THE EYES AND EARS OF THE OPHTHALMIC WORLD – SINCE 1975
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Optical retailing becomes tougher Optical retailing in Australia more diverse than ever, and more competitive too, with some of the traditional ‘boundaries’ being cast aside.
Hugh Taylor new ICO president Professor Hugh Taylor, of Melbourne, has taken up the presidency of the International Council of Ophthalmology at its annual congress in Tokyo, Japan
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Optical retailing is more diverse than ever; more competitive too O
ptical retailing in Australia is more diverse than ever, and more competitive too, with some of the traditional ‘boundaries’ between the different levels of supply being cast aside, predictably evoking mixed responses from competitors and customers alike. Major news of the moment is Essilor International’s pending purchase of what is said to be the world’s biggest online optical retail group, Canada-based Coastal Contacts, for $C430 million, with a binding purchase agreement being signed and the purchase expected to be completed in a few months’ time. That has almost coincided with the opening in Sydney of a bricks-and-mortar retail store by a subsidiary of Clearly Contacts, Clearly.com.au. which not only sells contact lenses, but prescription glasses and sunglasses as well. More are planned for later this year. Until now, Clearly.com. au has been an online retailer, initially establishing its operation at Sydney’s inner suburb of Alexandria, first with contact lenses and then glasses and sunglasses. Now it has a physical store in a busy part of the Sydney CBD, with others no doubt to follow. Adding some fuel to the fire is the strong rumour that a 60-store optical retail group is or is about to be offered for sale, although when contacted by Insight, the principal of that company declined to comment, but (tongue in cheek) said his company is
The Clearly.com.au store in Sydney’s George Street profitable and in view of Essilor paying $430 million for Coastal Contacts, which lost $C15 million the previous year, his company must be worth $1 billion! Essilor International’s chairman and chief executive, Mr Hubert Sangieres, commenting on the purchase of Toronto Stock Exchange company Clearly Contacts, said: “The internet has an important role to play in helping us to fulfill our corporate mission of enabling people to enjoy a better life through better sight. “The first step towards good visual health is a comprehensive eye examination. But in our industry, as in many others, the purchasing process is becoming more diversified. “The internet, if used properly, can help to drive market growth by educating consumers and making it more convenient
for them to enjoy good visual health. “With Coastal, Essilor is acquiring a recognised online vision-care platform. Our commitment is to shape this distribution channel for the benefit of the entire industry as well as consumers.” Essilor Australia’s chief executive officer and country manager, Mr Tony Gray, said that as the acquisition has not closed Essilor cannot engage in discussions yet on operational matters with Clearly.com.au, although his company’s view is that the specific retail needs related to optics, such as advice on complex and innovative lens options, are best channeled first through the traditional bricks-and-mortar channels. Essilor is the market leader for ophthalmic lenses in Australia.
Clearly.com.au ‘grey imports’ all of its stock from suppliers who have signed contracts with the parent company Clearly Contacts, including a good number of well-known brands, meaning local suppliers are largely left out in the cold. Online sales are said to account for about four per cent of the global vision-care market, which is estimated to be worth about $100 million at retail. Essilor says that online sales are likely to continue to increase at a double-digit rate for the foreseeable future. It has been involved in online distribution for several years through its subsidiaries FramesDirect and EyesBuyDirect and through MyOnlineOptical, a turnkey ecommerce engine that enables American eye-care practitioners to offer an online complement to their in-store offerings. Meanwhile, Specsavers, with 37 per cent of the retail optical market here, has just celebrated its fifth year in retailing in Australia, with an all-day seminar and a celebratory dinner black-tie dinner in Melbourne, attended by over 500 joint-venture partners and company staff and (see page18). And sitting quietly watching it all, is OPSM with a new television commercial that has an Australian flavour just launched (see page 45), as well as increasingly-nervous independent practitioners and corporatised buying groups. Continued on page 5
AUSTRALIA’S LEADING OPHTHALMIC NEWSPAPER – SINCE 1975 www.insightnews.com.au
AUSTRALIA’S LEADING OPHTHALMIC NEWSPAPER – SINCE 1975
TAFE training venues: stick to Randwick
THE EYES AND
PUBLISHED MONTHLY BY Modern Optics Pty Ltd
Optical retailing becomes toughe r
Optical retailing in Australia more diverse than ever, and more
competitive too, with some the traditional ‘boundarie of s’ being cast aside.
Hugh Taylor new ICO president
Professor Hugh Taylor, of Melbourne, has taken up the presidency of the International Council of Ophthalmo logy at its annual congress in Tokyo, Japan
14/03/14 11:31 AM
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EARS OF THE OPHT HALMIC WORL D – SINCE
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Specsavers 5th-yea r celebration
Specsavers celebrated its fifth year in optical retailing here at a dinner for over 500 franchise partners, with $100,000 raised for The Fred Hollows Foundation
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read with interest the article on page 16 of the March issue of Insight, which I totally endorse. Dr Lewis Williams writes, as expected, an interesting article about the development of an as-yet-tobe-built TAFE College at Kingswood (an outer western suburb of Sydney – 50km from the CBD). That college, it is proposed, will be the new location for optical dispensing at OTEN. I have long advocated that all optical-dispensing education should be at the one location. TAFE is currently the chosen provider of education for the optical dispensing industry; we have an excellent college at Randwick (8km from the Sydney CBD) staffed by very knowledgeable people. Dr Williams writes that they have the latest equipment, which as a matter of interest to your readers, has been supplied by friendly members of the Optical Distributors and Manufacturers Association at very reduced cost. Randwick is a very convenient location for both day students and OTEN students, if they share the one location nearby motels are available at reasonable prices for country students doing block sessions. One location would mean reduction in educational costs, teaching staff located in the one place, and hopefully sufficient students would mean the appointment of a head teacher for the faculty, who will show an interest in the industry he or she represents. With TAFE currently the chosen provider of education to the
John Jackson OAM Sydney, NSW Chairman, NSW Optical Dispensers Licensing Board (now abolished); Past President, Guild of Dispensing Opticians; Past President, The International Opticians Association; Chairman, NSW Optical Dispensing Education Trust Fund
Assistant health minister censured by Senate
8,139 copies within Australia T Insight’s circulation for the previous issue (March 2014) has been independently confirmed by Benbow & Pike Chartered Accountants at 8,139 copies.
optical dispensing industry, students are paying their way and TAFE seems to be happy with the current arrangements. Common sense should prevail, as should the opinion of ADOA; perhaps Insight might like to do a survey and see the response from optometrists and optical dispensers (Insight will do so: Ed.). Randwick is a convenient location accessible to the city (an added attraction for country students). Perhaps forgotten, are the members of ODMA who host these students for industry inspections and are all conveniently located. Randwick should and must be the only centre of excellence for optical dispensing education. One serious problem will be transferring a faculty from one TAFE district to another; the Australian Dispensing Opticians Association must address that problem, remembering that Randwick is already teaching distance education. If a transfer of the dispensing faculty cannot be amicably arranged, then Randwick will need to aggressively campaign for students. Further discussions between ADOA and TAFE should perhaps be more positive. ■
he federal assistant health minister, Senator Fiona Nash, has been censured by the Senate for misleading it and refusing to produce documentation about her employment of a junk food industry lobbyist as her chief of staff.
The opposition says Senator Nash’s position is no longer tenable and has called on her to resign after the censure motion was passed 37 to 31 votes. Only three such censure motions have passed in the past 10 years. ■ www.insightnews.com.au
First bricks-and-mortar store for Clearly.com.au opened in Sydney T Continued from page 3
he firs bricks-and-mortar store for Clearly.com.au has opened in George Street, Sydney, in the heart of the CBD retailing area. Originally an online supplier of contact lenses, Clearly.com.au (a subsidiary of Canadian listed company Coastal Contacts in the throes of being bought out by Essilor International for $C430 million) now retails complete prescription glasses as well as sunglasses and accessories, both online and through the George Street store. The company here is headed by managing director Geoff Henshaw, a Canadian, who migrated here with his family last year. The George Street store is striking and not only has built-in
appeal during the day but also during the evening, when its lighting makes an effective marketing piece that attracts the attention of passers-by. The general modus operandi is that patients/clients, armed with an existing prescription or one provided by the on-site optometrist, try on some of the 600-700 SKUs on display (out of the 3,000plus range) and, after deciding which ones they wish to purchase, they proceed to a bank of four computers and key in the details of their prescription (under the watchful eye of staff ), which goes to the company’s wholesale operation at inner suburb Alexandria, where the prescription and frame(s) selected are verified and sent on to Canada for surfacing and/or fitting, from where they
Geoff Henshaw, Clearly.com.au managing director ANZ are returned to Australia when completed. Frames and lenses are all supplied from Canada, where the company negotiates
volume-purchasing deals with suppliers, hence its prices are very competitive, particularly for contact lenses, which, perhaps surprisingly, are mainly bought here from the local subsidiaries of the major manufacturers. Clearly.com.au is a sleek operation, combining what seems to be the best of both bricks-andmortar and online worlds. The company is a firm believer in the value of word-of-mouth advertising, instancing it as attracting two-thirds of its clientele. However, it is also a strong user of online advertising to promote itself. Recently, it received results of Monash University’s Australian Centre for Retail Studies Retail Omnibus Survey, which it found encouraging. ■
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90 enrol at Deakin University for optometry double-degree course N inety students enrolled for this year’s first year of Deakin University’s double-degree course in optometry and vision science, up from 64 enrolments three years ago. There were 920 applicants for the course this year and 225 acceptance offers to students with GPA of 6.0 (distinction average) and ATAR of 92.9, (the fourth-highest for entry to a Deakin course). The third cohort consists of 74 per cent females and 26 per cent males, with 67 per cent from metropolitan areas and 33 per cent from non-metropolitan areas. Fifty-eight students are from Victoria, NSW 12, SA 5, Queensland 3, Tasmania 2, WA 2, ACT 1, NT 1 and New Zealand 1. The figures were announced by the foundation director of optometry studies and chair in optometry within Deakin’s School of Medicine, Professor Harrison Weisinger, at its Orientation Day in Geelong on 4 March. Deakin’s optometry course is unique in its use of the trimester system, which enables students to complete studies that what would ordinarily take five years in just under three-and-a-half years. The teaching and learning elements of course are innovative and technologically driven. Optometry will use a problem- based learning approach, as well as team-based learning, clinical skills laboratories, simulations plus short and long residential clinical placements. Addressing this year’s cohort, Professor Weisinger said the course mission is to produce graduates who are “work ready” and who are “motivated to work in areas of need”. The course highlights are a growing, world-class, diverse academic team; a teaching facility at the Australian College of Optometry in Melbourne; accreditation with  conditions, most of which have been complied with; an ophthalmic and retail optics program; and the first graduates coming later this year.
Course director Alex Gentle
Foundation director of optometry studies and chair in optometry within Deakin’s School of Medicine, Professor Harrison Weisinger, and Mayor of Geelong, Darryn Lyons at the Orientation Day
Deakin Optometry’s premises Professor Weisinger said there is a shortage of practitioners, with those in practice at present doing more of the eye-care work than
ever before, which medicine understands is necessary. Deakin Optometry’s involvement with the Australian College of
Optometry and the establishment and fitting out of a facility there for undergraduates to gain patient experience was greatly assisted by the support of OPSM and Specsavers, Professor Weisinger said. Professor Alex Gentle, course director at Deakin Optometry, described the structure of the course, explained how the teaching and learning methodologies work and why they are used, before showing videos of some of the sessions in action. The program is the first ‘accelerated’ one in Australia and is a mix of vision, health, science, public health and business, with three Year 1 optometry units out of 12, Professor Gentle said. The curriculum is authentic backward-design problem-based learning (drives whole program), with team-based learning (frequent assessment of learning outcomes) leading to clinical skills development from early-on, he said. Innovations in the course are to make “work ready” by optometric business stimulation; extended (residential) clinical placements (recruit from and return to regional areas; few pre-requisites for entry (a good students is a good student); and location in a purpose-built building (Regional Health Hub). Years 1 and 2 lead to BVisSci, while Year 3 and half of Year 4 lead to MOptom degrees. ■ Further reports from Deakin Orientation will be published in the next issue of Insight.
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Hugh Taylor takes up presidency of the International Council of Ophthalmology
rofessor Hugh Taylor, Melbourne Laureate Professor and the Harold Mitchell Chair of Indigenous Eye Health at the University of Melbourne has taken up the presidency of the International Council of Ophthalmology. He took up his two-year appointment with the ICO at the 2014 World Ophthalmology Congress on 2-6 April in Tokyo, Japan, succeeding Dr Bruce Spivey of the United States in the position. Professor Taylor is the first Australian and the first person from the southern hemisphere to be appointed to the role. His appointment was announced early last year. He is recognised worldwide for his leadership in trachoma, advocacy for improved Indigenous eye health and other initiatives to eliminate avoidable vision loss. He has held numerous leadership positions, including previous vice-president of the International Agency for the Prevention of Blindness and has been the ICO director for advocacy and is the current ICO treasurer.
Within Australia he was professor of ophthalmology at the University of Melbourne for 20 years and established the Centre for Eye Research Australia. He is currently deputy chair of the board of Vision 2020 Australia. Dean of the University of Melbourne’s Faculty of Medicine, Dentistry and Health Sciences, Professor Stephen Smith, congratulated Professor Taylor on his appointment. “Professor Taylor brings with him great experience in both clinical and research work. He has been a champion of improved health outcomes for Australian Indigenous communities,” Professor Smith said. “His early experience of reviewing Pakistan’s eye-care services on behalf of the World Health Organisation, led him to take up the challenge of convincing governments to take vision loss seriously and demonstrating why – with limited and competing health dollars – eye care must be made a global priority.” Professor Taylor’s new role with the ICO comes at the same time as the most recent statistics
Hugh Taylor on blindness are published in a study in the British Journal of Ophthalmology. Australia has recorded a 21 per cent reduction in the prevalence of blindness in the last 20 years, according to The Global Burden of Disease study. “Those figures are encouraging as even though the world’s population increased over this time, the rates of blindness have reduced dramatically so that the actual number of people who are
blind has decreased,” Professor Taylor said. In high-income countries like Australia, the most-common cause of blindness changed from cataract in 1990 to macular degeneration in 2010. Australia has the lowest rates of blindness and vision loss than the rest of the world and is similar to most high-income countries. While Australia is performing well globally, Aboriginal and Torres Strait Islanders still experience higher rates of blindness due to cataract, uncorrected refractive error, diabetic retinopathy and trachoma. Professor Taylor warned that as most of that is preventable and treatable, Australia needs to continue to improve access to eye care and ensure that indigenous Australians do not miss out on the essential eye care they need. “While the figures are encouraging for the general population, the concern is that we are still not making headway with indigenous Australians, as they continue to miss out on the eye care they need. More work needs to be done,” Professor Taylor said. ■
Bring back anatomy classes: AMSA
‘dumbing-down’ of anatomy teaching is leaving medical students ill-equipped to enter clinical practice, according to the Australian Medical Students’ Association. Australian medical students have not been formally required
to dissect cadavers for almost 40 years, even though dissection has been fundamental to anatomy teaching since the Renaissance. The amount of time and course work devoted to anatomy has been slashed in recent years and varies widely among medical
schools, according to the students’ peak body. AMSA is calling on the Australia Medical Council to develop national standards that explicitly dictate the minimum anatomy content expected from graduates in medicine.
“In the absence of national guidelines for the teaching of anatomy, the level of basic anatomical knowledge held by some graduates might be inadequate for competent practice,” a spokesmen for the AMSA said on 7 April. ■
Transitions launches new virtual demonstration tool
ransitions Optical has launched ‘Transitions Viewer’, a virtual demonstration tool that helps to demonstrate the function and benefits of its family of photochromic lenses.
The online tool is designed to be used by consumers before visiting their optometrist, and is also intended as a demonstration tool to be used by optometrists and dispensers in-store. Launching this month, the
tool can be accessed anytime from a laptop, desktop, tablet or mobile device. The tool helps users understand how Transitions lenses enhance vision and the lenses that are available to them.
Transitions Viewer is available at www.transitions.com/ en-au/virtual-viewer. Transitions Viewer will also launch in the app store and be available to consumers on iPads for free early next year. ■ www.insightnews.com.au
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World’s BIG Breakfast held in Sydney CBD’s Wynyard Park
The long table dressed with white-linen tablecloths
he World’s BIG (Beat Invisible Glaucoma) Breakfast was held in Sydney CBD’s Wynyard Park on the morning of 11 March, hosted by Glaucoma Australia. There was a long table dressed in white linen with matchingcoloured chairs, for representative of Glaucoma Australia and the ophthalmic professions and industry to sit and enjoy a light breakfast, as well as interested passers-by. The breakfast was provided by Vittoria and Baker’s Delight. Whilst proceedings were informal there was a small introduction and a handout that hopefully will be used by the general media in attendance to create a buzz about glaucoma awareness during World Glaucoma Week (9-15 March). The BIG Breakfast was part of Glaucoma Australia’s campaign to remind the community that glaucoma is largely an invisible disease and that the best insurance is to have an optic nerve check as part of a regular eye examination.
Glaucoma Australia, like practitioners, is concerned that an estimated 150,000 people in Australia who have glaucoma don’t know it, however the good news is that it can be detected through an eye examination and largely treated. Also, that early detection and treatment are the keys to halting or delaying sight loss and blindness caused by the disease, especially if there is a family history of the disease as it runs in families. Specsavers was an official partner of Glaucoma Australia’s World Glaucoma Awareness Week. Optometrist and professional services director at Specsavers, Mr Peter Larsen, said: “Glaucoma is the leading cause of irreversible blindness worldwide, and is known as the ‘sneak thief of sight’ because it has very few symptoms until the condition is advanced. “We recommend having an eye examination every two years. “It is one of the significant eye diseases and its detection, where it exists, is essential during eye examinations, particularly if there
Plenty of discussion at the long table
is a family history of glaucoma. The BIG campaign, included a series of BIG breakfasts around Australia during World Glaucoma Week. “Fifty per cent of people with glaucoma in Australia are undiagnosed. That’s why it’s so important to have a regular optic nerve check as part of a comprehensive eye test. Early detection is vital to preserve vision as, by the time symptoms develop, significant sight loss has usually occurred. Glaucoma is truly an invisible disease,” Glaucoma Australia’s national executive officer, Mr Geoff Pollard, said. “Forty per cent of Australians have their eyes tested less often than every two years or have never had their eyes tested. “Glaucoma can affect people at any age but the incidence does increase dramatically with age – one in 200 people aged 40 has glaucoma – rising to one in eight by the age of 80. “About 11,000 Australians are blind from glaucoma at any one time – it is a tragedy that is largely preventable.”
