I completed my ophthalmology training in Russia in 1985 and later earned a PhD from the University of New South Wales in 1996. I got involved in multiple sclerosis (MS) research in 2008, when I conducted a pioneering study on the structure-function relationship in the visual systems of patients with optic neuritis. Later I also led studies on optic nerve remyelination, which have become benchmarks for MS therapy trials. I have also been involved in international clinical trials as both an investigator and study designer. I have secured over $6 million in research funding, including grants from the National Multiple Sclerosis Society (USA) and the National Health and Medical Research Council (NHMRC). My collaborations span institutions in Germany, Israel, Italy, Spain, and Canada, reflecting my commitment to global research partnerships.

My involvement in MS research is attributed to my background in ophthalmology and neurology, where the visual system plays a significant role. MS often affects the optic nerve, leading to vision-related symptoms, which naturally aligns with my expertise in visual system disorders. My early work with optic neuritis – an inflammation of the optic nerve common in MS – sparked a deeper interest in understanding and addressing the neurological and visual impacts of MS.

Apart from the development of new therapies addressing disease progression (such as BTK inhibitors), the first adaptive clinical trial in MS in Australia, PLATYPUS (PLatform Adaptive Trial for remYelination and neuroProtection in mUltiple Sclerosis), targeting progressive MS, represents another major innovation. This trial design allows simultaneous testing of multiple treatments, aiming to expedite the discovery of effective therapies for progressive MS.

My research aims to better understand “smouldering” inflammation in MS – the slow, ongoing damage that happens around older lesions, even when a person is not having relapses. This hidden process is now recognised as a major cause of long-term disability and brain tissue loss, yet we still do not know how well current MS therapies control it.

To address this, I am leading the first real-world Australian study using MRI and clinical data from the MSBase Registry. We are measuring tiny changes in chronic lesion growth over many years, using a new imaging marker called Chronic Lesion Tissue Expansion (CLTE). By comparing each person’s lesion growth before and after they switch to a treatment such as ocrelizumab, fingolimod or natalizumab, we can see whether these therapies truly slow smouldering inflammation.

Our goal is to provide people with MS and their clinicians with clearer evidence to guide long-term treatment decisions.

Smouldering inflammation is increasingly recognised as the main driver of slow, irreversible progression in MS. Unlike relapses, this process is silent on day-to-day symptoms yet steadily damages brain tissue over many years. At present, we do not know whether the MS therapies used in routine care are able to slow this type of chronic inflammation, because it cannot be detected with standard scans.

My research addresses this major gap by using a new MRI measure that can track tiny amounts of growth at the edge of long-standing lesions. By analysing real-world data from people who switched therapies, we can determine whether treatments such as ocrelizumab, fingolimod or natalizumab reduce this slow-burning damage.

This work will help shift MS care from focusing only on relapses to also targeting the underlying processes that drive long-term disability. It will give clinicians and people with MS clearer evidence to guide treatment choices and future clinical trials.

I do find satisfaction in the potential impact of my research on improving diagnostic tools and treatment approaches for MS, particularly as my work addresses a challenging and complex disease with profound effects on patients’ lives. The process of uncovering insights that could influence clinical practices and help slow or prevent disease progression is very rewarding.

On the challenging side, managing the technical and methodological complexities of imaging biomarkers in MS research is demanding. Balancing the need for precision and innovation with limited resources and strict timelines in grant-funded projects also presents a challenge. Furthermore, communicating the nuances of my findings to the scientific community while ensuring the clinical relevance of my research is demanding.