Ian Constable interview, 6 December 2015 and 9 December 2015

Ian Constable interview, 6 December 2015 and 9 December 2015

Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute)

Professor Ian Constable AO trained in ophthalmology in New South Wales before being appointed as Clinical Retinal Fellow at the Massachusetts Eye and Ear Infirmary and a Lecturer at Harvard University.
He is a consultant retinal surgeon at Royal Perth, Sir Charles Gairdner and Princess Margaret Hospitals and was Managing Director at LEI from 1983 to February 2009.

Constable, Ian

University of Western Australia Historical Society

Copyright University of Western Australia

MP3 files

Oral History

Julia Wallis

Ian Constable

Mosman Park, WA

Interview 1: 1 hour, 3 minutes, 48 seconds
Interview 2: 1 hour, 34 minutes, 35 seconds
Total: 2 hours, 38 minutes, 23 seconds

128 kbs

Interview 1
00:00:00 Introduction by Julia Wallis
00:00:38

Track 2
00:00:00 Ian Jeffrey Constable (IJC) was born in Sydney in 1943. Father a civil engineer. Mother a high school teacher. Moved to Parkes, NSW when IJC was aged 4 as his father inherited the family farm in Forbes. His father had worked on the Sydney Harbour Bridge and continued to work as a civil engineer and worked on the farm on weekends. When IJC was aged six, his father resigned and the family moved onto the farm full-time. IJC’s older brother was to carry on the farming tradition and it was expected that IJC would make his own way. He more or less brought himself up as his mother and father worked full-time. He attended a one teacher school. A couple of his class mates were very gifted. In the 1950s, the town was cut off by frequent floods and he did his schooling by correspondence. He sat for a scholarship at Shore School in North Sydney. He did not get the scholarship but the school accepted him anyway.
00:08:43 IJC’s father applied his engineering knowledge to survey and irrigate the farm. Wool was £1 for a pound in 1952. The family were not poor but they were not well off either. When IJC got a Commonwealth Scholarship to university he was hoping to study arts but his father was more practical and advised him to study medicine as it took 6 years and was better value for money. IJC worked very hard at the Shore School to get in the top half dozen in his class. There were some luminaries amongst them. A good proportion of the scholars were country children. When IJC went home for the holidays he was expected to pitch in with the farm work. He did the night shift for the ploughing and the irrigation.
00:16:22 Prime Minister Menzies started the Commonwealth Scholarship scheme. The top 10% of children across the nation received a free education if they gained good results in their leaving certificate. IJC has happy memories of Shore School which had high academic standards particularly in science, technology and mathematics. IJC also studied 3 languages. When he was aged 16, he left school to attend the University of Sydney. There were about 780 first year medical students which was whittled down to approximately 340 in second year. Medicine was rote learning and written examinations rather than practical examinations. Students did have to assist in operations and help to deliver babies but the majority of their practical training was done during the intern years at a teaching hospital.
00:23:00 After six years, IJC did not know what he was going to do with his degree. He was accepted into the Royal Prince Alfred Hospital (RPAH). It was highly academic but the working hours were arduous. Pay was £14 per week which was a third of a teacher’s pay. By this time he was married and his wife Elizabeth was teaching in Leichhardt. He had wanted to be a general physician but got to know some of the specialties and became interested in ophthalmology. After 2 years at RPAH a vacancy came up and he became a trainee in ophthalmology for two years. Then he got a postgraduate scholarship from the University of Sydney for Harvard. This caused some consternation when he left but the opportunity was too good to miss. He left for Boston in 1970 having graduated at the end of 1965.
00:28:51 Medical research was in its infancy in Australia. The clinical care in Sydney and general anaesthesia was far superior but there was not much research in ophthalmology apart from the work of Sir Norman Gregg at RPAH. IJC had to wait 18 months to get into the clinical research programme at Harvard. This project was funded by the Cancer Institute in Washington and lasted for the duration of his time here. At the same time, he did the clinical training and the American Board and became a permanent resident. He was appointed Acting Director and was also a junior lecturer in the Harvard Medical School.
