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Holden: Pioneer of treating global refractive error
Brien A. Holden PhD, DSc, OAM, is credited with making great strides in addressing the epidemic of myopia.
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As part of Primary Care Optometry News’ 20th anniversary celebration, in each issue throughout 2015 we will profile a “Pioneer in Optometry” as chosen by the PCON Editorial Board.
In this issue we honor Brien A. Holden PhD, DSc, OAM.
“Dr. Holden’s unique ability to not just identify a worldwide problem, but his tireless efforts to solve a global issue make him a trailblazer,” PCON Editorial Board member Jenny Coyle, OD, MS, FAAO, shared. “He’s been the pioneer of solving uncorrected refractive error across the world by promoting solutions from every angle – education, innovation and persistence.”
PCON Editorial Board member Kerry Giedd, OD, MS, FAAO, said: “I imagine there is no optometrist, living or deceased, who has impacted more lives than Brien Holden. From his work in the development of silicone hydrogel lenses, to leading efforts to provide sustainable eye care on a global scale, to his initiatives to understand and control the epidemic of myopia, to the vast array of his other endeavors, Brien is a true pioneer who has conquered innumerable frontiers in eye care. While there are so many accomplishments on Brien’s CV, what I find most impressive about Brien is his philanthropic spirit.”
In an interview with PCON, Holden shared his beginnings in optometry and what he considers to be his most significant contributions to the profession.
The Soweto Drive for Sight gave some beautiful people beautiful vision, Holden said.
Image: Holden BA
PCON: Why did you choose optometry as a career path?
Holden: When I finished school I was interested in being in a “health care professional,” but dentistry meant teeth, medicine took too long and pharmacy (which I have come to learn to respect) meant pill pushing. My mother introduced me to a family friend who was an optometrist in my hometown of Melbourne who convinced me to pursue optometry. I was told it was a “nice and easy 9-to-5 profession.” It has worked out to be a lot more than that.
PCON: How has your career unfolded?
Holden: In ways that I never dreamed of. I graduated from Melbourne University in 1965, worked in an optometry practice for 1 year, then traveled to London, partly to complete a Diploma of Contact Lens Practice. I was later convinced by Ian Bailey, a research student at the City University of London at the time, to “have a go at research.” So I undertook a PhD in the area of corneal reshaping with contact lenses there, and when I completed that in 1971 I returned to Australia, becoming a lecturer at the school of optometry at the University of New South Wales (UNSW).
We started to specialize in contact lens research, collaborating with industry and other researchers, which led to the establishment of the Cornea and Contact Lens Research Unit at UNSW in 1976. I had a life-changing opportunity for sabbaticals in the U.S. and U.K., where I realized that our cornea and contact lens research was ground-breaking and that there were great people on this planet – the giants – on whose very generous shoulders you could stand and see the future, as Sir Isaac Newton once said. These were people like Polse, Mandell, Hill, Ruben and, later, Vannas, Rao, Mertz, Wichterle and, much later, Earl Smith and Serge Resnikoff.
Back in Australia in the 1980s, we wrote the recipe for safe physiological lenses, the Holden-Mertz Dk/t criteria, and co-developed silicone hydrogel lenses with Adrian Hunter, BSc, PhD, and CIBA Vision, high performance soft toric lenses (the best of the now Cooper torics) and multifocal lenses (the Alcon Air Optix Multifocal). We licensed this intellectual property to industry, and the royalties we received, along with substantial grants from the Australian Government, allowed us to continue our research explorations. In 1985 we re-configured as an independent, university-affiliated, research institute based at UNSW, which has now morphed into the Brien Holden Vision Institute. The institute has gradually evolved into a research and social enterprise organization that now employs more than 300 people globally through its scientific, research, innovation, education, licensing and public health blindness prevention activities.
I did not remain completely on the research side of optometry. My great friend and renowned Indian ophthalmologist and leader, Nag Rao, made me aware that there were hundreds of millions of people blind or vision impaired globally because of uncorrected refractive error, and he suggested that because I was an optometrist, I and the optometry profession needed to do something about this. In 1998 we established an international organization (now part of Brien Holden Vision Institute) to help establish sustainable eye care systems in developing communities and became involved with the World Health Organization and International Agency for the Prevention of Blindness to try to eliminate uncorrected refractive error for the 625 million people currently affected. The institute, partly funded by Optometry Giving Sight, has now conducted programs in more than 50 developing countries to reduce the burden of unnecessary vision impairment, disability and poverty created by the lack of vision and eye care services.
PCON: What are you doing now?