Glaucoma Facts • Glaucoma is the leading cause of irreversible blindness worldwide. • One in eight Australians over 80 will develop glaucoma. • First degree relatives of glaucoma patients have an eight-fold increased risk of developing the disease. • 50 per cent of people with glaucoma in Australia are undiagnosed. • Australian health care cost of glaucoma in 2005 was $342 million. • The total annual cost of glaucoma in 2005 was $1.9 billion. • The total cost is expected to increase to $4.3 billion by 2025. ■ For more information: www.glaucoma.org.au Rosanne Michie MWC Media PR Account Manager 0411 868 535 Rosanne@Mwcmedia.com.au Geoff Pollard Glaucoma Australia (02) 9906 6640 firstname.lastname@example.org
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Two AMD treatments debated 1% vs. 7.1% adverse cerebrovascular events in the first year of use
ged-macular-degeneration treatments were the topic of discussion at an event chaired by Assoc Prof Alex Hunyor Jnr at the 45th Annual Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists in Hobart. Prof Hunyor opened with a short presentation on endophthalmitis following intravitreal injection for AMD. He gave an endophthalmitis figure of one case in 5,641 injections. He noted that culture-positive cases of the acquired disease almost invariably had a poor vision outcome whereas culture-negative cases usually recover and counselled that if both eyes are to be injected on the same day then entirely-separate procedures must be used for each injection to preclude any possibility of a related double disaster. Furthermore, he bought into the debate about the use of facemasks by discussing droplet spread at injection time. Although he mentioned ‘shouting’ surgeons specifically, his general advice was to use a mask regardless. He also asserted that the use of pre- and post-injection topical antibiotics served no purpose. However, he did offer an opinion on the two main topical antibiotics employed, Betadine and chlorhexidine – the latter is slower to act and more comfortable for the patient.
Heavy artillery The next part of the session wheeled out some heavy artillery, Dr Paul Beaumont and Prof Paul Mitchell. Although some expected or even hoped for a session featuring some fireworks between the two presenters, what transpired was a more gentlemanly and
scholarly exchange as is more befitting a RANZCO annual scientific meeting. Dr Beaumont presented first putting him at a slight disadvantage. On the topic of Lucentis and stroke he noted that in high-risk cases its use has an odds ratio of 7.5 for having a stroke whereas in low-risk cases no increased risk is discernable. His advice was to avoid the use of Lucentis in highrisk cases as there may be an associated much greater risk of TIAs (transient ischaemic attacks), an increased risk of a stroke, but a decreased risk of myocardial infarction. Switching to the topic of the use of Eylea, Dr Beaumont cited reports that found up to 20% of the active ingredient was lost to the systemic circulation where it decreases the amount of free VEGF circulating in blood plasma presumably because of its intended action of ‘trapping’ VEGF. Dr Beaumont attributed an increased risk of TIAs and strokes to that lowering of circulating VEGF.
Strokes In an otherwise healthy population he gave figures of TIAs and strokes in Lucentis users as 1.1% and in Eylea users 7.1%. In high-risk cases he estimated the risks could be up to 4x higher that those figures. Avastin users also face attendant risks but those were not detailed as the topics under discussion were related to Lucentis and Eylea. In the light of a possible connection between the use of the various anti-VEGF treatments and stroke, Dr Beaumont believes that all patients should be warned of the possible side-effects. Prof Mitchell then spoke, commencing with the VIEW studies (1 & 2 – related to the treatment
of neovascular AMD by either Lucentis or Eylea). Once again he raised the issue of adjudication of results from clinical trials. The European Medicines Agency’s wide-ranging data collection criteria means that any adverse event whether it was related apparently to the clinical trial in progress or not, is included in trial data. That means that data cannot be omitted selectively and inclusion may mean that something not understood to be related and/ or relevant at the time may become significant at a later date as our knowledge base expands. Adjudication would seem to be an attempt to seek the middle ground between including all and excluding all believed to be irrelevant, e.g. an accident involving a pedestrian subject being hit by a child on a bicycle may me due to the subject’s medication, may be due solely to a careless child, or may be due to something else trial drug-related that has an adverse outcome but which is outside our current understanding of its effects. Using the widely-accepted clinical trials end-point criteria defined by the Antiplatelet Trialists’ Collaboration (APTC) relating to: cardiovascular, haemorrhagic, and unknown death; nonfatal myocardial infarction; and non-fatal stroke, Prof Mitchell stated that while stroke was age-related, the rate in neovascular AMD patients was twice the age norm and after the age of 85 was found to be as high as 2% per annum. The stroke rate is also driven by the incidence of TIAs to some extent, i.e. TIAs are a harbinger of further troubles ahead. When Eylea use was considered, the stroke rate was approximately
equal to the age-norm whereas those receiving Lucentis tended to experience stroke at a lower rate than the age-norm. In the VIEW studies, vision impairment predicted an increase in overall mortality and perhaps only somewhat predictably, cataract surgery alone decreased mortality by 33% (not every older, vision impaired person spends their life near unfenced cliff edges surely). Not surprisingly in the light of the foregoing and the general vision improvements AMD treatments usually bring, anti-VEGF treatment in AMD also decreases mortality rates. Citing the adjudicated data from the VIEW studies, the death rate with Lucentis went from 2% to zero. Regardless of the actual figures, Prof Mitchell’s clear advice was not to alarm patients unnecessarily. He also acknowledged that while the raw cardiovascular data suggests that in older patients (80-85?) the use of Lucentis (as opposed to Eylea) looked to be safer (1% vs. 7.1% adverse events in the first year of use, 3% vs. 9% in the second year), once ‘adjudication’ had been applied the numbers were actually no different. That matches the report of the VIEW studies carried out across the world that confirmed similar efficacy and safety outcomes with both products (Heier et al., 2013). According to Prof Mitchell, if anything, there is probably some general concern surrounding the use of the various forms of antiVEGF therapy now in use. ■
Heier JS et al., 2012. Intravitreal Aflibercept (VEGF Trap-Eye) in Wet Age-related Macular Degeneration. Ophthalmology 119: 2537 – 2548.
EVERYBODY READS INSIGHT! 14
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Saks on Eyes Alan P Saks MCOptom [UK] Dip.Optom [SA] FCLS [NZ] FAAO [USA]
Proof of the Pudding Getting back to work after a month of travel was pretty much as expected: Wall-to-wall ‘special patients’ with a myriad of complex problems. These are often the ones who’ve now been waiting a couple of weeks to be seen. It all fortunately went rather more smoothly than expected and that was relief in itself. What it did however drive home were a number of the things I’ve been rabbiting on about these past few months. Patient loyalty and retention was demonstrated in no uncertain terms. On my first day back 80% of the patients seen were from my previous practice – that we sold around five years ago and which the new owner on-sold to the Luxottica group three years ago. Of those seen, that first day back, two were seeing me for the first time in many years. One had not seen me for seven years (LASIK in 1999) and another over five years ago. Some I’d seen in the past few years since moving. They included a recent graft rejection, an ‘idiopathic’ Drance haemorrhage, a diabetic, two KC RGP wearers, an EBMD, a breast-cancer patient and an irregular astigmat, who I’ve seen since she was a kid – in between living in Vanuatu and France – and is now a London-based lawyer. As previously mentioned, there are no more loyal, successful and satisfied patients than long-term RGP patients. Some are veterans of thirty, forty and fifty years or more in hard lenses. Sadly one of the most loyal, the
first and longest continuous hard lens wearer in NZ – fitted in the 1940s – in the very building still occupied by the practice today, passed away earlier this year. She was a dear old soul with some heavy-duty eye problems and severe KC. She maintained her RGP wear, with minimal complaints, for nigh on seventy years! She never consulted another practice in all that time apart from a few visits to co-managing ophthalmologists. You don’t get better loyalty than that.
Loyalty To further illustrate that such loyalty is not a fluke, two days later I saw a chap, with severe keratoconus, whom I’d fitted in my practice in South Africa, when he was thirteen. His KC manifested after a year at sea on a yacht trip to NZ and back to Cape Town. We believe the triggers were irritated eyes from salty sea spray, extreme brightness, ‘squinting’, eye rubbing and poor diet, due to a lack of fresh fruit and veggies. Today he’s a forty-year-old financial expert in commodities and derivates trading and a lecturer at Auckland University. He’s followed me through three practices in NZ, with stints in high finance in London and Hong Kong, where I referred him to colleagues who took great care of him. That’s another key point: develop an international referral network to take care of your patients. Build loyalty and respect. We all know Australasians are big travellers who like to take off for years at a time and work all over our incredible planet. Like my aforementioned patient, many return to have families and raise their kids in better places than London and HK. They will come back and see you. Provided you
looked after them with pertinent referrals, reports, information, consideration and easy communication via email or your website: Which also serves to help them find you, years later. We’re very lucky to live in this part of the world but it’s nice to have the ability to travel. Practise has carried on much along these lines since my return. As I write this column I note a few more challenges are keeping my book solidly booked. The very next case I saw, as I continued this column, was one I have seen regularly, over almost twenty years. She’s suffers from albinism, nystagmus and has cosmetic-occluder soft lenses, with occupational and bifocal spectacles of around +3.00/-7.50x180 and an add of +3.50. She does amazingly well as a graphic designer, despite her limited 6/38 vision! Her management has been frustrated by discontinuation of her semi-occluder ‘cosmetic’ soft lenses, which had provided her with fantastic results for well over twenty years. It’s taken a while to find a replacement she is happy with. It’s been hard finding the time to review reports and patient requests that piled up in my absence. Add to that some complex custom RGP designs, clinical trials and new referrals – inwards and outwards, there’s hardly a dull moment.
Make the Right Choices A ‘grateful’ patient initially relayed one such report to me. She’d called the practice on Xmas eve complaining of floaters and a ‘crescent shape’ in her left eye. We duly fitted her in during the mid-afternoon. I examined her left eye and made a diagnosis of PVD. As I always
do, I also checked her asymptomatic right eye and noticed a faint shadow, on the superior edge of the infrared monitor of the fundus camera. I got her to re-fixate and imaged a great big lesion. Although not darkly pigmented I diagnosed a melanoma, a few disc diameters in extent, superior temporal to the ONH and above the macula. I confirmed this with my Volk Digital Wide Field fundus lens. Now you try and find an ophthalmologist, on Xmas eve at 3pm. At any rate I spammed a few of my favourite ophthalmologists. The first to respond – within around thirty minutes – was one of our stars, direct from his holiday home. Now that’s commitment and service. He in turn contacted one of his on-call colleagues who saw her and confirmed my suspicions. The patient was seen by a retinaloncologist around New Year. She has since had the eye enucleated, due to the melanoma’s location near the macula and ONH, where radioactive plaques would cause too much damage. She had a prior history of bowel cancer twenty years ago. On biopsy cytogenetics showed ‘monosomy 3 and additional copies of 8q’. Alas, she thus has a significant risk – greater than 50% – of metastatic liver disease, within the next few years. She came in to the practice recently and thanked me for detecting her life-threatening condition and if not saving her life, at least extending it. Of course she did not thank me for losing an eye. A number of optometric and ophthalmological colleagues have told me that in such circumstances they would have only examined the symptomatic eye … There’s a lesson in there somewhere. You be the judge. ■
BCLA invites photo competition entries
he British Contact Lens Association is inviting online submissions for its 2014 photographic competition, by the
closing date of 25 April. The BCLA photographic competition culminates during the association’s Annual Clinical
Conference and Exhibition and attracts entries from contact lens practitioners across the globe. As well as receiving the accolade
of best photograph of the year and a great prize, all winning entries are subsequently published in Contact Lens & Anterior Eye. ■ www.insightnews.com.au
MDF seeks $6-million over 3 years from government for helpline T he Macular Disease Foundation is seeking $6 million over three years from the federal government, through the health minister, Mr Peter Dutton, to fund Australia’s only national macular disease helpline. The foundation says it has received an average of only $163,000 per year in Commonwealth funding since 2005, with no funding for its helpline.
Support is being sought from eye-care practitioners, whom the foundation has asked to write to Mr Dutton asking that he support its pre-federal-budget submission for 2014-15. Practitioners are asked to point out that the foundation is the sole national organisation addressing macular disease and has filled in “an enormous gap” in public health by providing world-recognised
prevention, early-detection and support programs. Also, that the helpline is a frontline service providing callers (patients, family, carers and health professionals with information and support on macular disease, lowvision aids and support services. Furthermore, that it is the only telephone helpline in Australia covering all macular diseases – macular degeneration, and
recently diabetic retinopathy, retinal vein occlusions and other macular dystrophies. And that it services macular degeneration, the leading cause of blindness in Australia which primarily affects older people, with over one million people showing some evidence of that disease, which accounts for 50 per cent of all blindness and severe vision loss. ■
Medical students outline solution to rural maldistribution
ith rural Australians continuing to suffer poorer access to health care, the Australian Medical Students’ Association is calling for greater training opportunities to serve the rural population. The acting president of the
AMSA, Kunal Luthra, said on 6 March there is a clear, evidencebased strategy, particularly highlighted in last year’s Mason Review, to create and maintain a sustainable rural health workforce. “There are three key factors that correlate with increased likelihood
to work in the country; a rural upbringing, rural exposure during medical school, and training opportunities in rural Australia”, Mr. Luthra said. “Currently the federal government requires medical schools to have one quarter of the intake
from of a rural background. AMSA believes that figure should be one third to reflect the wider population. “There is strong evidence that students who grew up rurally are more likely to eventually serve the rural community as a doctor.” ■
Specsavers marks 5 years retailing in
It wasn’t an F-18A in the flesh but as close as you can get; RAAF ‘Afterburner’ pilots addressed the seminar
Dame Mary addressing the dinner
pecsavers held an all-day Partnership Seminar followed by a Gala Dinner and Awards for more than 500 of its franchise partners gathered in Melbourne on Sunday 9 March from across Australia and New Zealand to celebrate the completion of Specsavers first five years of optometry and retail operations in ANZ. The participants welcomed the company’s co-founder Dame Mary Perkins as special guest and speaker at both events. The dinner, hosted by Specsavers frame-range partner, Alex Perry, was a spectacular affair and included the Specsavers
Maori Haka welcome for the New Zealand delegates
More than 40 partners joined the 5-Year Partner Club in March
Comedian Julia Morris
$100,000 raised for The Fred Hollows Foundation Partnership Store Awards for 2013 and a Platinum Prize Draw in support of The Fred Hollows Foundation – as well as a final surprise appearance in the form of comedienne, Julia Morris. With all Platinum Prize Draw tickets purchased by store partners at their tables, a total of $84,000 was raised, which Dame Mary ‘topped up’ to realise the magical figure of $100,000 on the night.
Among the prizewinners A happy Ruth Hollows (daughter of Fred and Gabi Hollows) and the foundation’s chief executive officer Penny Tribe, received a cheque from Dame Mary and Specsavers’ global retail director and general manager ANZ, Derek Dyson.
ANZ with seminar and dinner The Specsavers Partnership Store Awards for 2013 comprised a total of eight awards with the two pinnacle awards ‘Best New Zealand Store 2013’ and ‘Best Australian Store 2013’ being won by Specsavers Newmarket (North Island) and Specsavers Midland Gate (Western Australia) respectively. Earlier in the evening, Dame Mary joined a group of more than 40 store partners, welcoming them into the Specsavers Five-Year Partners Club. The group is made up of partners who have recorded five years or more as a franchisee with Specsavers in Australia or New Zealand. That boosts the number of Five-Year Partners Club members to more than 200 across Australia and New Zealand. ■ Dame Mary, Alex Perry, Ruth Hollows and Derek Dyson received the $100,000 cheque
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Interview of Dame Mary Perkins: Dame Mary Perkins was interviewed by the editor of Insight, Neil Forbes, on 9 March. Here are his questions and Dame Mary’s answers: ■ Specsavers has had phenomenal growth in Australia since it was established here five years ago as a retailer (following its earlier wholesaling activities) six years ago. The company is now No. 1 in terms of retailing and professional services provided. How was that achieved? Like anything it has involved an enormous amount of hard work from a really talented group – and groups – of people. Interestingly, while many of Australian and New Zealand team had a lot of UK Specsavers’ experience, even more did not. Those local individuals and teams with no prior experience with Specsavers have played an equally important part in helping the Specsavers partnership model really take off in both countries.. While having the right people is one part of the success, the other part relates to having a really good plan and being ready to invest in that plan to turn it into reality. Our coming to Australia and New Zealand entailed a lot of heard work and considerable outlays and risk, which we were willing to undertake because we were convinced there would be a positive response to what we offer. It was a case of it having to work. ■ What next? Well, the job is never done. There are always new challenges in terms of looking to continually improve the professionalism, the experience and the value we provide to our patients and customers. We still need to provide the easiest possible access to all Australians and New Zealanders and that means we need to continue to open new stores, while we are finding that many of our stores are already bursting at the seams. So those stores need to increase in size with more consulting rooms and more dispensing desks – meaning greater floor space. 20
■ When you started Specsavers in the UK, did you have the same rate of growth as you have had here during the past six years? I can’t make a direct comparison because in the UK we started with a single store, then a second and built up to our first 100 stores over a number of years. In Australia we opened 100 stores in 100 days and more than 150 in the first year. But while the markets are different, one constant has been growth: we’ve never had a year when we haven’t recorded like-for-like growth in our stores and the whole partnership is very proud of that.
■ When you decided to open your retail operations in Australia, were you confident it would be as successful as it has been? ‘If you had told me six years ago that by 2014 we would have opened almost 300 Australian stores, 50 or so New Zealand stores, having helped more than 600 owner-operators to get into their own businesses, I wouldn’t have believed you. We never thought for a moment it would happen that fast. I remember Doug, in early 2008, before we opened our first Melbourne stores, standing outside our Port Melbourne office and looking up at the Melbourne CBD skyscrapers and it was all very daunting. He realised that not a single person in those buildings knew who we were and that to succeed we had to make sure they did know us. The fact that that has happened so quickly is a testament to the strength of the offer we put to customers. ■ Do you agree with the DeloiteAccess finding that there will be a shortage of 1,500 optometrists in Australia by 2030? I am hoping that with Flinders and Deakin universities soon producing first-class graduates, adding to greater numbers coming out of the likes of University of NSW, the shortage will be
averted. Time will tell. However, with a population that is due to grow one third by 2030 and the over-60s group due to be 50% greater, we need to be planning for an increasing number of annual graduates over time.
■ When you commenced retailing here, both Doug and yourself were adamant that retail prices here were too high (perhaps 40 per cent too high) and that you would be working to lower the retail prices. It appears that has been successful, however some maintain that two pairs for $200 is largely a myth and that the bill is often hundreds of dollars more than $200 for two pairs. True or false? False. You only have to go into a Specsavers store anywhere in Australia and witness our $39 range right at the front of the store to see that. All those frames include single vision lenses and our ‘two pairs complete with single vision lenses’ range starts at $149. Specsavers has always been about allowing people to make informed choices with all prices and lens options clearly on display – so that there are no surprises at the till. If you are multifocal wearer and you currently select from the very clearly marked $349 designer range, that price includes multifocal lenses – for two pairs. When Specsavers first arrived here, you’d be lucky to pay that price for one pair of glasses with multifocal lenses. ■ During the five years, you have made significant contributions to the various universities that train optometrists and various professional associations and organisations, despite some of them being hostile towards Specsavers. Does that concern you? Will it affect your plans for the future? Not at all. Most of the reticence shown towards us a few years ago has evaporated and we are building some really good relationships with the universities.
