Professor Robyn Guymer AM
CERA Deputy Director, Head of Macular Research
Professor Robyn Guymer AM leads CERA’s macular research, with a focus on investigating age-related macular degeneration.
Professor Robyn Guymer AM
CERA Deputy Director, Head of Macular Research
MBBS, PhD, FRANZCO, FAHMS
Professor Robyn Guymer AM is a Deputy Director of CERA, the Head of Macular Research at CERA, and Professor of Ophthalmology at Melbourne University. She is also a senior retinal specialist at the Royal Victorian Eye and Ear Hospital.
She is a clinician scientist who leads a team of researchers primarily investigating age-related macular degeneration (AMD).
Professor Guymer has investigated genetic and environmental risk factors for AMD, predictors of response to treatments for late AMD, as well as being a principal investigator in many industry sponsored trials. She is on several pharmaceutical advisory boards and is part of the Mactel consortium, the Beckman/Ryan AMD initiative (USA) and the International Classification of Atrophy (CAM) group.
She is currently investigating new strategies for treating early stages of AMD and is working to identify novel imaging and functional biomarkers and surrogate endpoints to improve the feasibility of conducting early intervention trials. She is a member of the Macular Society and an inaugural fellow of the Australian Academy of Health and Medical Sciences.
Professor Guymer was named a Member in the General Division (AM) in the 2018 Queen’s Birthday Honours List, recognised for her significant service to medicine in the field of ophthalmology, particularly age-related macular degeneration as a clinician, academic and researcher.
She was also awarded the NHMRC’s 2016 Elizabeth Blackburn Fellowship for the top ranked female research fellowship in clinical medicine.
Key research questions
- How do we predict, who amongst the many people with the early stages of AMD, is at high-risk of progression?
- Having identified early imaging signs of cell loss, can we validate them as a robust biomarker to facilitate their widespread use?
- Can we slow progression of AMD using subthreshold laser interventions?
- What is the cause of reticular pseudodrusen, a high-risk phenotype of AMD?
- How can we improve self-monitoring of vision in the early stages of AMD?
- How do we optimize treatment outcomes in wet AMD with the least need for repeat treatment?
- How do we optimize the dissemination of our current understanding of AMD to community eye care professionals?
- How do we develop a community network of eye care professional and develop new ways of delivering eye care, especially as it relates to chronic eye disease?
- Can we establish a registry of early disease in the community to facilitate early intervention trials?
Funding and support
Project RPD: A pathway to translation: uncovering novel causes, genetic associations, and potential intervention strategies for AMD
This project aims to uncover the underlying aetiology of reticular pseudodrusen, (RPD) which we hypothesize are genetically determined and once identified, will provide critical information for developing new interventions and biomarkers to improve outcomes for those with high risk AMD.
This project is in collaboration with the research groups of Professors Erica Fletcher, Melanie Bahlo and Alice Pebay.
Laser intervention in Early stages of Age-related macular Degeneration (LEAD) study
The LEAD study is a 36-month, multicenter, randomized, sham-controlled trial of nanosecond laser used to slow progression of intermediate stage AMD. It reported the primary outcome in 2018. In participants with iAMD without signs of late AMD, no significant difference in the overall progression rate to late AMD between those receiving laser and sham treatment were observed.
However, subthreshold nanosecond laser treatment may have a role in slowing progression for those without coexistent RPD and may be inappropriate in those with RPD, warranting caution when considering treatment in clinical phenotypes with RPD. We continue to follow the majority of cases for 5 years and will see the last participants in mid 2020. (ACTRN12612000704897) and (NCT01790802).
Microperimetry in Atrophy Progression Study (MAPS)
This project examines whether a new method to measure the ability of to perceive different light levels within the area where tissue loss is occurring could help us better evaluate promising new treatments in atrophic AMD.
Predictive Imaging in the Early Stages of AMD (PRIME) Study
This prospective project aims to combine modern imaging methods including optical coherence tomography angiography (OCTA) and artificial intelligence to improve risk stratification and identification of high-risk AMD individuals to monitor more frequently to enable the early detection of neovascular AMD.
Multi-spectral functional imaging study
Subjects with early stages of AMD are often associated with poor night vision due to rod photoreceptor dysfunction. Currently, assessing rod photoreceptor function using a subjective psychophysical test is arduous, variable and lack of spatial resolution.
This project aims to develop a multi-spectral functional imaging technique for assessing rod photoreceptor function objectively with a high spatial resolution. The technique will allow better studying the disease pathophysiology and monitoring progression clinically.
This research is conducted in collaboration with A/Prof Peter van Wijngaarden and Dr Xavier Hadoux.
