BHVI

Professor Brien Holden OAM has been a major figure in international eye health and vision care for nearly 40 years. His influence extends across science, research and development, professional and academic education, public health and as an advocate for the profession of optometry. He has been instrumental in establishing and guiding a series of ground-breaking national and international organisations that continue to make important contributions in vision and eye health. He has also been at the forefront of international efforts to address avoidable blindness and vision impairment, especially that caused by uncorrected refractive error.

His contributions have been acknowledged through a host of national and international awards and honours – most recently through the renaming of the Institute for Eye Research the Brien Holden Vision Institute.

The early years

Following the completion of his optometry training at Melbourne University in 1964, Brien Holden embarked on an impactful journey by boat to the UK with his new wife. Seeing the poverty and hardship at several port stops along the way stimulated a lifelong interest in humanitarian pursuits and social justice. After completing his PhD in corneal and contact lens research in the United Kingdom at the City University London in 1971, Brien returned to Australia to take up a position as Lecturer at the University of New South Wales (UNSW) in Sydney. This proved to be an incredibly fertile research and educational environment in the early 1970s.

It was here that a group led by Brien Holden began to quickly develop expertise in soft contact lenses – a new modality for vision correction. Brien's influence was not only felt in contact lens studies and research, but also in teaching diagnostic drugs. His UK qualifications enabled him to be both the first person to be registered in optometry to use diagnostic drugs and the first teacher of the subject in Australia.

In 1973, Brien and several postgraduate students began research to determine what was needed in contact lenses to maintain eye health. This group managed to attract the interest of other researchers to work with them, expanding beyond the original goal of understanding the effects of contact lenses on the cornea to include all aspects of contact lenses – from lens design, material properties and performance to the effects of a wide range of ocular devices, procedures and contact lens solutions on the eye.

Building organisations and creating breakthrough research

The Cornea and Contact Lens Research Unit (CCLRU) was established in 1976 by Brien to develop the specialty within what was then known as the School of Optometry at UNSW (it later became the School of Optometry and Vision Science). This CCLRU became the basis for the phenomenal growth in research activity within the School of Optometry in subsequent years. By this time the group had grown to over 30 people, the largest in the world engaged in this area of research. It went on to make significant contributions to the world of contact lenses – understanding the eye’s needs, developing toric soft contact lenses and setting the agenda for clinical care of contact lens wearers.

The CCLRU quickly grew, along with its reputation, attracting industry interest and funding. By the end of the 1970s its staff included optometrists, biologists, physiologists, biochemists, microbiologists and biostatisticians. It began to develop a postgraduate research programme as well as expertise in continuing education, delivering contact lens education to thousands of practitioners and educators throughout Asia. Key world leaders in the field were attracted to Sydney to help develop the international reach of the group.

The CCLRU expanded its operations to become the major organiser of contact lens related clinical trials around the world, collaborating with what is now one of the world’s leading eye research Institutes and hospitals, the LV Prasad Eye Institute (a long-time research partner).

The success of the CCLRU spurred Brien Holden onto further challenges. Brien and colleagues saw the need for an independent, but University affiliated, Australian institute to promote and develop eye research and education. In 1985, Brien and colleagues established the Institute for Eye Research as a non-profit Approved Research Institute.

The Institute undertook a range of both applied and basic scientific and clinical research projects dedicated to advancing knowledge of the eye and vision system and to create innovative vision correction products. It managed this by employing a policy of engagement with external organisations as a way to draw on expertise from around the world to create inventive solutions to some of the major challenges facing the field. The Institute forged long-standing associations with organisations through the CRC program such as the LV Prasad Eye Institute and the University Hospital in Helsinki.

When the Australian Government established the Cooperative Research Centres (CRC) Program in 1991, Brien immediately saw an opportunity to create new breakthroughs through the relationships between research and industry that the Program promoted. The Cooperative Research Centre for Eye Research and Technology (CRCERT) was established in 1991 and through this program with Brien as Director, developed collaborations with Bascom Palmer Eye Institute, University of Houston and the Centre for Eye Research Australia among many others.

