Copyright (2006) Epsilon Magazine

Professor Minas Coroneo talks about the bionic eye, the latest breakthrough in the field of ophthalmology, the pros and cons of medical research in Australia, and growing up Greek in a Kytherian household in the Hunter Valley region in the early sixties.

Words and Portrait, Savvas Limnatitis

"Let’s get one thing straight: what we are offering is not a miracle cure for blindness, but a great step forward”. The softly spoken, bespectacled, fifty-something man, sitting opposite me in what used to be the late, great, Fred Hollows office at Randwick’s Prince of Wales Hospital is talking about the latest developments in the field of ophthalmology and is picking his words very carefully.

And for good reason. After all, modern medicine and its offering of solutions -often of the quick-fix type - to an unprecedented number of diseases to anything remotely fitting the description between cancer and obesity, drug dependency and the centuries old problem of ageing, has made it increasingly easy to be designated a quack, instantly converting years of dedication and research into laughable and best-to-be-avoided obsessions of absent minded professors in long white coats.

Thank God then that modesty has never been a prominent feature in scientific research. For judging by the inches of columns in journals both medical and mainstream (even the media from Greece got in on the act) dedicated to the findings of Professor Minas Coroneo and his dedicated team of researchers there are not exactly small, steps forward but giant leaps, that can revolutionise the way blindness is treated. Professor Coroneo and his team have been working on the project for over five years now. While their first efforts on designing a device that would help patients with genetic eye diseases that have lost their sight received the thumbs up from the rest of the medical world, it was the team’s recent human trials that have made the rest of the world sit up and take notice.

Hailed as a medical breakthrough, the bionic eye does not offer full sight - at least not for the time being. It will eventually however provide blind people with enough “functional vision” to negotiate their way across a room without bumping into objects.

During one of his numerous visits to Kythera, Dr Coroneo was struck by the lack of properr opthalmological facilities on the island. Realising that the only options available to the ageing population of his parent’s birthplace was a visit to Athens with all the problems and hardships such a scenario involves, Dr Coroneo quickly set out to rectify the problem. Calling on the help of his associates both in Greece and Australia as well as the rest of the world, Dr Coroneo’s original idea was soon transformed into the establishment of an eye clinic. Situated at Potamos’ hospital the new eye clinic serving the Kytherian community is equipped with all the necessary equippement and apart from the services of a regular ophthalmologist it also offers those of an optometrist. Not surprisingly, your reporter has gained this information not from Dr Coroneo himself, who carfefully avoided mentioning this little known fact about his life outside of his office, but through a mutual friend who, in his turn, could not speak highly enough of this introvert scientist. How much does this say about his character? You be the judge of that.

THE BIONIC EYE

What exactly is the bionic eye and how did you come to be involved?

About ten years ago my colleague, Dr. Halliday, who has spend his life looking after people that were blinded by hereditary conditions that result in disease of the retina, decided to retire. The general group of these conditions is called retinal dystrophy, and retinitis pigmentosa is the most common of them. It affects one in five thousand people and it’s the commonest cause of blindness in young people. He was interested in the genetics of this and had built a big database. When he retired, the hospital didn’t replace him and on top of my all my other work, I ended up having to do his clinics. So I am sitting here in Randwick having to look after all these youngish people that are blind. I do not like this type of practice because in modern ophthalmology we help people. You come in; have an operation, go home and the next day you can see. So that was outside the normal activities I had been used to. Around 2000 there was a programme on TV about an engineer in New York called William Dobelle who had spent his life trying to develop bionic eyes. He had implanted electrodes into the visual part of the brain of a blind person. When he had started the computers that were required to run this filled a rather large room. By 2000 the computer was a laptop and the person was shown walking around with this device. I thought this was fantastic, but the technology was really crude. People can loose their sight at any time and depending on how it is lost, will determine what sort of “bionic eye” that needs to be developed. Dobelle had a system where he placed electrodes in the brain and his early patients had them running out of their skulls, which is very dangerous because you could get infections. It struck me then that the leading company for stimulating any sensory system is Cochlear, an Australian company based in Sydney. They have the best technology in bionic ears. We rang up Cochlear and told them we had all these blind patients and asked if we could work with them to develop a bionic eye. They have been very helpful in giving us access to their technology.

How long did the original process take?

We spent about five years working with animals. We took off-the-shelf components and that was a big advantage for us because we are competing with overseas groups that are better funded than us, and employ similar technology. But we didn’t have to reinvent the wheel. We had a leading company with the right technology, which we borrowed. The reason for the recent publicity is that earlier this year we started doing some work with patients. This is the first study in humans that we are aware of in Australia.

How long before the bionic eye becomes available to the public?