Our plans are to support the optometry schools in pursuing their goals – to produce the best graduates that are suited to looking after the nation’s eye health.
■ Will there be another Australian managing directorCEO in the future? I am sure there will be, so long as they are the best person for the job. It’s interesting to note that while, in the early days, many people came from UK Specsavers to Australia and New Zealand, nowadays the trend has been reversed. There are a large number of people from here who are now going over to run and manage things in the UK – that’s the great thing about an international group. ■ Would you outline the purpose for this weekend’s meeting versus the one to be held in Sydney later in the year? Today’s Partnership Seminar is a meeting of all our store partners, our franchisees. It’s actually the first time we have brought together all 600 partners together at the same time in the same place. We completed our first five years of retail operations this year and so this gathering is a big celebration of that fact. We have outlined next year’s annual plan and had some great external speakers give their insights to how we can continue to achieve such big things in 2014-15 and beyond. We were also really proud of the fact that the partners banded together to raise $100,000 at our Gala Dinner and Awards for our community partner The Fred Hollows Foundation. By ‘Sydney meeting’ I think you are referring to the now annual Specsavers Clinical Conference. That’s an annual CPD and networking gathering for optometrists from across the Australian and New Zealand store network. This year it is taking place on Sunday 14th September and it’s also open to non-Specsavers optometrists too. Like last year, we are expecting 400 delegates to be present. ■ www.insightnews.com.au
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RANZCO and CERA to join nine others in $13m research program T he Royal Australian and New Zealand College of Ophthalmologists and the Centre for Eye Research Australia are to join forces with The Queen Elizabeth Diamond Jubilee Trust and nine other partners in the fight against avoidable blindness. Eleven expert institutions from across the Commonwealth will come together for the first time as the Commonwealth Eye Health Consortium, thanks to a £7.1 million ($13 million) grant from The Queen Elizabeth Diamond Jubilee Trust. Coordinated by the International Centre for Eye Health at the London School of Tropical Medicine, the consortium will pursue vital research into conditions such as diabetic retinopathywhich leave millions without sight. Worldwide there are 285 million visually-impaired people, of whom 39 million are blind. Yet 80 per cent of blindness and visual impairment is curable or treatable. Good quality eye-care is a scarce resource for millions of people across the globe, including in many Commonwealth countries. Announced on Commonwealth Day 2014 (9 March), the major grant by trust will support the newly-created consortium to deliver an integrated program of fellowships, research and technology. As one of the consortium’s highly-respected eye health organisations and academic institutions, RANZCO will work with others to deliver the program, which will help strengthen health systems to prevent blindness and make high qualityeye-care available to all. The program delivered by RANZCO and the consortium will support: People: strengthening capacity to deliver eye care, through training and information sharing, including Public Health for Eye Care Fellowships, Masters courses, clinical fellowships and 22
a Commonwealth-wide diabetic retinopathy team training network; Knowledge: deepening understanding of avoidable blindness and approaches to tackling it, through research fellowships;
Tools: development and roll out of technology such as the Portable Eye Examination Kit (Peek) system which will help identify and diagnose eye problems in any setting using only a smartphone; and OpenEyes, an electronic patient-record system to replace inefficient and unreliable paper systems.Those have the potential to bring about a revolution in affordable eye care. Dr Stephen Best, president of RANZCO, said: “We are pleased to be involved in this excellent initiative – a collaboration that focuses on eye health workforce development and building local capacity through education, research and innovation. We thank the Queen Elizabeth Diamond Jubilee Trust for its generous contribution, which enabled this partnership that will assist in eliminating avoidable blindness by 2020.” Sir John Major, chairman of The Queen Elizabeth Diamond Jubilee Trust, said:“I am delighted that The Queen Elizabeth Diamond Jubilee Trust is able to fund this important programme. With the invaluable and diverse talents of so many specialists – from all around the Commonwealth – we can, together, lead the fight against avoidable blindness worldwide.” Dr Matthew Burton, ophthalmologist and senior lecturer at the London School of Hygiene & Tropical Medicine,said: “We are very pleased to be working with The Queen Elizabeth Diamond Jubilee Trust. Blindness is devastating for millions of people yet so much of it could be cured or prevented. The
About the Consortium and the Trust Members of the Consortium are: International Centre for Eye Health (ICEH); College of Ophthalmology of Eastern, Central and Southern Africa (COECSA); Royal Australian and New Zealand College of Ophthalmologists (RANZCO); Royal College of Ophthalmologists (RCOphth); West African College of Surgeons (WACS); Aravind Eye Hospital (AEH); University of Cape Town (UCT); Centre for Eye Research Australia (CERA); Moorfields Eye Hospital (MEH); LV Prasad Eye Institute (LVP); and Singapore National Eye Centre (SNEC). The Queen Elizabeth Diamond Jubilee Trust is a charitable foundation established in 2012 to mark and celebrate Her Majesty The Queen’s 60year contribution to the Commonwealth. The trust has received donations from governments, corporate partners, trusts, foundations, community groups and individuals from across the Commonwealth. Its mission is to enrich the lives of people from all backgrounds within the Commonwealth, and its programs work in alliance towards eliminating avoidable blindness and to empower a new generation of young leaders. With a five-year timeframe in which to deliver successful programs, the trust’s aim is to leave a lasting legacy, owned by the whole Commonwealth, to honour The Queen.
funding will enable organisations and individuals to team up through the Commonwealth Eye Health Consortium and overcome some of the obstacles blocking access to eye care.” Colin Cook, Head of the Division of Ophthalmology of the University of Cape Town, South Africa, said:“We are very grateful to The Queen Elizabeth Diamond Jubilee Trust for its support towards eye care and the elimination of avoidable blindness in the Commonwealth. The African saying is ‘How do you eat an elephant?’ to which the answer is ‘one mouthful at a time, piece by piece, and with a lot of help from your friends’. This initiative is a wonderful illustration of this teamwork, and we are grateful for the opportunity to participate as members of that team.” The Commonwealth Eye
Health Consortium is a group of regional eye-health organisations, training and academic institutions from several Commonwealth countries, which brings together a range of complementary skills and capacity to deliver an integrated five-year program offellowships, research and technology in three priority eye diseases: trachoma,diabetic retinopathy and retinopathy of prematurity. Funded byThe Queen Elizabeth Diamond Jubilee Trust, and co-ordinated by the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, it aims toachieve a major long-term impact instrengthening eye health systemsand improve quality of eye care for many people throughout the Commonwealth. ■ www.insightnews.com.au
FOR THE FULL SPECTRUM OF CAREER OPPORTUNITIES... GO TO SPECTRUM-BLOG.COM – ParTnershiP, emPlOymenT, lOcum, sTudenT and GraduaTe rOles. In early 2013, we quietly launched a new website for optical professionals across Australia and New Zealand – spectrum-blog.com. Its aim? To present, in realtime, all the emerging Partnership, Locum, Student, Graduate and general Employment opportunities on offer in our new and current stores. Now, just one year later, we’re already welcoming more than 450 unique visitors each week to the site, on average. More than 1500 optical professionals have signed up to receive regular email updates on particular types of role, as and when they emerge. The big benefit? It’s easier than ever before for us to match up optical professionals just like you with the roles you may have your heart set on in one of our stores. So, if there’s a particular role, in a particular location in a particular region of Australia or New Zealand that you’re seeking, visit Spectrum to see what’s on offer and then contact one of our recruitment team members... the key individuals are all listed on the site’s ‘Contact Us’ page.
FCA Established Franchisor of the Year 2013
FCA Excellence in Marketing Award Winner 2013
Australian Retailer of the Year 2013
Australian Retail Employer of the Year 2013
spect Visit rumor sim blog.com ply typ e ‘Spe Spect csavers rum’ in to yo search engin ur e
Roy Morgan Research No. 1 for eye tests 2013
Asia-Pacific Best Retail Training Organisation 2013
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Our optical practice designs and fit-outs are predicated on modular fittings and elements which offer the advantage of shorter planning and execution times, cost-savings and price transparency. Modular elements also offer the ability for a practice to be “refreshed” simply by re-positioning fittings within a practice, or they can easily be transported and reinstalled in new premises Flexibility Customization to every demand and each budget Sales increase Shop fittings provide the best environment for sales promotion Individuality Realizing a unique shop concept that only you have Compatibility We guarantee that products can be retrofitted at any time and are available over years Cost control Matching the budget to the planning - an absolute must! Readiness Short planning time- and implementation phases!
ACO’s Visiting Optometrists Scheme extended in Vic and SA T
he Australian College of Optometry’s Visiting Optometrists Scheme contract with the federal health department has been extended to include some additional sites through to June 2014. Some of the new sites were identified by the department as areas where more services were required for Aboriginal communities. As a result the ACO applied for, and was granted additional funding.
The new sites are: Aboriginal Health Services at Kerang, Morwell and Bendigo in Victoria and at Mt Gambier and the Riverland region in South Australia. Additional sites were added to increase the focus on residential aged care clients, elderly clients and clients with diabetes. Those sites are: Boort and Birchip in central Victoria and Minyip, Jeparit, Rainbow and Edenhope in the Horsham region.
The ACO provides care of communities experiencing disadvantage through the provision of comprehensive public health eye care. ACO staff also contribute as locum optometrists in the Brien Holden Vision Institute program in the Northern Territory. Further information: Dr Genevieve Napper, lead optometrist at Aboriginal Services (03) 9349 7476 or firstname.lastname@example.org. ■
Focus Conference: Melbourne in May
Contact Contactus usat: at: email: email@example.com Email: firstname.lastname@example.org web: www.intelligentstyling.com.au Web: www.intelligentstyling.com.au Phone: 1300 550 612 Phone: +61 2 96340121 Mobile: + 0411 384 384
The Melbourne Exhibition and Convention Centre
he Melbourne Focus Conference is being held in the Victoria capital on 25 May, which provides an opportunity for delegates to explore the delights of that city in mid-Autumn.
Where to stay? Melbourne Exhibition and Convention Centre (MCEC) is located within walking
distance from a range of hotels to suit any budget. Focus Conference’s accommodation partner, Hilton Melbourne South Wharf, is ideally placed with direct access to MCEC. This modern and stylish hotel in located on the banks of the Yarra River with rooms offering city or bay views. Focus Conference delegates can take advantage
of the discounted rate of $295 for a King Room. Book directly through www.focusmelbourne.com.au
What to do? Melbourne is renowned for fine dining establishments – many of which are located within Melbourne’s CBD. Why not treat yourself on Continued on page 28 www.insightnews.com.au
University of Technology Sydney to offer Master of Orthoptics degree T
he University of Technology Sydney is to offer a Master of Orthoptics degree in the Graduate School of Health, under the leadership of Prof Shalom Benrimoj (head of school). It is doing so after the University of Sydney decided to end its postgraduate, twoyear postgraduate Master of Orthoptics degree, with student intake for 2014 skipped due largely to factors outside the control of the Discipline of Orthoptics. The factors at the University of Sydney related to a reduction in the diversity of courses offered across the Faculty of Health Sciences at Sydney, affecting some of its disciplines while retaining a focus on its large programmes such as physiotherapy, speech pathology, exercise and sports science, medical radiation sciences, and occupational therapy. The UTS course will be one of only two in Australia (the other is at La Trobe University in Melbourne where a four-year, full-time, combined Bachelor of Health Sciences and Master of Orthoptics is offered). It is likely to be conducted on the UTS Broadway campus, near Sydney’s Central Railway Station. The exact start date and appointments of academic staff are yet to be confirmed, however all going well the first students will enter the Masters course in 2015; it all depends on when accreditation is received. “UTS prides itself on a strong commitment to high-quality practice-orientate education, with links with professions and industry partners and this announcement is outstanding for our profession,” the president of Orthoptics Australia, Ms Meri Vukicevic, said. “There have been many people, behind the scenes, who have been working tirelessly to ensure that a home for the course was found and deserve immense thanks for all their efforts over the www.insightnews.com.au
Meri Vukicevic many months in the lead-up to this wonderful news, including: Australia NSW • Orthoptics Tertiary Education Working Party; • Neryla Jolly, Sue Silveira, Ann Macfarlane, Julia Kelly, Mara Giribaldi, Handan Otay and Connie Koklanis; • Associate Professor Kathryn Rose, together with her staff in the Discipline of Orthoptics at University of Sydney; • Orthoptics Australia NSW president, Michelle CourtneyHarris, and NSW State Council; • Emeritus Professor Stuart Campbell, higher education consultant; and • Many more too numerous to name. So, a new chapter begins in the history of orthoptics in Australia.” UTS was ranked in the 401st500th bracket and 17th-19th in Australia in the 2013 Academic Ranking of World Universities. It was founded in its current form in 1988, although its origins trace back to the 1870s. It is part of the Australian Technology Network of universities and has the fifth largest enrolment in Sydney. The present-day UTS originates from the Sydney Mechanics’ School of Arts (the oldest continuously running Mechanics’ Institute in Australia). In the 1870s, the SMSA formed the Workingman’s College which
UTS’ Broadway campus was later taken over by the NSW government to form, in 1878, the Sydney Technical College. In 1969, part of the Sydney Technical College became the New South Wales Institute of Technology (NSWIT). It was officially unveiled by the then NSW Premier, Mr Neville Wran. It was reconstituted as the University of Technology, Sydney (UTS), in 1988 under an Act of NSW State Parliament. UTS gained that ‘university’ status prior to the default renaming of Colleges of Advanced Education (CAEs) under the Higher Education (Amalgamation) Act
1989. In 1990, it absorbed the Kuring-gai College of Advanced Education and the Institute of Technical and Adult Teacher Education of the Sydney College of Advanced Education, under the terms of the Higher Education (Amalgamation) Act 1989. Although its antecedent institutions go back as far as 1893, they took new shapes from the 1960s, creating a new university focused on practice-oriented education with strong links to industry, the professions and the community, and with a growing research reputation and a strong commitment to internationalisation. ■ APRIL 2014
Revisit all the moments that have defined the ophthalmic professions and industry in the past 38 years!
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This issue marks a major milestone for INSIGHT – it is the 400th issue
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Over 38 years we’ve seen many changes in the ophthalmic professions and industry; ophthalmic professionals’ stars rise and fade, restructuring of the industry, clinical studies that have led to revolutionised eye-care, the struggles and triumphs of eye-care practitioners, new companies emerge as leaders, existing companies merge, established companies fold, and old technologies made redundant by new technologies.
INSIGHTâ€™S 400th Issue Online Special After a record 38 years and 400 issues, weâ€™re proud that INSIGHT is the highest circulated ophthalmic publication in Australia. To mark this milestone, INSIGHT has produced a special online 400th issue that revisits all the significant and industry changing news over the past 38 years. Take a journey down memory lane by reliving all the industry-altering moments that have defined our professions and industry and makes it what it is today by visiting the INSIGHT website to read this special online edition.
Visit www.insightnews.com.au INSIGHT statistics Published for 38 years, readers rely on INSIGHT for hard-hitting news supplying the facts that are reliable, accurate, independent and unbiased. Ophthalmic professionals respect INSIGHT because we identify the issues that need to be covered and challenge our readers through intelligent reporting and analysis.
INSIGHT is the most-read ophthalmic publication with 88% of practitioners regularly reading it.
If ophthalmic practitioners were to read only one publication, 74% would choose to read INSIGHT only.
78% of ophthalmic practitioners rely on INSIGHT to keep up-to-date with the ophthalmic professions.
85% of practitioners believe INSIGHT provides balanced and independent reporting.
Research conducted at ODMA2013 in Brisbane.
Mido attendance up 5.4%; 45,000 visitors
Entrance to the exhibition
rganizers of the Mido optical trade exhibition held in Milan, Itlay, on 1-3 March, have reported that the three-day event was visited by more than 45,000 people, 25,000 from other countries and 20,000 from Italy, an increase of 5.4 per cent over last year. The exhibition remains number one international showcase for the eyewear industry, with more exhibitors and more visitors than any other. “Many new companies chose Mido for their debut, some noteworthy names returned, there was a desire to increase business areas, and a buzz could already be felt on the eve of the exhibition,” Mr Cirillo Marcolin, president of Mido, said on 7 March.
“If we look beyond the numbers, we were particularly happy to note a feeling of enthusiasm at the stands and to see trade people ready to do business,” added Mr Giovanni Vitaloni, Mido vice-president. “That also emerged from an initial analysis of the questionnaires that were handed out to the exhibitors at the end of the show and we hope that this is an indication that a new, more positive outlook is gaining ground among the people working in the industry.” According to the organizers, the show got off to a strong start on the Saturday, with attendance remaining good on Sunday when
Bigger than Texas!
opticians from central and southern Italy, took advantage of the ‘A Train to Mido’ free transport service. The positive trend was confirmed on Monday, the closing, day, with trade people staying until closing time to see new products and sign orders. “Many new companies chose Mido for their debut, some noteworthy names returned, there was
a desire to increase business areas, and a buzz could already be felt on the eve of the exhibition. And it delivered the expected results. “We are very happy with this 2014 Mido show,” concluded Mr Marcolin. “Things went far better than expected. We look forward to seeing everybody at Mido 2015, slated for 28 February to 2 March.” ■
Continued from page 24
Theatre & Exhibitions
Saturday night or reward yourself after the conference on Sunday? The Age Good Food Guide 2014 has awarded 3 chef hats to the Flower Drum and Vue de Monde and two chefs hats to Cutler & Gross, Ezard, Grossi Florentino, MoVida, Rockpool Bar & Grill, Spice Temple and Rosetta – all within walking distance of MCEC. Remember to book early though as some will book out months in advance! And don’t forget drinks afterwards at one of Melbourne’s hard-to-find but sophisticated bars!
Melbourne’s CBD is a shopping mecca for visitors.From large department stores to edgy boutiques, you are sure to go home with your bags full. H&M opened its first Australian store at Melbourne’s historic GPO on 5 April 2014 with the new Melbourne Emporium due to open shortly after. Melbourne Emporium will boast flagship stores for some of fashion’s biggest International & Local labels including Australia’s first Uniqlo.
