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Take a journey down memory lane by reliving all of the professions and industry altering moments that have defined them and makes them what they are today, by visiting the INSIGHT website to read this special online edition.
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Revisit all the moments that have defined the ophthalmic professions and industry in the past 38 years! UE ISS
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.
After a record 38 years and 400 issues, we’re proud that INSIGHT is the highest circulated ophthalmic publication in Australia.
AUST RAL IA’S
This issue marks a major milestone for INSIGHT – it is the 400th issue
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OBA’s ‘standing’ claim thrown out by Supreme Court of Queensland ■■ ‘Litigation delays affecting patient safety’, say ASO and RANZCO presidents
he claim by the Optometry Board of Australia that the Australian Society of Ophthalmologists and The Royal Australian and New Zealand College of Ophthalmologists did not have legal standing in regard to the diagnosis and treatment of glaucoma has been thrown out by the Supreme Court of Queensland, with costs awarded against the OBA by Justice James Douglas on 19 December. The matter was heard by Justice Douglas on 30 August 2013. At issue was the standing of ASO and RANZCO to challenge changes to the role and responsibilities of optometrists, initiated by the OBA early last year. ASO and RANZCO lodged a court challenge when the Australian Health Practitioner Regulation Agency (AHPRA) and the OBA would not resile from extending the scope of practice allowing optometrists to diagnose and treat glaucoma without oversight by ophthalmologists, as had been the case for about ten years. “A legal victory for ophthalmologists in the Supreme Court of Queensland today has regrettably not alleviated concerns about patient safety,” RANZCO commented after Justice Douglas’ decision was handed down. “This [decision of the OBA and AHPRA] overturned traditional medical practice in which ophthalmologists have overseen patient diagnosis and treatment for glaucoma.
“The concern is that optometrists have been approved to assess medical conditions that are beyond their learning and experience. “By contrast, ophthalmologists study for seven years to become doctors and then spend another five years to become
■■ ‘[Both bodies] have no special interest… beyond that of any other member of the public’, says OBA A spokesperson for the Optometry Board of Australia said the board acknowledges the Supreme Court of Queensland’s ruling in favour of ASO and RANZCO on the question of their standing to challenge changes to the role and responsibilities of optometrists under the board’s
OBA’s response A spokesperson for the Optometry Board of Australia said the board acknowledges last month’s Supreme Court of Queensland ruling in favour of ASO and RANZCO on the question of their standing to challenge changes to the role and responsibilities of optometrists under the board’s revised Guidelines for use of scheduled medicines which were released in March 2013. The board will defend its position when the ASO and RANZCO legal challenge is next before the courts and will make no further comment in the interim, the spokesperson said.
medical eye specialists. An ophthalmologist would acquire 12,000 hours of clinical training in treating eye disease before being authorised to responsibly initiate treatment for patients.” Justice Douglas’ ruling has been welcomed by ASO president, Dr Arthur Karagiannis and RANZCO president, Dr Stephen Best, however, both stressed their concern at the delay occasioned by the OBA challenging standing. Sadly, they said, a court hearing date cannot now be secured until May or June this year “with thousands of Australians potentially at risk of defective diagnosis in the interim”.
revised Guidelines for use of scheduled medicines which were released in March 2013. The board will defend its position when the ASO and RANZCO legal challenge is next before the courts and will make no further comment in the interim, the spokesperson said. The ASO and RANZCO initiative is fully supported by the Australian Medical Association, which has described the optometrists’ move as out of step with expert opinion on best patient care for those suffering glaucoma which is a serious eye disease affecting 300,000 Australians. The Medical Board, of Australia
though, has taken no legal action to challenge the original decision. The ASO-RANZCO legal challenge sought a return to the collaborative co-management regime of treating glaucoma that was in place before OBA amended the optometrical scope of practice. The applicants argued that that it is generally inappropriate to dismiss judicial review proceedings on the ground of standing, Justice Douglas said. Furthermore, the focus of the applicants’ concerns was on the standards of professional care to be applied to patients rather than their individual members’ financial interests. In his view, Justice Douglas said, in this case it would have been preferable to deal with the [standing] issue at trial. The Optometry Board of Australia’s case was that OSA and RANZCO have no special interest in the matter of glaucoma diagnosis and treatment beyond that of any other member of the public and that their position as professional bodies of ophthalmologists does not provide that standing. Justice Douglas, in his judgment, said his conclusion was that the applicants [ASO and RANZCO] have shown that they have standing to bring the application, with the result that the respondent’s [OBA’s] application should be dismissed. Continued on page 6
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Justice Douglas said that in determining standing, regard must be had to the public interest in the observance by statutory authorities of the limitations upon their activities which the legislature has imposed. The code of conduct of RANZCO requires its 788 members to treat the interests of their patients as paramount and RANZCO requires its members to enter an oath in which they must swear or affirm that patients are their first concern, Justice Douglas said. Ophthalmology is the specialty of medicine concerned with the diagnosis and management of disorders of the eye and visual systems and the diagnosis and treatment of glaucoma is within the specialty of ophthalmology, he said. Furthermore, the guidelines approved by the board and ministerial approval permit optometrists to treat glaucoma patients in circumstances without the supervision of the members of ASO to ensure that treatment is in the best interests of those patients. Also, RANZCO is responsible for determining standards of care by its members in the practice of ophthalmology, however the combined effects of the guidelines and ministerial approval is that it permits optometrists to treat glaucoma in circumstances where that treatment is not subject to the standards of RANZCO. And Justice Douglas pointed out that no individual ophthalmologist elected to be an applicant in the court proceedings, i.e. the focus of the applicants’ concerns was on the standards of professional care to be applied to patients rather than to individual members’ financial interests. Justice Douglas said the OBA’s “abandonment of the shared care arrangement” between ophthalmologists and optometrists in issuing the guidelines deprive RANZCO its capacity to determine the standards of care of the patients
concerned and, accordingly, gives it a special interest in challenging. Counsel for OBA and RANZCO had said that what they brought to the subject matter of the litigation was informed concern that went beyond that of general members of the public, with each organisation having a special interest in patient safety in that area of ophthalmology greater than that of a member of the general public, Justice Douglas said. However, counsel for the OBA maintained that responsibility for determination of standards of treatment by optometrists now rests with the Medical Board and there was no need for a role to be accorded to OBA and RANZCO to challenge the legality of the instruments. In his conclusion and orders, Justice Douglas said the evidence established to his satisfaction that the OBA’s and RANZCO’s roles in setting and advocating standards of patient care for the treatment of glaucoma by ophthalmologists over many years gave them standing to challenge the validity if instruments which, although directed to the conduct of optometrists, have the effect of removing ophthalmologists from their previous role in the process. Also, that the applicants have an interest in the treatment of glaucoma which may be nonmaterial but which is very different indeed from that of a diverse group of ordinary Australians associated by some common opinion on a matter of social policy which might equally concern any other Australian. “Their functions as organisations, historical roles in the regulation and advocacy for standards of patient care and the specialised knowledge derived from their membership set them quite apart from other members of the public,” Justice Douglas said. “In my view, their standing is clear and certainly not so obviously untenable that their application should be dismissed at this stage.” ■
Saks on Eyes Alan P Saks MCOptom [UK] Dip.Optom [SA] FCLS [NZ] FAAO [USA]
Success? What makes for a successful practitioner? It’s a good question and one that has many facets. We can, among other things, measure success in terms or patient outcomes, economic returns or personal satisfaction. Ideally these multiple facets will be interrelated and one will enhance the other but not always. To my mind, having observed many successful practitioners, over many years, the keys to success seem to be related to personality e.g. confidence, (which to some degree comes with competence), empathy and manner. They say that the first three minutes when dealing with a patient are critical to establishing a relationship. My observation of practitioners, my own experience on the receiving end of medical care and that gleaned from patient feedback, confirms this.
EHRs? Although it has many positives, the advent of electronic health records (EHRs) is probably one of the worst things to happen to patient-practitioner interaction. An optometrist or GP (or whoever), sitting with their back to a patient typing data into the system has got to be the worst development in healthcare in recent times. I’ve been on the receiving end of such backward behaviour from two GPs over the past fifteen years. It didn’t impress me and my confidence in them is thus not great. Optometrists guilty of such behaviour are missing out on eye contact, observation of things like pterygia, xanthelasma, arcus, strabismus, red eye, anisocoria,
tics, body language and so much more. Quite often - simply while doing an initial case history – I have already made a mental note of things to investigate further. I’ve often made a tentative diagnosis just from observing, even before the patient history or detailed examination gives me further clues. For instance an atopic eye rubber, squinting to see, tells me we may have a cone on our hands. The history of ghost vision, failed RGPs and so on tells me more. All this before I find 420 micron corneas or blatant topographic signs. So, as per the aforementioned examples and many others, we have used simple human interaction to make a lot of deductions. Sitting typing into a computer with your back to a patient is in my view an absolute no-no.
Note to Self. I generally take written notes that are scanned and linked to the patient’s electronic record and I type pertinent data directly into the EHR. My notes are usually quite extensive and include a lot of the normal things like history, meds, symptoms, refractive and oculomotor findings, internal and external exam and so forth. I also add comments or notes or indicators relating to poor endpoints, visual quality, observations about blinking and Rx variability etc. Electronic records don’t allow for one to record variable ‘bracketed’ refractive findings or nuances such as ghost vision, polyopia and so on. I often revert to my scanned records when problem solving or for reviews. I also make drawings on my written records, location of lid abnormalities, records of trial contact lenses used, NaFl fitting patterns and more. In my view there is still nothing that beats written records as a supplement to hard data entered into a practice management system. Some people are adopting iPads and tablets to input data and drawings, while maintaining
eye contact for some of the time. No doubt in time this will evolve. For now I find it slow, clunky and limiting? Others I know employ a scribe to enter data and make notes. Although this sounds ideal it is also limited to some degree and many will find the cost prohibitive. It also means that one is constantly calling out findings and thus communicating with the scribe as opposed to the fee-paying patient who wants your attention. Potentially voice recognition could also be used but is alas still too limiting. All said, one needs to do what one is comfortable with but also consider what meets professional and ethical standards of ‘best practice’. The upside of EHRs is that they provide a snapshot of relevant findings that are easily shared with other providers and in time will be accessible by all care-givers (within the limits of privacy).
The Powers that Be… Bureaucracy is in my opinion a hindrance to ideal care. There’s just too much red tape: Too many obstructive rules and regulations that detract from doing the best we can. Medicare creates quite a bit of frustration, from what I can tell. In some countries like the USA medical insurers and the like are exerting ever more control on patient care and provision of services, billing, coding and the like. Too many specialist practitioners complain that they are being investigated or questioned because they do ‘too many’ specific procedures when compared to the ‘average’. I could go on forever but I am sure most or you have experienced the frustrations that such ‘well intentioned’ but out of control bureaucracy creates. It is of course unfortunately getting a lot worse in Australia and with time will create ever more frustration. It seems to affect us with everything we do – from registration, to CPD, to practice, employment, taxation,
insurance, Medicare, record keeping, privacy and much more.
Happiness Stan. Nothing says more than a happy, enthusiastic patient with a great outcome. Such patients are our best ambassadors and the best, most successful and least expensive form of marketing we can do. As I always say, a happy patient will over time drive dozens or new patients into your practice while an unhappy one will likewise go out of their way to tell everyone to stay the hell away! A good outcome can simply be a great cosmetic outcome from using a hi-index lens, a fantastic frame or pair of trendy sunnies. On the other hand we may have succeeded in fitting a frustrated keratoconic where others have failed, or solved ‘learning problems’ in a child. There are many ways we can excel and provide wonderful solutions. It costs a whole lot more to gain a new patient through marketing than it does to make existing ones happy and gain resultant referrals. As I’ve mentioned in previous columns, it amazes me that some practitioners’ egos get in the way of common sense: when a nocharge remake or a credit would sort things out they argue in front or others in the waiting room or get so heavy handed that it ends in a professional complaint against them. For the sake of a hundred dollars it ends up costing thousands in terms of wasted time and legal fees, never mind a black mark against your name. There is much more to discuss as far as success and its measures are concerned and indeed ways to enhance patient outcomes and satisfaction. Space however precludes getting into more in this column but I will continue to weave such concepts into future editions. For now do your best; do unto others as you would be done by and here’s to a great 2014. ■
Optometrist appointed chair of Notre Dame’s Medical School Advisory Board
ydney optometrist Mr Paul Sheehan has been appointed chairman of the Medical School Advisory Board at Notre Dame University in Sydney, a first for an optometrist. Mr Sheehan is the first optometrist in Australia to be appointed to such a position. He has held a variety of positions since graduating in optometry from the University of New South Wales in 1989, including heading up NIB Eyecare in Newcastle, being a co-founder and director of Union Optical in Melbourne, and a co-founder and director of Mylens Optical, an online optical business selling contact lenses, prescription glasses and sunglasses based in Artarmon, Sydney. Through his contacts within the union movement and government, Mr Sheehan played the major role in preventing Medicare benefits for optometrical consultations being dropped by the Keating government in 1993, a role that has never been acknowledged by Optometrists Association Australia, which has claimed the honour of doing so. He was a member of the New South Wales Board of Optometrical Registration in 1987-90. Currently he is a director of Metro Dental in Melbourne (from January 2011) and a director of Mylens Optical, based in Artarmon, Sydney, which is an online optical business selling contact lenses, prescription glasses and sunglasses. He has been a director of Smart Eyes Melbourne
what you would expect in a small package
Paul Sheehan and Charlestown since January 2006 and a director of Yangoda Pty Ltd for 22 years. Yangoda is an ancillary health advisory company which established medical, optical and dental services primarily for health-insurance funds and universities around Australia. His consultancy work has included AHM, HCF, NIB, Teachers Health, Peoplecare and Rt Health Funds over 29 years. He was managing director of Optifashion Australia Pty Ltd (August 2007-November 2009). Optifashion Australia was the company through which Safilo SpA of Italy established 68 retail stores in Australia.
Headed off ‘Mediscare’ Through his contacts within the union movement and government, Paul Sheehan played the major role in preventing Medicare benefits for optometrical consultations being dropped by the
Keating government in 1993, a role that has never been acknowledged by Optometrists Association Australia, which has itself claimed (wrongly) the honour of doing so. Although OAA had launched a strong lobbying program involving its members, it was having difficulty in gaining traction with the federal government. Mr Sheehan was asked to see if he could assist by putting optometry’s case to the union movement and in turn to the government. He agreed to do so, taking optometry’s case to the then secretary of the ACTU, Mr Martin Ferguson, who in turn went on television to state plainly that removal of the Medicare benefits for optometrical consultations would damage the universal health scheme and was, therefore, unacceptable to the union movement. The government soon announced it would not remove the benefits for optometrical consultations. ■
TWO WINS FOR FRAME MANUFACTURER
Three-year jail sentences for frame counterfeiting in China T wo men in China have each been sentenced to jail terms of three years after being found guilty of manufacturing 20,272 counterfeit frames bearing the ‘Silhouette’ registered trademark and ‘Made in Australia’. Each of them has also been fined RMB60,000 ($A11,100), with one of them to also be under fouryear probation. All of the 20,272 frames (which cost RMB121,632 ($A22,500) have been confiscated.
The case was brought against the two by Silhouette International Schmied AG, of Austria. The Wenzhou Ouhai People’s Court on 12 November ruled the following: 1. The two defendants used a mark identical to a registered trade mark without the authorisation of its owner on the same commodity; their conducts constituted the especially serious situation in the crime of counterfeiting a
registered trade mark; 2. The defendant Wu Huajin committed the crime of counterfeiting a registered trade mark and is sentenced to 3-year imprisonment with a fine of RMB60,000 (no probation); 3. The defendant Wu Huafei committed the crime of counterfeiting a registered trade mark and is sentenced to 3-years imprisonment with a 4-year probation and a fine of RMB60,000;
4. All of the seized 20,272 pairs of counterfeit frames are confiscated. In another case brought by Silhouette International Schmied AG, on 8 November the company was awarded $US166,000 costs after an appeal was lost by Universal Vision Biotechnology Co Ltd and the manager of that company, Mr Wang Chong Hua, heard by the Fifth Tribunal of the Supreme Court in Taiwan. ■
Evidence-based optometry conference in Adelaide in April
n ‘Evidence-Based Optometry Conference’, convened by Optometry and Vision Science at the School of Medicine, Flinders University, will be held at the Intercontinental Hotel in
Adelaide on 7-8 April. Speakers include Isabelle Jalbert, Laura Downie, Rod Baker, Brad Kirkwood and Konrad Pesudovs, who will explore the latest clinical optometry research
‘therapeutics’. Information and enrolments: Nicola Robinson at firstname.lastname@example.org or Deb Sullivan deb.k.sullivan@flinders. edu.au. ■
Store Manager Dispenser Melbourne CBD
Optometry Partnership Melbourne CBD
To passionately provide great eyewear and eyecare is a key to our company’s success. We go out of our way to be the best in our industry and create a unique customer experience which makes our consumers feel great. eyeclarity has won a number of major Australian awards for this. We are extending our brand to a premium Melbourne CBD shopping location and our new innovative optical retail concept,(a world first) which will inspire our consumers and set a new bench mark within the industry. You Are; • A current Store Manager or experienced Second in Charge, you have experience leading a team and understand the demands of what running a retail store represents, from developing people performance, overseeing sales targets and merchandising. Collaboration, resilience and strategic thinking are essential. Use your open communication skills to understand, engage and deliver a company vision in your store. • You love retail and passionate about eyewear, fashion and giving great customer service.
