PROFESSOR BRIEN HOLDEN
Professor Brien Holden was a leading champion for research and the development of new and better vision care technology and products.
He generated over $1.3 billion in research, education and humanitarian funds and was described by Professor Earl Smith at the award of his Honorary Doctorate in Humane Letters at the University of Houston as, "the most influential optometrist of our generation."
His efforts were acknowledged through a host of national and international awards and honours, including an Order of Australia Medal for his work in eye health and vision science; the Schwab Social Entrepreneur Award for Africa 2010 at the regional World Economic Forum; the Charles F. Prentice Medal (optometry's highest scientific honour) and seven honorary doctorates from universities in Canada, South Africa, UK and the US.
In 2010, the Institute for Eye Research was renamed the Brien Holden Vision Institute in recognition of his contributions.
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 Australia (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. 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.
Its staff included optometrists, biologists, physiologists, biochemists, microbiologists and biostatisticians and it became 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) in India.
The CCLRU 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. It also developed a postgraduate research program as well as expertise in continuing education, delivering contact lens training to thousands of practitioners and educators throughout Asia. World leaders in the field were attracted to Sydney, helping develop the international reach of the group.
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 and in 1985, they established the Institute for Eye Research as a non-profit research institute.
The Institute for Eye Research 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. This included forging long-standing associations with organisations 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 with Brien as Director, developing collaborations with Bascom Palmer Eye Institute, CSIRO, University of Western Sydney, Queensland University of Technology, the Optometric Vision Research Foundation and later, the University of Houston and the Centre for Eye Research Australia, among many others.
CRCERT received grants of $37 million over 13 years and provided the basis from which the 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 $1 billion a year in sales and $300 million in total royalties (divided amongst the CRC participants). The CRCs also made important contributions in the areas professional education and vision care delivery.
Brien and his researchers also developed the technology that resulted in the creation of 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 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. This was a major barrier to the development of successful extended wear contact lenses. Brien had laid much of the foundation for this breakthrough through his earlier research, such as specifying the minimum oxygen transmissibility required to avoid excessive levels of corneal oedema during daily and extended contact lens wear. Conducted with colleague Dr George Mertz, this became known as the ‘Holden-Mertz criterion’. The silicone hydrogel lenses have earned billions in product sales for industry.
Over the years Brien collaborated with every major industry organization. Other products to reach the market under his leadership include multifocal contact lenses for presbyopia (co-developed with Ciba Vision) and spectacle lenses to control the progression of myopia (co-developed with Carl Zeiss Vision).
One of Brien’s defining characteristics was his willingness to take risks and the CRC Program provided a platform for the kind of breakthrough research that would yield immense rewards if successful. He instigated several projects in the surgical area through this program – some didn’t succeed, but others, such as the ‘Accommodating Gel’, a polymer gel to replace the aged natural lens of the eye for those with cataract and presbyopia has demonstrated feasibility, and still holds the promise of a revolutionary treatment.
A more recent investment was the development of a neuro-ophthalmic device that could detect a range of general health disorders by observing the visual system. The ability of this device to detect concussion is currently being explored and it could be a major benefit to the world if it proves effective.
Brien began his research career in the area of myopia, having undertaken his PhD in the late 1960s on the topic of orthokeratology. It again became a major focus later in his career as evidence began to show that myopia was rapidly reaching epidemic proportions across the world. In 2010, there were an estimated 1.4 billion myopes around the world. Research now indicates this number will grow to around 5 billion by 2050 if left unchecked, and include almost 1 billion high myopes who will be at a significantly increased risk of potentially blinding conditions.
Understanding the emerging threat to vision that myopia presented, Brien installed this as a major program of Vision CRC when it began in 2003, with the objective of developing an optical device that would control the progression of the condition and prevent people moving into the high myopia category. Collaborating with University of Houston School of Optometry, the program delivered a spectacle lens (co-developed with Carl Zeiss Vision) that demonstrated an ability to slow the progression of myopia in children with a certain parental history, released commercially in 2011.