For 2014 Melbourne Winter Masterpieces is featuring two major international exhibitions; Italian Masterpieces from Spain’s Royal Court Museo del Prado at the National Gallery of Victoria International and Dreamworks Animation The Exhibition at Australia Centre of the Moving Image. For those who prefer performing arts, the Australia Opera is presenting “Carmen – Bizet” at the State Theatre, Art Centre Melbourne and Melbourne Theatre Company is on stage with “Ghosts by Henrik Ibsen” at Southbank Theatre. For musical theatre, “Wicked” continues its long run at The Regent Theatre while “The Rocky Horror Show” is playing at the Comedy Theatre. Make sure you don’t miss out by booking your tickets in advance through the venues. ■
Café Culture Melbourne is a coffee city. When you need a break from shopping stop in at one of Melbourne’s famous cafes. Try Pelligrini’s Espresso Bar for a traditional brew or one of the new kids on the block like Brother Baba Budan, Dukes or Little Bean Blue, among others.
Aerial shot of the exhibition
Sport If sport is more your scene Melbourne Rebels play NSW Waratahs at AAMI Park on Friday 23 May. Alternatively, experience AFL played at its traditional home, the MGC on Saturday 24 May. Grab a pie and a beer and watch Collingwood try to defeat West Coast in this twilight fixture.
Exit Strategy: Selling your practice – By Kathy Allen*
ou may have spent years working long hours, developing relationships and building your practice. But what happens when you want to sell? Planning your way out can be one of the most critical things you will do in life. The reason is simple – when the time comes to sell or retire, your practice will only be worth as much as someone is willing to pay for it. It doesn’t matter how much hard work and money goes into setting up and operating a business – if you can’t find common ground with a willing buyer, your business will be worthless. Therefore, what you do to plan your exit will go a long way towards helping you achieve the outcome you want, on your terms. We see many cases where business owners have no exit strategy at all. The general plan seems to be that bridges will be crossed when the time comes, at which point the business will be sold at a healthy EBIT multiple and everyone will walk away happy. In reality, what they often find is that at this point there is no bridge to cross and it’s too late to do anything about it. Incidentally, EBIT stands for Earnings Before Interest and Taxes. A multiple of EBIT (for example 2x, 3x, 4x etc.) is often used to measure the value of a business. Unfortunately, many business owners expect there to be certain EBIT multiple ‘standards’ within their particular industry, and that when the time to get out finally is at hand it’s a simple case of applying that multiple and making a clean break through a sale of the business. The optometric profession is no exception. Many practitioners expect that an EBIT multiple of 4-5 times is more than reasonable for the amount of work that has been put in. That view may be further enhanced when looking at the value of the net
Kathy Allen assets of the practice. In reality, a straight sale of a practice often results in a multiple closer to 2 or 2.5 times, and sometimes even less. In addition, some practitioners are finding that there are very limited buyers out there to begin with. However, the value of a practice can be significantly improved by putting a little work into developing an effective succession plan. There are a number of barriers that can get in the way of finding willing and attractive buyers. Within the practice, things like poor internal systems, a lack of documentation, having the wrong staff and other obvious weaknesses can put off prospective purchasers or reduce the price they are willing to pay. Just like selling your house or car, an important component of any succession plan is detailing – making your business look its best so that it makes a great first impression. But that still doesn’t bring buyers to your door. One of the realities of the optometric profession is that often your largest pool of potential buyers is the next generation of optometrists, and that means negotiating with the dreaded ‘Generation Y’!
We’ve all heard the clichés about Gen Y. They’re lazy, they don’t want to commit to anything, and they won’t listen and demand too much in return. In our experience, we’ve found most of these stereotypes to be untrue for young optometrists. Instead, many young practitioners are hard workers eager for an opportunity to step out into private practice. However, they are often averse to long term debt and may want more immediate returns if they are to make an investment. Ironically, despite their enthusiasm, many young optometrists are already working in practices that have no plan for succession. They are wary though of discussing a possible transition because they perceive that the current owner will want too much for the practice. In many cases, they’re right. So how can buyer and seller find common ground? That is where the science of succession planning becomes an art form. There is no onesize-fits-all approach, but there are many different options that can reduce the gradient between buyer and seller and achieve an outstanding result for both. A gradual transition is one method. That can be vendor financed, so neither side needs necessarily to go out and borrow any money. Rather than looking for a buyer who is willing to pay a lump-sum sale price, which presents a much steeper gradient to a potential purchaser, a plan is put in place for the practice to be gradually passed on, over a period of years. Payment is made through future dividends (or other share of profit). The senior optometrist is able to wind back slowly, achieving a greater work/ life balance by working fewer hours while still maintaining an interest in the practice. At the same time, the reputation of the business is better protected by
having a familiar face around to preserve relationships, educating regular customers about the changes that are coming and ensuring that everything transitions smoothly. In the eyes of a prospective buyer, that can greatly enhance the perceived value of the practice. In the meantime, the owner continues to draw both a salary and dividends which amount to far more than the original sale price would have been. There are many other benefits for both sides too. But perhaps the best part about a plan like this is that potential buyers may be working in the practice right now. No advertising is required, no long and painful searching is necessary, and both buyer and seller are spared the awkwardness of dealing with people with whom they otherwise have no relationship. A deliberate and creative succession plan can maximise your chances of finding willing buyers. It can also enhance the probability that buyer and seller achieve an outcome that is mutually satisfactory. Sadly the alternative is often that practice owners must work for much longer (and/or at longer hours) than they would like. In some cases they even end up closing their doors and walking away, abandoning decades of investment for lack of a willing buyer. It doesn’t have to be that way. Want to know more? Please contact Kathy Allen at Dewings on 08 8291 7905 or email on email@example.com ■
*Kathy Allen is a director and senior tax partner of South Australia chartered-accountancy-andconsulting firm Dewings who has worked closely with the Optical Distributors and Manufacturers Association in assisting development of independent ophthalmic practices.
Indigenous artist’s work replicated on frames; $25 donated for each sale I ndigenous artist Langaliki ‘Dolly’ Langeliki has agreed to her work being replicated on spectacle frames as a result of Specsavers and The Fred Hollows Foundation joining forces to help Close the Gap on vision loss between indigenous and nonindigenous Australians through Specsavers donating $25 for each sale of a limited-edition frame. Langaliki Langeliki, who has undergone two cataract operations thanks to the foundation, lives in Pukatja, 435km south west of Alice Springs, and paints in the dramatic style for which the Ernabella region is famous. In 2006, she had one eye successfully operated on for cataract, then the sight in her other eye began to fade. Luckily, The foundation was focusing on eye operations in remote central Australia, with week-long intensive surgical sessions. The timing was right and her other eye was operated on successfully. She can now get around on her own and, most importantly, she can get back to her painting. The limited-edition spectacle frames are inspired by her work ‘Nyinnga”, the cold time of the year. Regaining her sight has given her the confidence to leave her aged care home to spend time with her family and concentrate on her art. “I just want to get back to my painting”, she said. Aboriginal and Torres Strait Islander adults are six times more likely than other Australians to go blind, even though their children have better vision than the mainstream population. The foundation’s founding director, Gabi Hollows, has welcomed the latest project: “It’s essential that Aboriginal and Torres Strait Islander people have access to good quality eye services. Ninetyfour per cent of adult vision loss is preventable or treatable, sometimes overnight, but as more than a third of indigenous adults have never had an eye examination, many disorders go undiagnosed.
we are aiming to reach $1million this year.” An estimated 2,500 of the limited-edition frames will be sold exclusively at Specsavers stores and will retail within the ‘Two pairs for $199’ range. ■
“That’s why funding is vital. Specsavers initiatives like this help us carry out sight restoring work not just here but around the world.” Optometrist and professional services director at Specsavers, Peter Larsen said: “In our stores, every pair of glasses sold means a donation to the foundation via our Specsavers Community
Program. So we are delighted to further extend our support to the foundation via this initiative of a limited-edition frame. To date, Specsavers has raised more than $900,000 for the foundation in Australia and New Zealand, and
The painting replication is on the inside of the frame
Artist on video On a video received by the foundation that same morning, the artist said: “Hello my name is Dolly Langaliki When I’m looking at these glasses, I’m looking at my design I can see the spinifex there What they’ve done is really good and I’m happy with it This painting is about different places around here I’m happy now because they put my designs on these glasses I’m happy now When they pulled that cataract out, I can see clearly now. I can see good again Get your glasses at Specsavers and help Fred Hollows.”
Founding director Gabi Hollows with two of the Langaliki Langeliki paintings that are replicated on Specsavers’ best-selling frame style Toby Photo: Insight www.insightnews.com.au
RANZCO HOBART MEETING
RANZCO Annual Scientific Congress, Hobart – Part 3. The 45th Annual Scientific Congress of The Royal Australian College of Ophthalmologists was held in Hobart on 2-6 November. Here is Part 3 of Insight’s report on the congress by Lewis Williams, PhD.
AMD: Harvard Medical School’s perspective
Joan Miller The Novartis Breakfast featured international invited speaker Prof Joan Miller (Harvard Medical School) speaking about managing neovascular AMD. Prof Miller’s data showed that more than 90% of AMD patients avoid moderate vision loss through the use of anti-VEGF therapy and about 33% achieve 6/12 vision or better. Despite the claims and counter claims, she stated that in practice the users of Lucentis or the cheaper alternative, Avastin, eventually achieve similar visual outcomes. Her preferred use of these products is monthly. In cases that are detected early, Prof Miller suggested a ‘watch and act if necessary’ approach to ongoing care. The use of ICG (indocyanine green) dye in angiography was recommended and any sign of choroidal neovascularization (CNV) warranted routine anti-VEGF therapy. She described the ‘treat and extend’ philosophy as being “popular” without actually endorsing it enthusiastically. Her recommendation was for three-monthly injections monitored only by VA assessment unless other indications suggest www.insightnews.com.au
that closer investigation is prudent. After the first 3 months, a close assessment was recommended to guide the next step. Unfortunately, some ‘wet’ AMD cases never dry out significantly and the presence of ultrastructural intraretinal hyperreflective flecks (IRHF) are important predictors of fluorescein angiography leakage. Seen in OCT imaging, IRHFs are thought to be indicative of intraretinal cysts and/or subretinal fibrosis and are seen in diabetics as well. Prof Miller suggested that greyscale OCT imaging be used when finer gradation of features is desired as the false colour used commonly can distract the observer. While she suggested using OCT as the ultimate guide when switching from Lucentis to Eylea, Prof Miller suggested that an eight-week period with the new drug be used routinely as that has been found to be of “some use”. She urged caution when deciding on a course of action following the discovery of subtle leakage in fluorescein angiograms because the use of a laser can stimulate unpredictable inflammatory responses that might have a worse outcome than no treatment at all. In cases of choroidal neovascularization from presumed ocular histoplasmosis (POHS), Prof Miller said that while some cases respond well to a single anti-VEGF injection that has up to a 12-month beneficial effect, eventually recurrences become more frequent. Perhaps somewhat more controversially, she raised the possibility that high myopes might benefit from regular, e.g. every 6 months, injections of anti-VEGF with or without current indications especially if the patient is young. She also suggested that neuroprotection of the retina be considered in such cases. The scarring process can
also help keep sub-retinal fluid levels down or low even without antiVEGF treatment but the VA might not improve either. The older AMD treatment of photodynamic therapy (PDT) was mentioned as a possible cause of a decrease in VA due to inflammation and if it was to be considered for use, some concurrent anti-inflammatory treatment (dexamethasone was mentioned) was recommended. The irradiation time in PDT was recommended to be halved as RPE cells are sensitive to the radiation component. Prof Miller cautioned that it has become too easy to ignore the appearance of the fundus when OCT imaging is available – that is imprudent in her opinion. In pathological myopia, angiograms may be required to show leaks as OCT may prove to be not as useful. She also noted that OCT images in high myopes were more difficult to interpret. RPE layers that appear to be thick may not actually have as much subretinal fluid as first thought and because of the existence of an RPE pump, sub-retinal fluid may not need removal or may be stable and not be responsive to anti-VEGF treatment. Biomarkers for progression of any of those conditions are either unknown, not recognized, or not understood. In Prof Miller’s second lecture, a retinal update, she gave AMD risk factors as: age, cardiovascular issues, hyperopia, and smoking. Anti-VEGF therapy is used because it targets VEGF, a mediator of angiogenesis. She mentioned lipids, lipofuscin, and A2E (A2E is a retinoid by-product of the formation of retinal lipofuscin) which is interesting because there are moves away from the previous view that A2E was implicated in human
retinal degenerations because recent studies suggest that there is little A2E in the human macula, a view opposite the one long-held and its rôle as a toxic agent in AMD in also now being questioned. The studies that led to those revisions have also shown that IRHFs are probably explained by ‘stacked cells’ rather than high intracellular lipofuscin content as was first thought (see above). Prof Miller described AMD as a difficult disease to study genetically because it becomes manifest late in life and has a high prevalence. The studies into the aetiology of AMD are necessarily complex. The chromosomes 1q32 (inflammatory and immunological functions – 1q31 has also appeared in the AMD literature) and 10q26 (location of the HTRA1 gene – polymorphisms of the HTRA1 gene have been associated strongly with AMD in various studies – 10q26 also has some responsibility for extracellular matrix creation and maintenance) have been studied but to date the results have been equivocal. The all-important age factor is related, probably among other as yet undiscovered/not understood factors, to an increase in neutral lipids being deposited in Bruch’s membrane. The latter is an extracellular matrix of collagen and elastin, the quality of which is important to tissue integrity (see 10q26 above). Pathological changes in that matrix are detectable at various stages of AMD. Normally, angiogenesis is a programmed response to injury, inflammation, toxicity, and cellular stress. Numerous therapeutic strategies are under investigation, e.g. complement pathway regulation, the light cycle and A2E, inflammation control or elimination, reducing amyloid beta deposition APRIL 2014
RANZCO HOBART MEETING
in the RPE and sub-RPE layer, e.g. in drusen (which are extracellular material between Bruch’s membrane and the RPE). Lipoproteins from the photoreceptors also play a rôle in the well-being of the RPE. Tellingly, all stages of AMD also involve inflammation. An alternative approach of protecting the neural retina is also being investigated, i.e. neuroprotection. ■
Multifocal intraocular lenses
Con Moshegov The course on multifocal IOLs (MFOILs) produced some interesting information. Dr Con Moshegov (Sydney) stated that from a marketing perspective the desired state was to be ‘spectacle-free’ and that could form the basis of a presbyopia-correcting practice. In his case, word-of-mouth referrals accounted for more than 50% of his patient base and consequently, no external advertising was required. From his experience, freedom from spectacles was the goal of young and old alike (he also has a refractive surgery presence). He described monovision as not being for everyone and not something everyone likes (that goes for practitioners as well). The downsides of monovision include: decreased stereopsis, compromised distance vision, and the possibility that phorias can become decompensated permanently. He noted that monovision was an illegal mode of correction for commercial pilots and truck drivers. Dr Patrick Versace (Sydney) divided the options for presbyopia into those with or without concurrent cataract needing extraction.
Patrick Versace Those needing cataract extraction can choose monovision, MFOILs, accommodating IOL, or a corneal inlay. Those with clear crystalline lenses could choose monocular laser refractive surgery, presbyopic LASIK, or a corneal inlay. He noted that the United States FAA (Federal Aviation Administration) bans monovision unless the resumption of flying is preceded by at least a 6-month adaptation period. Given the income ramifications of such an adaptation period it is probably an option unexercised largely. On the inlay front he claims 4 years of experience with the Kamra device and he accepted that although it was not universally accepted, it was an easy-to-reverse procedure. At least two alternatives are available (Presbia’s Flexivue Microlens and ReVision Optics’ Raindrop). He admitted that corneal physiology is still an issue with inlays. Although mentioning the AkkoLens Lumina, Visiogen-AMO’s Synchrony, Lenstec Tetraflex, and B&L’s Crystalens ‘accommodating’ IOLs specifically, Dr Versace regarded none as being really successful in practice. The Lumina product is based conceptually on an Alvarez lens (1967 patent: LW Alvarez & WE Humphrey. LWA: 1911 – 1988). Other methods of correcting presbyopia, e.g. the experimental capsular bag refilling with a suitable low viscosity elastomer, are still in research where they have existed for a considerable period of time already. The liquid crystalbased PixelOptics variable-power spectacle lens technology has been applied to an intelligent, electronic IOL by ELENZA, the ELENZA Sapphire AutoFocal IOL, and this melding of technologies can be
expected to become more common in such experimental endeavours in the future. Dr Versace divided multifocal IOLs into segmented, e.g. oculentis’ lentis, asymmetric diffractive MFOIL, e.g. the Acri.Twin diffractive bifocal, and rotationally asymmetric refractive MFOIL, e.g. lentis Mplus and Mplus X. While he finds most refractive MFOILs perform similarly vision-wise, the light losses inherent with diffractive IOLs is still an issue. Apodized (an optical method of altering [smoothing] the transition from one diffractive zone to the next with a view to decreasing the extraneous light not contributing usefully to either the distance or near image, all in the interest of improved image quality [subjective and objective]) diffractive IOLs, e.g. Alcon’s AcrySof ReSTOR varies the light distribution between distance and near images depending on the lens power whereas the Zeiss refractive IOL, e.g. AT LISA/ATLISA tri/AT LISA toric apportions 65% of light to distance and 35% to near images respectively. Dr Moshegov uses diffractive IOLs which he believes are ideal for presbyopes (i.e. those not so young) who desire to be spectacle-free. He finds previously emmetropic presbyopes, hyperopes, and myopes >4 D, make the best candidates although extensive computer usage can create some difficulties. Interestingly, he stated that LASIK for presbyopia was temporary at best. The best IOLs candidates also had certain behavioural characteristics, e.g. being easy going, and if necessary, some psychometric testing might be advisable. From the surgeon’s perspective, bilateral implantation is desirable and the implantation should be as close as possible in time, as little as 30 minutes was suggested, to head off possible amblyopia issues. When ‘same’ session implantation is not possible, his suggestion was dominant eye first, second eye 1 to 2 weeks later. His approach is to attempt to keep vision outcome expectations realistic by explaining to the patient that they will never be 25 again and, despite the claims, modern medicine cannot provide ‘perfect’ vision. He balances that with the counterclaim that the outcome will be better than two pairs of glasses or
progressive power spectacle lenses (PPLs) (not everyone would agree necessarily with the latter). Despite sharing the ‘multifocal’ terminology (erroneously in the case of PPLs), he emphasized that MFIOLs were not the same as PPLs especially in light of the fact that with MFIOLs there is no head or gaze position alteration required (it would serve no purpose). Dr Moshegov described the visual outcome at distance and near with AMO’s TECNIS MFIOL as being excellent but conceded that glare and haloes were an adaptation problem to the extent that driving may be difficult for the first few nights but some perceptual/neural adaptations occur over the first 3-6 months and most find their vision very acceptable. He noted that the near point was relatively close at 35 cm. His parting advice was not to detail all the possible downsides/ disadvantages of all the options available because that tended to provide the patient with a wish list/shopping list of problems with which to confront their surgeon at a later date. While he saw computer use generally as an unresolved issue, he noted that MFIOLs were a much appreciated solution to a very common problem, albeit an under-reported one, of trying to read labels on unfamiliar hair-care products in hotel bathrooms (what he didn’t mention was the additional problem confronting older presbyopes when package designers deploy small dark coloured lettering on lighter, but similar coloured bottles and/or product so that not only is there a letter size issue but there is also a poor contrast (colour and brightness) issue between label and background).