To passionately create great eyewear and eyecare is a key to our company’s success. We go out of our way to be the best in our industry and create a unique customer experience which makes oubr consumers feel great. eyeclarity has won a number of major Asutralian Awards for this. We are extending our brand to a premium Melbourne CBD shopping location and our new innovative optical retail concept,(will be a world first) which will inspire our consumers and set a new bench mark within the industry. You Are; • An experienced Optometrist who wants more from Optometry. You want to be the best and be a commercial success, love people and get involved in developing a new store. You understands the demands and challenges working in a dynamic environment, able to develop and lead a team, want to deliver premium eyecare and have excellent communication skills to understand, engage and deliver a company vision, provide premium eyecare as a partnership. We can offer you the following; In return for your hard work and dedication you will be a partner in a premium eyecare practice • Competitive salary • Partnership benefits of building an asset • Work with a supportive team • Have access to great business resources and support • Secure your future Career and personal development • Great working environment and people • The chance to be part of a culture based on great working relationships • Great prospects for growth Make your mark, don’t miss this great & unique opportunity apply now. email@example.com
We can offer you the following; In return for your hard work and dedication you will be entitled to fantastic benefits including: • Competitive salary • Great incentives for high achievers • Career and personal development planning • Great working environment and people • The chance to be part of a culture based on great working relationships • Great prospects for growth Make your mark, don’t miss this great & unique opportunity apply now. firstname.lastname@example.org
and the ways to evaluate and incorporate research outcomes into an optometry practice. Attendance for the two days of the conference will attract 36 CPD points (9 CPD points for
Editorial Nothing like the truth
he ‘Publication Whose Name We Do Not Utter’ claims on its website and in promotional material that it “is only distributed to medically qualified eye care professionals in Australia and New Zealand”, surely one of the most untruthful claims ever published in a publication purportedly aimed at the ophthalmic professions and industry. No matter who dreamt it up, responsibility for that claim lines squarely with the two publishers of the publication at issue. Don’t they know what they’re talking about? Or is it a deliberate and definite falsehood designed to somehow give the publication kudos it doesn’t deserve? Or is it nothing more than a simple mistake? Perhaps it’s one of the first two possibilities; perhaps not. But the third one is simply not tenable because not only has the claim been published prominently on the website of that publication for an indeterminate length of time, but also in promotional material provided to no less a fine body than Vision Australia, which is where it became known to Insight in the lead-up to a forthcoming low-vision conference. How can such a claim be made? Easily of course (as shown in this instance), but does it have any basis? No, it has none whatsoever. The great majority of the publication’s recipients (about 87 per cent) are not “medically qualified”, being optometrists, optical dispensers, orthoptists and their supporting industry. The remaining 13 per cent are medically qualified,
being at most 800-plus ophthalmologists and perhaps a small number of other medical practitioners. Any plain reading of the facts of ophthalmic life disqualifies all of the remaining 87 per cent of the recipients as being medically qualified. Yes, an increasing number of optometrists have undertaken and continue to undertake study of therapeutic drugs, but given the limited exposure they have to clinical work embracing use of such drugs during training (as low as 50 hours for them versus tens of thousands of hours for ophthalmologists) they can hardly claim to be “medically qualified”. That is not casting dispersions because it is unlikely the optometrists themselves would consider themselves to be “medially qualified”. If they want to be, then they must be nothing less than graduates in medicine. As for optical dispensers, even the more self-believing among the thousand of them would not consider themselves anywhere near “medically qualified”. So what is it all about? Insight’s experience with a major drug company in regard to our publication’s eligibility to publish advertisements for that company is perhaps a guide. That drug company claims that we lack the right to do so because in its (and perhaps any other drug company’s) eyes we are a consumer publication, meaning for us to do so would be to breach Medicines Australia’s rules about drug companies not advertising to consumers. Absolute nonsense of course, and a claim that we
are in the process of challenging in a number of ways. How convenient, then, for a claim to be made that the recipients of one of the ophthalmic publications – the ‘Publication Whose Name We Do Not Utter’ – “is only distributed to medically qualified eye care professionals in Australia and New Zealand”, particularly when at least one advertisingdecision-maker has fallen for that line and perhaps needed to have that belief bolstered. What it does mean is that a drug company that has signed up for some advertising may have done so under a false impression, courtesy of the publication concerned. And it may well be that the “medically qualified” representations contained on the publication’s website and in information provided to existing and potential advertisers are clearly false and misleading and in breach of Section 52 of the Trade Practices Act. Insight has been published for all of the ophthalmic professions and industry for 38 years, without resorting to cheap and patently untruthful claims such as that mentioned here. And we intend to keep doing the same. After all, advertisers are entitled to be provided with complete and accurate information about the circulation and readership of any publication asking for them to invest their adverting dollars with it. The last things they want provided are dodgy claims that cannot be justified and are misleading, certainly if they are dishonest and designed to fool young players; nothing like the truth. ■
Abolish AHPRA: Melbourne surgeon
Melbourne paediatric surgeon, Dr Paddy Deawan, has called for abolition of the Australian Health Practitioner Regulation Agency, describing
it as “a destructive and unnecessary layer of bureaucracy that should be abolished”. Dr Dewan is a longstanding critic of AHPRA and says there is an “underlying
systemic dysfunction” within the organisation. “It’s a very broken system that has hurt many patients, many practitioners and has resulted in taxpayers costs. ■
than you would expect in performance
OPSM brand expands in Tas with Optomeyes becoming a franchisee T he OPSM brand will be expanded in Tasmania in February, when optometry chain Optomeyes joins OPSM under its full-format franchise model. From mid-February, there will be 15 locations operating under the OPSM banner in Tasmania – 13 franchised OPSM stores and two corporate stores. The 15 locations under the OPSM banner is ironical given that for years the chairman of the then listed company OPSM Group Limited every year at its annual general meeting used to complain about his company being unable to operate in Tasmania due to the “archaic” provisions of the state optometrical legislation that demanded all optical dispensing be by optometrists. That legislation was eventually changed to permit optical
dispensers to operate in Tasmania. OPSM announced the latest addition to its franchise operations in Tasmania on 7 January, saying the company “has enhanced its position in the Australian eyecare and eyewear market with the announcement Tasmanian optometry chain Optomeyes has joined the OPSM franchise network which will result in 15 OPSM stores across Tasmania from mid-February. “The rebranded Optomeyes stores will remain locally operated, with the added benefit of access to world-leading exclusive technology and an expanded range of products in eye care and eyewear.” Matthew Bradford, the new general manager of the OPSM franchise stores in Tasmania, said: “OPSM’s positioning and proven system of operation attracted
Optomeyes to the franchise network, in addition to ongoing investment in providing worldleading technology. “OPSM was a good fit with the Optomeyes brand, bringing together a highly respected and long serving local eye-care provider in Tasmania, with a leading global company.” Tasmanians will now have improved access to world-leading technology like the new Optos Daytona Ultra Wide scanners, which are exclusive to OPSM and allow optometrists to see a 200-degree view of the retina in a single scan in less than five minutes, compared 45 degrees using standard digital retinal scanning machines. Eyelines, the largest Tasmanian optometry group, operates 13 practices statewide and services
an additional 12 locations around the state, with a local management team based in Hobart. It was established in 1997 and has expanded at a steady pace since, with six stores in the south of the state, five in the north and two on the northwest coast “The Tasmanian optical industry is set for a major change through the acquisition of Optomeyes”, William Downie, Eyelines chief executive officer, said. “Our optometrists and optical-dispensing staff use the latest technology to be certain every customer can enjoy healthy vision and comfortable eyewear. “We are continually upgrading to new technology.” Over 33, 000 Tasmanians attending Eyelines practices last year. ■
International visitors drawn to Optrafair London exhibition
isitors from Australia, Austria, Croatia, France, Greece, Hong Kong, Italy, Morocco, Netherlands, Nigeria, Pakistan, Portugal, Saudi Arabia, Spain, Sri Lanka and USA are among those who have booked their flights and pre-registered for Optrafair London, which will run from 11-13 April at Kensington, Olympia in London. Some 10 per cent of those already registered are coming from abroad with other visitors drawn from every corner of the United Kingdom, and with many keen to make a good weekend of a trip to the Capital. Forty-eight per cent of registered visitors are from independent practices with the decision makers keen to see the hundreds of new product launches and the
broad array of business management and IT providers, diagnostic technology companies and to source new suppliers for their frames, sunglasses, lenses and laboratory work, contact lenses and sports eyewear. More than 350 brands will be represented from more than 120 different suppliers – and many with enticing show deals on offer. Some 90 per cent of the exhibition space has now been booked by the broadest range of optical suppliers ever to gather – the diverse, and innovative, practice-building opportunities of Optrafair London! Finance companies and job opportunities for those who want to move ahead with their career will all be eagerly discussed to find out about the opportunities available.
All aboard for London Continuing education and peer-review sessions organised by Optician magazine are hot topics, gaining free CPD points and top business tips. And for those who like to party, the Optician Awards at The Hilton, Park Lane, beckon with
the chance to hear about the winning businesses that lead the field in UK optics. Jigsaw Bookings have a variety of hotel packages available, particularly at the nearby Tara and Hilton Hotels. Information: www. optrafair-london.co.uk. ■
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IDEAS van to help prevent avoidable blindness in Qld communities
Indigenous performers from the Kalu Yurung Dance Troupe at the IDEAS van launch in December
ueensland Health has provided $5 million to the Queen’s Diamond Jubilee in a world-first project aimed at treating and preventing avoidable blindness in Aboriginal and Torres Strait Islander communities in Queensland. With Queensland Aboriginal Islander Health Council as a major partner in this pilot project, it will be helping to reduce preventable blindness from diabetes by providing education, equipment and specialist clinical support to 27 Aboriginal Medical Services in Queensland. Facilities will be located in Toowoomba, Charleville, Mt Isa, Townsville, Cairns, Mackay, Rockhampton, Hervey Bay and Morayfield. In partnership with the Royal Flying Doctor Service the scope will be expanded beyond those nine hubs, helping to tap into the more rural and remote areas. Queensland health minister Lawrence Springborg said: “Diabetes affects one in three adult Aboriginal and Torres Strait Islander people in Queensland
and can have a debilitating impact on the sufferers’ vision. However, most blindness caused by diabetes can be prevented, which is why this project is so important.” Diabetes affects one in three adult Aboriginal and Torres Strait Islander people in Queensland which can cause preventable blindness. The project enables the delivery of enhanced diabetes care through improving aboriginal health workers’ knowledge of diabetes and diabetes-related illnesses. Clients will be managed through appropriate referral pathways to receive treatment, including specialist eye care at the regional specialist centres or at a purpose-built, fully-equipped and specially-designed ophthalmic 60-foot truck – the IDEAS van – Indigenous Diabetes Eyes and Screening van. Device Technologies has supplied much of the screening equipment for this world-first initiative at discounted prices as well as providing staff to help with screenings. ■
Lawrence Springborg, Queensland health minister, and Selwyn Button, CEO, Queensland Aboriginal and Islander Health
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Hollows Foundation signs 10-year agreement with Diabetes Federation T he Fred Hollows Foundation on 29 November announced it had signed a 10-year partnership agreement with the International Diabetes Federation to tackle a challenging complication of the disease that can lead to blindness. “By 2035, diabetes could become the leading cause of blindness,” Mr Brian Doolan, chief executive officer of The Fred Hollows Foundation, said. “But Fred Hollows wasn’t a man who walked away from a challenge.” The launch was held at the Baker IDI Institute just days before the start of the World Congress on Diabetes in Melbourne. “We are proud that Fred’s Foundation is establishing this partnership with the IDF, and while we are daunted by the size of the task before us we are excited by the opportunity of working with the federation to make sure people with diabetes do not suffer unnecessary blindness.” Mr Doolan described the new partnership as a timely one given the sharp rise in diabetes globally. “Urgent action is needed to help people avoid blindness from
diabetic retinopathy through access to a sight-saving eye examination once a year. Unless we do the groundwork now, four out of five of those people won’t have access to adequate eye care services, Mr Doolan said. The Prime Minister, Mr Tony Abbott, has welcomed the alliance and says the federal government will play its part fighting the disease and its consequences. “The government has plans to support the development of a new National Diabetes Strategy. This will inform how existing health resources can be better coordinated to address one of the most serious health challenges facing our country and our world,” Mr Abbott said. The new alliance will embed eye care as part of general health care for people living with diabetes and work towards new global guidelines on treatment. The partnership will also collaborate on rolling out diabetes programs in a range of developing countries that are expected to include mass screenings. It will invest in low-cost treatment services to address diabetic
The late Fred Hollows at work retinopathy, and contribute towards building a skilled workforce to provide good quality care in all aspects of screening, treatment and management of the condition. An estimated 1.3 million Australians have diabetes. Of those, 300,000 have diabetic retinopathy and more than half will have suffered some form of vision impairment. Diabetic retinopathy is already the main cause of blindness
among working age adults worldwide. People most at risk are those with poorly managed diabetes or high blood sugar levels and high blood pressure, particularly if they also have kidney disease. Diabetic retinopathy was one focus of the biannual World Congress on Diabetes on 2-6 December. More than 10,000 delegates attended along with 400 exhibitors. ■
Contact lens can deliver glaucoma medication for at least a month
esearchers in the United States are one step closer to the often-speculated concept of continuously delivering drugs to the eye via contact lenses. For nearly half a century, contact lenses have been proposed as a means of ocular drug delivery that may someday replace eye drops, but achieving controlled drug release has been a significant challenge. Researchers at Massachusetts Eye and Ear/Harvard Medical School Department of Ophthalmology, Boston Children’s Hospital, and the Massachusetts Institute of Technology are closer to an eye drop-free reality with the development of a drug-eluting contact lens designed for prolonged delivery of latanoprost, a 16
common drug used for the treatment of glaucoma, the leading cause of irreversible blindness worldwide. “In general, eye drops are an inefficient method of drug delivery that has notoriously poor patient adherence. This contact lens design can potentially be used as a treatment for glaucoma and as a platform for other ocular drug delivery applications,” Dr Joseph Ciolino, MD, Massachusetts Eye and Ear cornea specialist and lead author of the paper (In vivo performance of a drug-eluting contact lens to treat glaucoma for a month), said. The contact lenses were designed with materials that are FDA-approved for use on the eye. The latanoprost-eluting contact
lenses were created by encapsulating latanoprost-polymer films in commonly used contact lens hydrogel. Their findings are described online and will be in the January 2014 printed issue of Biomaterials. “The lens we have developed is capable of delivering large amounts of drug at substantially constant rates over weeks to months,” Professor Daniel Kohane, director of the Laboratory for Biomaterials and Drug Delivery at Boston Children’s Hospital, said. In vivo, single contact lenses were able to achieve, for one month, latanoprost concentrations in the aqueous humor that were comparable to those achieved with daily topical latanoprost solution, the current
first-line treatment for glaucoma. The lenses appeared safe in cell culture and animal studies. This is the first contact lens that has been shown to release drugs for that long in animal models. The newly designed contact lens has a clear central aperture and contains a drug-polymer film in the periphery, which helps to control drug release. The lenses can be made with no refractive power or with the ability to correct the refractive error in myopic or hyperopic or eyes. “A non-invasive method of sustained ocular drug delivery could help patients adhere to the therapy necessary to maintain vision in diseases like glaucoma, saving millions from preventable blindness,” Dr Ciolino said. ■ www.insightnews.com.au
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Franchisors could be fined up to $50,000 for breach of code F ranchisors could be fined as much as $50,000 for breaches of the Franchising Code of Conduct if the federal government picks up where the former government left off. The franchise sector has been regulated by the compulsory code since 1998, but to date it does not include penalties for breaches. According to small business minister Mr Bruce Billson on 6 January, “the government advocates penalties to help enforcement of the code”. The government also plans to extend unfair contract provisions to protect small businesses as well as consumers. In 2013, the Wein review of the code made 18 recommendations to update it, which were not
implemented due to the federal election. Mr Billson said the federal government wants to ensure that franchisors who breach the code face consequences; that franchisees which are harmed have the resources to seek remedy; and that there is a nationally-consistent regulatory framework rather than a fragmented state-by-state approach. The government wants to stamp out ‘jurisdiction shopping’ by national franchisors looking for morefavourable states and territories to conduct legal action. A regulatory impact process is expected to be completed by mid-year. Mr Billson said the potential fines of $50,000 will be for “serious but less egregious [shocking]”
breaches of the code, while there will still be full legal avenues and major fines for those found to be conducting “egregious” breaches. He said the aim is to ensure a level playing field for franchisor and franchisee. Franchise Advisory Centre principal Jason Gehrke said penalties are less about the treatment of franchisees, and more of a matter of adhering to the code. For example, Mr Gehrke said if a franchisor fails to give a disclosure document, a fine could be relevant. “What would be a concern is the extent of the fine and the cause of the penalties – if it is an innocent or insignificant breach, a fine could be disproportionate,” he said. “If they are required to provide a list of franchisees, and that list
doesn’t include the franchisees that just joined the network, or if there are franchises in a state of transition, with one being sold to another, that inaccuracy could result in a fine.” Mr Gehrke said most franchisors won’t be worried about the potential of penalties, as most adhere to the legislative requirements implemented in 1998. “Most are not concerned about fines, providing the extent of the fines or penalties are limited, clear and unambiguous,” he said. “As part of the government’s preelection policies, it also promised to take a ‘root-and-branch’ review of the competition law policies. “Anything from the Wein inquiry that is adopted, they would want to make consistent with the competition law reviews.” ■
Pupil reflection could help ID some criminals
ew research led by a psychologist at the University of York is using advances
in the level of detail available in digital photography to harness this human ability for use in forensics.
