Letters to the Editor

REFERENCES 1. McNab AA, Francis IC, Benger R. Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcomes in 21 cases. Ophthalmology 1997; 104: 1457–62. 2. Jafek BW, Ward PH. Infraorbital perineural invasion by tumor. Radiology 1971; 101: 617–8. 3. Campbell WW Jr. The numb cheek syndrome: a sign of infraorbital neuropathy. Neurology 1986; 36: 421– 3. 4. Terashi H, Kurata S, Tadokoro T et al. Perineural and neural involvement in skin cancers. Dermatol Surg 1997; 23: 259–64. 5. Larson DL, Rodin AE, Roberts DK, O’Steen WK, Rapperport AS, Lewis SR. Perineural lymphatics: myth or fact. Am J Surg 1966; 112: 488–92.

The Royal Australian and New Zealand College of Ophthalmologists’ ophthalmic support to developing countries We read the recent letter, ‘Ophthalmic support in developing world countries’1 with interest and applaud the authors for highlighting important issues pertaining to volunteer activities. We agree that such activities play a vital part in enabling developing countries to work towards eliminating avoidable blindness, and should be in alignment with the World Health Organisation Global Action Plan 2014–2019.2 International development is embedded in the current Royal Australian and New Zealand College of Ophthalmologists (RANZCO) strategic plan as an organizational response to this need.3 RANZCO is leveraging its core competencies in ophthalmic education and professional standards to contribute to international development, focusing on the Asia-Pacific region.4 The approach is organizational, but also recognizes the ongoing place for individual activities. A critical component, uncommon in the international development sector, is the fact that Fellows (members of RANZCO) give their time and expertise on a pro bono basis. RANZCO is compliant with best development practice through its accreditation with the peak body for Australian not-for-profit aid and development organizations, the Australian Council for International Development (ACFID).5 The ACFID Code of Conduct seeks to ensure good development outcomes through good governance,

Competing/conflicts of interest: No stated conflict of interest. Funding sources: No stated funding sources.

transparency and accountability. RANZCO is an active member of the peak international eye health advocacy body, the International Association for the Prevention of Blindness.6 RANZCO works in partnership with local stakeholders in the Asia Pacific, and as part of consortia such as Vision2020Australia Global Consortium and the Commonwealth Eye Health Consortium, to advocate for, and build capacity in, ophthalmic education and professional standards for eye care. It is important to highlight that this typically involves working with national ophthalmological societies, to apply and implement best practice principles to ophthalmic education. The peer-reviewed and validated resources of the International Council of Ophthalmology are utilized as the foundation for educational programmes. This not only promotes and demonstrates standard setting to benchmarked international standards, but also provides an in-built mechanism for ongoing development and improvement. RANZCO has a track record, which continues, of working in partnership with ophthalmic organizations in the Pacific, Cambodia, Vietnam and Indonesia. Call for expressions of interest are regularly made for Fellows who wish to participate. The final matching of Fellows for these development projects is based on relevant experience, expertise, subspecialty interest and availability. RANZCO does not limit its engagement just to ophthalmic curriculum and teaching development. Leadership development is an important part of long-term capacity building. RANZCO has established a Regional Leadership Development Program for key regional ophthalmic personnel. The programme involves several leadership capacity building and mentoring activities and includes sponsored attendance at the RANZCO Annual Scientific Congress. Additionally, regional ophthalmologists and residents are offered international scholarships to the annual RANZCO Congress. These are popular and sought after. Alongside the organizational response, RANZCO recognizes and respects that individual volunteer activities are ongoing. Good practice guidelines have been developed, and are easily accessible on the RANZCO website to assist these activities. Those considering, or engaged in, volunteering can use them as a developmentally sound framework for their activities. The guidelines cover, among other things, • • • • •

Assessing one’s individual contribution to international ophthalmology activities Clinical teaching of local eye care practitioners Teaching ophthalmology in developing countries Donated items of equipment or consumables Use of recycled spectacles.

Taken together, all of these initiatives build upon the remarkable track record of the many individual Fellows activities in the past. Collectively, they represent a responsible, coherent and considered response to eliminating avoidable blindness and the Global Action Plan. This response is only possible through continued

© 2014 Royal Australian and New Zealand College of Ophthalmologists


Letters to the Editor goodwill and the contributions of motivated and ethical individuals. Neil Murray FRANZCO,1 Catherine Green FRANZCO MMedSc2 and Gerhard Schlenther MBL MPH3 1

Rotorua Eye Clinic, Rotorua, New Zealand; 2Centre for Eye Reseach Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, and 3Royal Australian and New Zealand College of Ophthalmologists, Sydney, New South Wales, Australia Received 23 July 2014; accepted 24 July 2014.

REFERENCES 1. Thomas R, Lawlor M. Ophthalmic support in developing countries. Clin Experiment Ophthalmol 2014; 42: 397–8. 2. Available from: AP2014_19_English.pdf?ua=1 3. Available from: about/our-organisation/strategic-plan 4. Available from: international-development

291 5. Available from: what-is-acfid 6. Available from:

Regional susceptibility of the optic disc to retinal nerve fiber layer thinning in different optic disc types of eyes with normal tension glaucoma The diagnosis of glaucoma is based on optic disc cupping, thinning of the circumpapillary retinal nerve fiber layer Competing/conflicts of interest: No stated conflict of interest. Funding sources: This retrospective study was approved by the institutional review board of Tohoku University Graduate School of Medicine (Study 2012-1-574), and was supported in part by JST grants from JSPS KAKENHI Grants-in-Aid for Scientific Research (B) (T.N. 26293372) and for Exploratory Research (T.N. 26670751), and by the JST Center for Revitalization Promotion.

Figure 1. Regional susceptibility by quadrant and percentage of patients with significant thinning of the retinal nerve fiber layer (

The Royal Australian and New Zealand College of Ophthalmologists' ophthalmic support to developing countries.

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