00:34:31 In 1973, IJC was contacted by a person in Sydney who told him that the University of Western Australia (UWA) was looking to set up an ophthalmology department. Later he received a personal visit inviting him to come to Perth. Lions had funded the project and UWA were prepared to host the new department. David McAuliffe picked him up at the airport and took him to his home. David saw 200 patients on a Saturday morning. IJC was taken out to dinner at the River Room at the Parmelia by three different factions at the university on the same night!
00:39:40 The following day he attended a barbeque at a farm in the foothills. It was quite a culture shock. There was great suspicion of him because he came from the eastern states. Also, everyone was related to somebody else in Perth so it was very easy to make a faux pas. Boston’s population was 3 million people in 1973. There were 250,000 postgraduate students from all over the world studying at twenty four different universities in the Boston area. Nobody in Boston asked about your background. An academic board meeting at UWA was full of ex British academics who seemed to have come over to Perth to retire.
00:45:36 What motivated IJC to come to Perth? He was 31 years old in May 1974. UWA offered IJC an associate professorship in the Department of Surgery at Royal Perth Hospital (RPH) which he did not think was attractive enough. Finally, he was offered a Full Chair and $1 million in research funds and his wife Elizabeth was offered a tenured job as a lecturer in the Education Faculty at UWA. They decided to give it a trial for 2 years.
00:47:24 Bob Linton was an ophthalmologist and supporter of the Lions clubs in WA and was a key mover and shaker who pushed for IJC to get this position along with David McAuliffe, Ray Whitford and Chris Wilson. Bob Linton had persuaded the Lions Clubs that they needed an eye hospital in Perth and then they decided this was too expensive and that they should have a Chair in Ophthalmology and would fund an academic department at UWA. This was approved in 1970 and UWA agreed to pay the salary for 5 years. Lions were a significant political force. The Health Department put up half the money and RPH threw in a secretary.
00:51:26 When IJC arrived in 1975 he had one room in RPH, a secretary and a million dollars. It was up to him to make it work. He was flying back to Boston every month for the first year as he had to fulfil a research grant. He saw lots of patients at RPH but had skills that nobody else had in WA so he was in great demand. At the end of the first year he was performing operations in two theatres all day on a Saturday as well as working during the week. He had meetings with Lions every couple of months. Lions had started screening programmes in glaucoma. IJC would do screenings in country WA. Then he also did diabetic retinopathy. This lasted for 10 years. It created an enormous amount of publicity and boosted the profile of the Department. In 1980, the State Government gave IJC an Advance Australia Award.
00:55:15 IJC also visited Arthur Lim, the leading eye surgeon in Singapore, on his way to Perth. He became guardian to Lim’s children who were boarding at school in Perth. He and Lim co-wrote Atlases for trainees in the eye field. It became a best seller in the third world and was published in 14 different languages. IJC developed a reputation in Asia and he and Lim set up training programmes. In 1976, he began to perform operations in Australia and Asia using machines he had brought with him from Boston. This also added to his prestige. Many people wanted to come to Perth to train with IJC for a year. Private patients started to arrive as well. This meant that he had his own source of money instead of it all going into the UWA pot. IJC set up an independent institute and went half time. He used a model whereby they had a private medical practice within the university. This model still exists and funds 14 surgeons. It is the largest group in Australia and a percentage of their earnings goes back into the Institute which is a charity. This in turn funds the infrastructure for their research.
00:59:06 By 1980, IJC was on the National Health and Medical Research Council (NH&MRC) medical research committee and he had hired a group of researchers out of various funds and had a number of research grants. In about 1980, the Institute held 90% of the research grants funds in the whole division of surgery. Eventually, they became independent of surgery but this was not until the 1990s. Bernard Catchpole the Professor of Surgery was enormously helpful. When IJC arrived he was young and unknown and being based in RPH was effectively sidelined from the medical school that had been set up at the new Sir Charles Gairdner Hospital (SCGH). The model IJC set up was to hire post-doctoral science graduates rather than doctors. He wanted people to do basic investigational research. There was some resistance to this. Luckily IJC was able to follow the model that was pioneered by Byron Kakulas . Rotary had raised money to give Byron a Chair in neuropathology.
01:03:10 END OF INTERVIEW 1