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As the most commonly photographed objects are faces, there is potential in mining detailed facial images for hidden information. Until now, photographers might reasonably have assumed that their own face was absent from the image. But the research, led by Dr Rob Jenkins, of the Department of Psychology at the University of York and published in PLOS ONE, overturns this assumption. By zooming in on high-resolution passport-style photographs, Dr Jenkins and coresearcher, Christie Kerr, of the School of Psychology, University of Glasgow were able to recover the faces of bystanders from reflections in the eyes of photographic subjects. The recovered bystander images could be identified accurately by observers, despite their low resolution. To establish whether these bystanders could be identified from the reflection images, the researchers presented them as stimuli in a face-matching task. Observers who were unfamiliar with the bystanders’ faces
performed at 71 per cent accuracy while participants who were familiar with the faces performed at 84 per cent accuracy. In a test of spontaneous recognition, observers could reliably name a familiar face from an eye reflection image. Dr Jenkins said: “The pupil of the eye is like a black mirror. To enhance the image, you have to zoom in and adjust the contrast. A face image that is recovered from a reflection in the subject’s eye is about 30,000 times smaller than the subject’s face. Our findings thus highlight the remarkable robustness of human face recognition, as well as the untapped potential of high-resolution photography.” The researchers say that in crimes in which the victims are photographed, such as hostage taking or child sex abuse, reflections in the eyes of the photographic subject could help to identify perpetrators. Images of people retrieved from cameras seized as evidence during criminal investigations may be used to piece together networks of associates or to link individuals to particular locations. ■ www.insightnews.com.au
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TGA imposes sanctions on ‘glaucoma-drug’ advertiser False claims were made in contravention of Therapeutic Goods Act and Code
he Complaints Resolution Panel of the Therapeutic Goods Administration has imposed sanctions on a company for its advertising of ‘Bright Eyes Drops for Glaucoma’ on the internet that makes false claims about the drug in breach of the Therapeutic Drugs Act and its Regulations and Code. However at the time of going to press the drug was still being advertised on the internet by ‘Ethoseyesite.com’ in seeming defiance of the sanctions imposed by the panel. Also, there had been no response to the complaint by the advertiser. The panel investigated the advertising after a complaint was made, the complainant requesting anonymity. The advertisement was headed “Bright Eyes Eye Drops For Glaucoma” with a subheading “Control and medicate ‘The Sneak Thief of Sight’, followed by representations as to the product’s use for glaucoma including: “Glaucoma affects over 310,000 people in Australia alone, that is one in eleven Australians who will develop glaucoma.”; “Glaucoma is the leading cause of vision damage and blindness in Australian’s (sic)”; “If you don’t treat your eyes with eye drops You may or will develop nerve damage at a relatively low pressure”; It continued: “Early diagnosis can help slow the progression of the condition using Ethos Bright eyes to minimise loss of vision”; “The recommended course of treatment is to use one box containing 2 x 5ml bottles a week, for a period of six weeks with 80% of patients report seeing significant improvements within this time frame”; “Eye drops as a course of medication is recommend (sic) on all major Glaucoma websites including: Asian-Oceanic Glaucoma Society Australian and New Zealand Glaucoma Interest Group Royal Australian and New Zealand 20
College of Opthalmologists”; “Bright Eyes drops are safe to use....”; and many others. The panel on 17 October determined that the advertisement to be in beach of the Therapeutic Goods Act and its Code on a number of counts. The panel was satisfied that the advertisement promoted a product that was represented to be for therapeutic use. The Act prohibits the publication of advertisements for therapeutic goods that are not included in the TGA Register. None of the products or ingredients promoted in the advertisement were included in the register, and the advertisement therefore breached the Act. The panel, therefore, found that aspect of the complaint justified. The code requires that advertisements for therapeutic goods “contain correct and balanced statements only and claims which the sponsor has already verified.” It prohibits representations that are “likely to arouse unwarranted and unrealistic expectations of product effectiveness” and prohibits representations that “mislead directly or by In the absence of any evidence from the advertiser, the Panel was satisfied that the advertisement contained many representations that had not been verified, were not correct and balanced, were likely to arouse unwarranted expectations, and were misleading, in breach of these provisions. These included the representations outlined in paragraph 15 above. The code prohibits advertisements that are “likely to lead to consumers self- diagnosing or inappropriately treating potentially serious diseases”. In the view of the panel, the advertisement was very likely to lead consumers into self-diagnosing or inappropriately treating glaucoma, a serious disease. That aspect of the complaint was therefore justified. The code prohibits representations that therapeutic goods
are endorsed by healthcare professionals. The panel found that the advertisement represented the advertised product to be endorsed by healthcare professionals through the representation that the product is recommended by groups of healthcare professionals such as the Royal Australian and New Zealand College of Ophthalmologists. This aspect of the complaint was therefore justified. The code, prohibits advertisements that “refer, expressly or by implication, to serious forms of diseases, conditions, ailments or defects specified unless prior approval is given under the Therapeutic Goods Act 1989.” The
diseases and conditions specified in the code include “serious forms of” a wide range of health concerns. The panel was satisfied that the advertisement breached this provision because of the many references to, and representations about, glaucoma. This aspect of the complaint was therefore justified. The advertisement ought to have contained the words “always read the label” and the words “use only as directed” and “if symptoms persist see your doctor/ healthcare professional” The advertisement did not include these mandatory statements. This aspect of the complaint was therefore justified. ■
The sanctions imposed A statement on its determination was issued by the TGA’s panel on 11 December: The panel requests ethoseyesite.com, in accordance with the Therapeutic Goods Regulations 1990: a) to withdraw the advertisement from further publication; b) to withdraw the all of the representations made in relation to glaucoma; c) not to use the representations in (b) above in any other advertisement*; d) where the representation has been provided to other parties such as retailers or website publishers, and where there is a reasonable likelihood that the representation has been published or is intended to be published by such parties, to advise those parties that the representation(s) should be withdrawn; e) to arrange for publication on the website www.ethoseyesite.com of a retraction in the form of, and in accordance with, the conditions set out in the attachment to this determination; and, f) within 14 days of being notified of this request, to provide evidence to the panel of its compliance, including a response in writing that they will comply with the panel’s sanctions, and where appropriate, supporting material such as copies of instructions to advertising agents or publishers, or correspondence with retailers and other third party advertisers. The advertiser’s attention is drawn to the provisions of sub-regulations which permit the panel to make recommendations to the secretary in the event of non-compliance with this request. In practice, determinations that have not been complied with generally are referred to the TGA for follow-up action. Referral to the TGA may result in an order being made under Regulation 9 of the Therapeutic Goods Regulations to enforce compliance with the panel’s determination. Noncompliance with this order could also result in suspension or cancellation of the product entry from the Australian Register of Therapeutic Goods. Regulation 9 Orders issued by TGA for advertising complaint determinations finalised by the panel after 1 November 2010 will be publicised on the TGA’s website at http://www.tga.gov.au/advert/complaint-investigations.htm
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Top-selling AMD drug runs into a roadblock in its home market B ayer’s aged macular degeneration drug Eylea has run into a roadblock in its home market, Germany, Reuters reports. Sales of the drug have taken off since the European Union gave it the green light in late 2012, but now Germany’s cost watchdog has thrown up a roadblock for the second time. On 2 January, the German Institute for Quality and Efficiency in Health Care (IQWiG) said it was unable to assess whether Eylea provided an advantage over its rival, Novartis’ Lucentis – an opinion that could hurt sales for Bayer in its home market. Under the country’s
much-maligned pricing rules, new treatments must prove superior to existing competitors in order to command top dollar. But as Reuters reports, IQWiG said the way in which the macular oedema drugs were administered during trials – neither was administrated in the way regulators specified when they approved Eylea for use in Germany – prevented it from drawing a conclusion. The opinion could affect the level of reimbursement patients receive from public insurers in Germany. The country’s medical cost-benefit agency takes those opinions into consideration, and that agency is set to publish an
analysis of Eylea within the next three months. Bayer said it would issue a response to the statement within the next three weeks. Germany’s pricing formula, rolled out in 2011, met with ire from drug makers that has far from subsided. Since then, pricing frustrations have driven some pharmaceutical companies to pull their products from the German market. Eyelea has come before IQWiG before, as a treatment for wet agerelated macular degeneration, and couldn’t show itself superior to Lucentis based on what a company spokesperson at the time called
a technicality. “The main reason for [IQWiG’s] conclusion of no additional benefit is the fact that the current label of Lucentis has never been studied in a clinical trial,” Bayer’s spokesperson said in May. Elsewhere, Eylea has not exactly wanted for revenue. The drug hauled in €122 million ($165 million) for Bayer, which markets it in all countries outside the United States in the first half of 2013; the company has said it expects up to €1 billion in peak annual sales. And in the US, where Regeneron is responsible for marketing, Eylea has put up impressive numbers, including $643.7 million in firsthalf 2013 sales. ■
OneSight has an eye out for indigenous creative talent
uxottica’s not-for-profit organisation OneSight is on the look-out for creative indigenous artworks by emerging artists to transform into unique eyewear as part of their broader mission to continue to reduce the gap between indigenous and non- indigenous Australians’ eye health. OneSight is encouraging indigenous Australians to submit artworks which have an overarching story relating to vision, sight and culture to be featured on an exclusive Ray- Ban Indigenous special edition Wayfarer sunglasses – in collaboration with OneSight. The collection will be sold at OPSM, Sunglass Hut, Laubman & Pank and specialty stores, with $50 from each sale helping to fund OneSight programs across rural and regional indigenous communities in Australia. “Not only will the artist receive recognition for their work from the wider Australian public, they will also gain up to $10,000 worth of professional development of their choice and the profits from the licensing fee from each pair
of glasses produced with their design,” OneSight’s director of community, Robyn Weinberg, said. “The competition is open until 7 March and will be judged by a series of leaders in the indigenous community, including Alison Page and Aden Ridgeway, along with Antonio Miyakawa, executive vice-president marketing, creative direction and product at Luxottica Group SpA [Italy] and Christopher Beer, chief executive officer of Luxottica Group Asia Pacific.” Aden Ridgeway, a prominent member of the Australian indigenous community, and a member of the OneSight advisory board, has played a key role in the establishment of the program and continues to support the work of OneSight in indigenous communities. “OneSight is an organisation aiming to change the face of eye health care for indigenous Australians and reduce the alarming statistics we see every year. OneSight offers assistance to communities which would otherwise have little to no access to eye
health and eye care services,” Mr Ridgeway said. Alison Page, the creative director of the National Aboriginal Design Agency and a representative on the judging panel of the competition, said the inititative is a great opportunity for the next generation of emerging artists to make a name for themselves in the design community. “Cracking into the arts world can be difficult. This is a great initiative for our young people to gain recognition in the arts and design community and see their work appear all around Australia, while also gaining a significant level of professional development and payment for their work. “OneSight is giving everyone the chance to find their artistic voice and a medium to express it through whilst staying true to our culture and heritage.” Finalists in the competition will have their full artworks displayed in a pop-up national exhibition to coincide with the launch of the
Ray-Ban Indigenous special edition Wayfarer in Summer 2014-15. The OneSight Foundation, a not-for-profit organisation founded by global eye care and eyewear company, Luxottica, brings to remote and disadvantaged communities free eye screenings and free glasses as required, along with eyehealth education. It works closely with Aboriginal communities across Australia to build sustainable eye health management programs. To enter the competition or for further information, including terms and conditions, budding artists can visit www.onesight.org.au/ rayban. ■ *Centre for Eye Research and University of Melbourne, National Indigenous Eye Health Survey – Minum Barreng (Tracking Eyes), source: http://iehu. unimelb.edu.au/publications/?a=163365
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Business health: Prevention is better than cure – By Kathy Allen*
s eye-care practitioners you know it’s better to monitor and manage ocular health through regular check-ups than to wait until something goes wrong. But do you take the same approach to the business health ofyour practice? Traditionally, small to medium businesses have tended to use financial data as a means to an end – to comply with the obligation to lodge a tax return. It means that financial statements are often prepared long after the period which they reflect has passed. Most people have a feel for how their business is running long before they see the financial statements of course. And it’s also true that there may be some middle ground. Many business owners may not have a complete set of financial data available to them on a regular basis throughout the year, but it’s likely that most will have access to some key performance indicators – sales, debtors, bank balances, etc. – from their internal systems. Plus, you can often just tell when things are going well and when something is wrong. Even so, this just isn’t the same as having a detailed picture of the financial performance of your business. Your financial data is your business health chart – it contains everything you need to know about the condition of your business. So it follows that the key to measuring and maintaining business well-being is timely information. Gut-feel can only get you so far. The more information you have, and the more upto-date it is, the better you can identify problems and seize new opportunities. One way to manage your financial data better is to take advantage of the new wave of accounting products that are now hitting the market. Applications like Xero and MYOB AccountRight
Live use daily bank feeds to automatically input your data, code much of it to the relevant account for you, and store it in the cloud. This means that both you and your accountant can have access to your transactional information in a single shared ledger, as early as the day after the transactions themselves occur. Progressive accounting firms are taking advantage of this by offering bundled services. Some will do your bookkeeping and reconcile your accounts for you, in the same ledger that you yourself are using (by storing it in the cloud), effectively giving you access to your own qualified CFO. And it may cost less than you think. It’s possible that with the efficiencies gained through bank feeds and automatic coding, an accountant can offer you bookkeeping, reporting and monitoring, and your year-end tax work for the same cost as you are currently paying for separate bookkeeping and accounting services. In most cases your practice software will be able to export data directly into one of these next generation accounting packages. That takes care of the historical data. But what about projecting for the future? This is where business modelling comes in. Once you have an accurate and up-to-date picture of the performance of your business, you can then take this information and leverage it. Business modelling really involves going through the financial aspects of your practice with a fine-toothed comb, analysing each element and investigating how it is affected by others. You can then use this information to plan for the future. Perhaps you’re thinking of expanding your operations? Or maybe you’re considering winding back your own hours and taking on someone else to help?Or maybe you just wantto know what you need to do to increase your profit
by 10 per cent. If you can build a financial model of your business, based on your historical data and the way in which each component affects the other aspects of your practice, you can play with the numbers to see what will work and what won’t. For example, if you think you can convert 50 per cent of your consultations into sales of frames, lenses, etc., how many consultations do you need to perform per day to make the kind of profit you’d be satisfied with? Or if you do want to take on that second optometrist, how will the cost of his or her salary affect your bottom line, and what kind of growth would you need to see to make it worthwhile? What about discounting - should you discount your products to keep up with the bigger players, or might another marketing strategy be more effective? If you can analyse every component of your business, and then monitor the actual performance of your practice against your plan, you can adapt to change much more quickly. You can identify those things that are working well for you and prepare for upcoming threats in a way that is far more timely. The good news is that you don’t have to build a model like that yourself. There are tools out there, and your accountant can help you. If you’re an independent practice, we haveworked withODMAtodesign a model that will help you analyse all of the financial components of your optometry practice and test any number of scenarios for adaptation and growth. You can see a demonstration of the model at www.dewings.com.au/resources/ eye-care-industry/optometristsin-practice-getting-the-numbers-right Obviously, there is some time and effort involved here. It would be nice to have a business that just works – one where we have
Kathy Allen a cash cow that just continues to produce money or one where customers just come looking for us. A lot of entrepreneurial ‘success stories’ can make us feel like that’s the usual MO for business, and lead us to ask “why isn’t this happening for me?!” The reality is that for most of us, business is competitive, and is characterised by peaks and troughs. Simply, it takes hard work to ride these waves and make it successful. Like people, a regular checkup of thehealth of yourpractice is essential. It goes a long way towards ensuring that your business stays in tip-top shape. The more information you can have about the health of your business, the more valuable your check-ups will be. Knowing your business well can help you withstand external pressures, innovate, grow and distinguish yourself from the competition. Ultimately it’s about protecting your investment and making sure that you maximise your return from it. ■ *Kathy Allen is a director and senior tax partner of South Australia charteredaccountancy-and-consulting firm Dewings who has worked closely with the Optical Distributors and Manufacturers Association in assisting development of independent ophthalmic practices.
