Gonin Medal

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

2. 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 • H Fuglsang • Z Gregor • C Gregory J Greenwood A Hardcastle P Hamilton G Hageman C Hammond E Hèon G Holder D Hunt C Inglehearn M Jay B Jay B Jones C Kemp E Kohner I Lengyel P Luthert S Lightman WI McDonald J Marshall A Milam D Minassian S Moss A Moore S Ono T Peto A Robson G Ruben K Sehmi G Sheriadah G Serjeant E Stone J Vingerling R Weale A Webster A Wright J Yates

3. Fellows H Scholl D Sharpe G Silvestri S Schmitz-Valckenberg J van Soellen A Smith P Stanga R Steinmetz T Stout J Sung D Swanson H Tabandeh J Talbot J Talks V Tanner V Teeters T Tsang G Turner A Ullis V Vaclavik E Vankuijk J Vingerling M Vortruba S Vujosevic D Wagner A Webster J Wells T Wolfensberger B Wright J Wroblewski N Young J Cosgrove N Cox J R Coco Cosgrove N Cox R Coco J Cosgrove N Cox L Da Cruz S Dandekar H Dollfus S Downes S Dubovy C Egan A Ekstein K Evans J Fan D Farnworth G Fish C Flaxel T Gillow T Gin B Godley M Goldstein M Gorin Z Gregor M Gross R Grey E Gurwin R Guymer R Ahuja A Ambresin I Audo R Barnes M Barondes S Beatey C Bellman T Berninger D Bessant P Betancourt J Bowbyes S Boyd C Blythe J Bowbyes R Brecher M Brantley R Braunstein A Calcagni M Capon A Casswell G Chaine C Chee J Chen I Chisholm V Chong V Christopoulos E Chuang P Cleary R Clemmet R Coco • R Haimovici • P Hamilton • R Hampton • N Harper • E Hay • F Holz • J Hopkins • D Hornan • A Hoskin • H Jackson • S Kabanarou • S Kaushall • H Klassen • J Keis • R Kim • A Koh • D Kohen • F v Kuijk • M Kurz • C Lane • N Lansel • N Lois • B Leroy • A Luckie • L Lyness • M McGibbon • I Mantel • A Marinescu • J Marks J McKibbin M Michaelides A Moore P Ng D Newman R Ober A Okubo S Owen S Pagliarini I Palmvang D Pauleikhoff M Perks L Pelosini T Peto P Polkinghorne B Piguet S Qureshi S Ransome P Rath A Reck D Rosen A v Rückmann P Rush R Rosa J Sandbach D Sarraf R Schlingerman S Schwartz G Schoepner

4. World blindness 1972 Trachoma Onchocerciasis Nutritional Infective keratitis Cataract

5. Onchocerciasis – world distribution

6. Onchocerciasis Vector – black fly

8. Onchocerciasis adult worms

9. Onchocerciasis microfilariae

10. 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.

11. Onchocerciasis French / Belgian blindness largely corneal other lesions: retinal optic nerve - peripheral loss British surface disease – skin and cornea retinal lesions genetic Savannah worse than rain forest

12. John Anderson Harald Fuglsang MRC fillaraisis unit, Douala Brian Duke

13. Clinic - Tcholire

14. Onchocerciasis Age 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

15. Onchocerciasis retinal disease: temporal lesions over insertion of long cilliary arteries into choroid Anderson J, et al Trans R Soc Trop Med 1976; 70: 378-95.

16. Onchocerciasis optic nerve disease peripheral VF loss

17. Onchocerciasis Pattern of optic nerve disease as percentage of population Savannah Rain Forest Swelling 27 12 Atrophy 56 67 Total 83 79

18. 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.

19. Treatment of Onchocerciasis WHO recommendations: Head nodule 15 mfs/ snip near eye Remove head nodule Give: Banacide (DEC) Suramin BUT

21. DEC treatment of Onchocerciasis Bird 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

22. 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

23. DEC treatment of Onchocerciasis

24. Day 0 DEC treatment of Onchocerciasis visual field loss Day 4 Day 8

25. Treatment of Onchocerciasis DEC - makes them blind Suramin - kills them Ivermectin - infertility in female adult worms Vector control

26. Treatment of Onchocerciasis 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

27. 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

28. 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.

30. 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

31. Potential biological therapy for retinal dystrophies Growth factors Gene therapy Cell transplantation

32. CNV in age-related macular disease Responsible for over 50% of blindness in Western Society Physical treatments disappointing: Laser photocoagulation Photodynamic therapy Transpupillary thermo-therapy Ionising radiation

33. Biological treatment CNV Based on an understanding: of the physical changes of the biological processes initiating of biological treatment

34. Neovascularisation RAP PEDF/VEGF CNV

35. Secondary Endpoint:Mean Change in Visual Acuity Over Time 2 3 4 5 6 7 8 9 10 11 12 1 * P < 0.0001 Ranibizumab 0.5 mg (n=240) Ranibizumab 0.3 mg (n=238) 10 Sham (n=238) 8 +7.2 +6.5 6 17.7 letter benefit * 4 2 0 -2 Visit (months) ETDRS letters 17.0 letter benefit * -4 -6 -8 -10 -10.5

36. Institutions Therapeutic advances resulted from importation of knowledge from the laboratory to clinical management Institute of ophthalmology Moorfields Eye Hospital

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

38. A.A. Milne; Winnie-the-Pooh, 1926 On 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 grows That hardly anybody knows If those are these and these are those.

39. A.A. Milne; Winnie-the-Pooh, 1926 On Wednesday, when the sky is blue, And I have nothing else to do I sometimes wonder if it’s true That who is what and what is who? On Thursday, when it starts to freeze And hoar-frost twinkles on the trees, How very readily one sees That these are whose but whose are these?

40. A.A. Milne; Winnie-the-Pooh, 1926 On Wednesday, when the sky is blue, And I have nothing else to do I sometimes wonder if it’s true That who is what and what is who? On Thursday, when it starts to freeze And hoar-frost twinkles on the trees, How very readily one sees That these are whose but whose are these? On Friday.…………………….