ASPREE: ASPirin in Reducing Events in the Elderly (ASPREE) trial: AMD substudy
A primary prevention, randomized clinical trial (in conjunction with Monash University, Professor John McNeil) investigating the effect of low dose aspirin on the incidence and progression of AMD.
Using Artificial intelligence (AI) to analyse OCT images in AMD
With several different international academic groups and industry we work with leaders in AI research in AMD we are collaborating on finding ways to predict progression of AMD, to identify high risk characteristics and to develop automatic algorithm to allow high speed detection of these markers.
In addition we are working to understand the best protocols to use when considering treating neovascular AMD to achieve the best long term visual results with the minimum number of treatments.
International intervention trials
First in disease studies
MacTel Phase 3 Renexus (NT-501) Trial
This study investigates the safety and efficacy of ciliary neurotrophic factor (CNTF) in participants with macular telangectasia type 2 (MacTel) in a Phase 3 clinical trial. NCT03316300
Evaluation of the R:GEN Laser System as an Intervention in Subjects with Early Stages of Age-related Macular Degeneration (AMD) for Safety and Exploratory Efficacy Outcomes (Lutronics)
The Primary study objective is to evaluate the safety and feasibility of the OcuDyne Ophthalmic Micro Balloon Angioplasty System in subjects with nonexudative age-related macular degeneration. ACTRN12619001315101 (OcuDyne)
International natural history trials
The ARIS aims to further characterise Reticular Pseudodrusen (RPD) and to further understand the progression of early AMD to late stage disease. NCT03092492
MacTel natural history study
This study enrols affected Mactel Type 2 people and their affected family members into a registry to learn more about the disease. The register is used to identify persons eligible for treatment trials.
This trial aims to better understand the role of the choriocapillaris (CC) in the formation and progression of non-exudative AMD by imaging the retinal pigment epithelium (rpe) and the choroidal microvasculature and by studying their inter-dependence.
This study will determine if the loss of the CC could prove useful as an anatomic clinical trial endpoint in future drug trials. NCT03688243
An observational study to evaluate the natural progression of anatomical and functional visual parameters in genetically defined subjects with Geographic Atrophy (GA) secondary to.to AMD.NCT03894020 (Gyroscope)
The objective of this study is to broaden the participation of community eye care professionals in identifying people with GA secondary to AMD so that they can be invited to participate in SCOPE.
Classification of Atrophy international consensus group (CAM)
As a part of the International classification of Atrophy group we work towards consensus documents to define AMD based upon new imaging criteria to enable researchers and industry to use agreed upon staging criteria for their own research objectives.
Community eye care
Online education course – “Age-Related Macular Degeneration for Primary Eyecare Practitioners”
We have recently completed an online course on the newest advances in AMD clinical management, designed for optometrists and primary health providers in the community.
The course was designed in collaboration with colleagues at the University of Melbourne, and is available here.
Community Eyecare professional trial network (CiTN)
We are working to develop a network of community based eye care professional to be part of a new way of recruiting for trials, and to provide ongoing, sustainable training and education in chronic eye diseases.
We have a preclinical laboratory which works on models of AMD and retinal degenerations. The team works with biotech companies to perform early pre-clinical studies to advance them towards clinical trials.
Guymer RH, Rosenfeld PJ, Curcio CA, Holz FG, Staurenghi G, Freund KB, Schmitz-Valckenberg S, Sparrow J, Spaide RF, Tufail A, Chakravarthy U, Jaffe GJ, Csaky K, Sarraf D, Mones JM, Tadayoni R, Grunwald J, Bottoni F, Liakopoulos S, Pauleikhoff D, Pagliarini S, Chew EY, Viola F, Fleckenstein M, Blodi BA, Lim TH, Chong V, Lutty J, Bird AC, Sadda SR: Incomplete Retinal Pigment Epithelial and Outer Retinal Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 4. Ophthalmology 2019 (Epub). http://dx.doi.org/10.1016/j.ophtha.2019.09.035
Guymer RH, Wu Z, Hodgson LAB, Caruso E, Brassington KH, Tindill N, Aung KZ, McGuinness MB, Fletcher EL, Chen FK, Chakravarthy U, Arnold JJ, Heriot WJ, Durkin SR, Lek JJ, Harper CA, Wickremasinghe SS, Sandhu SS, Baglin EK, Sharangan P, Braat S, Luu CD, Laser Intervention in Early Stages of Age-Related Macular Degeneration Study G: Subthreshold Nanosecond Laser Intervention in Age-Related Macular Degeneration: The LEAD Randomized Controlled Clinical Trial. Ophthalmology 2019;126:829-838. DOI: 10.1016/j.ophtha.2018.09.015.