Interview 2
00:00:00 Introduction by Julia Wallis
00:00:39

Track 2
00:00:00 When IJC first came to Perth he was installed at RPH with a secretary. He increased the Lions screening programmes and visited Lions Clubs throughout Western Australia two evenings a week for just over two years. He visited over 140 Lions Club. This cemented the support of the Lions Clubs and publicised the ophthalmology services. The ophthalmologists in Perth also demanded his services and he was very busy seeing patients (both public and private) in Australia and South East Asia. At first, the money went to the university and then dribbled back to ophthalmology until IJG set up a tax free foundation “The Australian Foundation for the Prevention of Blindness”. This money together with NH&MRC grants funded research. IJC set up a teaching programme which hadn’t existed before. He recruited a senior lecturer, Richard Cooper and post-doctoral science people to conduct research.
00:06:16 The Lions Save Sight Foundation was set up in 1970. This foundation provided core salaries for the research scientists. Most were from WA but one was from Cambridge University and another from Romania. RPH built an animal house. A dedicated research building was not built until some years later. The team ran out of space very quickly. In 1983, they transferred most of the laboratory activity to the old A Block in SCGH (this had been the chest hospital). The Lions Eye Institute (LEI) was now an independent legal entity and their new home served them well until the 1990s. Anyone they recruited had to have a link with RPH (which is still the major eye care centre). Half of IJC’s salary was put towards hiring Professor Ian McAllister. IJC’s secretary came from RPH and was very capable. She resigned in the 1980s.
00:10:12 Their reputation was dependent on being frugal and scientifically capable. Professor Valerie Alder became Deputy Vice Chancellor at Murdoch and Frank van Boxmeer became Head of Clinical Biochemistry at RPH. The core science emphasis differentiated them from other groups in Australia. At one time the group was the largest in Australia. They are the only group that uses private medical practice as a model for funding research. This model presently sustains 14 people screening and operating on eyes and a proportion of their earnings is ploughed back into the Institute. The group moved to SCGH in 1983 on a long term lease. There was never any question of moving to the UWA campus although there was talk about moving to the St John of God campus in Subiaco at one stage. The key Lions personnel involved in decision making (such as Jack Hoffman, Tom Cameron, Brian King, Kerry Price and John Knowles) were professional people and were eminent business people in Perth. The project was one of the first examples of good public outreach on the part of UWA.
00:14:32 Nobody at UWA minded that the group weren’t on campus. The Vice Chancellors were very helpful. Robert Street (1978-1985) joined their Board. Alan Robson (2004-2011) extricated the group from the Department of Surgery and made the group the centre of ophthalmology and visual science at UWA. This gave the group direct access to their funds instead of it going into the university pot. Chancellor Sir Lawrence Jackson (1968-1981) invited IJC to his home for dinner. Don Aitken (1981-1990), Justice Kennedy (1990-1998), Alex Cohen (1998-2000) and Ken Michael (2001-2005) were all friends and/or patients and were very helpful. IJC did not really feel part of the university but he was too busy to take part in many of the campus activities. He often travelled to Asia just for the weekend. He was also travelling to America quite frequently. It wasn’t compulsory to attend meetings at UWA and he tended to only attend those that were directly related to the Centre. As they did no undergraduate teaching, they were not really considered to be part of the medical faculty. IJC did take part in the university cricket club and attended Festival of Perth events. For 25 years, he did not take part in any of the lobbying for UWA funding. It was helpful being under the UWA umbrella as it assisted them to apply for NH&MRC grants. IJC held research grants continuously from 1975 to 2014. They also used UWA resources including animal houses, laboratories and ethics committees. Alan Robson realised that the centre was bringing in lots of infrastructure funding to UWA and supported them by providing more resources and salaries.
00:20:34 IJC joined the University Cricket Club in about 1975. The Club played a yearly match against the Swan Valley wine makers. It was a good way of meeting other UWA academics.
00:22:27 University ethics committees have tightened up over the years. In the late 1970s, the Sultan of Terengganu provided the Centre with a large colony of primates after IJC operated on his eye. One of the Vice Chancellors was opposed to primate research and it has since ceased in Western Australia. The gene therapy research is done on primates in Bejing, Shanghai and Singapore. IJC was Chairman of the Animal Ethics Committee in the 1980s and became the target of anti- Vivisectionists. A lot of this research can now be done on mice and by computer modelling. Research on humans can only be done if it has proved to be safe on animals.
