during the day. A major cause of IOP variation is changes in head and body positions, which result in IOP elevation with neck flexion or extension, or any recumbent position. Aqueous humor dynamics studies have indicated that positional changes in IOP are likely due to changes in episcleral venous pressure. In contrast, the circadian rhythm of IOP appears to be largely due to a nocturnal reduction in aqueous humor production rate, outflow facility, and uveoscleral flow rate. Although the clinical significance of IOP variations remains to be fully elucidated, appropriate selection of therapy can help to minimize fluctuations. (Arthur Sit, Rochester, MN, USA)
2. Twenty years of remote and indigenous health
   Over a period of 17 years, the Cape York Eye Health Project has provided 18,841 Optometrical Consultations, 9848 spectacles, 7530 Diabetic consultations, 4010 Ophthalmic consultations and 1,196 surgeries, mostly cataract, to a remote population of 17,000 people spread across a landmass the size of the state of Victoria. The most significant obstruction to the project has been the Federal State three-year political cycle, the one year public servant turnover cycle, and the six- to 12-month staff turnover in remote clinics. The other significant problem is that that ‘medical’ health delivery systems are only the tip of the health iceberg. Health care involves a seamless journey from conception to a healthy and stimulating childhood, to an advanced education, a job and home ownership. This is a journey that is denied in its entirety to up to a million Australians, including a sizeable part of the Indigenous population. A breakdown in this journey particularly at the level of conception to the age of five years can result in poor health outcomes, poor job outlooks, poverty and in many cases jail. Comprehensive health care, and attendant educational capacity, starts at conception. (Mark Loane, Brisbane, Australia)
3. Single cell electrophysiology following acute intraocular pressure elevation in mice
   Following an acute IOP injury in mice, retinal ganglion cells show impaired ability to generate action potentials measured using whole cell patch clamp. This impaired excitability recovered at a later stage and was associated with an increase in ganglion cell membrane resistance suggesting morphological change over time. Slower recovery of excitability was observed in older animals, which correlates with previous data using the electroretinogram to measure ganglion cell function. (Eamonn Fahy, Melbourne, Australia)
4. Use of trypan blue dye in diagnosis of hypotony
   Bill Morgan presented an novel technique using trypan blue as an aqueous humor tracer dye to visualize the preferential flow pattern of aqueous following its injection into the anterior chamber. In cases of hypotony where the diagnosis is unclear it is most useful in highlighting preferential flow into cyclodialyisis clefts and can be seen to reflux back from the cleft during aspiration aiding the demarcation of such clefts. It is useful also in detecting occult bleb leak, over drainage and excess lymphatic flow from blebs. (Bill Morgan, Perth, Australia)

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