Not satisfied with the urgency with what he believed this emerging ‘epidemic’ was being addressed, Brien arranged, with the support of the Australian Minister for Health, Mr Peter Dutton, a World Health Organization Global Scientific Meeting on Myopia at the Brien Holden Vision Institute in 2015. The meeting brought together scientists, researchers and clinicians from each WHO region, to review the evidence on myopia, identify knowledge gaps and make recommendations to address this to better inform clinical practice and public health policy.
Carrying on the work that Brien began, the Brien Holden Vision Institute continues to pursue more effective treatments for myopia, working on novel contact lens and spectacle designs to provide better myopia control, developing education programs to assist practitioners manage their patients, and to help raise awareness about this emerging public health issue.
In many Asian countries minimal opportunities existed for contact lens practitioners to acquire initial or continuing professional education and it was common for contact lens fitting to be carried out by people without formal contact lens education. As a result, the standards of care available varied considerably.
In 1990, Brien and colleagues from the CCLRU instigated the Asia Pacific Contact Lens Education Program (APCLEP) as a way to educate contact lens practitioners in countries across the Asia-Pacific and improve eye care, contact lens education and contact lens fitting. This included raising sponsorship from the ophthalmic firm Bausch & Lomb, which helped support the program. Its first series of lectures were held in China and over the next 10 years APCLEP reached over 20,000 practitioners.
Brien Holden was also involved in the establishment of the International Association of Contact Lens Educators (IACLE) and as President (1991-2000), 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 International through Brien Holden Vision Institute.
Brien also made important contributions through his involvement with the School of Optometry and Vision Science at UNSW where he evolved from Lecturer in 1971 to Scientia Professor in 2001. He had visiting appointments at universities across the globe, including the United Kingdom, Finland, United States, Canada and China.
He created many opportunities for postgraduate research students through the organisations he was been involved with, including supervising or co-supervising over 30 PhD students The CCLRU, Institute for Eye Research, CRCERT, Vision CRC and Brien Holden Vision Institute have all possessed strong student programs and many graduates have become some of the finest professionals, researchers and educators in their fields.
These organisations have educated almost 200 PhD and MSc students.
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 supplied over one and a half million pairs of spectacles to financially disadvantaged people in NSW from 1992 to 2014.
In 1998, he co-founded the International Centre for Eyecare Education (ICEE) (now Brien Holden Vision Institute, Public Health) to establish eye care services in developing communities throughout the world. It 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 also made a significant contribution to global initiatives to address avoidable blindness and vision impairment through his involvement with the peak global bodythe International Agency for the Prevention of Blindness (IAPB) and through the World Health Organization (WHO) Refractive Error Working Group.
Along with colleagues Dr Gullapalli ‘Nag’ Rao and Dr Serge Resnikoff,, Brien made important representations to have refractive error recognised as a leading 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.
Brien Holden Vision Institute instigated the inaugural World Congress on Refractive Error in 2007 which has further promoted global efforts in this area. 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.
With colleagues from the Brien Holden Vision Institute, and with CBM, Fred Hollows Foundation and Vision 2020 Australia, Brien was instrumental in developing the proposal that resulted in an allocation from the Australian Government of $67 million over four years to eliminate avoidable blindness and impaired vision in the Pacific region.
His 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. In the following years he continued to emphasis the link between avoidable vision impairment, disability and poverty.
With over 400 million people needing vision correction and more than 100 million blind or vision impaired because they don’t have access to an eye examination and a pair of glasses – including 11 million children – India faces a huge task in addressing this need. It was estimated that the country will need at least 100 schools of optometry over the next few decades to meet the demand for fully qualified optometrists. Ensuring that quality education is delivered in all these undergraduate programs would require the development of a minimum of 1000 optometric educators who are capable of facing the challenges ahead to help produce around 5000 optometry graduates per year.
The ‘Delhi Declaration’, a blueprint for the reform needed to meet this challenge, was signed in 2010. As a result, several organisations have now been established to unify the profession, provide the regulatory leadership needed and to help build education capacity. These include the Indian Optometry Federation, India Vision Institute (joint initiative of the Brien Holden Vision Institute and LVPEI) and the Optometry Council of India.