Prototyping & Lab Measurement
CONGRATULATIONS! To Neil and the team at Insight on their 400th issue!
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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 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.
People Founding director of MDF retires
Ita Buttrose presented a service award to Paul Beaumont The founding director of the Macular Disease Foundation Australia, Dr Paul Beaumont, was announced at the foundation’s annual general meeting in Sydney on 10 December. Dr Beaumont has given 12 years of service to the foundation and has played a key role in raising awareness and understanding of issues surrounding macular disease among health-care professionals and the general public. Over the period of his 12-year tenure, his roles have included chairman of its board and medical committee, New South Wales state chairman, and member of the research committee. “It was with great regret that I reached the mandatory retirement dictated by the MDF constitution that only allows a board member to server for a maximum of 12 years,” Dr Beaumont told Insight. The foundation’s patron, Ms Ita Buttrose, on behalf of the foundation and the wider macular degeneration community, thanked Dr Beaumont for his outstanding commitment and dedication to improving the eye health of Australians”. Ms Elizabeth Carr, chairman of the foundation, said: “Thank you Dr Beaumont for your foresight and courage to establish a foundation with the aim of reducing the
incidence and impact of macular degeneration in Australia. Your commitment to those living with macular degeneration, their families and carers, will have a long-lasting and far-reaching effect.” Dr Beaumont is one of Australia’s international experts on diseases of the retina and has published benchmark papers on diabetic retinopathy, retinal vein occlusions and macular degeneration in world journals. Having commenced his career as a consultant neuro-ophthalmologist at Prince of Wales and Royal Prince Henry hospitals in Sydney, Dr Beaumont established a highly-successful private practice in Macquarie Street, Sydney, while remaining actively involved in teaching and clinical research. He is a regular guest speaker at international meetings, and has trained both national and international medical retina fellows in his approach to the assessment and treatment of retinal diseases. Dr Beaumont practises on Sydney’s northern beaches as well as in Macquarie Street.
Ivan Goldberg receives US Glaucoma Foundation’s 2013 Robert Ritch Award The Glaucoma Foundation in the United States presented its 2013 Robert Ritch Award for Excellence and Innovation in Glaucoma to Professor Ivan Goldberg, of Sydney, a noted international figure in the glaucoma community. The announcement and presentation was made at TGF’s Annual Benefit Ball in New York City on 3 December. The award recognises the contributions of individuals who have played a significant and unique role in promoting the medicine and science of glaucoma. It is named in honour of Dr Robert Ritch, founder of TGF and its medical director, who received the inaugural award in 2008. Other winners have
Left to right: Gregory Harmon, chairman of The Glaucoma Foundation; Scott Christensen, president/chief executive officer of The Glaucoma Foundation; and Ivan Goldberg at the award presentation been Dr Paul Kaufman (2009), Dr Theodore Krupin (2010), Dr Jonas Jost (2011), and Dr George Spaeth (2012). Prof Goldberg is director of Eye Associates in Sydney, head of the Glaucoma Unit and visiting ophthalmologist at Sydney Eye Hospital, as well as a clinical associate professor at the University of Sydney. He is president of both Glaucoma Australia and of the Australian and New Zealand Glaucoma Interest Group. In 2009 he was the recipient of an Order of Australia Award “for services to glaucoma and the community nationally and internationally”. Within Asia and globally, Prof Goldberg’s experience and knowledge in the field of glaucoma have been recognised through his election as the founding president of the South-East Asia Glaucoma Interest Group (SEAGIG) and later the Asia Pacific Glaucoma Society and president of the World Glaucoma Association (2006-2007). He is also a past president of the Royal Australian and New Zealand College of Ophthalmologists. “We congratulate Professor Goldberg on his many achievements, including the significant role he has played internationally in the founding and growth of the professional associations that have helped transform knowledge and skills about the diagnosis and
management of glaucoma,” Dr Gregory Harmon, chairman of The Glaucoma Foundation, said.
Safilo appoints global commercial director Safilo Group, a worldwide leader in the premium eyewear sector, announced on 17 December that it has appointed Mr Henri Blomqvist to the newly-established role of global commercial director. Mr Blomqvist reports to Ms Luisa Delgado, çhief executive officer of Safilo Group, and oversees all commercial wholesale operations worldwide. A native of Finland, Mr Blomqvist spent the last ten years at Procter & Gamble, where he acquired experience in the areas of sales and commercial management, on several worldwide brands, most recently as international commercial leader of Braun. He held several local, regional and international roles covering a variety of countries, including Nordic, parts of Western Europe, Russia, Turkey, the Middle East, Korea and Australia. “We are very pleased to count on Henri in the Safilo Group management team. He brings strategic commercial leadership experience and is positioned to strengthen Safilo’s commercial capabilities, as we refine our stated sales strategy and in turn differentiate our manufacturing and logistics choices accordingly.” ■
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Eye-movement test assists diagnosis of major adult psychiatric disorders A n eye-movement test that assists diagnosis of major adult psychiatric disorders, devised by researchers at the University of Aberdeen in Scotland, recognises unusual eye movements to help clinicians identify illnesses such as schizophrenia, bipolar disorder and severe depression. It is hoped the assessment will make the process of reaching an accurate diagnosis more efficient. There is a plan to ‘commercialise’ the test for use in mental health care worldwide after it successfully competed against five other finalists in the 2013 Converge Challenge Awards on 24 September for the first prize of £60,000 ($A102,000). Dr Philip Benson, a senior lecturer in psychology at the University of Aberdeen University’s School of Psychology and one of the academics behind the test said: “We’re absolutely delighted to have won this prestigious Scottish competition. The win is a testament to the strength of our business proposition and this enables us to move forward quickly with the university to commercialise the eye-movement test through a new company. “Delivering an accurate and timely diagnosis remains one of the most pressing responsibilities of modern psychiatry. There aren’t any objective diagnostic tests available to routinely validate decisions made by clinicians. “It has been known for over a hundred years that individuals with psychotic symptoms are unable to smoothly track slowly moving objects with their eyes. Their gaze tends to lag behind the object
and then catch up with it by making rapid skips called saccades. Professor David St Clair, chair of mental health at the University of Aberdeen and a consultant psychiatrist at National Health Service Grampian said: “Our test will help clinicians arrive at an informed diagnosis much sooner and reduce the time patients spend in clinics. “That will mean they receive appropriate treatment sooner too, helping them resume a more normal life. We believe the test may also have the potential to identify individuals who are at risk of developing mental-health problems before they arise.” Supporting the academic team to address the many challenges in delivering this type of assistive tool into the broad sphere of global healthcare is Mr Madhu Nair, a technology entrepreneur and Satire
Fellow with experience in developing early-stage opportunities in the software and life-science sectors both in the United Kingdom and the United States. Mr Nair said: “Our simple eyemovement tests can recognise schizophrenia and other major psychiatric disorders with better than 95% accuracy and within 30 minutes – a step change for psychiatry. The need is significant with one in five adults suffering from some form of mental ill health during their lifetime and 5 per cent developing major psychiatric disorders. A staggering US$2.5 trillion is spent annually due to mental ill health which is the largest cause of disability worldwide.” The 2013 Converge Challenge Awards took place on 24 September at Heriot-Watt University’s Edinburgh campus
The competition is open to staff postgraduate and final year students of all Scottish universities and research institutes and is the largest business competition and entrepreneurial training program in Scotland. The development of the commercial opportunities for the test is being supported by the Royal Society of Edinburgh’s Enterprise Fellowship scheme, the University of Aberdeen and the Executive Director Designate Programme, a funding scheme conducted by the University of Strathclyde. The Saccade Diagnostics team is also participating with the University of Aberdeen on the Design Council’s Design Leadership program, receiving expert advice and training on the design aspects of the service model. ■
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A simple eye test for multiple sclerosis developed at ANU
cientists at the Australian Centre of Excellence in Vision Science based at the Australian National University are making use of how the automatically-contracting pupil reflex that occurs when stepping out into bright sunlight is connected to the brain as a potential new way of testing the severity of multiple sclerosis. Dr Eman Ali and her ACEVS colleagues have used an instrument they are developing to accurately measure the pupil responses of MS patients and have found that the pupils of MS sufferers respond appreciably slower. The finding opens the door to a simple and quick way of tracking the severity of MS over time: the slower the response, the worse the MS. “Our instrument uses special patterns of flashing lights that the patient looks at for four minutes,” Professor Ted Maddess, a vision scientist at ANU who is head of the ACEVS team, said. “We use infrared cameras to measure light-induced changes in the diameters of both pupils, and with computer tracking we can measure the diameter to within a micrometre 30 times a second. “We have just published the results of our study of 85 MS patients, and we find that in MS patients the pupil response is about 25 milliseconds slower than in our control group. Although the study is preliminary, we believe the test has good potential in individual patients because it can precisely measure the speed of their
response to within a millisecond. “So instead of an expensive MRI to track the condition, the new method gives an accurate readout after just a few minutes. That quick and easy test might, in the future, allow MS patients to be assessed on the spot and have their medication adjusted accordingly.” MS is a potentially devastating neurological condition affecting the myelin sheath of nerve fibres, leading to sensory disturbances and muscle weakness. Vision, speech, and walking are most often affected, and pain can occur. Puzzlingly, MS affects different people in different ways, but the condition inexorably gets worse with age and there is currently no cure. Some patients experience acute, inflammatory attacks while others don’t. “MS is the most common neurological disability in adults, with about 12,000 sufferers in Australia,” Professor Maddess said. “Although it seems to be some sort of immune disorder, its cause is still obscure. “There are many puzzling aspects to MS, and there are many theories. “Our main aim in this work was just to find a way of accurately monitoring the progression of the disease, a single measure that relates to the degree of disability. MRI is good for giving insight into the inflammation associated with episodic attacks, but it’s not so good at monitoring the chronic decline that’s always going on.
Using a TrueField to accurately measure pupil responses
About Seeing Machines Seeing Machines, is an AIM- ‐listed technology company (AIM is the London Stock Exchange’s international market for smaller growing companies) that specialises in visual computing systems that track faces, eye and facial features in real time. Its software and engineering services are used in products and applications that range from devices that detect eye disease to prevent loss of sight, to those that improve driver safety and save lives. Seeing Machines technology is used worldwide across the automotive, mining, gaming, transport and aviation industries; as well as many of the leading academic research groups, transportation authorities, and defence departments. Seeing Machines is based in Canberra, Australia and Tucson, Arizona and counts Toyota, Nissan, Motorola and Bosch among its customers.
“If we can use our pupil measurements to monitor the decline, we might be in a better position to adjust medications, which often have unpleasant side-effects.” The instrument to measure the pupil responses is the same one which has also been shown to be helpful in diagnosing vision loss in glaucoma, diabetes, and age-related macular degeneration. The device was developed by Professor Maddess together with Associate Professor Andrew James and other ACEVS team members.
Under the name ‘TrueField’, it is being commercially developed by an Australian company, Seeing Machines, which plans to sell it as a multi-purpose medical diagnostic instrument. TrueField has already received American Food and Drug Administration clearance, and Professor Maddess is hopeful it might, after some more research, also find a role in monitoring MS. He believes it has good prospects of reducing the high treatment costs associated with the disease. ■
Register online for MIDO: no waiting time
he MIDO trade fair in Milan, Italy, on 1-3 March is using the fast-lane system this year, with the PDF of your online registration as the entry ticket. You can either print it and take it with you 32
or save it on a smartphone or tablet. There’s no need to wait at the reception desk, just go straight to the fast-lane scanners and you’re in! Optimize your time with no waiting and no standing in line!
Those registering online from 6 January 2014 will be entered into an iPad prize draw. For a list of exhibitors go to http://www. mido.com. ■
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RANZCO Annual Scientific Congress,
Alex Hunyor Jnr
he 45th Annual Scientific Congress of The Royal Australian and Neaw Zealand College of Ophthalmologists held in Hobart on 2-6 November maintained the usual RANZCO standard despite being closer to the Antarctic than other congress venues – the weather could be described as brisk at times. Assoc Prof Nitin Verma and his local organizing committee and the RANZCO Scientific Program Committee chaired by New Zealand’s inimitable Prof Helen Danesh-Meyer are to be congratulated for a job well done. The only issue that became apparent is a local one, i.e. Hobart is ill-equipped to handle such large conferences, a factor the city and state is aware of. Plans for a venue that can handle such large meetings are already in-train. The scientific program started with Sunday’s ‘Bayer Breakfast’ which, like all breakfasts held subsequently, was held in the City Hall adjacent to the Hotel Grand Chancellor, the meeting venue.