CRCERT received two CRC grants and provided the basis from which the Vision Cooperative Research Centre (Vision CRC) was established in 2003 and a Vision CRC extension granted in 2009 – a total of $85 million in CRC funding over 25 years. This level of government support attracted over $800 million in industry and partner investment in the CRCs.

These organisations achieved their goals of delivering breakthrough research and innovative products, with products delivering over a $1billion a year in sales and $25 million a year in royalties. The CRCs have also made important contributions in the areas professional education and vision care delivery.

Research

Brien Holden’s research focus has been in the area of ocular health with contact lenses and surgery and vision with all forms of vision correction. He has been a driving force behind the development of a number of lens products. Most notably, the creation of the third generation of soft lenses to correct astigmatism and the co-developer of the breakthrough highly oxygen permeable silicone hydrogel lenses with CIBA VISION, which have revolutionised the contact lens market.

Institute researchers developed the technology that resulted in the development soft toric contact lenses for the correction of astigmatism. These lenses were successfully launched worldwide in 2002 and rapidly became one of the most successful toric designs ever launched.

The Institute co-developed with another industry partner highly oxygen permeable breakthrough silicone hydrogel contact lenses. The invention of the silicone hydrogel contact lens solved the problem of supplying high enough levels of oxygen to the cornea to overcome the problem of hypoxia and added over $1 billion per year to industry in returns.

Most recently, research conducted with partners through the Vision CRC resulted in the development of a silicone hydrogel multifocal soft contact lens for the correction of presbyopia.

With collaborators around the world, Brien Holden is currently working on new technology to slow the growth of myopia. This condition currently affects the sight of more than 1.6 billion people worldwide and through the efforts of the Institute for Eye Research, the University of Houston School of Optometry and industry partners through Vision CRC, this research is delivering products to treat myopia.

The CRC also spun of a US based for-profit company Adventus Technology Inc and an Adventus Technology (Australia) subsidiary to take to market, mini sub-epithelial implants for refractive correction and a revolutionary dynamic gel lens system to restore normal vision to the more than a billion people around the world with ageing sight (presbyopia).

Education

During the 1980s the use of low oxygen permeable extended wear lenses became widespread throughout Asia, creating a need for professional education to increase the standard of contact lens education throughout the world. Brien Holden and colleagues from the CCLRU instigated the Asia Pacific Contact Lens Education Program (APCLEP) as a way to educate contact lens practitioners in many developing countries and ensure safe contact lens wear.

This included raising sponsorship from the ophthalmic firm Bausch & Lomb, which helped support the program. APCLEP sought to ensure the programs it delivered were sustainable, targeting contact lens educators to ensure that knowledge would be passed onto the next generation of practitioners, enhancing local educational capacity. The program reached over 20 000 practitioners.

Brien Holden was also involved in the establishment of the International Association of Contact Lens Educators (IACLE), which developed educational infrastructure and resources specifically targeting hundreds of contact lens educators throughout the world. IACLE programs now exist in over 60 countries. Similar programs were initiated for educator and practitioner training in refraction and progressive spectacle dispensing in association with Essilor through ICEE.

Brien Holden has also made important contributions, especially in the area of post graduate academic education, through his involvement with the School of Optometry and Vision Science at UNSW where he was appointed Lecturer in 1991, and later professor. He has also had many visiting appointments at universities across the globe, including the United Kingdom, Finland, United States, Canada and China.

Brien has also created many opportunities for postgraduate research students through the organisations he has been involved with. The CCLRU, Institute for Eye Research, CRCERT, Vision CRC and ICEE have all possessed strong student programmes and many graduates have become some of the finest professionals, researchers and educators in their fields.

The Institute has educated 150 PhD and MSc students and currently supports over 40 postgraduate researchers.

Global and Indigenous eye care

Brien's postgraduate education began in 1965 in the United Kingdom and the lengthy journey by boat included several port stops along the way. At locations such as New Guinea and Sri Lanka he observed the conditions of poverty that many people there at the time were forced to survive in. The experience had a major impact on Brien's future activities, inspiring a commitment to engage the optometric community to increase efforts to help those in need.

With colleagues Brian Layland, David Pye, Debbie Sweeney and Frank Back he established VisionCare NSW in 1992 to manage the NSW Government Spectacle Program, which delivers subsidised eye care to those in need. VisionCare NSW has since supplied over one million pairs of spectacles to financially disadvantaged people in NSW.

