OD Q&A: Brien Holden

Where did you grow up and where did you go to school as an undergrad?

I was born in Melbourne. I lived there for 23 years and did my Bachelor of Optometry at the University of Melbourne. Then I worked in practice for a year, I got married, jumped on a boat with my wife and sailed to England.

Why did you go into optometry?

Actually, I was a poor student and failed my high school first time around. My mum said to me, “What are you going to do?” I said, “Well you know, pharmacy-who wants to sell pills. Medicine is too long. Dentistry’s teeth.” She said, “I know an optometrist. Let’s go talk to him.” He ran a big optometric practice in Melbourne, and I thought, “This is a pretty nice, clean, easy way of making a living, and it involves people. I like people. Well, I’ll have a go at optometry.”

When you were sailing to England with your wife in 1964, the poverty in some of the ports you stopped at along the way motivated your interests in humanitarianism and social justice. Was there a specific moment that still lingers?

We landed in Columbo, which in those days was in a country called Ceylon, now Sri Lanka. I was just shocked. Port Morsby, New Guinea, was eye opening but Columbo…there were almost-dead people lying in the streets, there were lepers, there were beggars, and I thought, “Shit, this is not right. People shouldn’t be living in this sort of poverty.” That mobilized a background of teaching from my mother and my school that you should care about other people as much as you care about yourself.

How did contact lens research become your focus?

The variety of challenges: how does this shape fit the eye and why does it stay on the cornea, why do we get infections, how do we get the lens to rotate to correct astigmatism? There’s a whole bunch of challenges initially related to the physical, mechanical side of contact lenses, and then secondly, to the biological and physiological side, and it was the whole range of very interesting challenges.

You used to see patients. Did research draw you away from seeing patients?

I’ve never ever really lost interest in patients. I remember a lady when I was in my first year in practice who came in who was a +6.00 D prescription. She was about 40, had 4 kids, and she couldn’t see a bloody thing. I did her refraction and supplied her with a pair of glasses-and it changed her life. I mean, she walked out the practice, she could see leaves on trees, she could see her kids 10 feet away. That was a tremendous joy.

What attracts you to research?

Research fascinated me and never ceased to fascinate me. I love to spend time looking at information, generating information, and trying to find out. For example, we’re doing a huge project in China. The guy I’m working with has 1,200 people who are between 6.00 D and 30.00 D of myopia. Why do these people become myopic? People don’t understand that high myopia is becoming the major cause of permanent blindness in Asia because of damage to the retina and the side effects of glaucoma and cataract. Why do some people head off to -20 D and others just stop at -4.00 D? What is it about their genetic makeup, their environment, and all that sort of stuff-I mean, there is no more pressing question to me.

How many patents do you have or are involved in?

Uh, [laughs,] I don’t know. Our organization probably has about, I don’t know, about 40 patent families, and in those families there might be 1 to 5 patents. Maybe there’s a couple hundred patents.

When there's a major disaster, how does your organization respond?

When we had the tsunami in 2004, we waited for 3 or 4 days before we sent any groups to restore spectacles because you’ve got issues related to health, safety, and so forth. Soon after, people have to have their vision restored. Optometry has responded well to that.

When those events grab headlines, how do you bring attention back to eliminating preventable blindness as a public health challenge?

When the dust has settled and you’ve done what you can for people who’ve had a problem, you have to make sure the governments of the world, and particularly the World Health Organization, understand the cost of people not having a pair of glasses that they should have is around about $202 billion in lost productivity. The lack of a pair of spectacles and an eye examination prevents children from learning at school and adults from working, and it drives people into disability and poverty. All of that lost opportunity for the 640 million people around the world who are affected is absolutely tragic. Now, it’s got to compete with AIDS, heart disease, and cancer in terms of getting the attention of governments, industry, and so forth. But if you point out that, look, if we rehabilitate these 640 million people, which will cost about $25 million, then those people can be productive members of society. Society would be much better able to tackle all those life-threatening conditions if people can see.

Tell me about the Intelligent Retinal Camera Project.

We started to wonder, “What’s the next best thing we can get into in terms of extending the role of the optometrist from refraction and vision care into primary eye care?” A guy named David Green said, “You should come and see what we’re doing in Prescott, AZ.” Tom Cornsweet there has been inventing stuff in the optical industry for 50 years. Tom had the idea that he could make a high-resolution, low-cost, tri-stimulus camera which could capture a retinal image and use algorithms to analyze features of significance in the retina, like hemorrhages and vessel changes, with an automatic diagnostic feature built into the camera. We invested in the company-the aspiration being an affordable, high-tech camera that would perform diagnostic analyses and then eventually diagnoses. If you’re in a tent in Malawi and you’ve had only a couple of months training with the delivery of a pair of reading glasses, if you’ve got a retinal camera there, you take a picture and if the camera says this person has diabetes, take them 100 miles to the nearest center for treatment.

You're known for having a very informal speaking style when you're at the podium. Why is that?

[Laughs] I think life should be fun. And you know, I’ve got a bit of a bizarre sense of humor. I like to have a joke; I like to have fun. I think it’s more interesting for the audience if you can get involved with them. I love working with audiences, I love working with students, I love working with people who’ve got a sense of humor. So, it’s good to take the mickey, have a bit of fun, and see if you can get a response.

What would you change if you had it to do over?

In the last 28 years, I’ve put a kilo on every bloody year, and I’m now 128 kilograms. I’d probably keep that to half a kilogram. [Laughs] In terms of greatest regrets, I really don’t have any. I wouldn’t go back one day in my life in case it wasn’t as good as it has been.

What is the craziest thing you've ever done?

We were at the Bausch & Lomb research symposium in Edinburgh, and there was a debate with me and Tim Grant against a couple of other guys. So myself and Tim Grant dressed up in kilts, and we hired a piper. The other guys walked out on the stage and we, of course, marched down the aisle with the piper. [Laughs] Yeah, we won the debate, obviously. It was just a lot of fun. Optometrist are terrific people, you know. They’re not full of themselves, they have a bit of a laugh, they respect knowledge, they respect integrity, they’re not absolutely impressed with themselves as being very important.

What do you do for downtime?

I love to play golf with my oldest son; he drags me out to the golf course when I’m home. I’ve got four grandkids, and I love being with my grandkids. I love having a drink with my mates wherever they are around the world.

What is one thing no one knows about you?

The one thing I would like to see, which is a bit bizarre, is Earl Smith get the Nobel Prize. Earl has discovered a way to prevent hundreds of millions of people from going blind from high myopia, which is to control the progress of myopia. I would just love it if we did enough work to establish that we can prevent hundreds of millions of people from getting high myopia and going blind from it and someone traced that back to Earl Smith and said, “You’re not just a prince of a man, but you deserve the Nobel Prize. So, here it is.”ODT