Treatment of AMD Assoc Prof Alex Hunyor Jnr (Sydney) chaired the event which covered the first year of clinical experiences with Bayer’s Eylea VEGF-trap injectable ocular pharmaceutical for the treatment of AMD. Prof Hunyor’s own data showed that Eylea at 2-monthly dosages produced an equivalent clinical
Nitin Verma outcome (about 3 lines improvement in VA) to monthly doses of Lucentis, the current yardstick for such treatments. Dr Adrian Fung (Sydney) conducted a switch-over study in 33 patients (mean age 79 years) commenced in 2012 using criteria based on raster OCT scans, PED (pigment epithelium detachment) height, and sub-retinal fluid measured as a cross-section height in OCT images. All patients were previous Lucentis users who had exhibited no adverse events before his trial began. Three monthly loading injection of Eylea resulted in no significant improvement in VA but by 6 months a small but significant improvement was recorded. Interestingly, retinal thickness did not improve. One case showing an improvement at 6 months had already received 40 Lucentis injections. Dr Fung noted that Eylea did not decrease intra-retinal fluid volumes but most users showed improvements in retinal anatomy. However, he did note a subgroup of the study that had recurrent subretinal fluid issues that required monthly Eylea injections. Dr Andrew Chang spoke of his experiences in switching to Eylea treatment in 49 ‘resistant’ AMD cases that showed CNV (choroidal neovascularization) secondary to their AMD despite having received AMD treatment for up to 3.5 years previously. Three monthly injections of Eylea were given as a
loading dose and that improved their VA. However, when the injection rate was stretched to 2-monthly the VA dropped by about 3 letters (almost half a line). Anatomically, the retinal thickness decreased rapidly initially but with 2-monthly applications the retinal thickness recovered some of those losses. In the difficult cases, the retinal thickness varied over time by as much as 40 microns. Dr Chang’s (Sydney) experiences showed that despite previous intensive use of Lucentis, Eylea produced improvements in VA and decreased sub-retinal fluid. He noted however that sub-retinal fluid ‘creeps back’ between injections resulting in an 8-week cycle of variation. He noted no significant ocular or systemic side-effects. Assoc Prof Tony Kwan (Queensland) reported that in new AMD cases (no previous antiVEGF exposure) Eylea decreased sub-retinal fluid and improved VA by about one line (early AMD implies VA loss not as severe – yet). In his experience (located in Queensland), Eylea’s 2-monthly regimen was more suited to those patients that have to travel long distances for treatment. Assoc Prof Nitin Verma’s (Tasmania) experiences matched those of his colleagues following three loading doses. He found that all patients appreciated the less frequent injections. Prof Paul Mitchell spoke about longer-term Eylea studies
Andrew Chang spanning 52 and 96 weeks using proactive and reactive criteria for injecting decisions. A reactive response was triggered by a decrease in VA, an increase in retinal thickness, or an increase in sub-retinal fluid all with the aim of preventing moderate losses of vision. That goal was achieved in 95% of cases at 52 weeks and 92% of cases by 96 weeks. Between those two times about one line of VA was lost. He concluded that tiny amounts of sub-retinal fluid as imaged by OCT may not be so important. In the VIEW series of studies (1&2) the safety of AMD treatments (Lucentis, Eylea) was assessed and any adverse events including falls, illness, colds, etc. were recorded. Serious adverse events were recorded in about 25% of all study groups. The death rate in Lucentis users was about 2.7% and was about 3% in Eylea users. Gastro-intestinal issues arose in about 2-3% of all patients. There was no statistical difference between groups for serious ocular adverse events although Lucents had a 0.8% endophthalmitis rate versus Eylea’s zero. The stroke rate was the same for both groups (0.8%). It is noteworthy that the European Medicines Agency’s data shows that in patients over 85 years of age, Eylea has a greater rate of cerebrovascular events (TIA, stroke, etc.) with Lucentis at 3.4% and Eylea 9.5%. Prof Mitchell raised some of his concerns about such data related to definitions of such events and he noted that
Hobart – Part 1.
attempts to ‘adjudicate’ the itemization produced anomalous death results, e.g. Eylea 2.5%, Lucentis zero when the background death rate at the ages involved is about 1.2% (e.g. UK: 1.2%, Denmark: 1%). In summary he noted most adverse events including death occurred in the first year of treatment, no dose-response relationship was established, and some problems were TIA-driven. As far as efficacy and safety were concerned he believed that the two treatments were similar, non-inferiority was established for Eylea, and after 52 weeks Eylea could be injected quarterly unless indications suggested otherwise. He also noted that while some patients had the same VA and their retinas had been ‘dried-out’ they were still unhappy with their remaining VA. His conclusion was we don’t know if treatment should be applied until the retina is ‘bone dry’ and some sub-foveal fluid may not be a disaster.
Update on glaucoma The scientific program proper commenced with Prof Kuldev Singh (Prof of Ophthalmology, Stanford University School of Medicine) giving an update on glaucoma. Prof Singh was one of four invited speaker for the congress. The other invited speakers were Prof BCK Patel (Prof & Chief of Ophthalmic Plastic and Facial Recontstructive and Cosmetic
Surgery, Moran Eye Center, University of Utah), Prof Joan Miller (Prof of Ophthalmology, Harvard Medical School), Dr David Chang (Clinical Prof of Ophthalmology, University of California, San Francisco). Prof Singh’s lecture sought to clarify some of the myths and misconceptions regarding glaucoma care. Presenting ‘the big picture’ he estimated that only 25 to 50% of people with glaucoma are aware of their condition, those that are aware are often not under care, and those under care are not compliant. He believes that that has been the case for much of modern history. Only a small percentage go blind. Despite all those issues, some patients do well while others do poorly, regardless of their circumstances and treatment, implying we still do not have all the answers. He discussed the AGIS (Advanced Glaucoma Intervention Study) funded by the National Eye Institute (NEI, USA). Treatments included two sequences: argon laser trabeculoplasty (ALT), then trabeculectomy, then trabeculectomy again (ATT sequence) or, trabeculectomy, then ALT, then trabeculectomy again (TAT sequence). The second and third steps were only performed if the first step of the sequence failed (criteria: IOP >18 mm [Hg pressure], magnitude of the field defect). If the IOP was <18 mm all the time the outcome was accepted as being good. In
fact the average IOP result was 12.3 mm. A century ago the magic number sought was 21 mm. Despite, or because of, all the results over the years Prof Singh still believes that glaucoma care is more art than science, a situation that probably sits uncomfortably with those that prefer a more rigorous basis to their clinical behaviour and decision making. Furthermore, he believes that glaucoma progression remains unpredictable. While the prevailing view regarding IOP is ‘the lower, the better’ he believes that the benefits may not be worth the risks implicit in the heavier-handed treatments required to pursue remaining but marginal reductions. To that end Prof Singh asserted that the target IOP approach to therapy is erroneous and the first myth to fall is that every mm of IOP lowering is beneficial. Supporting that assertion is the findings from a large (>44,000) Swedish study that uncovered 255 new POAG cases. The use of ALT or simply no treatment seemed to make little difference to the prognosis. While the study did show some benefits of treatment, little benefit was shown in relatively low pressure cases. While the AGIS study confirmed the current view that IOP variability is a risk factor for disease progression it failed to confirm whether it was a cause or an effect. A confounding factor is the ‘dynamic range’ of IOP which has
Paul Mitchell been shown to be dependent on the IOP itself. That means that a 5mm +/–20mm case is more serious than a 30mm +/–20mm case. Compounding the issues are the lack of good short-term studies of IOP variation and the infrequent measurements used for practical reasons in long-term studies. Despite poor compliance levels overall, patients with more serious disease are more likely to take their medications (perceived threat is greater?). However, patients with poor after-care or follow-up are more likely to have severe glaucoma. Surveillance of glaucoma patients was described by Prof Singh as ‘the elephant in the room’ because follow-up adherence and medication compliance were not the same (attend but not use). Equally, taking medication but not attending follow-up sessions was described as ‘dangerous’. When POAG and cataract occur in the same patient, cataract surgery alone is sufficient in 30-40% of cases to lower IOP to ‘safe’ levels. Phacoemulsification lowers IOP, has no adverse impact on any future ALT, and improves VA (successful cataract surgery and IOL implantation assumed). Where possible consider cataract surgery first but Prof Singh’s advice was not to make such a move the day before going on holidays or to a conference. In his view IOP variation was not a proven risk factor. Continued on page 36
CONFERENCES Continued from page 35
Council Lecture The Council Lecture for 2013 was delivered by Assoc Prof Julian Rait (University of Melbourne). Even the title was intriguing: Is patient experience the early warning system for patient safety? Prof Rait made the point that all manner and means of goods and services suppliers are now subject to public opinion via social media, rating sites, customer satisfaction agencies, and consumer organizations. He warned that medical practice was no exception and such means can result in the transformation of medicine and how it is practised. He named Facebook, YouTube, Twitter, Google +, and personal blogs as the most common forms of communication that have the power to teach, learn, communicate, work, play, and influence how people think. From a medical point-of-view people have unprecedented access to information on diseases, their treatment, and the practitioners catering for them. To compound the issue further he stated that people are no longer interested in simply rating a service, rather they want to tell their story – a double-edged sword. About 54% of patients now check their experience on-line after consulting their medical practitioner. Given the often misplaced belief in, and reliance on, what they read on-line, that means in effect that the practitioners ‘output’ is being double-checked. To some extent in response to that scenario, the MDA National (Australia’s main medical defence organization that aims to support, protect, and promote medical professionals) is moving from a ‘complaints’ culture to an ‘improvement’ culture. In line with that shift, Prof Rait counselled that practitioners should resist sidelining patient reviews and feedback and instead seek ways in which such information can lead to better clinical performance and outcomes. In his opinion, medical services are loosing touch with the public and increasingly, patients reject the ‘behind closed doors’ approach of yesteryear. Rather, they want feedback, they want great care, and view on-line sources as being independent and a useful way of harnessing the
‘wisdom of the crowd’. Quoting Dr Neil Bacon, a UK nephrologist who created IWantGreatCare.org in 2008, Prof Rait suggested the encouragement of patient feedback by giving a small card with the practice’s or practitioner’s web page URL on it. Furthermore, he suggested that receipt of such feedback be acknowledged in a brief (or automated) e-mail reply. Any follow-up necessitated by feedback should be responded to subsequently. Experience has shown that on-line reviews are, surprisingly to some, overwhelmingly positive (88% or more), about 6% are negative, and about 6% are neutral. There is some evidence that a positive patient experience and general satisfaction with the interaction is linked to better treatment outcomes. To counter that evidence is other information that suggests that those patients more satisfied with their interactions are more likely to take more medications, make more visits to their practitioner, experience more hospital stays, and die sooner. If adverse reviews are published a practitioner can: ask the author to take down/remove, ask hosting site to review, or forward a letter of demand/cease/desist. Prof Rait’s opinion was that softly, softly was often better. He also advised that traditional professionalism applies to on-line interactions and he noted that there were few legal cases available (precedents) to offer guidance. Regardless of the circumstances, statements that damage reputations must be avoided and confidentiality must never be broken. The use of photos must be directly related and relevant, require patient permission, and any subsequent usage, e.g. teaching purposes, requires additional permission specific to that purpose. He advised specifically to avoid the creation of an on-line relationship with past or present patients. His parting advice to practitioners was to develop their own websites and to create a YouTube presence.
Corneal clinic update One of the afternoon session was a Corneal Clinical Update chaired by Dr Michael Loughnan (Melbourne).
The first presenter was Dr Dermot Cassidy (Melbourne) who spoke about non-graft surgical treatment of keratoconus. Those include: corneal cross-linking, intrastromal rings, or both used in combination. Cross-linking was found to work well, provided a validated outcome, and a modest improvement in VA. The maximum K readings generally improved (flattened) by around 1D over the following 3 years and that resulted in about one and a half lines improvement in VA. The technique used is to monitor the changes in Ks before cross-linking is done and if too unstable the process is delayed. A minimum corneal thickness of 400 microns is required and the cornea must not be affected by herpes simplex keratitis, pregnancy, or active pathology, etc. Dr Cassidy noted that up to 90% of cross-linked corneas exhibit some form of haze postsurgically for 3-6 months. Sterile infiltrates are noted in the cornea in up to 7.6% of cases. Other methods of preparation are under investigation including accelerated cross-linking (more intense irradiation for shorter periods), transepithelial administration of riboflavin, and iontophoretic drive of riboflavin into the cornea. The use of intrastromal rings (Intacs and KeraRings) was detailed and the use of experimental hexagonal and elliptical ring cross-sections was mentioned. The rings can be used in pairs or singly depending on the condition and its severity. The insertion channels are being formed increasingly by a femtosecond laser but while the method does not affect the outcome overall it is considered to be safer. The use of intrastromal rings results in a VA improvement in about 50-70% of cases but the outcomes remain unpredictable. Usually, some 5–7D of corneal flattening can be achieved. However, in some 10–37% of cases, decreased VA may be experienced. Complications are usually uncommon and those that do arise are seldom serious (overall complication rate of about 5.7% was reported). The use of intrastromal rings requires a minimum corneal
thickness of about 450 microns and a clear central cornea. Poor predictability remains a problem and advanced keratoconus is unsuited to their use. There is limited long-term data on their use and no data shows that their use actually decreases progression of the original condition. Overall, the rings are better when used before crosslinking or in association with it. Dr Cassidy believes that corneal topography is essential to any preparation for intrastromal rings or cross-linking and the latter procedure is possible in those as young as 11 or 12.
Corneal transplants Dr Jacqui Beltz (a Tasmanian practising in Melbourne and no stranger to speaking engagements in Australia) detailed the use of lamellar corneal transplantation (LK or lamellar keratoplasty), an increasingly popular, albeit challenging technically, category of surgical techniques used to replaced diseased corneal tissue with a donor replacement. Despite the attraction of using a femtosecond laser to create an interface when dissecting the cornea surgically, the current devices result in a poor quality optical interface. Higher resolution devices targeting better interface quality are under development. LK for keratoconus usually involves removal of 200 microns or more of the anterior cornea leaving the eye as a closed system, i.e. DALK (deep anterior lamellar keratoplasty). DSEK/DSAEK (Descemet’s stripping [automated] endothelial keratoplasty) is the complement of DALK in that it is the posterior cornea that is replaced. Again the eye remains as a closed system unlike the more traditional PK (penetrating keratoplasty) in which a whole thickness tissue transplant occurs, i.e. ‘open sky’ surgery. Since about 2004, DSAEK has become regarded as the ‘gold standard’ for treatment of cases of endothelial decompensation. However, the technique is more difficult than the PK alternative and hyperopic shifts can occur. A more recent technique, DMEK (Descemet’s membrane endothelial keratoplasty), in which just Descemet’s membrane and its endothelium are transplanted has gained in popularity because of its
promise of better visual outcomes (hyperopic shift about 0.4 D) that are achieved sooner. At best only about 50% of PK cases achieve 6/12 or better vision. Detachment of donor tissue in DSEK/DSAEK cases is possible in which case a PK may be required. According to Dr Beltz, up to 33% of DSAEK cases result in 6/6 VA, with DMEK about 45% achieve 6/6, while about 49% of ultrathin DSAEK reach 6/6. The latter involves 2 micron ultramicrokeratome slices of tissue created for transplantation. Unfortunately, the detachment rate in DMEK is relatively high and up to 16% of donor tissue is lost from the eye bank system due to DMEK detachment/failure. Dr Con Petsoglou (Sydney) addressed the issues of corneal neovascularization briefly. He defined acute as occurring in under 6 months and chronic as over 6 months. The first line of care is to treat or eliminate the stimulus to the vascular proliferation on and in the cornea. Once the stimulus is taken care of he recommended 2-hourly treatment with a steroid, a treatment that should be tapered once the epithelium has healed. If the vessel ingression is >2 mm and no epithelial defect is apparent he suggested an antiproliferative agent be used. He recommended three monthly subconjunctival injections of Avastin into the most active quadrant of the anterior eye, but recommended against such an approach in frail patients. If the vascularization only involves a few old vessels a simple expedient is to perform a fine-needle cautery of them. On the subject of topical Avastin he admitted that there was little supporting evidence for its use and its availability was still an issue.
Complicated cataract cases Monday’s ‘Abbott Breakfast’ featuring Dr David Chang (San Francisco), Prof Paul Mitchell, and Dr Daniel Black (Queensland). Dr Chang discussed very frankly, in fact refreshingly so, his experiences and difficulties dealing with complicated cataract cases, e.g. crowded anterior chambers, brunescent crystalline lenses, and contact between iris and posterior cornea in angle-closure. A recurring threat was the combination of a thick lens and weak zonules that can lead to torn zonules. While the use of Healon EndoCoat or other viscoelastic to protect the corneal endothelium is considered routine, the use of a Malyugin ring (Dr Boris Malyugin, Russia) is less common. The Malyugin ring is a disposable plastic 4-corner anterior chamber device to dilate a small pupil mechanically. It is used during phacoemulsification and results in less tissue damage than that from the use of conventional iris retractors. Dr Chang also expressed a preference for using an MST Capsule Retractor while chopping lens nuclei. In his hands viscoelastic needs to be applied 2-3 times during surgery to ensure the endothelium is protected adequately. In his experience, corneal oedema post-surgically can last from 1 to 4 weeks. Prof Mitchell spoke about diabetic retinopathy (DR), proliferative DR and non-proliferative DR and diabetic macular oedema (often DME reflecting the US spelling of oedema). He noted that DR can still progress even when glycaemia and blood pressure are controlled adequately.