Guymer RH, Markey CM, McAllister IL, Gillies MC, Hunyor AP, Arnold JJ, Investigators F: Tolerating Subretinal Fluid in Neovascular Age-Related Macular Degeneration Treated with Ranibizumab Using a Treat-and-Extend Regimen: FLUID Study 24-Month Results. Ophthalmology 2019;126:723-734 DOI: 10.1016/j.ophtha.2018.11.025
Wu Z, Luu CD, Ayton LN, Goh JK, Lucci LM, Hubbard WC, Hageman JL, Hageman GS, Guymer RH: Optical coherence tomography-defined changes preceding the development of drusen-associated atrophy in age-related macular degeneration. Ophthalmology 2014;121:2415 DOI: 10.1016/j.ophtha.2014.06.034.
Finger RP, Wu Z, Luu CD, Kearney F, Ayton LN, Lucci LM, Hubbard WC, Hageman JL, Hageman GS, Guymer RH: Reticular pseudodrusen: a risk factor for geographic atrophy in fellow eyes of individuals with unilateral choroidal neovascularization. Ophthalmology 2014;121:1252-1256. DOI: 10.1016/j.ophtha.2013.12.034
- Dr Carla Abbott – Research Fellow
- Dr Zhichao Wu – Senior Research Fellow
- Dr Luba Robman – Senior Research Fellow
- Ms Melinda Cain – Clinical Project Manager
- Ms Emily Caruso – Senior Clinical Trial Coordinator
- Dr Amy Cohn – Ophthalmologist
- Ms Kai Lyn Goh – Clinical Trial Coordinator
- Ms Susan Griffin – Research support and Executive Assistant
- Ms Lauren Hodgson – Senior Research manager and manager of grading centre
- Dr Galina Makeyeva – Senior Retinal Grader
- Mr Tony Pham – Clinical Trial Coordinator
- Ms Pyrawy Sivarajah – Clinical Trial Coordinator
- Quan Findlay –PhD student (co-supervisor)
Kai Lyn Goh – MPhil Student (co-supervisor)
Himeesh Kumar – PhD student (co-supervisor)
Jessica Ma PhD student (co-supervisor)
Crystal Nguyen – PhD student (co supervisor)
Selwyn Prea – PhD student (co-supervisor)
Josephine Wong – PhD student (co-supervisor)
- Dr Brendan Ansell. Walter and Eliza Hall Institute.
- Professor Alice Pebay, Department of Anatomy and Neuroscience University of Melbourne
- Associate Professor Fred Chen, Lions Eye Institute, W.A.
- Dr Jenny Arnold, Marsden Eye Specialists
- Dr Ben Gu. Florey Institute
- Professor Marimuthu Palaniswami, Department of Electrical and Electronic Engineering, University of Melbourne
- Professor Phil Rosenfeld, Bascom Palmer Eye Institute, Miami, USA
- Professor Ruikang Wang, Department of Bioengineering, University of Washington, USA
- Dr Nadia Waheed, Tufts University School of Medicine in Boston and Director of the Boston Image Reading Center, USA
- Dr Aaron Lee, Department of Ophthalmology, University of Washington, USA
- Dr Adnan Tufail, Moorfields Eye Hospital, UK
- Professor Ursula Schmidt-Erfurth, Department of Ophthalmology at the University Eye Hospital, Vienna.
- Professor Steffen Schmitz-Valckenberg, University of Utah
- Professor Robert Finger, University of Bonn, Germany
- Professor Emily Chew, National Eye Institute, Maryland, USA
- Professor Usha Chakravarthy, The Queens University, Belfast
- Dr Christine Curcio, UAB School of Medicine, Birmingham, USA
- Dr Karl Csaky, Retina Foundation of the Southwest
- Professor Martin Friedlander, The Scripps Research Institute, California, USA
- Professor Gregory Hageman, University of Iowa, USA
- Professor Frank Holz, University of Bonn, Germany
- Professor Giovanni Staurenghi, University of Milan, Italy
- Professor Sadda SriniVas, Jules Stein Eye Institute, California ,USA
- Dr David Birch, Retina Foundation of the Southwest, USA
- Nova Eye Pty Ltd ( previously Ellex)
- Toukcan Labs
- Medmont International, Pty Ltd
- OpenEye Foundation
- Lutronic Vision
- Nacuity Pharmaceuticals
Funding and support
Thank you to the following organisations for their support:
- BrightFocus Foundation
- Macular disease Foundation
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