Holden: The world is faced with an emerging crisis as myopia prevalence rises globally and the risk of vision loss associated with high myopia becomes more worrisome. We estimate that by 2050 half the world’s population will be myopic, with approximately 10% being highly myopic. We need to act urgently to raise awareness and develop interventions that can significantly reduce the progression of myopia. I’m heavily involved in these efforts with some wonderful colleagues around the world such as Earl Smith, Tom Aller and Mingguang He (Guangzhou), and Padmaja Sankaridurg, Monica Jong and Ravi Bakaraju at Brien Holden Vision Institute.
There are the 625 million people who are blind or vision impaired due to uncorrected refractive error globally, and the optometry profession needs to do much more to raise awareness about this and generate the necessary funds to implement the solutions we know work. My colleagues and I (Kovin Naidoo and Amanda Davis) are very committed to that goal.
We are also continuing to develop further technology breakthroughs in vision correction, eye health and diagnostic instruments, and we have recently established, with leadership from Kah Ooi Tan, Yvette Waddell and Paul Erickson, several commercial entities to help take our designs and products to market. We have established a significant presence in Africa, Asia (especially China), India, Latin America and the Middle East in an effort to develop improved vision correction treatments, assist optometry development and improve access to eye care. These are all exciting ventures for our organization that I’m closely involved in.
PCON: What have you learned?
Holden: That it is all about people – the people you work with, the people in need, the people who run companies and governments. Most are good and caring, some are brilliant, some are wonderful, some are just incredibly awe-inspiring. I have learned that if you work with great people – the giants and great collaborators – you are empowered and your work is enriched immeasurably. These people are generous of spirit, caring, visionary, ethical and fun to be with. I have learned that education – good-balanced, thoughtful, knowledge-based education in all forms – is the key to empowerment, to poverty reduction, to eliminating prejudice and to maximizing the opportunity for all people to achieve their best.
On the other hand, the people that disturb me most (and fortunately I have had little contact with them) are the selfish, uncaring, narrow-minded people who are disrespectful of others because of their color, religion or gender, and they have no place in this world. Any of the “isms” are questionable, but racism is the worst, a curse on humanity.
PCON: What is your most significant accomplishment?
Holden: Collecting the right people as friends and collaborators in global macro and excellent micro programs and projects that have had impact. Not that I had much influence on it, but having a wonderful family. Growing in a profession, optometry, that allowed immense diversity in opportunity and contribution. Technically? I suppose assembling the teams and partnerships to co-invent the silicone hydrogel contact lenses. This was a breakthrough that not only provided a new level of safety and comfort with contact lenses and generated significant growth in the contact lens industry, but through the royalties we received it enabled us to pursue more ambitious research goals, education programs and public health initiatives.
PCON: What is your most cherished contribution to optometry?
Holden: Kovin, Serge, Nag, Amanda, Paul, Yvette and I have helped bring optometry front and center into pre-eminence in our world-leading research and blindness prevention activities, taking on some of the biggest challenges optometry has to face, and in the process attracting investment of more than $1 billion in support of research, education and public health. We’ve made inroads in developing significantly better science and vision correction products and helping many countries with significant eye care needs, assisting in the development of regulated optometry professions and optical technology, building teaching and research capacity and delivering eye care and affordable equipment and glasses. I’m also proud of the contributions and impact of our hundreds, even thousands of present and past employees and the postgraduate research contributions of more than 185 PhD and MSc graduates – the next generation of leaders in research, academia, industry and practice.
PCON: What do you enjoy most about optometry?
Holden: The people in optometry and ophthalmology who care. Optometry has given me the opportunity to work with many wonderful, caring, quixotic, talented people from a vast array of countries and cultures – geniuses like Arthur Ho, Klaus Ehrman, Percy Lazon and Ravi Bakaraju. I have had, and still do have, some great mates, like Earl Smith and Kelly and Jason Nichols, who are making massive contributions. I love research and the opportunity of translating our research into products that have been very successful at improving vision. On top of that, seeing the impact our people can have on a life in a developing community, through restoring good vision, is extremely satisfying.
PCON: What do you wish for the future of optometry?
Holden: I wish that optometry continues its growth in recognizing the big picture and that optometry never loses sight of the importance of providing optimal vision correction and best advice for all people who need our services. Optometry needs to make sure it puts the effort and emphasis into its training and professional organizations to take care of the people in need around the world; vision for everyone everywhere is a very important priority for optometry. Optometry will need to take a leading role in addressing the dual threats of the myopia epidemic and the increasing prevalence of other blinding eye diseases such as diabetic retinopathy and age-related macular degeneration. We should be at the forefront of driving awareness and developing and prescribing solutions, whether that is environmental, technological, therapeutic or behavioral interventions for these threats. – by Chelsea Frajerman Pardes