He then moved to the inclusion of fenofibrate (Lipidil by Abbott Laboratories – a cholesterol-lowering agent that lowers low-density and very low-density lipoproteins, raises high-density lipoproteins, and reduces triglycerides) to the treatment of DR. Fenofibrate is often used in conjunction with statins. When it was used in the ACCORD Lipid Trial (USA), fenofibrate decreased the progression of DR by 40%, a highly significant outcome according to Prof Mitchell. Interestingly, the beneficial effect was attributed to the use of fenofibrate per se and not any lowering of the low-density cholesterols. However, DR still progressed in 6.5% of fenofibrate users and 10.2% of the placebo group but the VA was not significantly different in either test or control groups. In a multi-country study the use of fenofibrate was shown to decrease the need for laser treatment by 31% over a 5-year period. Benefits from the use of fenofibrate can be measured in as little as 8 months and certainly before 1 year. Cumulative benefits show a 37% decrease overall but up to a 79% reduction has been ascertained in existing DR cases when fenofibrate was added to their treatment. Statins do not benefit DR cases. Lipidil is used at 145 mg per day. In response to a question about the mode of action, Prof Mitchell stated that fenofibrate works on the small blood vessels and thereby decreases peripheral neuropathy. The Australian TGA has not seen fit to approved the use of fenofibrate in Type 1 diabetes because there is currently no supporting evidence or literature. Dr Black gave an overview of the latest in IOLs with a focus on the TECNIS iTEC preloaded
IOL from Abbott Medical Optics (AMO). Despite the surgical skills required for, and demonstrated in, cataract surgery, Dr Black believes that ultimately the visual outcome of the procedure is still perceived as the yardstick of success. While complicating factors such as glaucoma and AMD can have effects on the visual outcome of cataract surgery he asserted that even great surgery can still be ‘undone’ by a poor choice of IOL type and the patient can still be unhappy with the end result. Because the overall ocular spherical aberrations (SAs) are usually positive, an IOL with some negative SA is usually beneficial to the resulting VA. Chromatic aberration from IOLs is also important and the TECNIS lens is designed to reduce that issue by about 12%. The use of a lower refractive index reduces the established problem of glistenings from the implanted IOL itself. Blue-blocking IOLs are no longer employed and Dr Black advised against the use of any visible spectrum light filtering IOLs. He also made a point that is all too often overlooked, poor tear film quality affects many biometric measurements made before surgery and always affects vision quality as well. He advised practitioners to ascertain those cases that require, or are likely to require, cataract surgery before a consultation so that biometry can be performed before any other procedures are carried out. The preloading of the TECNIS IOL means that there is no need to touch the optics of the lens, the infection rate and the incidence of TASS (toxic anterior segment syndrome) are reduced, and only a 2.4 mm incision into the eye is required. ■
2014 World Ophthalmology Congress in Tokyo in April
he 2014World Ophthalmology Congress, the ‘must attend’ global meeting in ophthalmology, will be held in Tokyo, Japan, on 2-6 April 2014. The WOC2014 is sponsored by the International Council of Ophthalmology and hosted by the Japanese Ophthalmological Society, and co-hosted by the AsiaPacific Academy of Ophthalmology. Bringing together the over 100
member societies of the ICO and ophthalmologists from around the world, the WOC2014 will feature world-renowned speakers and exhibits featuring companies displaying the newest products and services in the ophthalmic industry. The comprehensive scientific program will cover all subspecialties of ophthalmology, as well as advances in ophthalmic education and eye care.
The world-class congress is expected to at least match those in Abu Dhabi (2012), Berlin (2010), Hong Kong (2008), and Sao Paulo (2006). Tokyo is the vibrant capital of Japan. With over 12 million people in the official metropolitan area alone, it is the core of the mostpopulated urban area in the world, Greater Tokyo. This huge, wealthy, and fascinating metropolis brings
high-tech visions of the future side by side with glimpses of old Japan. Although still two months away, more than 6,500 ophthalmologists and 1,900 residents, medical students, allied healthcare personnel, and guests have registered for the 2014 World Ophthalmology Congress. There will be more than 90 courses, 590 accepted papers, 1,959 posters, and 128 videos. ■
Get set for Optrafair
n o d on
Put the 11th – 13th April 2014 in your diary now and register for Optrafair London.
Dedicated to the needs of the optical profession, Optrafair London will provide visitors access to the latest products and services, as well as ideas, networking opportunities and education to help further your career and build your business. So whatever your area of expertise, from optometrist to ophthalmologist, dispensing optician to practice owner, lab technician to receptionist. Optrafair London is the optical event you and your practice cannot afford to miss.
Everything and more from London’s most comprehensive optical show
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See over 350 brands exhibiting at Optrafair London
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Sunglass Hut flagship for Sydney
unglass Hut on 21 November opened its biggest and most innovative store, in George Street, Sydney. The Sydney flagship follows openings in New York, Miami, Los Angeles and London, featuring exclusive brands with specialised stylists trained on international fashion trends and face shaping to select the right sunglasses for Sydney’s fashionisti. Located at 413 George Street, the 300-square-metre store is the largest Sunglass Hut store globally, with over 1,400 pairs of sunglasses – the largest collection of sunglasses in Sunglass Hut Asia Pacific! It provides Sydney customers with large assortment of luxury, designer, lifestyle and performance sunglass brands, including international designer sunglasses such as Dolce & Gabbana and Prada and will house for the first time in Australia, New York fashion designer Tory Burch. As a monument to the Ray-Ban brand, a custom-made Ray-Ban lens chandelier has
Sunglass Hut’s flagship store in George Street, Sydney been created through the centre of the store, made from hundreds of recycled aviator lenses, highlighting that the store will have the largest assortment of Ray-Ban sunglasses in the Southern Hemisphere with over 364 unique models.
There are a ‘Luxury Room’ and a ‘Sports and Lifestyle Room’, the former containing an expanded brand assortment, including brands such as Bulgari, Burberry, Dolce & Gabbana, Giorgio Armani, Miu Miu, Persol, Prada, Versace and Vogue Eyewear. ■
Free movie screening at French Film Festival
o celebrate the launch of Crizal Prevencia – a lens that may reduce the risk of aged-related macular degeneration and cataract – Essilor is sponsoring the upcoming Alliance Française French Film Festival. Celebrating its 25th year, the Alliance Française French Film Festival is the biggest foreign film festival in Australia, along with being the largest celebration of French films outside of France. As part of its sponsorship, Essilor will be running a Crizal Prevencia cinema commercial
at each of the film sessions in all capital cities thereby allowing Essilor to reach a large audience with its Crizal Prevencia message. The commercial alerts the public of the dangers of UV to eyes, along with dangers of blue-violet light as a possible contributor to AMD. Cinema-goers are encouraged to visit their optometrist for further information about Crizal Prevencia. And eye-care practitioners in the Sydney, Melbourne and Brisbane areas have the opportunity to help Essilor celebrate the Crizal
Prevencia launch with free exclusive screenings of It Boy. It Boy is a funny and frothy film that is sure to appeal to lovers of fast-paced romantic comedies. The exclusive screenings are in Sydney (Palace Norton, Leichardt) on 25 February, Melbourne (Palace Como, South Yarra) on 12 March and Brisbane (Palace Barracks, Brisbane) on 13 March. RSVPs are essential. RSVPs open from 17 January at www.essilor-rsvp.com.au. Enquires: Eleonore at email@example.com or call (02) 9714 4576. ■
Sound system substitutes for visual images
device that substitutes sounds for visual images, with training, may be a useful way of enabling people with sight loss to perceive their surroundings. Sensory substitution devices
have been researched for many years and systems replacing visual stimuli with tactile or auditory stimuli have been of some benefit. A new device, the vOICe sensory stimulation device, encodes images taken by a camera worn by
the user into auditory ‘soundscape’, associating height to pitch and brightness with loudness in a leftto-right scan of any video frame. Views are refreshed about once per second, with a typical image resolution of up to 60x60 pixels.
Researchers at the University of Bath in England were able to show that users, even without training, could achieve up to 6/120 Snellen acuity. That compared favourably with the current expected acuities after stem cell implantation. ■
New lens technology launched with TV commercial and digital advertising
ransitions Optical has launched 2014 with the release of a brand-new lens technology, new campaign including new television commercial, digital advertising and practice point of sale designed to capture consumer attention throughout the year. The company’s marketing and retail services manager, Kerry Brock, on 13 January said there are great opportunities for practices to leverage to enhance their practice and patient experience. “We offer practices the chance to create greater patient satisfaction with our brandnew-generation product, Transitions Signature VII lenses, and for the first time promoted by our new television commercial currently airing on prime time television and popular free-toair channels,” Ms Brock said “With stunning creative, the commercial
features a new ‘Modes’ campaign theme, Transitions Signature lenses and highlights the new Chromea7 technology, which makes the lenses more responsive to UV in more situations. “Practices also have access to live wearer testing insights which will maximise the opportunity to convert clear lens wearers to the new lenses lenses and serve as proof points to recommend with confidence. “When tested, eight out of ten clear-lens wearers preferred the new lens over their regular clear lenses and 96 per cent of those tested were impressed with the indoor clarity. “Further, our research tells us that once you convert those wearers a huge 94 per cent will come back and get Transitions from you time and time again.” In 2013, Transitions Optical also launched
their first ever children’s vision screening program for 5-8 year olds in schools in Australia which will continue in 2014 including a national launch. ■
Join us to host
tHe woRLD’s B.i.g BReakFast during World Glaucoma Week 9 - 15 March, 2014 Let everyone know your event is ON – tell your family and neighbours, spread the word through social media and email your work colleagues. Raise much needed funds for community ‘Family History Awareness’, Glaucoma Australia’s telephone support line and eye health provider resource materials. With your assistance we can help save sight. Visit www.glaucoma.org.au/BIGbreakfast for a host pack and other information.
RegisteR now www.glaucoma.org.au/BIGbreakfast
Make tHe woRLD’s Big BReakFast a success www.insightnews.com.au
Perth reunion of 13 DipOpt(WA)- qual
s part of a history project to uncover the whole DipOpt(WA) story, a reunion of course graduates was held in the same University of Western Australia building that hosted some of the original courses offered – the School of Physics. The adjacent Geology Annex was also used during the course but it was not accessible on the day. A total of 13 graduates attended. The team pursuing the story consists of WA project coordinator and optometrist Mr Ian Sim (a University of New South Wales graduate) and Insight writer and photographer Dr Lewis Williams (a Queensland Institute of Technology and UNSW graduate). Quite some time ago WA optometrist Mr Gary Crerie started an oral history project with the same aims in mind. Several other graduates are participating in the history gathering but due to location (out of town, interstate, or overseas), health (some are in their 80s and 90s), or other reasons they were unable to attend on the day (Wednesday 4 December 2013). Some three or four are believed to be deceased and it was the passing of Mr Don Noack in 2012 and the preparation of his obituary for Insight that resurrected
the issue of the untold story of the diploma first heard from Mr Noack in late 1973. The Diploma in Optometry (WA) was run under the auspices of the Western Australian Optometrists Registration Board with significant help from the University of Western Australia. It ran as a three-year part-time course from an initial intake in 1947 (first diplomas conferred early 1951) until completion of its last course at the end of 1968 (last diploma conferred early 1969). The Dip Opt(WA) story is probably the greatest untold chapter in Australian optometric education and not a single word about it appears in History of Australian Optometry written by the late Adelaide optometrist Mr Charles Wright and published by the Australian Optometrical Association in 1988 as an Australia Bicentenary Project. From UWA records so willingly and professionally compiled by UWA archivists Ms Maria Caravalho and Ms Miriam Congdon and UWA records management officer Ms Christina Garnett, it appears that a total of 42 candidates at least started the course. At least 27 graduated, some changed academic strands before graduation, e.g.
dentistry, engineering, while others changed career after graduation, e.g. medicine and then ophthalmology, journalist/ media production/technology writer, business and later, charity management, and in the case of one of the first graduates, science teacher because of no interstate reciprocity in the 1950s. As a result of when the course was offered, no Dip Opt(WA)s are baby boomers (born 1946-1961 is a common definition). The UWA involvement was due largely to the personal interest and efforts of the professor of physics and mathematics at UWA, Prof Alexander David Ross (1913 to 1929, physics only 19291951 – life: 1883-1966). Fittingly, the reunion was in the foyer entrance to the Ross Lecture Theatre. As a result of his involvement, Prof Ross held a position on the registration board for many years, a position later reserved for his successors right up until the time the AHPRA/OBA assumed national registration responsibility in 2010. It may not be a coincidence that two of Australia’s most significant contact lens pioneers (Messrs Don Noack and Don Ezekiel) are graduates of the same course.
All the local planning and arrangements for the reunion and the gathering of the history by Mr Sim have been ably supported by Mr Tony Martella (CEO, OAA[WA]) and Ms Jude Martindale (Perth OAA office manager). Financial support for the exercise has been provided by the OAA(WA) and that generosity is gratefully acknowledged.