00:28:40 When the Centre moved to SCGH they were given 30 rooms of space as opposed to 4 rooms at RPH. Instead of being a university department only supported by the Lions Save Sight Foundation and RPH they now became the Lions Eye Institute (LEI) which was an independent body and held a 30 year lease to the space at the Queen Elizabeth II (QEII) Medical Centre. The recruited more young people who are now professors. They all went half time at the university which meant for the other half of their time they could see patients and generate revenue. Revenue is made quite quickly because the turnover of patient consultation is fairly quick. They have an obligation to teach, to serve in a public hospital and to do some basic research. At one stage, LEI did more than 20% of all the ophthalmology in Western Australia. Today it is more like 10%. It was crucial to have independent space rather than use space in a university or a public hospital. The LEI created a tension within the hospital due to the fact that they were independent of the hospital and had different rules but the new premises made the LEI very productive. They developed an artificial cornea and solid state lasers and were awarded grants of $3 million and more from the Department of Industry and Commerce in Canberra. They eventually expanded to having 150 scientists and support staff in QEII. Laser surgery was first introduced in 1976. IJC visited the Premier (Sir Charles Court) with two of the Lions. The State Government donated one to RPH.
00:34:45 By 1990, the LEI was well recognised. Big financial backers included Sir James McCusker, Bill Wylie and Sir Lawrence Wilson. In 1992, there was a huge public fund raising drive which generated $8 million to build the new Centre at 2 Verdun Street, Nedlands. The Government gave them a 99 year lease on the land within the QEII. They also kept their space in A block at SCGH. In about 2005, they ran of space in Verdun Street. Alan Robson asked IJC to join with him to lobby in Canberra along with Fiona Stanley from the Children’s Hospital and Peter Klinken from the Western Australian Institute for Medical Research (WAIMR) (now the Harry Perkins Institute of Medical Research). In 2007, Prime Minister John Howard awarded them $1 million for a State Medical Facility. This built the block that is the Harry Perkins Institute of Medical Research at SCGH. LEI was awarded one floor in that building on a long term lease. This provided an adult research facility in WA. IJC considered that the scientists are better off cross pollinating rather than confining themselves to eye research only. It is working well since the building opened in 2013. LEI now has three spaces – the original floor on A Block, the LEI red brick building on Verdun Street and a floor in the Harry Perkins Building which are all accessible from each other.
00:41:06 The research demands are great and the practice is very large (15 doctors). LEI see 50,000 patients each year. The research groups are pretty much self funded. Some clinicians work with them so that the results can be more easily transferred to the patients. Diabetes affects sight. Safety campaigns have reduced many industrial accidents. People live longer so there are more incidences of macular degeneration, cataracts and glaucoma. Thousands of people use laser surgery to correct myopia. This was only invented in the late 1980s. Micro surgery is much more precise and cataracts can be operated upon much earlier than before. In the last 10 years, LEI has been using biochemical antibodies that are injected into the eye to prevent macular degeneration. Medical science is advancing rapidly. There are even ways to help blind people using artificial vision. Stem cells and gene therapy are other new advances. IJC has been working on gene therapy for the last 15 years. LEI has a science base which means that they can be involved in the development of these things. Perth is not the biggest group now as eye research has become the norm. LEI is comparable to the University of Sydney. The University of Melbourne is bigger. Eye research is now much more the norm. Australia rates very highly in research on a per capita basis but they are behind in developing patents.
00:50:02 In 1976, Professor Fred Hollows from the University of New South Wales began to push for an increase in Aboriginal eye care. Through the College of Ophthalmology he obtained a big Federal grant to look at Aboriginals across the whole of Australia. IJC volunteered his time and spent 6 weeks in the Kimberley. Professor Ida Mann had screened Aboriginal people in WA for trachoma and was very passionate about their health care. IJC also did screening and operations in Geraldton. IJC volunteers his time 1-2 weeks per year and the LEI is very supportive of this programme. Associate Professor Angus Turner has taken over this programme now and does a lot of rural surgery. Visiting Aboriginal communities has increased IJC’s interest and collection of Aboriginal art (including paintings by Paddy Bedford).