Ilan Sebban Dr Ilan Sebban (Sydney) added to the discussion by nominating previous refractive surgery patients
RANZCO HOBART MEETING
as poorer candidates for MFIOLs although he admitted that overall, MFIOLs gave better visual outcomes than their ‘optics’ might suggest. He suggested that new patients be advised not to look directly at bright lights and traffic lights as a way to manage glare and haloes during the early adaptation phase. For the not uncommon 6/6 ‘not happy’ patients he suggested that their vision be optimized for their most important distance. He also nominated large pupils and large angle kappas (the angle between the pupillary axis and the visual axis, i.e. a decentred pupil with respect to the line of sight) as problems of which to be wary. Building on what Dr Versace had presented he noted that while Zeiss MFIOLs performance was largely pupil-independent, pupil size in Alcon MFIOLs tended to present similar brightness at distance and near but with large pupils, the near tended to be dull while the distance tended to be overly bright relatively. He did note that the Zeiss trifocal tended to be less pupil-independent and large pupils with asymmetric MFIOLs delivered a blend of distance and near zone light to the retina whereas with small pupils, the same lenses delivered little or no near at all. Dr Moshegov added that 80% of his ReSTOR cases and 90% of his TECNIS cases were spectacle-independent but he did note that if no cylindrical IOL component was included, some spectacle support may be required.
higher-order aberrations might be making to the poorer than expected visual outcome. He also recommended that ‘premium’ IOLs be evaluated for possible use in each case. He warned fellows to be wary of previous orthoptic cases, especially those who might be harbouring a subtle amblyopia although in some cases some of those problems are resolved once the second eye is implanted. He also noted that corneas with significant aberrations before IOL surgery, especially when MFIOLs are implanted, are less likely to have good vision and/or are more likely to be a 6/6 unhappy case. His overall recommendation was to consider either a Nidek OPD aberrometer or an iTrace in the surgery suite. ■
Dame Ida Mann Lecture: The macula, fovea and blood supply issues
David Chang International speaker Dr David Chang wrapped up the session with his own experiences. He recommended the Tracey Technology iTrace wavefront aberrometer be used on unhappy MFIOL patients, especially the 6/6 unhappy cases, i.e. ascertain what contribution
The Dame Ida Mann Lecture initiated by RANZCO in 1988 was delivered by Prof Jan Provis of the Australian National University (ANU) Canberra. Prof Provis spoke about the macula, the fovea, and blood supply issues in the region. According to a recent study, the retinal ganglion cell density peaks at about 35,000 per square mm but in the fovea the situation is the inverse, i.e. its peak cone density equates to the lowest ganglion cell density. Prof Provis then addressed the issue of the avascularity of the
fovea itself, an area she referred to as the foveal avascular zone or FAZ. Being avascular confers an adaptive advantage on the ‘owner’ because of the high-resolution vision it affords. If small vessels shadow fewer than 3-4 retinal cones in the general retina, no angioscotoma results but given the packing density of cones at the fovea, even vessels that small will create a scotoma (angioscotomata are demonstrated practically and very clearly in OCT imaging, for example). Following eye opening at birth, a centripetal (towards the centre) migration of cone cells has been observed along with an increase in cone numbers in the macula region that continues for the first 2 years of life. Packing is achieved by changes in cell shape. Interestingly, the FAZ is defined before the fovea forms, meaning that at no stage is the fovea vascularized. Astrocytes lead retinal capillary growth and development, but once new vessels reach the ‘wall’ of the FAZ further progress is inhibited. At least part of the process is thought to involve IOP modulation because IOP is known to depress retinal growth. If capillaries traverse the foveal area there is no foveal development. Should foveal development be modified by premature differences in foveal structure it is still not possible to predict what the final VA achievable might be. A 1kg, 28weeks premature baby is 3x more likely to have significant adverse ocular and visual outcomes. Although the FAZ has no apparent anti-angiogenic factors at least 3 anti-angiogenic genes have been identified in the FAZ – Eph-A6 and PEDF (localized in the ganglion cell layer at the developing fovea) and NPPB although members of the ephrin and semaphorin axon guidance gene families from PEDF and NPPB may be the actual factors. Although they may give guidance they also possess repellant signalling properties. PEDF expressed by the RPE is in balance with VEGF (an anti-angiogenic factor), a harmony that may have significance much later in AMD. Astrocytes are repelled by Eph-A6 from ganglion cells thereby limiting vessel progress. Eph-A6 appears initially in the optic nerve head and progresses to the fovea over time. Vessels follow
but avoid PEDF and Eph-A6 (and probably other factors as well according to Prof Provis). Eph-A6 also plays a rôle in the pattern of retinal neural connections. Prof Provis summarized by stating that the neuronal development of the fovea was secondary to its vascular changes, genes that influence the vascular adaptation in the retina also control the mapping of the retina and retinal cell projection in the brain. The photoreceptors of the macula in general and the fovea in particular develop relatively slowly (10 weeks to 2 years). ■
The ‘business’ of ophthalmology
Subha Kadappu Dr Subha Kadappu delivered a lecture on the business of ophthalmology, created originally by Dr Robert Griffits who was unable to attend. Ophthalmology was described as following an atypical business model and two key aspects were the business of ophthalmology and business in ophthalmology. Ophthalmological practice had restricted competition, the profession trained its own competitors, its members learned from each other meaning there were few or no ‘trade secrets’, patient payments were subsidized by the government yet the profession determined how its income is spent. Other characteristics include: the considerable autonomy enjoyed by the profession and mostly self-regulation but with these comes considerable privileges tempered by significant responsibilities. To take care of business, continuous observance of the responsibilities is required making the privileges hard-earned. It was
RANZCO HOBART MEETING
also pointed out that it could all be withdrawn at the stroke of a pen especially if price gouging became a problem. Dr Kadappu presented the biggest challenges as being the fact that the patient pays for the profession’s services and the ‘gap’ between what they pay and what they are reimbursed by the government and health funds. ■
Late-onset AMD had ripple-on adverse effects on patient health and they became a risk to themselves to the extent that management and support services were affected. Given their age and attitudes, many carers did not see themselves as ‘carers’ and many were unaware of their entitlements as a result. ■
AMD: Care givers’ burden and stress
Myopia and skin cancer
Bamini Gopinath An interesting presentation on the burden and stress associated with wet AMD among care givers was given by Dr Bamini Gopinath. With foci on AMD the disease, its prevention, and its treatment, relatively little research has been done on those around the AMD patient who monitor and care for them often around the clock. Caring for AMD patients is known to be stressful and decreased physical and mental health is assumed to ensue. In a study of 500 AMD patients and 500 care givers, it was found that: the carer’s average age was 70 years, more than 27% were over 80 years of age, and 93% were family members. Of those, 57% were spouses, 34% were children of the patient, and just 1% were siblings of the patient. Not surprisingly, many carers had their own problems including health issues and 11% suffered from depression. Generally, the care givers had various problems at about 3x the rate of the normal population, mostly related to their caring activities. About 55% of carers stated their rôle also impacted others as well as affecting their state of mind, 34% changed their retirement plans, and 14% had their employment affected.
Dr Maria Franchina (Perth) presented data from a study that follows logically from existing studies that have shown repeatedly that those exposed to more light outdoors had a lower incidence of myopia. In an Australian context that means that those with skin cancers might be less likely to be myopic. Almost 2000 Caucasian subjects (average age 56.3 years, 8% with a skin cancer, 53.7% male) were assessed. Those with a history of cataract or existing cataract were excluded. While a full analysis will appear later in a paper from the study, preliminary data yet again confirms the efficacy of light in myopia minimization with the incidence in cancer patients being approximately half that of skin cancer-free subjects. ■
Vision 2020: trying to eliminate avoidable blindness Dr Iain Dunlop gave a brief presentation on the Vision 2020 initiative which has been a part of IAPB and the World Health Organisation activities since
1999. Vision 2020 Australia commenced local operation in October 2000 and among the ways it tries to eliminate avoidable blindness are through earning credibility through actions, creating useful hard research data, seeking broad ophthalmic sector ‘buy-in’, and using evidence-based methods to justify its activities. Dr Dunlop noted the imminent stepping-down of Dr Barry Jones from his position of chairman of Vision 2020 Australia means that there is a need to find a suitable, high-profile replacement who would act as an effective advocate and a single consultative voice for the organization’s mission. Among other activities, Vision 2020 Australia aligns its policies with Australia’s international obligations and manages the financial authority of AusAid’s ophthalmic pursuits. Since 2008 it has spent $45 million in its endeavours to eliminate avoidable blindness, some from commitments by the previous federal government with the assistance of former Labor senator and parliamentarian Mr Bob McMullan. Current theatres of operation include: Cambodia, Timor Leste, and Vietnam. RANZCO is also active in Fiji’s Pacific Eye Institute, the Solomon Islands (with the charity Foresight), and Timor Leste. Vision 2020’s global action plan amounts to universal eye health. ■
Challenge of ophthalmic education in India The challenge of ophthalmic education in populous India was the topic tackled by Dr Prashant Garg, training director of the widely known LV Prasad Eye Institute (LVPEI) in Hyderabad, India. Anyone who has been to the LVPEI will probably be familiar with both Dr Garg and the breadth and depth of the challenges presenting routinely to its many clinics.
Dr Garg detailed the pyramidal LVPEI Good Eye Care Delivery Model with a beyond-tertiary Centre of Excellence at the peak. Lower layers of the model refine the need for further eye care progressively so that only those in need occupy the scarcer and more expensive resources higher up the pyramid. Optometrical and para-optometrical services are a part of the pyramid’s base layers. Some of the challenges faced include: ophthalmological residencies that overlap responsibilities of the numerous medical colleges and the state medical boards. An additional complication arises because health is a state responsibility (just like Australia). As well, the usual lack of funds also applies but a far greater problem exists in the sheer magnitude of the problem (India is the world’s second-most-populous country, and probably destined to be the most-populous as a result of China’s previous one-child policy). The resulting lack of time for individual care and a lack of subspecialty services were also cited as problems. Medical colleges do not have enough time for comprehensive training and education and medicine in general has problems of lack of leadership, improper attitudes, and a lack of accountability. Furthermore, the country lacks a centralised certification system which leads to a variety of skill levels and some graduates not being ready to practice. As far as the national examination boards were concerned they were unpopular, applied variable standards, and had a centralized examination system with a poor pass rate. Dr Garg’s answer to how that can be changed included: more funds, more instruments, more teachers, more time for education including train-the-trainer programmes, a re-assessment of training centres, and setting minimum levels of competence. In his view, if excellence, equity, and efficiency are to be achieved, more short training courses and clinical-examination-skills tests are required. Given the magnitude of the problem that will take time, a lot of time. ■
SOUTHERN REGIONAL CONGRESS OVERHEAD
SRC’s move to March did not affect attendance; 924 versus 972 in 2013
SRC expo area during the Saturday lunch break.
SRC 2014 expo: bird’s eye view.
he Southern Regional Congress, organised by Optometrists Association Australia (Victoria Division), was held on 1-3 March in Melbourne, the first conference and trade expo for 2014. Historically held in the winter months, the move to March did little to affect attendance figures with 924 visitors in attendance compared to 972 visitors last year (in June 2013). There were 52 exhibitors participating in the trade expo, an increase on the 49 of SRC 2013. Ms Helen Papadimitriou, SRC coordinator, told Insight: “We are happy with the final attendance numbers, particularly in what is now a flooded market in terms of obtaining CPD points. The response proves that our OAA members still value the face-to-face method of learning with their peers.” Optometrists could earn up to 53 CPD points through the education program. Sessions ran over three days, and dual streams were
SRC 2014 expo: bird’s eye view.
SRC Dinner guests: Graeme Frauenfelder and Christopher Coady.
SRC Dinner guests: Hannah Peltzer, Hannah Guyatt, Lauren Usher, Stephen Tong and Sarah Wassnig.
held concurrently on the Sunday and Monday. The education program was designed by a committee of optometrists, for what it considered were current education needs
and emerging issues. With more points available than is needed for renewal of registration, optometrists were encouraged to skip a session to spend more time in the trade expo, in addition to the frequent breaks. Several social events were again included on the program including the SRC dinner on the Saturday night with 380 delegates booked to attend. The stand-out of the evening was the surprise swing lessons for guests. Those courageous enough to hit the dance floor to learn some swing moves were rewarded with a good time, whilst those not so courageous were rewarded with a good laugh. Also on the social program again was a rural optometrists dinner on the Sunday evening providing an opportunity for rural practitioners to share their unique challenges, experiences and ideas. For attendees
The SRC Dinner attracted 380 guests.
SRC Dinner guests learning how to swing dance. www.insightnews.com.au
Device Technologies booth in SRC expo. Essilor and Nikon booths in SRC expo.
with morning energy to burn, an outdoor fitness session was held on the Sunday morning taking advantage of the warm weather. In 2015, SRC will be held again in the warmer months – on 21-23 February. ■
Attendance Delegate State/ Country ACT NSW NT QLD SA TAS VIC WA New Zealand Cambodia Kenya Singapore
Percentage % 1 16 1 6 4 1 61 2 6 1 0.5 0.5
SOUTHERN REGIONAL CONGRESS
Digital and social media: Attracting new patients and increasing loyalty – By Kate Mulcahy
Digital analyst Anthony Dever with his modified Maslow’s hierarchy of needs.
he Johnson & Johnson Vision Care symposium at the Southern Regional Congress on 1-3 March explored the world of digital media and social networks providing practitioners with practical, simple and inexpensive strategies to improve their digital presence, acquire new patients and increase patient loyalty. The keynote speaker of the ‘If you build it they will come’ session was Anthony Dever, a digital analyst with R/GA, a worldwide digital agency with an impressive client base that includes Nike, Qantas and Telstra. Mr Dever amusingly presented a refinement to ‘Maslow’s hierarchy of needs’ in which digital is placed at the bottom of the pyramid to be of greater importance than the physiological needs. He shared R/GA’s four-step methodology for maximising digital opportunities during the patient journey; some of the following tips proved to be exceptionally easy yet effective in acquiring new patients and maintaining patient loyalty. 1. Easy to connect. That involves being easy to find and easy to connect with. Google was discussed at length because 91% of all search requests in Australia are performed in Google, as opposed to around 60% in other markets. Google now utilises ‘blended search’. Blended-search results feature images, video and other results that are not strictly websites. As an optometrist example, if a 36
Audience for the ‘If you build it they will come’ session at SRC.
consumer types into Google ‘optometrists in Glenelg’ the organic results returned (the ‘real’ search results as opposed to the paid ads) the practices that have Google+ pages have an enhanced and more prominent listing. The stores in the Glenelg area come up on a Google map. When you hover the cursor over each of the stores their address, phone number, opening hours, and even a photograph of the practice are featured. This obviously makes it easier for consumers to find and connect with that practice. Whether you have a website or not, it’s important you appear in these search results, particularly if you are looking to acquire new patients. So even if you only have a Facebook page rather than a website, to get this enhanced listing in Google search results set up a Google+ account. A Google+ business page is relatively easy – and free – to set up. So what’s stopping you from setting one up right now? Get Googling! 2. Social Proof. When consumers are deciding which optometrist to select, provide social proof of why they should choose you. People have always trusted recommendations of others whether online or offline. But now in the online space, those reviews are publicly visible. Granted, very few people submit reviews, Mr Dever quoted 8% of people will give a rating (out of five) and only 2% actually engage and write a review. However, 90% of people will read those reviews and ratings.
So what does this mean for you? If you know a patient has had a great experience with you, why not ask them to submit a review of your practice? Reviews can be submitted through websites such as Yellow Pages, True Local, Google and Yelp. So make sure you also set up free accounts with them. However, be warned that writing reviews yourself is unethical and if caught out Google will not look favourably upon it and will likely result in poor search results in the future. Unlike other industries, reviews cannot be ‘incentivised’ in the ophthalmic professions. 3. Easy to connect. Make sure you are easy to connect with. At a minimum have your contact details in your Google+ and other accounts, as well as your Facebook page and website. Mr Dever also discussed online appointment bookings that provide a seamlessly integrated approach for consumers online. He made the point that online appointment booking has become a consumer expectation of businesses whether large or small: consumers figure if they can book flights or taxis online, then why can’t they book an optometrist online? Whilst these services do cost – figures quoted were $20-$70 per month – it is highly measurable. One example cited by Mr Dever was a US practice whereby 20% of new patients came through online bookings with the value of those news patients in six figures.