I am hoping that there will be something available in the next five years. It might not be us. Now that might sound like a long time but given that we have been working on this for only five years, we feel like we are half way through this cycle. Just to make it very plain - and we have been very careful with any publicity because we don’t want people to think that we are about to have a product- what we have achieved is an important step forward. We took a slightly different approach to the one of some of our colleagues in the US. Normally, most of the groups that are working on the retina have put electrodes on it. The retina is like a film in a camera. It has a layer of cells that detect light and turn light into electrical signals. Those signals go to nerves that join up and form the optic nerve. Because the retina is very delicate and also because you have to open the eye, that approach involves some risk. Just imagine what might happen to someone with pieces of metal attached to their retina if they jump on a trampoline. The approach we took was to put electrodes on the outer wall of the eye and increase the current, so it still stimulates the retina. Because of this, we do not have to open the eye. We think that might be a more stable and safer system long term. So earlier this year, we put some electrodes on the outer wall of the eye of a patient, we stimulated those electrodes and the patient was able to see flashes of light.

Is the bionic eye the ultimate solution for people without eyesight?

The type of vision we think will happen initially won’t be anything like yours or my eyesight. It’s not going to be normal vision. The current Cochlear devices have about 30 electrodes. Imagine having 30 electrodes on the outer wall of the eye, which in theory means that if you turn them on at the same time, you will get 30 flashes of light. The idea is that you will have a series of flashes outlining objects. What we are trying to do here is to give people navigating vision.

How did the rest of the medical world respond to your findings?

We have published quite a lot of papers that have been well accepted. We were at a meeting in Detroit early this year when we presented this work and so far the response has been very positive. There is nothing really controversial about what we are doing. It’s just a slightly different approach. One of our big strengths is the link with Cochlear. They know how to built devices and get them to market. We think that puts us in a good position to actually develop something.

MONEY MAKES THE WORLD GO AROUND

You have applied to the US Patent Office for a patent. How important is it to get the rights to the patent? Is it to ensure that no one benefits financially from it? I get the feeling that money is not on the top of your list of priorities?

I am not driven by money. Otherwise I wouldn’t have been here. We have a company that was formed to get this product to the market. When you go down this path, there are certain commercial realities. One of these realities is to protect the intellectual property that has been generated by what we do. Because overseas there are a lot of people with more money than us, if we pass on ideas we can be left behind. What we are doing here is simply being careful. Once you get the patent, you can go to companies and say: “we have my commercial property, what is it worth and can we work with you to get it developed”. It puts us in a better position when we try to develop it.

Has the American dollar tried to lure you away from Australia?

Ha-ha. I have been tempted to apply for positions in the United States. It’s not that I find money attractive. But it’s a fact that a lot of people have been driven away from Australia because of the lack of investment. It’s not so much the money but more that our public institutions, our hospitals and our universities are not traveling well at the moment. Across the country, the public hospital system that’s supposed to be looking after Australians often has its problems. Academic work in hospitals under these conditions is very tough, at least for some of us. In Australia public funds go to patient care first, but research is also a priority. However, I know that some colleagues who work in similar institutions in the USA are much better supported than we are. On the other hand, the lack of resources makes you cunning. You have to make do and one of the great things about Australian investors and scientists is that to survive in a very competitive market, they have to be smarter and be able to out perform the competition. I have a great team of people that I work with and I am not sure I would be able to find them elsewhere. At the moment, I am happy trying to do what I am doing from here.

What about the Australian government? What has been its response?

We have had some funds from the Australian government. We have had an National Health and Medical Research Council grant a couple of years ago, that paid for a research assistant for a couple of years. It helped to get the basic work completed. Putting in grant applications is a lot of work and the amount of money that you get makes you ask if that is a good way to spend your time. We have tried very hard to get more. The German government is funding one of its projects to the tune of 50 million dollars a year. We currently have no government funding for this project. Many people that are in this situation apply every couple of years for small amounts that keep them going. It means that you spend a lot of energy staying afloat. It’s like treading water rather than swimming forward. Because of the recent testing, we are in a better position to go back to the government and say, “this is important in terms of having been developed in Australia, we would appreciate some support”. If you imagine being the Minister of Health, every time he turns around there is someone that has developed a cure for cancer or some other thing, he can’t possibly fund every project. I happen to think this is a very important one because one of the key determinants of quality in life is the ability to see. Particularly young people that have been affected by these diseases, they may have many many years of blindness and we are hoping to develop something that will enable them to walk around. We jokingly say that what we are trying to do is turn guide dogs into pets. Giving people that level of independence is a big deal.

