Prof Hugh Taylor
Intro: My name is Hugh Taylor and I am currently the President of the International Council of Ophthalmology
The eye is just a beautiful little jewel like organ, when you sit there and watch the way the iris and pupil respond on the slit lamp as you move the light on and off its just magical.
Screen: Paper One An animal model for cicatrizing trachoma
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The first paper to talk about was the work we did on an animal model of trachoma and I had spent a year or so working on trachoma and sort of seeing a lot of children and people with trachoma. And I was at Johns Hopkins as a young fellow and at a Christmas party and one of the researchers…research scientists there sort of asked me what was I doing and where was I from? And we talked about trachoma. “Oh trachoma that’s interesting! Would you like to try and make an animal model of trachoma?” I said that would be easy, all you have do is repeatedly re-infect the animal so of course they get trachoma and he said would you like to actually show that happens? So we put together a research grant and proved the importance of repeated episodes of reinfection. And what I hadn’t realized is that he and the rest of the experimental world had been trying to reproduce an animal model of trachoma for about sixty years and they had only ever used a single inoculation. And what we now know is that repeated reinfection is actually critical for trachoma and the people who go blind might have had somewhere like a 150 or 200 episodes of infection to get the severe scarring reaction they get. So, that confirmation of the importance of repeated reinfection really transformed our understanding of the treatment and interventions to control and eliminate trachoma and really formed the basis for the SAFE strategy as well.
Screen: Paper Two The ecology of trachoma: an epidemiological study in southern Mexico
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And I was doing some work in Chiapas in southern Mexico on onchocerciasis and the local public health doctor came in to sit “I understand there is an ophthalmologist here who knows something about trachoma and I sort of stopped right where I was sitting and said here I am and so we ended up doing quite a big study on the epidemiology and risk factors of trachoma in this community in southern Mexico and what we found was – the most important thing was the presence of dirty faces and the lack of face washing and facial cleanliness as the risk factor. So, this actually turned out to confirm that every child with a dirty face is a health hazard in terms of trachoma because those infected eye and nasal secretions get transmitted from one child to another and that is the way the infection gets passed from one eye to another.
Screen: Paper Three Comparison of Ivermectin and Diethylcarbamazine in the treatment of Onchocerciasis
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Again while I was at Hopkins I was sitting listening to one of the researchers talking about the work they were doing with using a DEC lotion–Diethylcarbamazine lotion–to try to prevent the bad reactions that one got with this drug when you were treating people with onchocerciasis and he had done some very preliminary studies and after the lecture I said to him “pretty lousy studies, you know you really could do a proper trial”…pretty silly of me. There were not a lot of people working on onchocerciasis at the time and so as an ophthalmologist very quickly I became one of the few ophthalmologists in the world who knew anything about oncho. So if you wanna get prominence I guess pick a tiny little field! But that was the first study that we did looking at onchocerciasis chemotherapy and then when ivermectin was first reported as having some effect against onchocerciasis we then did a major study in Liberia where we compared ivermectin against the standard drug which was DEC and against also placebo and that was first study was in 30 rubber tappers, people working on a rubber plantation collecting the liquid rubber from the trees and that showed the dramatic difference in adverse effects in between ivermectin and DEC and the tremendous reduction in disease intensity with ivermectin treatment. So that phase two trial, then we went on and did phase three trial with 300 or so looking at different dosages and timing and then after ivermectin got registered we did a very large safety trial with nearly 30 thousand people in the rubber plantations in Liberia to show the safety. Of course now we have something like 160 million doses of ivermectin distributed a year and onchocerciasis just last month [referring to 2016 when WHO announced this] was eliminated from Guatemala as it has been from most of the areas in Latin America and terrific progress is being made in the African countries as well.
Screen: Paper Four Effect of ultra violet radiation on cataract formation
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Early on in my career I spent a lot of time working in the Outback areas in Australia looking at the aboriginal people where first of all there is a lot of sun, Australia is a big sunburnt country. But it was really interesting to see how much cataract we were finding in Aboriginal people, un-operated cataract and partly it was lack of services but also it was interesting to see…to look at if there was some geographic variation because of the amount of UV light, there was data available in Australia about the amount of UV across the whole country. So, I was able to do some preliminary analysis and showed some association with cataract cortical and UV exposure.
And then again when I was at Hopkins we undertook a much more detailed study the Chesapeake Bay watermen study where we had these fishermen or people who work on catching crabs and oysters so there out exposed in sunlight sort of all day. And then did a very detailed study of that and showed that there was a very significant association between the amount of UV light that they get to the eye and the risk of developing cortical cataract. So, a little bit of UV is bad for you and a lot is lot worse.
Screen: Paper Five The economic impact and cost of visual impairment in Australia
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When I returned to Australia in 1990 as head of the Department of Ophthalmology there in Melbourne it was…I was sort of wondering what to do and I thought the first thing that we need is to find out what are the eye problems in our community so we did a big epidemiological study – the Melbourne Visual Impairment project. So, in about 2004 we started to do some work with a group of economists at a place called Access Economics where we started looking what were the actual cost implications of blindness and vision loss, how much was it costing the community and then what were the costs to do something about it? And we showed that in Australia at that time it was costing about 10 billion dollars a year to the community as a whole with the direct cost of the need to treat eye care…the eye disease, the indirect cost with people who had lost employment or carers that had to take the time off, also the burden of disease or the loss of well being. But if you actually put together the things that you needed to do, it was…there was about a five dollars savings for every dollar spent on curing or preventing eye disease. So, this was quite important and in Australia it convinced the Australian government to put together a National Framework for Eye Care but we were also approached by a number of other countries so we did similar reports in Japan, and in Canada and in the UK and some in the US and Paraguay and in New Zealand. So, I think those economic arguments about the cost and impact of eye care balanced against the cost and benefit of doing something about it are very important tools in advocacy.
Screen: Paper Six The prevalence and causes of vision loss in Indigenous Australians: the National Indigenous Eye Health Survey
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A few years ago I sort of said well you know if I get another good 5 or 10 years work in me and I can only do one thing what would I like to do and I thought there was still a huge unmet need in the Australian Aboriginal people. And so again to try to find out what the real problems and issues were we started this National Indigenous Eye Health Survey where we looked at thirty clusters of communities spread across the whole of Australia and we went to these areas and looked at all the Aboriginal children age 5-15 and all the adults over the age of 40. And what we showed is that the Aboriginal children actually start of with much better vision than other Australians. They have much less in the way of congenital problems with their eyes, they have much less myopia and many aboriginal people actually have much sharper visual acuity than what we define as the normal acuity. The average acuity for aboriginal people is about 6/3.5 or 20/12 where as some of them were seeing 6/1.5 or about 20/5. So extraordinary sharp vision, good vision in young people but by the time they reach the age of 40 and above they had six times as much blindness and more than three times as much vision loss and almost all of this was unnecessary preventable or treatable -cataract, refractive error, diabetic retinopathy and trachoma. So we started a big campaign and finally convinced the Prime Minister of Australia to commit to the elimination of trachoma and now the trachoma rates in those endemic areas have gone from 21% to 4.6% the most recent data. So, we are making really good progress for the elimination of trachoma.
There has never been a better time to be a doctor or to be involved in eye health because there has never been a time when we could do more to make blind people see again or to keep seeing people continuing to have good vision. What we really need to focus on is applying what we know now.