Panelists Alan Saks, Anthony Dever, Margaret Lam and David Stephensen. 4. Maintain connectivity. Maintaining connectivity refers to after-sale-service and patient loyalty. You can do this through your Facebook page or through regular eNewsletters. Consider content such as You Tube clips, information on research findings, eye-health tips, new products and any events you are holding. It’s about providing added value after the appointment and giving something back to your patients. Maintaining a Facebook page or producing an eNewsletter costs very little but requires your commitment, even if you only commit to one quarterly eNewsletter and do two Facebook posts each week. Mr Dever’s session was followed by a presentation by New Zealand optometrist, contact lens specialist and Insight columnist Alan Saks who discussed the opportunities technology provides in acquiring new patients, within the practice, and post-appointment to help maintain loyalty. A panel discussion then followed, led by Mr Saks with Anthony Dever and optometrists Margaret Lam and David Stephensen. At the end of the session, Johnson & Johnson Vision Care launched ‘Lenspal’, a consumer app that can also be used in-practice with patients. It contains videos on how to insert and remove lenses, tips for new wearers, and the functionality to set reminders of when to remove and replace lenses. ■
Optical dispensing facility at Randwick College opened
arch 26 saw the official opening of the new optical dispensing facilities located at Randwick College (RC), the Randwick outpost of TAFE NSW’s Sydney Institute (SI). The course, hosted previously on SI’s Ultimo campus, was featured recently in Insight (March). Forty invited guests attended the event, including representatives from academia (SI/ RC and University of NSW), the ophthalmic industry including the OpticlDistributors and Manufacturers Association, donors of resources, designers of the ‘optical dispensary’ at the heart of the facilities, and past and present students of the course. First speaker at the opening was Ms Carmel Ellis-Gulli, director of Randwick College, who detailed some of the discussions that had taken place occurred over the future direction of the course at Ultimo that led ultimately to its relocation to Randwick as an early component of the evolving health precinct developing at RC. That discussion included the possibility of discontinuing the course altogether leaving TAFE NSW’s OTEN Distance Education course as the only Certificate IV Optical dispensing offering by TAFE. As evidence of the correctness of the decision to continue and relocate, Ms Ellis-Gulli revealed that enrolments had quadrupled year-on-year and currently, the course has 25 students enrolled through normal channels and up to 45 students who are a part of a
Image on Dispensary Electronic Display
contract the college has with an ophthalmic practice chain. Ms Ellis-Gulli then introduced Mr David Riordan, institute director of the Sydney Institute conglomerate who welcomed the audience to the new Randwick facility. Mr Riordan revealed that student numbers in general are increasing, the health precinct including its affiliation with the nearby Prince of Wales Hospital is progressing, and that the optical dispensing course is a welcome addition to RC’s activities. He also noted that the proposed light rail (trams to older readers) service coming to the eastern suburbs would pass very close to RC and would be a welcome convenience for students of the college (the tram route will link Circular Quay [ferries], Central Station [trains] with RC and the PoW hospital. SI/RC estimate that approximately half a million students movements to and from the RC campus annually will be made eventually (service is scheduled to open in 2019 but issues about the proposed service are already arising) and steps are now being taken to lobby authorities for the inclusion of a pedestrian over-pass from the south side of the proposed Alison Road tram alignment to RC’s pedestrian entrance. For the safety of all concerned it is hoped that their lobbying effort will bear fruit. Mr Richard Grills, longstanding chairman of ODMA,
presented some of the history of optical-dispensing education in NSW starting with his time as principal of the Optical Dispensing Training Course run by The Guild of Dispensing Opticians which was open to those members who had their own optical dispensing practices and presumably their staff. One student of that course was David Wilson, who went on to become his successor as principal of the guild’s course and later head teacher of the courses run by TAFE NSW that eventually replaced the Guild course. Students graduating from those TAFE courses include all of the current teachers of the SI/RC and OTEN DE courses including James Gibbins, the new full-time teacher of the RC course. Dr Wilson wore several hats on the evening including visiting fellow, UNSW and research manager, Brien Holden Vision Institute’s Public Health Division. He provided further details of the more recent history of the education of dispensers, not just in NSW but the rest of Australia, New Zealand where he is still involved regularly in the OTEN DE dispensing course, and various parts of the world that choose to use the distance education aspect of the OTEN DE dispensing course. His current rôles involve creation of systems to provide eye care and optical appliances to those in need in the lesser world. His rôles in dispensing education
in NZ, conference presenter, and as a member of various Australian standards committees related to ophthalmic optics, are ongoing. The ‘grandfather’ of NSW optical dispensing and former longserving chairman of the Optical Dispensers’ Licensing Board until its disbandment as a result of deregulation, Mr John Jackson, accompanied by his wife Jeanne, was an honoured guest at the event. Small guided tours of the course’s workshop on the floor above were run until all of the facility had been shown to all who were interested. While some OTEN optical dispensing staff were present, several of the senior figures were unavailable due to teaching commitments in Perth and Brisbane. Most OTEN DE optical dispensing educators have contributed to the SI course when it was located on the Ultimo campus. Such co-operation can be expected to continue in various forms (OTEN DE is not part of the SI although both are part of TAFE NSW ). As a result of the relocation and the infusion of renewed energy and enthusiasm that a new home and new equipment brings, the new intensive (oneyear) course is off to a flying start under the management of RC and its full-time teacher Mr James Gibbins. Further details of the course: James Gibbins (02) 9469 8684 or firstname.lastname@example.org ■
RANZCO seeks reassurances from Queensland Health over contracts T he Royal Australian and New Zealand College of Ophthalmologists is “extremely concerned” about current developments in the Queensland Health specialist contract dispute. As the body responsible for the training of all ophthalmologists in Australia and New Zealand and the accreditation of the hospitals in which they train, RANZCO is particularly concerned that senior medical practitioners may leave the public health system. RANZCO president Dr Stephen Best said: “This would have a major impact on the
eye-care needs of the community, the quality of clinical services, the accreditation of hospitals as training posts and the training of future ophthalmologists. “It is not a simple process to replace specialist doctors. “Given Australia’s reputation for having one of the best training programs in the world, we do not see that overseas-trained specialists will necessarily be suitable educators. “We support the position statement by the Committee of Presidents of Medical Colleges that the Australian community is entitled to expect that medical
Stephen Best specialists will be trained to high standards of competence under appropriate supervision
to ensure the provision of high quality, safe patient care. “Queensland’s eye-care needs are particularly high for the indigenous population. Queensland ophthalmologists have a very good reputation for seeing to these needs, but without public hospital ophthalmologists and stable future training in Queensland that will inevitably decline. “We are calling for a rapid and appropriate solution from Queensland Health that will see the current standards and numbers of appropriate senior doctors maintained.” ■
SA Blue Sky Congress extended to optical dispensers and front-line staff
he Ninth South Australia Blue Sky Congress to be held in Adelaide on 6-8 November, usually for optometrists only, is being extended to include optical dispensers and front-line staff, with an additional education stream specifically for them and the accompanying trade exhibition open to all. The organiser, Optometrists Association Australia (SA Division), says it recognises that a thriving optometry practice is reliant upon the effective collaboration and coordination of expertise between optometrists, optical dispensers and all the practice team to ensure that each patient receives the continuum of care and positive purchasing
experience that will keep them coming back. OAA SA says the optometry sector is experiencing significant changes as the scope of practice of optometrists expands into therapeutics and new players enter the market and that governments across Australia are looking for optometry to step up and lighten the load for GPs and ophthalmologists so that essential eye care can be provided in a more timely and cost effective way to Australian communities. Furthermore, that those changes have resulted in a need for practitioners to be innovative in order to remain relevant and competitive and that in a thriving optometry practice now
more than ever there is a need for optometrists and optical dispensing teams to work together seamlessly. “Whilst the process of selling glasses is an integral and vital part of any successful optometry business and is primarily a retail experience, it’s important to remember that what we’re selling is unique and precious: good vision for life. Together, we should take pride in that,” the SA OAA said on 26 March. “In recognition and celebration of this unique partnership and the vital role that both parties play in the success of the optometry sector, the association is very excited about being able to provide an opportunity for optical dispensers and practice staff to
come together in a professional and social capacity at SA Blue Sky Congress 2014. “The congress will be held at the Adelaide Convention Centre. In addition to the usual two-day education programme provided for optometrists, we will also provide a separate, parallel education stream tailored for optical dispensers and their teams. “The content and speakers will be decided by a speciallyconvened optical dispensing advisory committee of a variety of experienced optical dispensers. The Blue Sky Play Time social event will be held on the evening of 7 November. Information: www.optometrists.asn.au/southaustralia. ■
Ophthalmologists warn against eye tattooing
he Royal Australian and New Zealand College of Ophthalmologists is concerned after viewing a segment during ABC News on 11 March on 38
outrageous body modifications including eye tattooing. The procedure was explained as “tattooing the sclera of the eye for artistic purposes”. Corneal
specialist Assoc Prof Mark Daniell explained the risks: “The eye is a very complex and sensitive organ and in no way should anyone consider tattooing it.” ■ www.insightnews.com.au
Italian prosecutors follow $281m fines with eye-drug-fraud probe A
fter their anti-trust-fighting colleagues levied $A281 million (€182 million) in fines on 5 March against Swiss drug manufacturers Roche and Novartis following allegations that they colluded to protect sales of their eye drug Lucentis, Italian prosecutors are now investigating possible market manipulation and fraud. Armed with evidence gathered in the anti-trust probe, the prosecutors announced on the same day that they are proceeding with their own inquiry. According to The New York Times, Italian authorities uncovered “numerous messages” between the two companies in which they discussed ways to persuade ophthalmologists and hospitals to use the expensive Lucentis, approved to treat wet age-related macular degeneration, rather than
Avastin, often used off-label for the same purpose at a small fraction of the price. Roche’s United States-based Genentech unit developed Avastin, and Novartis owns the marketing rights outside the US. Many ophthalmologists in the US and elsewhere (including Australia) choose to use the less-expensive off-label option Avastin, and the companies have fought back in a variety of ways. The Italian Competition Authority alleged in a statement on 5 March that the two companies worked together to block distribution of Avastin. Roche and Novartis said in press statements that they deny the allegations and will appeal the charges that sparked the fines. As for the subsequent legal investigation, sources say that no specific
France in midst of lengthy probe France is in the midst of a lengthy anti-trust probe into Novartis and Roche, with other countries in Europe tipped to follow. The Finance Ministry in France started looking into the AvastinLucentis pricing matter at the end of 2012 at the request of French health minister, and that investigation is still ongoing. The actions come as government-financed health systems in Europe are looking for ways they can trim their growing costs. The French health minister has talked about allowing the temporary use of unapproved drugs for “economic reasons”, while in Italy officials are looking at legislation that would allow off-label uses to save money.
Two companies deny allegations
Roche and Novartis deny there has been any market manipulation or fraud. Both companies ‘cartelised’ sales of the two drugs, the Italian Competition Authority said in a statement on its website on 5 March. According to the regulator, in 2012 their anticompetitive agreement cost Italy’s National Health Service more than €45 million in additional expenses. For that, it imposed penalties of €92 million on Novartis and €90.5 million on Roche. “The unethical tactics of Roche and Novartis to block the cheaper alternative at the expense of consumers are unacceptable,” Ms Monique Goyens, director of the European Consumers’ Organisation, said. Both Basel-based companies said they would fight the accusations. “Novartis will use its legal rights of defence according to due process and will appeal,” the company said in a statement. “We strongly deny allegations about anticompetitive practices between Novartis and Roche in Italy.” In their statements, the drug manufacturers commented about Lucentis, Roche’s $1.9 billion revenue maker, versus Avastin, a fellow anti-VEGF treatment that prevents blood-vessel growth. Lucentis “was designed to act specifically in the eye,” Roche said in a statement. “Avastin is approved for the intravenous treatment of patients with certain forms of cancer and is not manufactured or approved for use in the eye.”
executives are under investigation at present. The investigation is the latest turn in the ongoing Avastin vs Lucentis debate. Some research suggests the two treatments are equally effective, but Avastin has to be repackaged for use in the eye, and that can lead to dangerous contamination, Roche has long contended. The one issue that can’t be
debated, however, is cost: Italian regulators say a Lucentis injection there costs €900 (about $1,230) compared with €81 ($111) for Avastin. Italian regulators estimate that blocking access to Avastin for use in the eye cost the country’s health system €45 million ($62 million) in 2012 and could end up costing €600 million ($824 million) or more per year in the future. ■
Cheap overseas surgery ‘a risk’: Choice
eople considering surgery overseas should “do their homework” on a new private health fund service offering medical vetting and 12 months after-care for offshore cosmetic or dental work, consumer group Choice says. Health fund NIB plans to offer one-year ‘options packages’ covering patients who suffer a complication from medical procedures. It plans to address concerns about offshore medical practitioners and hospitals by vetting
surgeons and facilities as part of a move into the $300 million a year burgeoning Australian medical tourism market. The company says that will help consumers make informed decisions and has likened it to travel review site Tripadvisor. But Choice spokesman Tom Godfrey urged consumers to “do their homework” before taking up the new offerings. “NIB might try to vet the hospital, but when it comes to infection control there’s obviously still a risk,”
Mr Godfrey said on 25 March. “Consumers need to know that those hospitals don’t operate in the same standards as hospitals in Australia. “When you’re messing around with your health, it’s always good to be careful.” However, Mr Godfrey conceded consumers were “in a tough spot” given the high cost of medical care in Australia. “As health-care costs in Australia rise, the temptation is to look overseas to see if you can save
some money,” he said. The president of the Australian Medical Association, Dr Steve Hambleton, said the service could also end up putting more pressure on Medicare. In some cases, follow up after surgery lasts longer than 12 months –particularly for knee and hip replacements. “The decision to have surgery is a really important one and sometimes the right decision is not to have surgery at all,” Dr Hambleton said. ■ APRIL 2014
The care of parents now that their – By Mark Mattison–Shupnick and Keith M. Cross
ver wonder who’s more nervous – the child who’s getting their first pair of glasses, or the patient’s parent? It turns out that when faced with a new eyewear prescription for their child, parents often have concerns that they don’t necessarily know how to express. After all, most consumers know little about eyewear other than there are lots of styles, lenses are a mystery and they’re not sure what they should cost. To better understand the concerns of parents and how they’re being addressed by practitioners, PPG Industries commissioned a survey of 500 US adults in March 2012. The goal of the research was to learn how to better engage with today’s parents to promote a child’s vision as well as understand parent’s expectations.
Eyewear attributes – parental opinion Parents were asked to pick what
was most important to them when deciding on a lens material for their child’s eyewear. About half felt that a combination of lens attributes – clearest vision, thinness, light weight, impact resistance and UV protection – was the most important (figure 1).
Eyewear attributes – professional opinion If practitioners don’t take the time to explain to the parent about what qualities to look for in frames, lens material and lens design, in the parents’ eyes these products are just commodities. Unless practitioners take the time to talk about the difference in the lenses that come out of our practices, all lenses are equal in the parent’s eyes. But once they understand the importance of children–designed frames and the right lenses, parents are empowered to make a decision that is based on more than just price. To ensure compliance with
wearing the glasses, there has to be a balance between parental and child preferences. For example, a parent who chooses a bright red or blue frame should not be surprised when the child does not want or like to wear their glasses. It may simply be the colour. But clearly the decision should not be solely left up to the child either. It is important to engage both parties – the parent and the child – in order to help realise a visual solution that works well. Children will also be reluctant or refuse to wear their glasses if they’re experiencing distortion and/or discomfort. Lenses should be safe, clear and comfortable to wear. Safe – Safety encompasses protection from impact, scratches and ultraviolet radiation. In addition, lens finishing (beveling) requires that the lens be held firmly in a child’s frame. If the bevel gets rounded, the ability for the bevel
to hold firmly is diminished. As a result, be sure that your lab produces crisp edges for the best lens retention. Clear – Corrected vision delivered with the utmost clarity is always the goal. Lens designs and anti– reflective coatings also contribute to clearer, edge–to–edge vision. Comfortable – Comfort is a frame and lens combination. Frame bridge design must match the child’s nose bridge shape. For adjustable nose–pads, rounded and silicone pads are recommended so they don’t dig into the skin. For a saddle bridge, the nose–pads are splayed more so they better fit the flatter and wider surface area of the nose bridge, especially for smaller children. Lens comfort is also related to final lens weight, which is a function of refractive index, specific gravity, lens size (frame eye size) and lens processing thickness.
The first prescription For parents who aren’t already aware of the important role of vision correction, discuss the link between their children wearing their glasses (compliance) and the benefits that are being delivered. While education on eyewear care is a critical part of the discussion for new glasses wearers, it has to be done in a positive way in order to resonate with kids and avoid creating more pressure on parents than necessary. Focus on the benefits of wearing versus dwelling on the negatives. If you are working with a child who participates in sports, explain to the child how their glasses will help protect their vision and can improve their performance. Or if the child is more interested in books and schoolwork, explain how their glasses will help them focus and learn more on all that there is to discover in the world. New information supports
Figure 1 40
child needs glasses the concept of ‘school readiness begins at birth’. Many parents are already thinking about what they can do to give their child an advantage at birth. If improving a child’s vision is projected to help them in the classroom in the future, parents are more receptive to the discussion. A vision history of the child is a good place to start. Finding out if the child is struggling in school or finding out what they do (hobbies) and then making the connection for the parents defines what you prescribe/recommend. Children are much more accepting of glasses today, almost looking forward to wearing glasses, especially when they see other kids and celebrities with cool sunglasses or trendy looks.
Common care issues More than half of the parents surveyed said that their kids dropped, mishandled or improperly cleaned their eyeglasses or didn’t use a case (figure 2). Not keeping glasses on or getting them scratched or dirty gets in the way of good visual information. If kids can’t see well through
their glasses, they think glasses aren’t working. Not using the right case, keeping glasses in a soft case at the bottom of a backpack or no case at all will place frames out of adjustment and make wearing less comfortable. Ensure parents and kids clearly understand how to care for their eyewear.
Tips for more effective care Add a short lens care discussion as part of the examination process in–room, and then repeat it at the end of the dispensing process. Ask patients to echo back instructions, adding in humour for kids. Use a personalised care bag that includes advice, a bottle of spray cleaner, towelettes in individually sealed packets and a schedule for cleaning (for example, every morning just after brushing their teeth). Encourage children to return with eyewear periodically (for instance, every six months) to check on how well their eyewear is per forming. Is it being cared for, and if not does it need to be readjusted? Even if frames don’t need to be readjusted and the eyewear is performing well, a visit such as this may reinforce compliance with care instructions. Be sure to tell patients to come back for frame adjustments whenever needed. A well–adjusted pair of glasses also lasts longer. ■
Figure 2 www.insightnews.com.au
‘The care and feeding of parents, now that their child needs glasses’ was originally published in September, 2013 in 20/20, a publication of Jobson Medical Information LLC.
Business Briefs Luxottica and Safilo pay back $A73 million in tax; transfer pricing investigation Italian frame manufacturers Luxottica and Safilo will together pay back almost €48m ($A73 million) to the Italian Revenue Agency as a result of transfer pricing investigations. Safilo said that as a result of the tax audit for 2007, subsequently extended to 2008-2011, there was an increased charge of €21m, of which €7m was already accounted for in the financial statement of December 2012. It would be paid in 12 quarterly instalments. “The group remains firmly convinced that its conduct was appropriate. Nonetheless, Safilo has decided to accept the settlement proposal, as the key matters of the dispute are largely subjective, in as much as they imply, for instance, the evaluation of the arm’s length nature of the application of prices to foreign subsidiaries,” the company said. In its annual results, Luxottica said a determination concerning transfer pricing in 2007 involved charges of €26.7m. “The group has decided to accept the auditors’ report on their findings and pay the resulting sums for the year 2007. This decision was made knowing that the subject matter of the dispute is largely subjective and lends itself to divergent positions that are not easy to resolve in litigation, except at the cost of long and expensive defence proceedings with an inevitably uncertain outcome.,” the company said. It added that it had allocated provisions of €40m for the following years.