THE ROOT OF ALL... GOODNESS

What drives you and your team to fight bureaucracy? Wouldn’t it have been easier to give up?

It’s always easy to give up. I’ve been doing this for a while now and one of the things about being an academic is that most Australian ophthalmologists are very well trained and provide a very high level of service, and they are sitting in dark rooms across Australia diagnosing diseases, they are operating in theatres making people see better. The thing that partly drives me is that we sit there and we look at people with problems we can’t fix. Because I had intense training in science, as well as studying medicine, I tried to reconcile the interface between basic science and clinical medicine. On one hand I look after my patients, which I enjoy doing, but at the same time I am thinking about how I can treat this condition that otherwise can’t be treated. So I see myself partly as an inventor. If you have one or few inventions you treat people across the planet. That’s not an ego trip. It’s part of what is intellectually stimulating about this work. Clinical medicine can almost be like process work. You have to be very good at doing the same thing over and over again. Beyond that is this almost arrogant ambition to do something more than that.

A lot of people have taken the Hippocratic Oath, but not everyone follows it to the last detail. What makes you different?

It’s partly what you are suited to and partly what opportunities are there. I was extremely fortunate that extraordinary people trained me. I trained at the University of Sydney with John Young, the Head of Physiology. He was a very clever and very driven scientist. I had that background, and then I went to Germany where I trained with a guy who was a scientist as well as an ophthalmologist. When I returned to Australia I had Fred Hollows as a teacher for four years - as a matter of fact this used to be his office. I have had the appropriate training to do what I do. I remember I went to a lecture during my first week at the University of Sydney - this was in 1972- and I was inspired to go and work with John Young who was the speaker that day. You can be the benificiary of serindipitous circumstances. You find yourself in different situations in life where you have the opportunity to do things. On the other hand, my parents didn’t have a very good formal education, so when they came to Australia they were very determined that their children would be educated. I had the best education they could afford to give me at the time, and I have gone through life trying to achieve things.

While I admire your modesty, I can’t help but notice you have served in outback Bourke. What influenced the decision to go all the way there? Were you trying to pinpoint the exact location of “woop woop” on the map?

That was purely Fred Hollows. I arrived at this hospital in 1982. Prior to that in the 70's, Hollows had been all over outback Australia looking after indigenous and white people and anyone with eye disease. By the time I arrived that program had ended and the last outpost for NSW was Bourke. In my training - and I am pleased to see in the training of the people that are currently involved in this project - we provide a service to Bourke Hospital. It’s funny because I talk to people about Bourke and my instructions on how to get there is to find the last traffic lights in Sydney and then drive northwest for ten hours. You can’t miss it.

Other people would have taken the easy option and settled in a nice office in Sydney and try to make as much money as possible.

It’s possible that I have a very short attention span. Like a lot of people I need stimulation. Fred Hollows once said to me: “If you go into a practice and that is all you do, you will be brain dead by fifty”. I am pleased to report that I am 52 and I am not brain dead. It’s a great privilege to be able to sit here and do as much as I can. It hasn’t been easy; we have had a lot of difficult times in the last ten years. Sitting in this hospital-university situation when both institutions are not well supported in my view - and that’s a political statement, but I think a lot of other people share the same view- can be tough. Maybe the easiest thing to have done is to get up and go overseas. It’s just that I am rather happy to be surrounded by this group of great people trying to do something good.

THE KYTHERIAN CONNECTION

How did your parents take your decision to plunge into the uncertain field of medical research?

Town of origin - Potamos

Parachoukli - Belos

My father died when I was in the second year of medical school. As a matter of fact, he didn’t want me to be a doctor; he wanted me to be an engineer. For two reasons: he came to Australia from Kythera in 1920 and served in the Second World War. He was in the Ambulance Corps in Darwin when it was bombed and he saw surgeons operating and didn’t really like it. He thought doctors were fairly uncivilized. Back in Scone where he lived, he was there when they were building the Glenbawn Dam. There were a lot of Greeks that had come to Australia during that era. One of his best friends was the engineer that was responsible for building that dam. My father saw engineering as clean and helpful to the community, building bridges and stuff, and he wanted me to be an engineer. To that extent I disappointed him. On the other hand, in that era most people that did well at school were expected to study medicine. In Scone, the small town where I grew up the person that made the difference between life and death was the local doctor. He was an inspirational character.

What about your mother?

My mother passed away last year, but she lived long enough to see what I have become. I think I had disappointed her as well. Her idea was that when I finished medicine I would open a general practice somewhere locally. All these years that I have been going overseas she had a great difficulty understanding what I was trying to do.

Was it hard to retain your Greekness, growing up in the middle of The Hunter Valley with not many Greeks around?