A staunch advocate for quality education, Professor Holden explained; “Australia can assist by sharing lessons learned from the academic, professional and legislative pathway that we have followed over the last 80 years to become an effective health care profession. Optometry in Australia is now a very well defined profession and makes a significant contribution to the country’s welfare”.
Brien Holden was one of the driving forces behind the establishment of the Australia China Centre for Optometry Research and Development (ACCORD) in Guangzhou, China in 2012.
This joint initiative with the Zhongshan Ophthalmic Centre of Sun Yat-sen University, Guangzhou, China, has enabled cooperation in clinical and fundamental research into refractive error. Particularly in the Aisan context. .
Other major collaborators include Dr Antti Vannas, an outstanding researcher and surgeon, who opened up the world of ophthalmology research for Brien, enabling him to realise the potential for improved vision correction that could result from understanding the cornea and its response to surgery.
Dr 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. Cooperation between ophthalmology and optometry through partnerships with Antti Vannas, Nag Rao, Dr Hugh Taylor and, later, Dr Serge Resnikoff, was an enlightening and empowering experience for Brien.
Brien Holden’s contributions to the L V Prasad Eye Institute were acknowledged by LVPEI when it named its centre investigating the causes and treatments of eye conditions, the Professor Brien Holden Research Centre.
Over the course of his career, Brien Holden received over 30 national and international awards from organisations around the world for his contributions to research, eye care and health, including seven honorary doctorates from the U.S., U.K., South Africa and Canada. He delivered more than 90 Keynote Addresses, authored more than 220 refereed papers, 26 book chapters and 380 refereed abstracts.
Brien served as a member of government licensing, advisory and registration bodies, several boards of management and 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.
Layland B, McMonnies C & Davis S, Brien Holden: a remarkable life in optometry, Clinical and Experimental Optometry, Volume 99, Issue 4, July 2016: Pages 389–391
Click here to read article
Williams L, Obituary: Brien Anthony Holden (1942-2015), Contact Lens and Anterior Eye, Volume 38, Issue 6, December 2015, Pages 477–478
Click here to read article
TOP RESEARCH PAPERS AUTHORED AND CO-AUTHORED BY BRIEN
|Holden BA & Mertz GW, Critical oxygen levels to avoid corneal edema for daily and extended wear contact lenses, Investigative Ophthalmology & Visual Science, Oct 1984 Vol 25, 1161‐1167.|
|Holden BA, Sweeney DF, Vannas A, Nilsson KT & Efron N, Effect of long‐term extended contact lens wear on the human cornea, Investigative Ophthalmology & Visual Science, Nov 1985 Vol 26, 1489‐1501.|
|Holden BA, Fricke TR, May Ho S, Wong R, Schlenther G, Cronjé S, Burnett A, Papas E, Naidoo KS, Frick KD, Global vision impairment due to uncorrected presbyopia, Archives of Ophthalmology, Vol 126 (No. 12), Dec 2008.|
|TST Smith, a KD Frick,a BA Holden,b TR Fricke b & KS Naidoo, Potential lost productivity resulting from the global burden of uncorrected refractive error, Bulletin of the World Health Organization, 2009;87:431–437.|
|Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JKG, Brian G & Holden BA,‘ The incidence of contact lensrelated microbial keratitis in Australia’, Ophthalmology, 2008; 115:1655-1662.|
|Naidoo KS, Raghunandan A, Mashige KP, Govender P, Holden BA, Pakharel GP & Ellwein LB, ‘Refractive error and visual impairment in African children in South Africa’, Investigative Ophthalmology & Visual Science, 2003;44:3764-3770.|
|Holden BA, Mertz GW & McNally JJ. ‘Corneal swelling response to contact lenses worn under extended wear conditions’, Investigative Ophthalmology & Visual Science, February 1983.|
|Zantos SG, Holden BA. Transient endothelial changes soon after wearing soft contact lenses. Am J Optom Physiol Opt 1977;54:856-8.|