Luxottica reports ‘double-digit’ growth in Australia Luxottica Group has reported record sales of €7.3bn ($10bn)
for the year ended December 31 2012 with travel-retail making a strong contribution. Sales rose 7.5% at constant exchange rates compared to the previous corresponding period in 2012 and 3.2% at current exchange rates. The optical segment posted solid results in emerging markets, with comparable store sales showing double-digit growth in China, Hong Kong and Australia. Travel-retail sales reported “excellent results” increasing 25.3% at constant exchange rates compared to the same period the previous year. Sales in emerging markets increased 20% at constant exchange rates driven by excellent performance in China, Brazil and Turkey. Sales in North American rose 3.5% (in United States dollars) buoyed by the “outstanding performance” of the wholesale division which rose 6.7% (in US dollars). The company also reported “an almost surprising increase” in net sales in Europe of 11% at constant exchange rates compared to the full year 2012. The Retail Division reported net sales of €4.3bn ($5.9bn) with Sunglass Hut reporting a 11.2% increase in total net sales over 2012 results at constant exchange rates. Luxottica chief executive officer Andrea Guerra said: “We have completed another record year, achieving the best results ever for the group. These results once again exhibit our ability to successfully leverage the group’s growth engines and the opportunities available in our industry, which is still young and has huge growth potential. “We believe that 2014 will be a natural evolution of the year that has just ended. The early months are delivering positive results despite some bad weather and we believe they will set the stage for sales growth and profitability consistent with prior years. We have clearly identified our
growth roadmap and its drivers. “Our brand portfolio is increasingly strong, with RayBan continuing to be a global leader in its category and Oakley reporting excellent results in Europe and emerging markets. “We think that developed markets will continue to contribute positively to Group sales and profitability and expect even stronger growth in emerging markets, where we are continuing to invest. “Our goal is to enhance our local presence in Brazil, China, India, Mexico and Turkey. We are satisfied with the journey started and, looking ahead, we strongly believe that we have laid the foundation for building the success of tomorrow”.
Essilor: visual health, sunlenses and fastgrowing markets drove 2013 result Along with Essilor International’s announcement on 27 February that it has entered into a binding agreement to acquire all of the outstanding common stock of Canadian company Coastal Contacts for $C430 million, the company released consolidated financial results for 2013. Essilor confirmed a 1.5% revenue increase over 2012 to €5,065 million ($A.7.8 billion) The company said that in 2013, at a time of unfavorable exchange rate movements, its revenue increased by 5.4% like-for-like including bolton acquisitions, while the contribution margin rose to 18.1% of revenue, up 2.6% from year ago level. Highlights of the year included a further improvement in the company’s share of the worldwide lens market, to 37% of units, and a sharp increase in the contribution from fast-growing countries, which accounted for 21% of consolidated revenue for the year.
“In 2013, Essilor consolidated its positions after two years of strong growth,” Mr Hubert Sagnieres, Essilor’s chairman and chief executive e officer said. “The company improved every indicator and laid extensive groundwork in such futureshaping areas as visual health, the sunlens strategy and brand development, while further expanding in fast-growing countries. These initiatives have strengthened our confidence in the future and will help to drive faster organic growth in the years ahead.” Essilor noted that growth in 2013 revenue reflected a 2.1% like-for-like increase in revenue over the year, demonstrating an improvement in sales between the first half (up 1.2%) and the second (up 3.0%); a 3.3% impact from changes in scope of consolidation, led by the growing quarter-by-quarter contribution from the acquisitions strategy; a 3.9% negative currency effect attributable to the rise in the euro against most of the other billing currencies. The company said it rampedup its sunlens business by combining Essilor and FGX International’s expertise in prescription sunwear, polarisation, UV protection and distribution with the positions and brands of the companies acquired in 2013 (Polycore, Xiamen Yarui Optical/ Bolon and Suntech Optics) and early 2014 (Costa) in the midrange and performance sunlens segments. In addition, Essilor is continuing to accelerate its acquisition strategy, citing its pending acquisition of Transitions Optical for $1.8 billion, and the signature of 28 partnership agreements representing full-year revenue of €254 million. In the United States, Essilor said it has acquired a majority stake in the Arkansas-based prescription laboratory Plunkett Optical, which generates annual revenue of $3.3 million. Continued on page 43
Practice Dollars – By Karen Crouch*
Workplace bullying – what every workplace needs to know!
orkplace bullying may take many different forms. Regardless of its nature, it should be discontinued in order to protect staff self esteem and ensure healthy employee relationships – easier said than done as often it is more convenient to simply hope it will pass away or that the victim will adapt and accept the prevailing situation. As workplace bullying complaints reached unacceptable levels, in 2013 the Federal Parliament passed the Fair Work Amendment Bill 2013 (Amendment Act). This article helps explain and assists understanding of the new Fair Work Commission anti-workplace bullying jurisdiction. The Amendment Act introduced a range of changes to the Fair Work Act 2009 including a new Fair Work Commission (FWC) anti-bullying jurisdiction. From 1 January 2014 a worker who believes he/she has been bullied while at work may submit Continued from page 42
In 2014, Essilor said it is aiming for 10% to 12% revenue growth at constant exchange rates and a contribution margin of between 18.2% and 18.6% (excluding new strategic acquisitions) depending on the effective date of consolidation of Transitions Optical and final IFRS adjustment.
US Patent Office confirms Seiko Epson back-surfacelens patent; grants 6 more The United States Patent Office has terminated its re-examination of Seiko Epson’s patent 6.019.470 after confirming all of the patent’s 20 original claims,
an application to the FWC for an order to stop the bullying. The definition of ‘worker’ introduced by the Amendment Act is particularly important for employers to note as it has the same meaning as the Work, Health and Safety Act 2011 definition. Specifically, a worker is defined as an individual who performs work in any capacity, including as an employee, contractor, subcontractor, outworker, apprentice, trainee, student gaining work experience or volunteer. Also important for employers to note is that the Amendment Act has been drafted to exclude reasonable management action (e.g. disciplinary, if justified) carried out in a reasonable manner from being deemed ‘bullying’. With regards to the types of orders FWC may make, the order must be to prevent further bullying. Other than an order requiring payment of a pecuniary amount [penalty] the FWC may consider ordering individuals or groups of
and has also granted an additional six patent claims. The request to re-examine the original patent was filed by Ocuco Inc in May 2013. Seiko Epson’s patent was issued in February 2000 and covers the invention of back-surface progressive-power ophthalmic lenses. It is one of the key patents for free-form progressive lens designs and is the basis for the royalty that Seiko charges optical laboratories that produce backsurface progressive lenses. Citing deficiencies in the references submitted by Ocuco, the Patent Office examiner wrote: “The patent owner argues that the references fail to disclose or to have rendered obvious providing both a progressive refractive surface and an astigmatism
individuals to stop the specified [bullying] behaviour, reviewing an employer’s bullying policy, and provision of information, support and training. As each case and workplace will be unique, issued orders are likely to vary.
Preparing for the FWC anti-bullying jurisdiction Employers are encouraged to ensure staff responsible for managing workplace complaints and responding to employee grievances are provided with training on prevention and responding. Does your practice have comprehensive Grievance Policy and Procedures? Under the new jurisdiction, and as part of the information gathering stage, FWC can request copies of documentation regarding grievance and complaint handling procedures. Knowing such resources may be requested by the FWC, employers are urged to review their policies and procedures
surface on the same side of the lens. The examiner agrees.” The president of Seiko in America, Mr Aki Sukegawa, said: “We are grateful for the swift and decisive action taken by the USPO. This broad, fundamental patent covers both product designs and manufacturing methods for back-surface lenses to treat astigmatism. “The new claims 21 to 26 give our licensed partners additional protection to the original patent; we look forward to discussing the implications of the decision with those parties who have so far refused to engage in good faith negotiations to license the patent.” The president of Ocuco, Mr Robert Shanbaum, said: “We’re very disappointed in the outcome of the re-examination. We think that the patent examiner’s
to ensure compliance with Work Health and Safety obligations and consistency with language contained in the Amendment Act. When reviewing bullying policies and complaints-handling procedures, employers should download a copy of the Safe Work Australia November 2013 Guidelines on Preventing and Responding to Workplace Bullying from the Safe Work Australia website and consult the Anti-Bullying section of the FWC website for current information and resources. ■
Karen Crouch is managing director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal and financial management of practices. Contact Karen on M: 0433233478 email email@example.com or www. hpcgroup.com.au.
reasoning was demonstrably wrong, but in an ‘ex-parte’ reexamination, we don’t get to argue our case beyond the initial submission.”
Luxottica expects to sign $100 million licence Luxottica expects to sign a new eyewear licence worth at least $100 million in sales starting next year, according to its chief executive, Mr Andrea Guerra, “We will strengthen the licence portfolio in the next weeks or months ... the new licence that probably will come on board will start in January 2015,” Mr Guerra said. “The licence is at least 100 million dollars,” he said. ■
Contact lens launch: a result of lateral thinking of old and new technology B ausch + Lomb launched its latest daily disposable contact lens, the Biotrue ONEDay, at an event at Sydney’s Ivy Sunroom on 25 February. The innovative product is the obvious result of lateral thinking by B+L scientists who sought to combine the benefits of conventional hydrogels with the latest technology to overcome their tendency towards dehydration and the resulting pervaporation staining. Laboratory and clinical data presented at the event suggest they have succeeded. The evening was opened by Ms Wendy Ko, B+L’s senior product manager, optometry, who gave a brief overview of the product. Using the name HyperGel to describe the lens material (nesofilcon A), the material is a 78% water hydrogel (same as the cornea nominally) with a Dk/t of 42. The principal difference is the surfactants incorporated into the material that mimic the tear film’s anti-evaporative lipid layer. Their purpose is to act as a dehydration barrier with an attendant improvement in water and shape retention leading to comfort and vision improvements and a lack of pervaporation-induced corneal staining. The use of its HyperGel material in a daily disposable lens allows B+L to neatly side-step a hydrogel’s inherently lower oxygen performance. With a Dk/t of 42, the lens exceeds all published open-eye requirements. The lenses use B+L’s high definition optics and are a universal-fit series that is currently available only in minus powers (up to –9D). A plus series to +6.50 D is to follow “soon”. Ms Ko also introduced Mr Dan Spira, managing director of Valeant Pharamceuticals Australia (B+L’s new parent company) who addressed the audience briefly.
A B&L scientist in Rochester The audience was then addressed via a VOIP (voice-overinternet protocol) connection to Dr Daniel Hook, senior principal scientist at B+L’s US headquarters (2:00am his time). A set of synchronized slides to illustrate the presentation was projected locally. Continuing on B+L’s corporate theme of biomimicry, Dr Hook detailed the material and the thinking behind the product. The material is claimed to have a low Young’s Modulus (better for comfort) and a high tear strength (traditionally, high-water hydrogels have a low tear strength and an even lower initiated-tear strength, i.e. once a lens begins to fail, further failure is rapid and requires no or little additional effort). A Class II UV block is also incorporated, resistance to lipid and protein deposition is claimed, and the need for ion and water transport necessary for on-eye lens movement is met. Dr Hook noted that once traditional hydrogels, especially HEMA and N-VP-based materials, exceed the 70% water level,
issues such as durability and pervaporation become problematic. Enter EGDMA (ethyleneglycol dimethacrylate, a cross-linking agent) and NVP/TBE (n-vinyl pyrrolidone/t- butyl hydroxycyclohexyl methacrylate) that are used to form surface-active macromers (SAMs) (covered by a US Patent on which Dr Hook is listed as a co-inventor). Vinyl pyrrolidone is largely responsible for increasing the water content while TBE is deployed as a strengthening agent. Dr Hook went on to emphasize that SAMs are not a surface treatment but are a part of the lens material and are therefore, bound chemically. In a controlled-environment comparative test of various competitor products over 4 hours in a very low (<10%) relative humidity, the maximum Biotrue ONEDay dehydration was between 1.5 and 3.1%. The nearest competitor managed 5.5% at best. In real world tests of up to 16 hours lens wear, ONEDay managed a 2-2.64% loss whereas the nearest competitor managed 9.44%. Importantly, in hydrogels, significant water losses also result
in significantly-reduced oxygen availability to the wearer’s eye so such losses are undesirable.
Local clinical trials Experienced Sydney optometrist and contact lens practitioner, Mr Emmanuel Calligeros gave some of his experiences with the lens series while undertaking early field trials in his practice. He positioned the lens as the ultimate convenience (daily disposable) and a premium product using the latest technology. Like all daily disposable lenses, there is enhanced wearer safety because of the absence of a lens case and no lens-care products are required. He fitted some problem cases with success where alternatives had failed and also used them for intermittent contact lens wearers. He reported good wearer comfort with the lens. He did counsel against use of the lens series when the potential patient was simply seeking ‘the cheapest option’, when an existing patient still has lens handling issues, or in patients that have non-standard prescriptions. ■
OPSM launches TV commercial using diverse characters of Australia O PSM has launched a new brand television campaign to showcase its wide range of frames using the diverse faces, lifestyles and characters of Australia. The company’s commercial brings the breadth of OPSM’s range of frames to life through diverse individuals of Busselton, Western Australia. Shot over the course of a week, viewers go hunting ‘crays’ with free diver Marion, shopping with fashion designer Mladen, and crafting bracelets with the town jeweller John. The commercial also goes honey collecting with the local beekeeper, to dinner with the
Cohen family and to a game of rugby against the Dunsborough Dungbeetles. Everyone in shot is fitted with OPSM frames. Melissa Monneron, marketing director at Luxottica, said: “OPSM has looked after the optical needs of Australians for over 81 years, and in that time has matched faces with frames and lenses that suit their current lifestyle and personality. “The new campaign pays homage to that, because choosing frames is not just about great fit but finding a pair that suits your personality, and of course your budget. That is what we aim to do at our stores.” The 30-second commercial first aired on the Nine Network and
BCLA offering two-day packages
he British Contact Lens Association is offering delegates a number of ways to reduce their registration costs for the 38th BCLA Clinical Conference and Exhibition at the International Convention Centre, Birmingham, on 6-9 June. A new two-day value package, covering Sunday 8 June and Monday 9 June, has been designed with the busy independent practitioner in mind. It offers those who find it difficult to take a Friday and/ or Saturday out of practice the chance to enjoy two days of worldclass clinical and business education – and enjoy a saving of £50 when compared to booking the two days separately. Those who book before the early bird deadline of Friday 28 March will enjoy even greater savings on the two-day package, which includes entry to all CET sessions, the exhibition, Exhibitors’ Pavilion and Sunday night’s brand new ‘Unceremonious Event’ – a free and informal networking evening with
Channel Ten, with 15-second spots rolling out in following weeks. The campaign will also run online and in-store, including a unique digital catalogue, which delivers an interactive experience for consumers through ‘Shop Now’ links and an easy-to-use ‘Find In Store’ function.
Also integrated throughout the digital catalogue is video content featuring Busselton residents from the commercial’s spots, including free diver Marion in Oakley, fashion designer Mladen in Dolce & Gabbana, and town jeweller John in DKNY. ■
Insight closing down 1st APRIL: Insight is closing down after 38 years of publication, its editor and publisher, Neil Forbes,
drinks and a ‘Best of British’ buffet. The conference’s first-ever ‘live surgery’ event will be with Professor Sunil Shah undertaking a standard modern day phacoemulsification procedure with implantation of an intraocular lens, followed by a Lensar femtosecond laser cataract procedure with a premium lens implant. The procedures will be transmitted ‘live’ to the ICC and Professor Shah will then return to the auditorium to join in the discussion. Monday will also provide CET workshops, a specialty lens spotlight with Professor Patrick Caroline and Martin Conway, and Professor Phil Morgan’s BCLA Medal Address, ‘Changing the world with contact lenses’, which will close the conference. The BCLA’s Clinical Conference and Exhibition is the largest annual international event dedicated to contact lenses, and regularly attracts more than 1,000 delegates. Visit www.bcla.org.uk to book and/or apply. ■
announced today. Convinced? Check the date at the start of this item. ■
VIETNAM TO CAMBODIA TANDEM* BIKE RIDE 2014
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Women are infamous for their inclination toward shopping and eyewear is no exception. Not only do women shop for themselves, they frequently shop for the entire family and certainly give recommendations to both family and friends. Whereas men – while they do want to look their best – they may not want to spend too much time figuring out what their best is. In assisting men and women to select eyewear requires a slightly different approach, this month’s Insight Basics helps you to navigate the subtle differences between selling to the sexes.
Leading Ladies Rule number one
With most women, it’s fashion first. Observe your customers’ colour choices, hairstyles, clothing and accessories. Ask questions about lifestyle. Keep up with the newest in makeup, especially eye makeup. That said, fit and comfort are non-negotiable priorities.
Take advantage of the male aversion to shopping by selling multiple pairs and accessories (lens cleaners, readers, clip-ons, cases) so they can avoid coming back in the near future. Talk lifestyle. Ask questions about occupation and hobbies. Offer solutions: a polarised lens for fishing or boating and sport glasses for cycling.
The name game
Designer and lifestyle brands speak strongly to women. These names will influence how women approach your frame selection. Use your knowledge of these brands to help steer your female customers in the right direction.
Appeal to the logical side of the male customer. Explain technical features such as lightweight plastics, the flexibility of memory metals, the versatility and durability of titanium, premium lens materials, anti-reflective and anti-scratch lens coatings, photochromic technology and magnetic clip-ons, always emphasising their benefits. Men will pay for them if they understand what they are paying for.
Encourage browsing Women don’t like to be limited by a frame board of ‘women’s styles’. With the growing interest in the man-tailored look in fashion and eyewear and the fact it looks so good on so many women, your customers might find what they want in the men’s section just as they do in department stores.
Take a chance Don’t hesitate to present styles and colours that are different, even radically different from what they are currently wearing. Always show the latest trends – whether it’s a hot retro cateye or currently popular colours such as reds, blues, purples and greens. And speak frankly – women appreciate honest feedback. If a certain frame is too overwhelming or the wrong shape or colour, offer an alternative.
Age is only a number When assisting a mature demographic, NEVER describe eyewear as ‘age appropriate’. Most people don’t see themselves as old. Show options, including bold colours and daring shapes. But do note, if they are presbyopes, they will need frames with enough depth to accommodate progressive lenses.
Be the source
Outside the box Push the limits… a little. Show them a style that’s a bit bolder than they are currently wearing – perhaps a sleeker, modern version of the traditional aviator in flat metal or titanium, or a more daring color than brown or gray – blue is the colour of the moment.
Branded Put your knowledge of men’s fashion to use. Show brands that complement clothing labels. Brand loyalty can help you make the sale.
Comfort is king Eyewear designers are paying close attention to men who need larger eyewear and don’t want to sacrifice style. Larger eye sizes, extended end pieces, bowed and/or longer temples, spring hinges, unifit bridges and adjustable nose pads are options that can make for a better fit. Ask your sales reps what’s available.
The young guys
Look for niches: petites, tweens, sport glasses, larger designs – categories other practices might not have. And promote these niches, both in external and internal marketing.
Tween and teenage boys can be an overlooked category. Get connected and stay connected to this group through social media. Offer a selection of frames and brands tailored to their wants and needs so they will feel comfortable both in the store and in their eyewear.
The information age
The fashion finale
Keep women informed about cutting edge technology – the newest frame and lens materials and treatments, hinges and rimless designs. And keep them informed in the 21st century manner via your website and social media.
Never underestimate a man’s fashion sense. Once you have presented the facts about function, tell your male customers why the frame suits them – it complements their hair colour, their face structure. Men do want to look good, and genuine advice goes a long way.