There is schizophrenia about Australians’ attitude to migrants. On the hand most people were very supportive, my father had many friends and his was in business in Scone for about fifty years. There were a few xenophobes. I had an unusual name by Australian standards then. You can imagine what it was like having a name like that in Australia in the 1950s. Sometimes at school it was tough. I have a younger brother, who was big, and his attitude was that he would hit anyone that insulted him. So he became one of the boys. He was also much better in adjusting than me. My approach was to do it academically. In a way that attitude was because my parents rewarded academic success. My father would say that knowledge is power and I tried to know more than other people.

What about Greek traditions?

As for traditions, we only spoke Greek at home and so when at the age of five I went to infants school I couldn’t speak a word of English. My mother had a sort of reverse racism. She saw Australians as being a little bit uncivilized. She would see people crawling out of pubs drunk at five or six in the evening and think “God, what country did I come to”. In the end she had a lot of Australian friends. She arrived in Australia two years before I was born and she was a little concerned about how things would turn out. We didn’t have Greek school in the country so my formal Greek isn’t great, but for my kids we had a Greek teacher who came to our home. They both know how to read and write in Greek. They have been to Greece a couple of times and are very proud of their heritage. We still have property in Kythera and we have made sure our kids have gone to the island and know what is there. There was a church in Newcastle where we would go. I was christened here in Sydney at Hagia Triada. I am not a very religious person but I very much respect the traditions of our church, and as I have grown older I have come to appreciate them more.

Your name recently featured quite prominently in newspapers in Greece. Were you surprised by the attention you have received from the Greek media?

I was pleasantly surprised. The reason for this publicity is that recently we had a fundraising dinner. George Souris hosted it at the Parliament House and we had over 200 people attending. Leading up the dinner, the organisers thought that it would be good to get some publicity and I also did an extensive interview for ABC earlier this year. All that created a lot of interest. In fact one of the people who is very supportive of what we do is the Greek Consulate General, Mr. Raptakis and he got a lot of calls from Greece. He put them in touch with me and this resulted in several phone interviews. I have had some contact with the University of Athens. I went there a couple of years ago and met my counterpart. I was interested in building relations with Greece but when I came here I got swamped with a lot of other issues, and I haven’t done as much as I would have liked in that respect. I am very, very proud of my heritage, both Greek and Australian. I did a lot of my post graduate studies in Germany and I can remember coming back after being away for three years, thinking “I don’t really feel Australian now, but I don’t feel European either”. You get to the point where you think, “who the hell are you, anyway”. But I have snapped out of it now, I know exactly who I am.

How do you see the Greek community in Australia? Are we on the right path?

In many ways we are in a very privileged position. The Kytherians are a fairly tight knit group, they have their Association, and they have their dinners and everything else. Growing up in the country, one of the problems was that I had very few links with any of the Greek community when we moved to Sydney. In my high school, it was like the United Nations. I had Jewish friends and Italian friends, people from all over the world, all at the one place. Coming from the country to Sydney, it was like visiting Disneyland. I gradually have become more involved in the Greek community. I have been asked to address some functions and I find that the Greek community has in general been very supportive of what I do. John Howard made a comment recently that “Greeks are model citizens”. I have a paper clipping from one of AHEPA’s first meeting, held in Scone in the 1930s stating that what AHEPA was trying to do was to bring the best aspects of Greek culture into Australia. It’s very hard to find a better statement of intent on how to behave when you come to someone else’s country.

WHAT YOU CAN DO

Finally Professor, is there a way that people can help this worthwhile cause?

We have two foundations supporting this project. The Genetic Eye Foundation, which looks after people with these blinding conditions. People can donate money to that or they can donate money directly to The Australian Bionic Eye Foundation. Donations to both charities are tax deductible. Obviously, every bit helps but we are not relying on that. We are trying to get this commercialised as soon as possible so we can really move on with it. But if someone is looking for a good cause... Medical charities are numerous and there is a lot of “competition” out there. This one is a little bit different and at the moment we do need some support. At this present time we have four part time people working on this project but we don’t really have a lot of infrastructure to make things move forward.

MAKE A DONATION

The Genetic Eye Foundation,
Ms R. Sturt,
C/- Department of Ophthalmology,
The Prince of Wales Hospital,
High Street,
Randwick, NSW, 2031.
Telephone:
Ms R. Sturt (02) 9382 2493

Email, The Genetic Eye Foundation

Australian Bionic Eye Foundation,
Ms R. Serna,
C/- Department of Ophthalmology,
The Prince of Wales Hospital,
High Street,
Randwick, NSW, 2031.
Telephone:
Ms R. Serna (02) 9382 2307

Email, Australian Bionic Eye Foundation