Bronze of former professor of physics and mathematics at UWA, Professor Alexander David Ross (1913 to 1929, physics only 19291951)
ified optometrists – 46 years on
Left to right: Roma Russell (Sec. to Karl Knapp – Digby’s father, Digby is third generation optometrist), Libby Knapp, Digby Knapp, Geoff Steer, Doug De Caux, Nick Humphry, John Kirkwood, Ike Raiter (ophthalmologist), Graham Fist, Noele Fist, Don Ezekiel, Peter Gillett, Geoff Shackleton, Walter Pigeon, Lloyd Owens, Barry Waddingham, Winthrop Prof Ian McArthur (head of school, School of Physics, UWA), Ian Sim history project co-ordinator (WA). (Photos: Lewis Williams, Montage: www.ellewilliams.com)
The Geology Annex at AWU was also used during the course, as well as the School of Physics
The process of writing a comprehensive story of optometric history in WA that spans the 1920s when the concept of a local diploma was first mooted, until the more recent attempts (1970s) to create interest in a university course locally, is now underway. One unresolved dilemma is where or how it should be published as it will be too large for any ophthalmic periodical. Those that attended the reunion included (see photo montage by ellewilliams.com – L to R): Ms Roma Russell (secretary to Mr
Karl Knapp father of Mr Digby Knapp [DK is a 3rd generation WA optometrist], Ms Libby Knapp, Mr Digby Knapp, Mr Geoff Steer, Mr Doug De Caux, Mr Nick Humphry, Mr John Kirkwood, Dr Ike Raiter (ophthalmologist), Mr Graham Fist, Ms Noele Fist, Mr Don Ezekiel, Mr Peter Gillett, Mr Geoff Shackleton, Mr Walter Pigeon, Mr Lloyd Owens, Mr Barry Waddingham, Winthrop Prof Ian McArthur (Head of School, School of Physics, UWA), Mr Ian Sim history project coordinator (WA). ■
Two OAAs in US explore joint-education opportunities
he American Academy of Ophthalmology and the American Academy of Optometry will collaborate on educational initiatives to prepare and support their members to serve a growing population of patients, Vision Monday reports. They will develop educational opportunities over the next 12 to 18 months with a formal launch in 2015. The two academies’ leaders said they believe that truly effective collaborative care requires www.insightnews.com.au
coordination of education and standards of care between the professions of optometry and ophthalmology. According to a statement from the two organisations, they are engaging with each other in an effort to foster a mutual approach to serving a growing population of patients in the United States who are expected to require eye-health services in the near future. The organisations cite both the aging Baby Boomer population and
health care reform as reasons for an expected significant increase in the number of Americans seeking eye care. “More and more ophthalmologists are practising with optometrists in the same point-of-care environment and are seeking information and models that will optimise the impact for patients,” Dr David Parke, MD, chief executive officer of the American Academy of Ophthalmology, said. “The better prepared our two
professions are and the more effectively they work together, the better care we will be able to provide for all patients. “The professions of optometry and ophthalmology complement each other in many ways,” Dr Bernard Dolan, OD, president of the American Academy of Optometry, said. “It is refreshing to embark on this cooperative initiative in the area of continuing education to improve patient care in a collegial environment of mutual respect.” ■ FEBRUARY 2014
Specsavers is ‘Official Eye-Care Partner’ for Australian Open
Specsavers’ Spec Man, optometrist David Southgate and Channel 7 chief commentator Jim Courier at the Australian Open
ne of the Big 4 Grand Slam tennis events, the Australian Open, takes place in often searing 40C heat. Centre stage (if not centre court) this year is the Specsavers brand as ‘Official Eye Care Partner’. As part of the two-week event, Specsavers is on hand to help players, tournament staff and officials, including the ballkids, optimise their vision and maximise their eye-health. Heralding the Australian Open/ Specsavers partnership, former
world No.1 and Seven Network tennis commentator Jim Courier had his eyes tested by David Southgate, optometry partner at Specsavers Collins Place, Melbourne. In a photocall with journalists on Day Two of the tournament, Jim underlined the importance of sharp vision for peak performance, especially when analysing complex matches from the commentary box. “It’s great to see Specsavers as the Official Eye Care partner of the Australian Open. Eye care is extremely important, especially on
The Specsavers and Australian Open logo bright and sunny days when it’s essential to protect your eyes with a pair of polarised lenses”. As a bonus, all 256 main draw Australian Open players have received a pair of polarised
sunglasses designed exclusively for Specsavers by Australian designer, Alex Perry, to provide the players with the necessary protection against the Australian summer sun. ■
Optometrist-only CL manufacturer returns to Australasian market T
he Australian and New Zealand contact lens market is set to see a new development with the availability of the world’s only silicone hydrogel daily disposable family of contact lenses from Sauflon. The award winning lenses enable practitioners to fit the healthiest material in the most convenient modalities in a range of correction types including spherical, toric and multifocal contact lenses. Alan Wells, founder of Sauflon, a privatelyowned company told Insight: “We believe we have a product and service offering ideally suited to the Australian and New Zealand market, allowing latest technology products to be delivered at an affordable price point to both the eye-care practitioner and the consumer, providing practitioners with an opportunity to protect and grow their contact lens business.” It is a tailored approach to each market that has seen Sauflon become the world’s fastest growing contact lens manufacturer and pioneers in daily silicone lenses, experiencing 20 percent year-on-year growth for the past four years and expanding to service the needs of over 50 countries globally. The backbone of this growth is attributed to being industry innovators, along with Sauflon’s steadfast ‘Optometrist Only’ policy that sets this company apart from its competitors. Mr Wells saw changes in the market place that meant practitioners were more often than not prescribing lenses to patients, but subsequently losing the repeat sales to non-optical stores and internet sites. He realised that if a company could couple business support with innovative products, the net benefit would be to grow the contact lens market in a positive and fruitful manner. Chris Harous, Sauflon’s Australian and New Zealand managing director, with over 40 years in
the contact lens industry, told Insight: “We feel strongly about supporting the optical retailers to help grow and protect their contact lens business. The truth is, in Australia, internet sales of contact lenses sit at around 40 percent and this is growing. What this means is that every time an optometrist fits a new patient with lenses, 40 percent of sales generated will go to the non-optical sector. With Sauflon products they are only available through eye-care practitioners meaning these customers will not be lost to non-optical suppliers, particularly online”. Sauflon’s major breakthrough in terms of product, came when Sauflon began manufacturing its state-of-the-art, third generation, silicone hydrogel lenses and more recently with the launch the Clariti 1day family of silicone hydrogel, daily disposable contact lenses. Having created the world’s first silicone hydrogel daily toric and multifocal lenses, it is clear that innovation is a key driver in both manufacturing and product delivery. Mr Wells breaks down the ultimate contact lens into the ‘3 Cs’: “A lens must deliver on comfort, convenience and cost. Sauflon’s strategy rests heavily on that mantra and the belief that silicone hydrogel, daily disposables are a critical area for growth in the market place.” This thought is echoed by Professor Nathan Efron, research professor at Queensland University, when he said at the recent Sauflon Centre of Innovation opening in Hungary: “The obvious future for contact lenses is that they will become daily disposable.” Hungary is the main base for Sauflon’s unique approach to manufacturing, adopting a cellular approach to the creation of in a state-of-the-art facility that allows for rapid expansion and a manufacturing capability
The manufacturing facility in Hungary has an almost limitless capacity for production www.insightnews.com.au
Sauflon uses patented manufacturing techniques that is virtually without boundaries. This modular concept is unique and the capability for rapid expansion is being put through its paces currently with David Wells, joint managing director adding: “In the second half of 2013, we secured a AUD$100 million investment to support our growth and to expand our manufacturing base. We are investing significantly to push our strategy forward through excellence in manufacturing processes, and the continued support of leading edge research and development. We are passionate and committed to providing our customers with contact lenses in the healthiest material and safest modality providing the best vision outcomes, all at an affordable price point: our patented manufacturing process enables us to achieve this.” The future is appears to be bright for this pioneering company in the Australian and New Zealand markets as Mr Harous surmises: “I am confident optometrists and their patients will embrace our contact lenses and aftercare products; particularly our Clariti 1day silicone hydrogel family of lenses. We have a market leading product portfolio as well as a strong pipeline. Additionally we have a new stateof-the-art warehouse and distribution centre based in Adelaide and are currently in the process of building a strong sales team to help support the needs of the ANZ market.” ■
Sauflon’s rapid expansion is being accelerated by a $100m investment FEBRUARY 2014
Business Briefs Luxottica buying try-on technology Luxottica Group SpA has entered into an asset purchase agreement to acquire Glasses.com from WellPoint Inc and its try-on technology. Glasses.com’s proprietary virtual try-on technology uses a three-dimensional image of the consumer’s face and enables the customer to see the frame in detail from multiple angles. It also allows customers to send frame options to friends and family for their input and opinion, leveraging social media tools. Use of the technology is available direct to customers via free iPhone and iPad apps. “Today we are announcing the agreement to acquire a technology which we believe will benefit the overall eyewear sector and the optical industry in North America, a crucial market for our group and one to which we remain strongly committed,” Mr Andrea Guerra, chief executive officer of Luxottica, said. The company’s statement added that Luxottica “will invest in innovations to create an enhanced online experience that will be accessible to independent practitioners in North America”. Mr Guerra said: “This acquisition will function as a starting point to shape an independent, digital platform through which the North American market can and will access the unique domain, innovating the shopping experience and improving the quality of products and services available to consumers.” Luxottica’s statement pointed out: “The eyewear industry in North America is estimated today to be a $35.5 billion market with the opportunity to grow to $44 billion to $47 billion by 2020, according to Vision Council and company estimates. “Demographic factors, such as an increase in the number of individuals needing vision correction products, the projected increase in eye exams each year, and the greater penetration of premium eyewear are all expected to drive continued growth.”
1-800 CONTACTS in US being sold to private equity firm WellPoint Inc has announced it has signed a definitive agreement to sell its online contact lens retail subsidiary 1-800 CONTACTS to private equity firm Thomas H Lee Partners. , as well as entering into an asset-purchase agreement for glasses.com and its virtual try-on technology with Luxottica, both for undisclosed amounts.
According to the WellPoint announcement, the company will focus on core growth opportunities across both commercial and government business segments. Proceeds from this transaction will support the continued capital deployment strategies. In connection with the sale agreements, WellPoint expected to record an impairment charge in the range of $0.52 to $0.57 per share in the fourth quarter of 2013. As a result, WellPoint now expects GAAP net income of at least $7.88 per share for the full year 2013. Excluding the impairment charge, WellPoint continues to expect adjusted net income of at least $8.40 per share for the full year 2013. That guidance includes no investment gains or losses beyond those recorded during the first nine months of 2013. Each agreement is subject to customary closing conditions and each transaction is expected to be finalised in the first quarter of this year.
VSP in US now launches program for insurance brokers to sell direct to consumers VSP Vision Care in the United States has launched a program that will allow insurance brokers to sell VSP’s individual plan directly to consumers. Authorised brokers can now sell VSP individual insurance plans through a website hosted by VSP that allows clients to self-enroll. While that is the same VSP individual plan using the current VSP network of providers on the Choice “this is the first time brokers are able to sell VSP Vision Care’s individual plan directly to consumers,” a VSP spokesperson told VMail. Previously, brokers could only sell the plan through employers or groups. “Our goal is to deliver a first-of-its-kind, turnkey program to brokers that helps them provide value to their clients, as well as ultimately increase consumers’ access to affordable vision care,” Ken Stellmacher, senior vice president and general manager of VSP Individual Plans, said. “Brokers can enhance their suite of offerings and increase commissions through this program, which we’ve made simple through our online hub. Individual agents can register to become authorised sellers of VSP individual vision insurance, which is offered to consumers for less than $16 a month. The individual and family plans include a fully covered eye examination with a $15 co-payment, a $120 to $150 allowance for frames or contacts, 20 per cent to 25 percent discounts on add-ons and extra pairs, a fully covered contact lens examination and fitting with no
co-payment, and specialty services to treat eye conditions such as conjunctivitis and diabetic retinopathy. VSP’s individual vision insurance program for brokers is available in all states except Florida, New York and Oregon, which will be eligible early this year.
US Patent Office affirms Ocuco challenge to Seiko lens patent The United States Patent Office has found that the request for re-examination of Seiko Epson’s patent 6,019,470 filed by Ocuco Inc on 21 May 2013 raises “a substantial new question of patentability”, and has recommended that all 20 claims in the patent be cancelled in a ‘NonFinal Office Action’ published in October. Also affected by the decision is Carl Zeiss, which has already been litigated, with the jury findings largely in its favour. The patent, issued to Seiko Epson on 1 February 2000, covers the invention of backsurface progressive lenses. It is one of the key patents for free-form progressive lens designs, and is the basis for the royalty that Seiko charges to optical laboratories that produce backsurface progressive lenses. “This is the next step in our effort to get Seiko’s patent canceled – our request for reexamination of the patent was granted, and now, upon re-examination, the patent office has found our arguments persuasive,” Robert Shanbaum, president of Ocuco, said. “The Office Action is ‘non-final’ and Seiko Epson now has an opportunity to respond to the examiner’s findings,” Mr Shanbaum said. Ocuco, which produces Innovations laboratory management software, filed a request for the re-examination in early October, wherein they raised what they claimed were “substantial new questions of patentability” on all of the claims in Zeiss’ patent. In this action, the Patent Office agreed that Ocuco raised such “substantial new questions” and so will proceed with a re-examination of the patent in light of the questions raised. Mr Shanbaum said: “If we succeed, it will mean significant savings for our customers, but this is only the first hurdle our re-examination request had to clear. We’ve submitted our arguments to the Patent Office and they’ve agreed to consider them. We’re certainly happy about that. Now it will be up to the Patent Office and the patentee to put the information we’ve raised to the test. If the Patent Office
agrees with our analysis, the ultimate outcome still may not be determined for a year, maybe even a little longer. ” “Until then,” Shanbaum continued, “I want to stress that Zeiss’ patent remains valid until the Patent Office says it’s not, and Zeiss continues to be entitled to collect royalties from firms that practice their patent.” Last May, Ocuco filed a similar re-examination request on Seiko Epson’s patent 6,019,470, which like Zeiss’, claims the invention of broad classes of freeform progressive lenses. The Patent Office recently issued a Non-Final Office Action in which it found that Seiko Epson’s patent should be cancelled in its entirety.
Marcolin finlaises takeover of Viva International Italy’s Marcolin SpA, through its affiliates Marcolin USA and HVHC Inc, has announced it has finalised the acquisition of Viva International. “We are very pleased to announce the closing of the acquisition of Viva International,” Mr Giovanni Zoppas, chief executive officer of Marcolin, said. “The complementing of the brand portfolios, the balance between male/female, optical/sun segments and geographical end market areas are strategic key factors brought to the acquisition. The combination of Marcolin and Viva creates a leader of primary importance in the global eyewear industry.” According to the companies, Viva International sold 8.5 million frames in 2012, recorded $190 million in sales and includes a network of more than 160 agents in the American market. The portfolio of brands under licence includes: Guess, Guess by Marciano, Gant, Harley Davidson and other brands specifically dedicated to the United States market. In 2012, Marcolin sold about 5.5 million eyeglasses with over 700 models. Its portfolio of brands under license includes: Tom Ford, Balenciaga, Montblanc, Roberto Cavalli, Tod’s, Swarovski, DSquared2, Diesel, 55DSL, Just Cavalli, Cover Girl, Kenneth Cole New York, Kenneth Cole
Reaction and Timberland. The company’s own brands include Marcolin, National and Web.
Warby Parker raises another $60 million in Saeries C funding New York-basead optical retailer Warby Parker has received an additional $US60 million in Series C funding, led by its biggest current investor, Tiger Global Management. The company has raised a total of $115 million to date. The $60 million round is on top of the $55 million that the eyewear company received via its three previous rounds combined in prior years. In this latest round, Tiger Global Management was joined by other existing Warby Parker investors General Catalyst Partners, Spark Capital, Thrive Capital and First Round Capital. A spokesperson said the company plans to use the funding to reinforce its investments in technology, including doubling the size of its technical team, retail and customer service. In addition to special eyewear collaborations, Warby Parker moved further into the brick-and-mortar realm over the past year, opening stores in New York and Boston along with its presence in The Standard Hotel in Los Angeles, its ‘showrooms’ in Philadelphia, Oklahoma City, Chicago, Miami Beach, Charleston, Nashville and Richmond, Virginia, as well as its Warby Parker Class Trip Bus Tour which hit several cities around the US.
European online retailer secures £8 million in funding MyOptique Group Ltd, one of Europe’s leading online optical retailers selling prescription glasses (Glasses Direct and MyOptique), sunglasses (Sunglasses Shop) and contact lenses (LensOn) has secured £8 million ($14.6 million) in investment and appointed a new chairman to bolster its aggressive international expansion plans. The round was led by existing investors Acton Capital Partners, Highland Capital Partners and Index Ventures, who were joined by new investors Cipio Partners and GP Bullhound Sidecar, and will be used to fund both further growth and
potential acquisitions, the company said. Joining MyOptique Group as chairman is Maurice Helfgott, founder and chairman of Amery Capital, the leading advisor and investor company to digital, retail and consumer businesses, current senior independent non-executive director of LSE-listed Moss Bros and former Marks & Spencer main board executive director. MyOptique’s former director and chairman, Jamie Murray Wells, has stepped away from those roles, following the sale of the majority of his shares to Cipio Partners.
Optometrists and VSP form joint-venture partnerships in Canada FYidoctors, a private, optometry-owned eye-care provider based in Calgary, Alberta, with more than 400 optometrists at 212 locations throughout Canada, has formed a 50/50 joint-venture partnership with VSP Vision Care Canada to provide an eye-care benefit plan in Canada. VSP will market, sell and administer its vision-care-insurance platform to employers across Canada. Covered employees will then be able to access eye care from FYidoctors’ network of optometrists as well as its Vision Source Canada franchise locations. FYidoctors purchased Vision Source’s Canadian assets and operations last October. “FYidoctors and Vision Source optometrists will be invited to be on the panel, and other optometrists may be eligible for the panel as well, based on pre-established criteria,” Dr Alan Ulsifer, OD, founder and chief executive officer of FYidoctors is reported as telling VMail. “Optometrists outside of FYidoctors and Vision Source will be able to join the panel if they meet specific criteria,” Dr Ulsifer said. Currently, approximately 270 optometrists service 108 FYidoctors locations, and about 160 ODs serve 104 Vision Source Canada franchise locations, according to Dr Ulsifer. FYidoctors also operates its own free-form laboratory and distribution facility in Burnaby, British Columbia. ■
Cardiff looks to space with AMD instrument
n optometry department in the United Kingdom has combined with space engineers to develop an instrument to detect the early stages of age-related macular degeneration. Scientists at Cardiff University’s School of Optometry and Vision Sciences joined forces with engineers at the UK Astronomy Technology Centre (UK ATC) to create a retinal densitometer. Dr Tom Margrain, leading the department’s research alongside Dr Alison Binns, said: “One of the earliest signs of AMD is a
change in the way the light sensitive pigments in the macula regenerate after exposure to light. Working alongside engineers more used to designing state of the art instruments for ground and space technology, we’ve been able to develop the densitometer, which can assess this change by measuring, over time, the very small changes in the amount of light reflected by the retina after exposure to light.” The instrument measures the way the eye ‘dark adapts’ after exposure to a bright light, and is said to have increased sensitivity and
ability to measure responses to light from different parts of the retina. Tests on early stage AMD patients and controls showed the light changes on the macula could be accurately measured using the densitometer, which distinguished between the affected and non-affected groups. Dr Dave Melotte, innovation manager at the UK ATC, said: “Astronomy technology and vision science might seem poles apart but put the right experts together and they are able to achieve things that would be impossible by either group in isolation.” ■
Practice Dollars – By Karen Crouch*
New Year – Time for Reflection and Resolutions
very happy New Year and a prosperous 2014 to all readers. We trust you survived an eventful, safe holiday season and are in full recovery mode for yet another exciting year ahead. The beginning of a new year usually triggers some navel gazing, personal reflections on events of the past 12 months and formulation of new resolutions in preparation for the year ahead. Naturally, resolutions are aimed at improvements on the previous year’s lesser achievements and better performance for the upcoming year. The same ‘self-audit’ process is also relevant for health practices. While individuals’ plans and resolutions may be amended ‘on the fly’, business plans generally require deeper planning and more time to affect changes. Practices, like other businesses, are comprised of a few essential factors which operate in tandem and direct relationship to
each other, such as: • plans/goals (financial, non- financial, clinical, strategic) • administrative (client service) • personnel (employees, owners). The most obvious component that deserves attention at this mid-point of the financial year is a half-yearly review of progress to date, and more particularly, achievements to targets or budgets. You should construct a snapshot of progress to the end of the calendar year, reflecting not only performance to date, but also trends indicated by the past 6 months actuals. For example, does performance to date suggest year-end targets will be met/ exceeded by end of June 2014? If not, what changes are required (the New Year resolution) to ensure year-end targets are met? Of course, not all targets are financial in nature. For example, did client surveys, if conducted,
reflect the targeted level of satisfaction with service, clinical and administrative? Has the efficiency/speed of pre- and post-consultation client service improved? On the clinical front, have there been notable changes to government regulations that may require rewriting policy and procedure manuals? Do technological advances adopted by other practices deserve investigating to defend the practice’s competitive position? On the subject of business development, marketing plans deserve review. Analysis is required of how many sales conversions you achieved from various paid marketing initiatives last year to ensure only productive marketing avenues are pursued. And, of course, the need to maintain close ties with all referral sources is a matter for serious consideration. While practice ‘business’ usually receives most attention in mid-year reviews, the practice’s
most important resource, personnel, must not be overlooked. So, is it time to consider whether an effective Staff Appraisal system is in place and well planned to occur during the upcoming months? Is the appraisal program well documented and performance reviews planned? And, as the current financial year’s Business Plan is reviewed, attention should also be given to the practice’s longer term Strategic Plan. Does it also need tweaking and is it still achievable? ■
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 (02) 9439 3993; email firstname.lastname@example.org or www.hpcgroup.com.au.