‘Leading Ladies’ and ‘Masculine Reflection’ by Gloria Nicola were originally published in February 2014 and November 2013 respectively in 20/20, a publication of Jobson Medical Information LLC. APRIL 2014 www.insightnews.com.au
Google and Luxottica announce partnership for Glass device L uxottica Group and Google Inc have agreed they will join forces to design, develop and distribute a new breed of eyewear for Glass. The announcement offers a far-reaching strategic partnership between Luxottica and Google to work together across multiple efforts on the creation of innovative iconic wearable devices. Through this relationship, Luxottica and Google, who are setting the pace in their respective industries, will match up high-tech developers with fashion designers and eyewear professionals. In particular, the two corporations will establish a team of experts devoted to working on the design, development, tooling and engineering of Glass products that straddle the line between high-fashion, lifestyle and innovative technology. Luxottica added that its two major proprietary brands, RayBan and Oakley, which have a 10-year heritage in wearable technology that has evolved from MP3 to HUD devices, will be a part of the
collaboration with Glass; however details about these new products will not be disclosed until later. Mr Andrea Guerra, chief executive officer of Luxottica Group said: “We live in a world where technological innovation has dramatically changed the way in which we communicate and interact in everything that we do. More importantly, we have come to a point where we now have both a technology push and a consumer pull for wearable technology products and applications. “Seeing such a future, over the last years, Luxottica has invested heavily in building our technology platforms and digital solutions to combine with our products’ excellence. We believe that a strategic partnership with a leading player like Google is the ideal platform for developing a new way forward in our industry and answering the evolving needs of consumers on a global scale. “We believe it is high time to combine the unique expertise, deep knowledge and quality of our
company with the cutting edge technology expertise of Google and give birth to a new generation of revolutionary devices.” Google vice-president and head of Google X, Mr Astro Teller, said: “Luxottica has built an impressive history over the last 50 years designing, manufacturing and distributing some of the most successful and well-known brands in eyewear today. “We are thrilled to be partnering with them as we look to push
Glass and the broader industry forward into the emerging smart eyewear market.” The first collection generated by the partnership will combine high-end technology with avantgarde design offering the best in style, quality and performance. The forward-thinking devices will be the result of a new and unique strategic approach reflecting attention to detail, uncompromising quality and technology nurtured in the global market. ■
High-tech glasses may help surgeons ‘see’ cancer cells which glow blue
igh-tech glasses developed at Washington University School of Medicine in St Louis, USA, may help surgeons ‘see’ cancer cells, which glow blue when viewed through the eyewear. The wearable technology, so new it’s yet unnamed, was used for the first time during surgery on 10 February at Alvin J. Siteman Cancer Center at BarnesJewish Hospital and Washington University School of Medicine. Cancer cells are notoriously difficult to see, even under highpowered magnification. The glasses are designed to make it easier for surgeons to distinguish cancer cells from healthy cells, helping to ensure that no stray tumour cells www.insightnews.com.au
are left behind during surgery. “We’re in the early stages of this technology, and more development and testing will be done, but we’re certainly encouraged by the potential benefits to patients,” breast surgeon Dr Julie Margenthaler, MD, an associate professor of surgery at Washington University, who performed the operation, said. “Imagine what it would mean if the glasses eliminated the need for follow-up surgery and the associated pain, inconvenience and anxiety.” The current standard of care requires surgeons to remove the tumour and some neighboring tissue that may or may not include cancer cells. The samples
are sent to a pathology laboratory and viewed under a microscope. If cancer cells are found in neighboring tissue, a second surgery is often recommended to remove additional tissue that also is checked for the presence of cancer. The glasses could reduce the need for additional surgical procedures and subsequent stress on patients, as well as time and expense. Dr Margenthaler said about 20-25 per cent of breast cancer patients who have lumps removed require a second surgery because current technology doesn’t adequately show the extent of the disease during the first operation. “Our hope is that this new
technology will reduce or ideally eliminate the need for a second surgery,” she said. The technology, developed by a team led by Dr Samuel Achilefu, PhD, professor of radiology and biomedical engineering at Washington University, incorporates custom video technology, a head-mounted display and a targeted molecular agent that attaches to cancer cells, making them glow when viewed with the glasses. In a study published in the Journal of Biomedical Optics, researchers noted that tumors as small as 1 mm in diameter (the thickness of about 10 sheets of paper) could be detected. ■ APRIL 2014
Diary Dates 2014 APRIL 2-6 World Ophthalmology Congress (WOC) 2014 Location: Tokyo International Forum Imperial Hotel Tokyo Contact: http://www.woc2014.org
11-13 OPTRAFAIR London Location: Olympia National Hammersmith Road, Kensington, London W14 8UX Contact: www.optrafair-london. co.uk T: +44 (0)20 7385 1200
25-27 Australian Vision Convention (AVC) Location: Gold Coast Convention & Exhibition Centre Contact: www.etouches.com/ avc2014 or Ph: +61 7 3839 4411
25-29 2014 Annual Symposium & Congress of the American Society of Cataract & Refractive Surgery Location: Boston, Massachusetts Contact: http://www.ascrs.org/ future-past-ascrs-symposia-dateslocations
2014 Royal College of Ophthalmologists Annual Congress Location: International Convention Centre Birmingham, UK Contact: http://www.rcophth.ac.uk/ page.asp?section=518§ionTitle=Ann ual+Congress+2014
Retina International 2014 World Conference Location: Paris, France Contact: www.retina2014.com
21-23 XIII Ukrainian Congress of Ophthalmologist Location: Filatov Institute Odessa, Ukraine Contact: http://www.tou.orgua/en/ events/congresses/xiii-congress-ofophthalmologists-calendar
MACULAR DEGENERATION AWARENESS WEEK
4-8 ARVO 2014, Association for Research in Vision & Ophthalmology Location: Orlando, Florida, USA. Contact: www.arvo.org
8-10 12th Wenzhou International Optics Fair Location: Wenzhou, China Contact: http://www. chinaexhibition.com/ Official_Site/11-2460-WOF_2013_-_ The_11th_Wenzhou_International_ Optics_Fair.html
Ophthalmology – Hong Kong Location: Hong Kong Contact: firstname.lastname@example.org or website http://apgc-isohk-2014.org/
EVER 2014 Congress Location: Acropolis Convention Ctre Contact: http://www.ever.be/c_page. php?id=277
18-21 AAO Annual Meeting 2014 Location: McCormick Place Chicago, Illinois, United States Web site: http://www.aao.org
RANZCO EYE FOUNDATION
19 - 20
25-31 MAY Contact: 1800 111 709 or www.mdfoundation.com.au
NACBO Vision Conference 2014 Location: Coogee, Sydney Contact: www.acbo.org.au or Email: email@example.com
AUGUST 16 -17
BCLA Clinical Conference & Exhibition Location: ICC, Birmingham Contact: www.bcla.org.uk
Western Australia Vision Education (WAVE) Location: Pan Pacific, Perth Contact: +61 08 9321 2300 or Email: firstname.lastname@example.org
2014 Italian Society of Ophthalmology Annual Meeting Location: Rome, Italy Contact: www.soiweb.com
22-26 46th Annual RANZCO Scientific Congress Location: Brisbane Convention and Exhibition Centre Contact: www.ranzco2014.com.au
25-27 Vision-X Optometry Conference Location: Dubai World Trade Centre Contact: www.vision-x.ae/ optometry-conference
Association of Regulatory Boards of Optometry Inc. (ARBO) 2014 Annual Meeting Location: Philadelphia, Pennsylvania Contact: Website: www.arbo. org/2014_meet.php
ESCRS 2014 Web site: http://www.escrs.org/ Location: London, United Kingdom
International Strabismological Association Meeting Location: Kyoto International Con-ference Center, Kyoto, Japan
24-27 Manchester Royal Eye Hospital Conference Location: Manchester Conference Centre Manchester, United Kingdom Contact: www.mreh200.org.uk
25–28 112th DOG Congress of Ophthalmology Contact: http://www.dog-kongress.org
26-28 2nd Asia-Pacific Glaucoma Congress held in conjunction with the 10th International Symposium of
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Smartphone adaptor on slit lamp (Fits all sizes) • Save your photo or video during eye examination directly on to your phone • Extra software or hardware not required Usually $399 Now only
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POSITIONS VACANT Optical Dispenser/Assistant Our fully independent Optometry practice in Edgeworth, on the fringe of Newcastle and Lake Macquarie, has an exciting opportunity available for an experienced Optical Dispenser/ Assistant to join our team. Full or part time employment will beconsidered. Our patients enjoy friendly and personalised service in a relaxed atmosphere. We pride ourselves in providing fashionable and unique frames along with quality lenses.Your duties include optical dispensing and sales, as well as some administration and reception tasks. You will need a friendly, outgoing disposition and be a motivated team player. A positive attitude is essential. Trainee Dispenser
and Orthoptists are welcome to apply. Please call Andrew on 02 495 306 28 or email your CV to firstname.lastname@example.org!
Optical Dispenser Central Coast NSW Independent long established Behavioural Optometrist requires an Optical Dispenser for a full-time position. We have a modern practice selling high end products with a very loyal patient base. We are seeking a highly motivated, enthusiastic, energetic and experienced Optical Dispenser. Applicant must be a great communicator, must take initiative, be fashion conscious and well presented. The practice is easy going and prides ourselves on exceptional customer service. Please forward your resume
Practice for Sale – Airlie Beach, QLD Well established practice of 8 years in one of the most beautiful locations in the world. Enjoy a laidback lifestyle while drawing a significant wage. Consulting on average 4.5 days in a 6.5 day/week practice. Well trained, loyal staff. Astonishing local support, with clients also traveling from up to two hours away to receive excellent service and select from boutique frame range. High quality equipment, including full edging lab (optional in sale). Practice built out of love, and only on the market because of changing family situation.
Please phone 0401 693 253
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Optical Dispenser - Geelong New Vision Eyewear (under new management) is an independent, family focussed, Optometric practice located in the Geelong CBD. We are looking for a motivated, experienced Optical Dispenser to join our team on a full-time or part-time basis. Our practice is dedicated to offering quality eyewear and excellent customer service. Applicants with sporting interests, an outgoing personality and problem solving skills are encouraged to apply! Salary is negotiable dependent on experience and performance. Please contact Deborah on 0403 021 131, 5222 4042 or orders@ newvisioneyewear.com.au
Receptionist - Eastern Suburbs - Sydney Position available for a casual / part time receptionist in our practice. Previous experience in optical and computer knowledge would be an advantage . Contact Alan 02 93693115 email: firstname.lastname@example.org.
WORK WANTED Optical Assistant – Sunshine Coast Looking to get into the optical field as a part time or casual Optical Assistant on the Sunshine Coast, a couple of days a week starting June/July 2014. I’m bright and bubbly and willing to learn. Please contact Ashlee on 0424663563
HAT the retail optical scene is going through enormous change is no surprise. Until not so long ago, it was a comfortable, complacent industry, with OPSM the ‘big bad wolf’, grossly disliked by many ‘independent’ practitioners. OPSM didn’t really care because it had a great thing going with ophthalmologists, who would readily direct their patients to that firm, handing them prescriptions for glasses often in OPSM-addressed envelopes. Both parties enjoyed their solid and beneficial relationship for decades. OPSM knew where its bread was buttered and didn’t do anything to upset ophthalmologists, such as try to pinch their patients. Ophthalmologists were happy that they had ‘friendly’ dispensers to make up their prescriptions without fear of patient loss. By the early 1980s (post Medibank admitting optometrists to the universal health scheme), OPSM realised that optometry had made great inroads into the eye examination business, with the share of primary care reversing from 70 per cent to ophthalmologists (due to a biased anti-optometry, proophthalmology federal government policy for years) and 30 per cent to optometrists. It had become 70 per cent to optometrists and 30 per cent to ophthalmologists. So OPSM decided it had no alternative than to follow the source of prescriptions and began to quietly take on employee optometrists and to invest in optometrical practices.
By then, new ophthalmologists had been easing their way out of refraction-type consultations in the interests of doing more sophisticated work, so there was not much resentment of the OPSM change in direction; well not too much, although there was increasing concern when the company started to buy up the bigger practices, such as Gibb & Beeman in New South Wales, Coles & Garrard in Victoria and Laubman & Pank mainly in South Australia, Queensland and Western Australia. That all changed when Italy’s Luxottica bought out OPSM, ending a 60-plus-years reign as the biggest Australian-owned retail group. But the biggest change was yet to come – the entry of British firm Specsavers, which has become the biggest retail group in Australia with approaching 40 per cent of the market. And it’s confident of reaching 50 per cent market share by 2020, as it’s just done in the United Kingdom.
The estimate for ‘other’ industries is little changed. ‘Other’ includes wholesale and retail trade, financial services and communications. So where are the million jobs promised pre-election by Prime Minister Tony Abbott going to come from?
FFICIAL figures released on 27 February show investment slid 5.2 per cent in the last three months of last year – the most since the global financial crisis. And the plans for 2014-15 are even worse. The estimate financial offices reported to the Bureau of Statistics is 17 per cent down on the estimate for 2013-14 reported a year ago. The estimate for mining investment is down 25 per cent, and for manufacturing investment is down 20 per cent.
HAT a laugh the federal parliament has become, for some time literally running out of legislation to consider. What, exactly do the MPs do during the enforced hiatus? Play cards, lawn bowls or golf? Go to the members’ bar? Go home? Exactly what? Is it that the nation is in such good shape that there is no need for any change? Or is it that the government simply doesn’t sufficient policies in its backpack that it can’t come up with a day’s decent program of legislation? Who knows – or cares? Not the government, it would seem.
LREADY we’ve had a federal government assistant minister step aside until allegations against him are investigated by the New South Wales Independent Commission Against Corruption – just over six months since the September 2013 election. That’s not too bad, given that nine ministers in the previous [Howard] conservative government were forced to resign over its 11year lifetime. In fact it’s about on course to match that performance.
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30th anniversar y for Medicare
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A call for Medicare benefits for cataract surgery to be cut has tuned out to be a furphy.
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erhaps it’s a fortunate move by Senator Sinodinos because the drastic changes to regulations (note regulations as against legislation) covering financial advisers, whose drafting he has presided over, leave much to be desired. For example, the proposed changes will allow financial advisers to provide advice that’s in their own best interest, rather than their client’s. Given the behavior of so many in the financial game, that doesn’t look good except for the financial advisers. There are all sorts of laws and codes of conduct that insist practitioners of all manner of callings – take ophthalmologists and optometrists as an example – must act in the best interest of their clients/patients, with penalties ranging up to substantial fines and/ or deregistration (a.ka. being struck off ) for those who breach that requirement. So where is the benefit to the overall community in letting so-called financial experts do whatever they like when it comes to providing advice to their clienteles? Why should they be able to do whatever they like? Just because Arthur Sinodinos thinks it’s OK, as do his mates?
AST year, Apple reported pre-tax earnings in Australia of a mere $88.5 million on estimated income of $4 billion. How come? Its sales were transferred from Australia to Ireland where no tax is payable because it is managed and controlled in California. And it pays almost no tax in the US either because US law is based on where a company is legally registered. So while Australia gets itself in a rage over the fate of fruit packer SPC Ardmona and others, Apple International pays much much less than 50c tax for every $1,000 of income. In Australia, the company reported sales of $20 billion over the past four years. It’s all legally OK, but if it paid the proper amount due (the same as we all should), then farewell to a good whack of the need to raise other taxes or reduce services. Simple, n’est ce pas?
HERE’S always a way to make a fast buck, the latest being to steal medical practitioners’ prescription pads and write prescription for all sorts of drugs, including those on Schedule 8. An 80mg oxycodone semi-synthetic opioids tablet — considered the ‘standard unit of
currency’ on the black market — could fetch $5 to $20. Although prescription pads have the potential to net a thief prescription drugs worth thousands of dollars on the black market, offers for them seem to be low – about $50 to $100. Fortunately, almost every offer is knocked back.
OT so long ago, any suggestion of an ophthalmologist (or any other medical practitioner) doing a bit of self-promotion was absolutely forbidden, with substantial penalties for those who broke the rules. Now it seems to be an almost daily occurrence, with laser surgery for correction of refractive error the most common topic – have we got a deal for you! All up, it must be pouring heaps into everyawning media coffers. Ah, but it leads to people with problems seeking life-style improvements, which is beneficial, goes the argument. Yes, every chance. But it also brings in plenty of lolly for the Bright-Light Brigade.
ANTAS seems to be well on the way to oblivion, with the federal government at last saying ‘no’ to the airline’s request for all sorts of aid. There’s increasing demand for the heads of the CEO, Alan Joyce, and the chairman, Leigh Clifford. But the rest of the board have also presided over the series of debacles and they should all go too. Who to replace them? Baggage-handlers perhaps? Cleaners? Tea ladies? They couldn’t be any worse than the incumbents.
ELIGHTED to report that Australia’s richest women, the delectable (only kidding) Gina Rinehart, has now come a huge cropper in her bids to force journalist to reveal their sources. In the latest slap in the face, she has been ordered to pay legal costs of a journalist, Adele Ferguson, and The Sydney Morning Herald after she had tried to subpoena the journalist to produce recordings, texts, notes and emails. That’s the second time she (or rather her private company Hancock Prospecting) has been done over in the courts. Next on the agenda is the soap opera between her and some of her offspring.
HE Optometry Board of Australia’s decision to grant to optometrists who have completed one of the various therapeutic drugs courses the right to use the title ‘Ophthalmic Medicines Prescriber’, well-intentioned as it may have been, seems an unfortunate choice of words. Doesn’t it smack of inferring the user of that title is a medical practitioner, particularly the use of ‘ophthalmic’ (i.e. pertaining to the eye), as well as ‘medicines’ and ‘prescriber’? Is that what the OBA had in mind when deciding to hand out the right to use the term? If it was, then all it most likely does is confuse the issue of who diagnoses and treats what. Hardly in the best interests of the community, n’est pas?
S the federal budget’s May release-date draws nearer, I wonder how Optometrists Association Australia’s lobbying for removal of the cap on Medicare consultation fees is going in what Treasurer Joe Hockey insists are tough economic times. Given that health minister Peter Dutton seems incapable of little else than running up the flagpole possible changes to health policy to see what sort of reaction there is, as well as muttering about “fixing Labor’s mess” whenever he is asked a question during Question Time, there doesn’t seem much hope in regard to health spending for a long time to come. Perhaps all of the OAA lobbying is a waste of time, effort and money.
S Anzac Day approaches, I’m reminded of my one and only contact with the man who is now prime minister, Tony Abbott. At the time he was, from memory, health minister and was representing the then PM, ‘Honest John’ Howard, at the Anzac Day evening service. After the service at the Sydney Cenotaph, as he was about to enter his limo, which was parked on a pedestrians-only footpath in Barrack Street, I commented that he was setting a poor example by having his chauffeur park in such a spot, however he pretended not to hear me and jumped in and fled away. Not a good look.
Published on May 29, 2014