In 1998, he co-founded the International Centre for Eyecare Education (ICEE) to establish eye care services in developing communities throughout the world. ICEE now delivers self-sustaining education programs and ensures the necessary supporting infrastructure and supplies of spectacles and equipment exists to ensure these services are sustainable. The programs continue to build eye care services for Indigenous Australians and other communities throughout the world.

Brien Holden has also made a strong contribution to global initiatives to address avoidable blindness and vision impairment through his involvement with the peak global bodies - the International Agency for the Prevention of Blindness (IAPB) and the World Health Organization's (WHO) Refractive Error Working Group.

Along with colleagues Dr Nag Rao and Professor Hugh Taylor, Brien made important representations to have refractive error recognised as the main cause of blindness and impaired vision by the WHO. This is now a key theme for Vision 2020, the global initiative of the IAPB and WHO to eliminate avoidable blindness.

ICEE instigated the inaugural World Congress on Refractive Error in 1997 which has further promoted global efforts in this area
Brien Holden has been Chair of the WHO’s Refractive Error Working Group since 2001 and a Member of the Board of Trustees of the IAPB since 2004. As a critical part of this initiative Brien and colleagues developed the epidemiological data on the global size of the problem. This assisted in the development of a global plan of action to eliminate uncorrected refractive error by the year 2020.

Brien and colleagues from ICEE, CBM, Fred Hollows Foundation and Vision 2020 Australia were instrumental in developing the proposal that resulted in an allocation from the Australian Government of $45 million over 2 years to eliminate avoidable blindness and impaired vision in the Pacific region.

Brien’s commitment to this issue saw him address the National Press Club in 2005, where he alerted the audience of the enormous need for vision correction to address a problem that impacts on the health, quality of life, education and economic opportunities of so many. He continues to emphasis the link between avoidable vision impairment, disability and poverty.

Collaborators

All of Brien Holden’s career activities and achievements are a result of collaborative partnerships he has established with colleagues and organisations in Australia and around the world. With long-time colleague Brian Layland, they have achieved the recognition and service of optometry to community controlled eye care for Aboriginal people all over Australia, particularly in New South Wales and the Northern Territory.

Other major collaborators include Antti Vannas, an ophthalmologist who had a great influence on Brien, enabling him to imagine the potential for improved vision correction that could result from cooperation between the professions of ophthalmology and optometry.

Nag Rao, founder of the LV Prasad Eye Institute (LVPEI) in India, has been a long-term partner in both vision correction research and efforts to address avoidable blindness and vision impairment worldwide. He has also been an important figure in the development and successes of organisations such as the Brien Holden Vision Institute and ICEE.

Brien Holden’s contributions to the organisation were acknowledged by LVPEI when it named its centre investigating the causes and treatments of eye conditions, the Professor Brien Holden Research Centre.

Career

Over the course of his career, Brien Holden has received 29 national and international awards from organisations around the world for his contributions to research, eye care and health, including five honorary doctorates. He has delivered more than 90 Keynote Addresses, authored more than 220 refereed papers, 26 book chapters and 380 refereed abstracts.

Brien has been a member of government licensing, advisory and registration bodies including as a Member of the Australian Government Department of Health and Ageing Advisory Committee on Contact Lens Solutions. He continues in the role of Chairman of the Board of Management of VisionCare NSW, which he has carried out since 1992. He has also acted in an editorial capacity and as referee on a range of international academic journals.

In 1997, Brien Holden received the Medal of the Order of Australia for outstanding contributions to eye care research and education

Selected Awards

Organisations Brien Holden has helped establish and guide

• Cornea and Contact Lens Research Unit (CCLRU) at the University of New South Wales
• International Society for Contact Lens Research (ISCLR)
• International Association of Contact Lens Educators (IACLE)
• Institute for Eye Research (IER)
• Cooperative Research Centre for Eye Research and Technology (CRCERT)
• Vision Cooperative Research Centre (Vision CRC)
• VisionCare NSW
• International Centre for Eyecare Education (ICEE)
• Optometry Giving Sight
• Adventus Technology Inc and Adventus Technology (Australia)