24,000 attend Munich trade fair
here were over 24,000 visitors from more than 80 countries at the Opti trade show in Munich, Gaermany, held on 10-12 January at the Fairground Messe Munchen, Vision Monday reports. More than 500 exhibitors from 34 countries showed their products and collections in four soldout halls. In 2013, organisers reported 23,200 industry professionals from 70 countries attended the show and 491 exhibitors participated.
According to organisers, the trade show, which takes place annually in January, is the ideal start for the industry. “Concentrated, compact, efficient and friendly,” is how Dieter Dohr, chairman of the management board of the GHM Gesellschaft fur Handwerksmessen mbH, described Opti. “In Munich, the most trendy companies from all sections of the optical industry exhibit, from frames to lenses and contact lenses to technical equipment, low
vision, shop fittings and shop design,” Mr Dohr said. Ninety-four per cent of all visitors rated Opti as good or very good and gave organisers top grades. Additionally, 90 per cent of visitors said the search for novelties, or new products, was a priority for them this time and they found what they were looking for; many exhibitors used the opportunity to present their new collections and product innovations in the sections of design and technology.
For Mr Dohr, the increasing number of exhibitors, as well as visitors, is “a clear statement in favor of Opti and a clear vote for its date right at the beginning of the year.” Organisers said the Saturday was the best-visited day, followed by Friday, which also saw an increase in its number of visitors. The next Opti takes place 8-10 January 2015, a move from Thursday to Saturday, at the Fairground Messe Munchen. ■
PBS cost $1bn less in year to November P
BS spending and scripts processed declined again in November compared to the same period last year with the number of scripts
processed now showing nine months of successive falls and spending almost $1bn below the previous 12 months. ■
Phone: 0425 532 888 Email: email@example.com
Smartphone adaptor on slit lamp (Fits all sizes) • Save your photo or video during eye examination directly on to your phone Usually $399 • Extra software or hardware Now only not required
Order at www.opticoptik.com
Optical Dispenser/ Assistant
The position involves most aspects of practice management, dispensing quality frames and lenses, and sunglass sales. Ideally you’ll have a passion for fashion and design. Woollahra is a great place to work, and our patients are a pleasure to deal with. Trainee dispensers and orthoptists are welcome to apply, as positive attitude is just as important as qualifications and experience. Please call Richard Banks on 02 9328 2842, or email your resume/ CV to firstname.lastname@example.org.
Central Coast NSW - Rare Opportunity
Busy, well established Central Coast practice for sale. Independent full scope practice established over 8 years, only 45 mins easy drive from Sydney. Located in prime position in busy shopping centre. Centre is anchored by Woolworths, Coles, KMart and Aldi. Customer traffic in the centre is 4.8 million p.a. Modern fit-out, recently upgraded. Practice has good reputation in the area. Would suit new grad optometrist or optical dispenser. For further information please email email@example.com
Optical Mechanic/Dispenser Calamvale, Southside Brisbane
National Pharmacies Optical is an integral part of National Pharmacies, providing our members with personalised, quality optical services through our branches located across metropolitan Adelaide.
A full-time position for an optical dispenser/assistant in my boutique practice has just become available. Established for 14 years, we have built a reputation for supplying fashionable, quality frames and sunglasses, and pride ourselves on providing personalised service.
Practice for Sale
Positions Vacant Careers in Metropolitan Adelaide
Woollahra, Sydney Inner Eastern Suburbs
National Pharmacies offer: • Career opportunities in Optical Dispensing: blending your eye for style with your technical knowhow. • The opportunity to study on the job to gain a qualification in Optical Dispensing • Various positions available for experienced Optical Dispensers including trainee positions across metropolitan Adelaide. If you are seeking a challenging, satisfying career then visit our website at www.nationalpharmacies.com.au and click on “CAREERS” to view the available positions and to apply.
Optical Express is seeking an Optical Mechanic / Dispenser for our busy store. The position may be full time or part time. We are looking for a vibrant personality with exceptional customer service. Must be able to work some Thursday nights and Saturdays. Contact Max by email firstname.lastname@example.org
Representatives – all states
NEC is an optical Safety glasses and Sport glasses company winning the ABC Show the New Inventors in 2011. We are searching for Representatives in all States to promote our award winning IC Safety and IC Sport System to Optometrists and Corporate Industries. An ideal little line to compliment your collection with 20 % commission paid. Please call Andy 0415 348 096 or 07 3885 2634
Retail Assistant, Sydney Northern Beaches
We are looking for a Retail Assistant from April until June to cover an important staff member’s extended leave period. The position is three – four days per week. For enquires please call 02 9999 4756 or simply email your CV to email@example.com
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.
Sauflon Australian Territory Managers Sauflon is the fastest growing contact lens manufacturer in the world, manufacturing the widest range of contact lens care products in today’s market. Sauflon manufactures an extensive range of contact lenses including the latest generation silicone hydrogel lenses, available in daily disposable and reusable modalities. The clariti® family of lenses is positioned to help Eye Care Professionals provide the healthiest and most comfortable lenses to all of their patients in spherical, toric and multifocal designs. We are initially seeking applicants for positions in NSW and QLD with further opportunities available in each state as we move forward. The positions would suit an optical dispenser / assistant or receptionist wanting to take a bold new step in their career or current optical sales reps. Specifically, we are seeking applicants with a proven track record in sales, are highly motivated, able to work autonomously, have good computer literacy, strong administrative abilities, highly effective communication skills, and a great attitude. So if you are a confident team player with a strong sales focus and hold a current Australian driver’s license we want to hear from you! This is a fantastic opportunity for any experienced optical sales person to step up into a role that will provide accountability and front line sales management exposure. A generous salary package and ongoing training and support will be offered to the successful candidates. Applications, including your CV and cover letter outlining your skills and experience to firstname.lastname@example.org. au , all applications are treated in the strictest confidence and only those considered will be notified.
Please phone 0401 693 253
ERE we go for 2014, after everybody, hopefully, had an opportunity to rest up and get ready for what could be a watershed year as far as interprofessional relations are concerned. Probably the biggest event will be when the Queensland Supreme Court sets about deciding who is right in the dispute between the Australian Society of Ophthalmologists and The Royal Australian College of Ophthalmologists on one hand and the Optometry Board of Australia and the Australian Health Practitioner Regulation Authority on the other over diagnosis and treatment of glaucoma. It’s 1-0 to date in favour of the ASO and RANZCO, following that court’s decision of 19 December that those two organisations had legal ‘standing’ in the matter. With the matter of standing settled, the court will now hear the case brought by ASO and RANZCO against the OBA and AHPRA, probably in mid-year. That should be a hardfought battle between the two sides, with future relations between ophthalmology and optometry at stake. It may not be a pleasant sight, but perhaps sanity will prevail. Oh yes, it is expected the court hearing in May or June will take five days.
P for grabs is the position of accredited provider of CPD services to optometrists outsourced by the Optometry Board of Australia, currently held by Optometrists Association Australia. OAA has been the CPD-services provider ever since the OBA introduced mandatory CPD and should be the favourite for winning the contract and reappointment (tender applications were called to be made by late November). However a close contender could be the Australian College of Optometry, which could get the nod in the event of a boilover. After all, it is seriously in the education business and, desirably, keeps out of political matters. Were that to happen, OAA would be hit financially as it (national body and state and territory divisions) would have to pay ACO for CPD services, which it obviously has not had to do to date. It should be decided one way or another before long.
COMMENT on OAA membership: About 3 per cent of OAA floor members have dropped out recently, probably largely due to
the availability of alternative sources of professional-indemnity insurance cover. In itself, that may not be such a big deal (for the moment at least) but if it continues, then OAA has a major problem. With a membership of 4,000-plus, the 3 per cent drop out rate represents about 120 members, which in turn represents approaching $24,000 in lost annual-membership-fee income for OAA. If that 120 largely reflects the drop-out rate by corporate employees, franchisees or joint-venture partners where PI cover is now available, then imagine if it were to become a similar rate across the OAA floor membership at large. That would be a financial calamity for OAA – to the tune of millions of dollars. It may well be the time for OAA to consider its position, particularly its determination not to reveal to members exactly how much of their annual membership fees go to PI insurance cover and how much goes to its other activities. Then the floor members could judge if they are receiving value for their annual membership fees. And as an aside, whoever is providing OAA’s insurance cover must be onto a very good thing. After all, how many successful claims have there been over the years and for how much versus premiums paid over the same period? Perhaps a floor member or two might like to ask.
No matter what it’s called, it costs the people plenty!
NE of the Credlin-Murdoch-Abbott federal government’s pre-election promises was a very clear commitment to not make any cuts to health during its first term of office. It may have even been written in Tony Abbott’s blood. However one of the early moves it is promoting through its various mouthpieces is to introduce a $6 charge to see a GP, with some exemptions. Ah, but it’s not a cut, goes the argument, it’s just a charge. Get the difference? It’s so blatant a back-down on the pre-election commitment that health minister Peter ‘Plod’ Dutton won’t even make comment, not that he seems to ever want to do, and not even though it gives him an opportunity to make the by-now tiresome claim that everything is the former government’s fault. Brings to mind ‘Honest John’ Howard’s claim that the Medicare levy is not a tax. It may well be called a levy, but a tax it surely is.
F Medicare is in such a state as claimed by ‘Plod’, then one way to fix it is simple: jack up the Medicare levy, rather than fiddle around with a $6 charge to see a GP, with the attendant huge administrative costs for all involved. Surely the best way to make savings in the health sector is to abolish the private health insurance rebate of 30 per cent on membership premiums, which would save the health budget about $3 billion a year, compared to the estimated $750,000 in savings over four years through reducing “avoidable” GP visits generated by the $6-charge proposal. The 30-per-cent rebate has soared from costing $1.4 billion in 1999-2000 to $5.5 billion in 2012-13, which makes it an “unsustainable” cost that ‘Plod’ and his boss, Prime Minister Tony Abbott, keep going on about. But behind it all could it be that there’s a long-held view of the Liberal-National coalition that Medibank Private (the biggest private health fund in Australia) should be sold off, no doubt to their mates. And what would ‘the mates’ like? Health funds, including Medibank Private, to be doing huge business, thanks in good part to retaining the 30-per-cent rebate on healthinsurance premiums. Fattening the cow in readiness for a sale, you might say. HE granting several years ago to nonmedical practitioners and non-PhD holders the right to use the title ‘Doctor’, followed by an appropriate description of what the user actually is and/or does, has been interesting to watch, particularly who has such a sufficiently large ego as to actually take up the title. A reader with both feet on the ground recently summed up the reality of it all to your humble scribe: “They’re doctors if the can sign a death certificate; if they can’t they aren’t!”
N mid-December, Insight and presumably other media outlets received a press release from the Brien Holden Vision Institute announcing a new software product that provides a refraction student with a realistic experience of using a virtual refractor head to establish the subjective refraction (selected randomly by the program) of a virtual patient, i.e. an on-screen simulation of a normal clinical situation. www.insightnews.com.au
Imagine the surprise and anger felt by those who have years of experience with the basis of the product to realise that the creator/ author/programmer of the product was not acknowledged anywhere. The release barely tells the last 25 per cent of the story surrounding the Virtual Refractor as the product has been known for many years. The first 75 per cent spans more than 20 years of Dr Jack Alexander’s life while he was a full-time academic in the School of Optometry and Vision Science (UNSW) and its earlier incarnations. The product started life on an Amiga computer, progressed to an Apple Mac version and, for about the last 14 years, has existed as a Windows version. The missing 75 per cent of the story will be the subject of a future Insight article. Dr Alexander also created virtual retinoscopy and other clinically-relevant programs but they have been lost as computer platforms evolved. The Alexander Virtual Refractor has no serious competition although a few attempts have been made over the years, none in Australia. So much for the intellectual-property focus of the BHVI.
ARLY this year, Mrs Pluvius decided to have her prescription dispensed in a topbrand frame she had noticed a few days prior in a majors retail group’s flagship store. Entering the store, she looked at the brand-name’s section and could not see the frame she had fancied. A staff member came to her aid, rummaging through the stock shelves and boxes before advising that they had the frame in black but not in the tortoise she wanted. That was that, with no attempt to see if another store within the group had the tortoise frame in stock; not even an offer to advise when stock of the frame came in; no effort at
all to not lose a potential client. If that’s how the big guys operate, then there’s plenty of room for independents to do them like a dinner – big time!
HE 45th Scientific Congress of The Royal Australian and New Zealand College of Ophthalmologists in Hobart in November was officially opened by the vice-chancellor of the University of Tasmania, Professor Peter Rathjen, which is about as high as you can go in the academic hierarchy. But he was outranked by the official opening of the Orthoptics Australia Annual Scientific Conference held in Hobart at the same time as the RANZCO congress – no less than Mr Peter Underwood, former chief justice and now Governor of Tasmania doing the honours!
UNNY how fashion changes over the years. For decades manufacturers of all shapes and sizes sought ways to produce frames with concealed joints (or hinges as some called them), so as to do away with either riveted pins or trims. The answer ended up being high-frequency sound waves with a little heat thrown in for good measure. Now it’s the reverse: simple riveted pins are well and truly back in fashion. And they look smart too.
AVE you noticed how any cover-up of something that is embarrassing to governments is now subject to “national security” or “national interest”? It used to be “commercial in confidence”, but now it’s “national security” or “national interest” and, therefore, no comment can be made, our fearless leaders are now telling us. How convenient. It usually just means there’s a cover-up in play.
OON after the federal election, it seemed as though former RANZCO president Bill Glasson would probably shoo-in the by-election for former prime minister Kevin Rudd’s seat of Griffith in Queensland, whenever it was held. Now it seems nowhere near as likely as it seemed post-7-September, as the electorate, if the polls are correct, is already turning up its nose at the new federal government. We’ll all know on 8 February.
hat’s intriguing is why some suppliers insist on showing their prices to practitioners in certain trade-publication advertisements. The latest example is tinted prescription lenses for sunglasses at $14 a pair. Worse, it could be single-vision prescription lenses at $1 each, as was irresponsibly advertised in a publication not so long ago. Crazy; just the sort of thing to wreck the efforts of independent practitioners as they seek to maintain reasonable prices.
HE Australian Tax Office is considering letting big corporations oversee their own tax returns, rather than the ATO. The idea is to allow companies to use their own accountants to sign off on their tax bills. What about the dangers of conflicts of interest, greed or even intimidation corrupting the process? Some of the captains of industry just won’t be able to resist temptation; imagine the rorting that will go on! There’s already plenty, such as Google, but there’ll be plenty more.
umb office words and sayings that send people crazy: Going forward, To ‘action’ something, Touch base, Reach out, Circle back, Blue-sky thinking, Brainstorm, Thought showers, Take something offline, Low hanging fruit, Get the ball rolling, Drill down. Aaaaaaagggh!
Revisit all the moments that have defined the ophthalmic professions and industry in the past 38 years! This issue marks a major milestone for INSIGHT – it is the 400th issue. To mark this moment, INSIGHT has produced a special online 400th issue that revisits all the significant news that has shaped the profession and industry over the past 38 years. Take a journey down memory lane by visiting the INSIGHT website to read this special online edition.
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