00:59:30 Aboriginal children are very long sighted and can read two lines below what most Caucasians can read. Aboriginal and African people hardly even suffer from retinal detachments.
01:01:38 Using mathematical analysis of big data will be the next big thing in eye research. Further research also needs to be done on Deoxyribonucleic acid (DNA). Technology is getting more advanced and easier to use. Computers are the way of the future. Drugs will become more effective but are very expensive. Medical economics will be more highly scrutinised and controlled in the future. In the early 80s, the Department only had one huge Hewlett Packard computer that was almost impossible to programme. Mounting debt due to the demands on public health care is already a huge problem in the Western world. The major market for medicine is in America. IJC would like to see Australia becoming as high tech as Sweden, Switzerland or Finland.
01:09:32 While IJG is still healthy he has no plans to retire from the Institute. He is proud of the reputation of the LEI. He knows people in WA and can assist them with fund raising so he still feels useful. IJC stepped down as Director in 2009 but is still a Professor. The present director is Professor David Mackie.
01:12:47 More than half of the students studying ophthalmology are now women. It is delicate work, it is possible to work part time and there are very few late nights or weekend work.
01:14:02
Track 3
IJC stepped down as Director of LEI in 2009. He feels research is a younger person’s game and that it is important to have renewal and an injection of new ideas and energy. Professor Mackie has different skills and has a different management style.
From early on, IJC realised the importance of commercialisation in order to get the research flow onto the patients. $6 to $8 million dollars was raised to develop an artificial cornea. A company was formed and a development grant from the Federal Government gave them another $3 million to continue testing on animals and humans. It was given American Food and Drug Administration Approval. Artificial corneas were despatched from Perth all around the world. Unfortunately, the market was not as vast as expected. Eventually the project was sold to a company in New York and the LEI broken even. After two years the technology changed and the market collapsed.
LEI were the third group in the world to develop an excimer laser with a solid state system. Money was raised to build them in Perth and they were sold in Hong Kong, Jakarta and India. It was floated on the Australian Stock Exchange and $10 million was raised. Trials were done in the USA and the $10 million was spent in two years. The stock market changed in Australia and the company closed down.
The newest project is gene therapy and patents were made for that. A new company was started and it was listed on the US Stock Exchange. It has raised over US$300 million. Recent LEI glaucoma research has been licensed off to a group in the US in November 2015 for US$3 million. The American market is 60% of the value. Even in Europe, start-ups are very difficult to maintain.
In 1976, IJC visited Singapore and other parts of Asia and demonstrated equipment during surgery with new equipment. Indonesia became a very important partner. Post-doctoral fellows from Indonesia trained in Perth for a year and do a research project before returning home and passing on their expertise. About 100 of these people have been trained and are now leaders in ophthalmology in their region. The head of the health service in Singapore was a LEI fellow. The Asian links are important. IJC was President of the Asian Pacific Academy of Ophthalmology and this represents half the world’s population. In the 1980s and 1990s, he had several trips to India and China teaching the microscope, running courses and writing text books. Many Indonesian patients whose surgery was a bit more complicated came down to Perth for surgery. Every year a three day course is run in Bali which is attended by 500 ophthalmologists. IJC designed a cataract screening programme for Indonesia and successfully applied to the German government to fund it. Unfortunately the German and Indonesian governments could not agree on the accounting fundamentals so the money was withdrawn. One of LEI’s Indonesian fellows set up a chain of high quality eye hospitals in Indonesia.
China is very big and it is already very advanced in eye care. IJC used to visit China for cataract training. China is now very high tech and has a good health system in the major cities. India is also changing quickly.
In conclusion, IJC would like to thank the environment that the university has provided and values the independence that he has been afforded.
End of Track 3
END OF INTERVIEW 2

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Constable_Ian, Interview 2, Track 1
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