COOKIE Issue 09: The ebook version (The 'East Goes West' Issue)

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THE WORLD’S FIRST FUNKY OPTOMETRY MAGAZINE

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THE 'EAST GOES WEST' ISSUE

November 2022

cookiemagazine.org

How Asian eye care professionals and innovations are revolutionizing the world of optometry

The Asia Optometric Congress returns in full swing this year!

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LETTER TO READERS

From East to West Carving out a niche in the optometry industry

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ptometry, as a science and profession, has been greatly enriched by the contribution of Asian academics and practitioners. Going back — way back — in time, historians noted that the Chinese had a rudimentary knowledge of lens-making dating back many centuries. Undoubtedly, this tradition of research and innovation in vision care continues to the present. Dr. Pauline Cho of the Polytechnic University in Hong Kong has been a trailblazer in orthokeratology. Her colleague, Dr. Carly Lam, is credited with developing the Defocus Incorporated Multiple Segment (DIMS) lenses, which have been proven effective in myopia control. In Japan, ophthalmic equipment makers, such as Topcon, SHIN-NIPPON, Nikon, and INAMI, to name a few, are considered leaders in the field. Their equipment are used worldwide for the accurate diagnosis and management of myopia. Dr. Shinobu Ishihara, a Japanese ophthalmologist and army surgeon, invented the Ishihara color vision test to help detect color blindness. His design, which he first published in 1917, is one of the most widely used color blindness tests worldwide to this day. It is also worth noting that the first International Optometrist of the Year awardee was from the Philippines, Dr. Claro M. Cinco. He was recognized in 1988 by the World Council of Optometry (WCO) for his outstanding contribution to the development of optometry not only in the Philippines but also in the Asia Pacific region and the world. As I’m writing this, I am on my way to San Diego, California, to attend the American Academy of Optometry Meeting where I am slated to be recognized for my service with the WCO.

of Directors of the Asia Pacific Council of Optometry (APCO) as Treasurer from 2017 to 2019. APCO appointed me as a member of the World Council of Optometry Legislation, Regulation and Standards (LRS), Committee, and I was part of the WCO team that contributed to a project that put together the LRS toolkit. This toolkit is the culmination of an ongoing effort by our dedicated WCO volunteers over the years. This will serve as a resource to guide optometrists in their respective countries to develop professional associations and a legislative professional framework and expand their regulation and scope of practice. Those interested in utilizing the toolkit may contact the WCO Office at enquiries@worldoptometry.org. I am happy and humbled to be accepting this award, representing the many ODs from Asia who continue to make optometry a dynamic global discipline. With that said, for this issue, we recognize the many contributions of the East to the world of optometry. From the not-so-simple eye chart to the innovative pen-shaped camera for glaucoma testing, as well as the many brilliant Asian optometrists who have made a difference in optometry — we have certainly carved our niche in the industry globally. As always, we hope you enjoy this issue!

Best, Carmen Abesamis-Dichoso OD, MAT, FIACLE, FPCO, FAAO

I was given an opportunity to serve on the Board

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IN THIS ISSUE...

Optics

Cool Optometry Matt Young

CEO & Publisher

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Bespectacled Gamers… Get ready to ditch your glasses!

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A Peek Into the Humble Eye Chart From Dr. Snellen’s fundamental groundwork in the West to Prof. Miao’s SLVA charts in the East

Hannah Nguyen COO & CFO

Gloria D. Gamat Chief Editor

Brooke Herron Mapet Poso Editors

Maricel Salvador Graphic Designer Writers

Andrew Sweeney Joanna Lee Hazlin Hassan Nick Eustice Tan Sher Lynn

Kudos

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Back with a New Vision The Asia Optometric Congress returns in full swing this year!

Industry Focus: AAOS Connecting Asian optometrists in America

Cover Story

Customer Care

Ruchi Ranga

International Business Development

Brandon Winkeler Robert Anderson Adam Angrisanio

Published by

Media MICE Pte. Ltd. 6001 Beach Road, #09-09 Golden Mile Tower, Singapore 199589 Tel: +65 8186 7677 Email: enquiry@mediamice.com www.mediaMICE.com

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Innovation Penned in the East Revisiting GonioPEN, Asia’s best tool yet against glaucoma

Enlightenment

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Asian Fit Eyewear A guide to finding the right frames for the Asian face

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Moving Your Practice from East to West? Check education standards and have a plan

Society Friend

He Eye Specialist Hospital

We are looking for eye doctors who can contribute articles to COOKIE magazine. Interested? Let's talk! Send us an email at editor@mediamice.com.

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To place an advertisement,| advertorial, N o v e m bsymposium e r 2 0 2 2 highlight, video, email blast, or other promotion in COOKIE magazine contact sales@mediamice.com.


ADVISORY BOARD MEMBERS

Dr. Carmen Abesamis-Dichoso OD, MAT, FPCO, FIACLE, FAAO

Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. AbesamisDichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. She was awarded Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, Dr. Abesamis-Dichoso serves as the International Affairs Committee chair of the Optometric Association of the Philippines; director of the Special Olympics Opening Eyes in the Philippines; program manager of Optometric Association of the Philippines Vision Screening

Program and provision of eyeglasses with the United Nations Development Program in 10 areas and four Regions in the Philippines; and chairperson of the Special Olympics Healthy Athletes Program in the Philippines. Dr. Abesamis-Dichoso is a fellow of the American Academy of Optometry; a founding fellow at the Philippine College of Optometrists; a fellow of the International Association of Contact Lens Educators; an Asia-Pacific Regional advisor for the Special Olympics Opening Eyes; treasurer at the Asia-Pacific Council of Optometry; and is an AsiaPacific Council of Optometry (APCO) representative for the World Council of Optometry, in addition to being a member of the Legislation, Registration and Standards Committee. She has also authored numerous published papers and is a popular lecturer at industry meetings. carmen.dichoso@gmail.com

Dr. Joseph J. Allen is a practicing optometrist in Minnesota (USA) and the founder of Doctor Eye Health – an educational YouTube channel with more than 640K subscribers. In that channel he provides information about eye health, ocular disease and vision products. His videos cover a range of topics that his subscribers frequently ask about: eye floaters, glaucoma, dry eye syndrome, contact lenses, eyeglasses, and more. Dr. Allen

has been featured in Ask Men and Oprah Daily and was awarded the Media Advocacy Award from the American Optometric Association in 2021. In his free time, he enjoys rock climbing, running, playing video games, hiking, and biking.

Dr. Monica Chaudhry is a consultant optometrist and educator who have more than three decades of experience as an academic and a clinician. With her extraordinary skills in optometry education, she has recently ventured to be a freelancer educator, strategy advisor and practitioner. She is the founder of an online optometry up-skilling education platform – Learn Beyond Vision. Also, she has instituted some centers of excellence and vision centers, which aim to be a unique referral, academic and research units. Her name is well-known as a contact lens and low vision specialist and has a far and wide patient referral in India. Dr. Chaudhry has served at the All India Institute of Medical Sciences (AIIMS) in New Delhi, had academic experience with various universities, including the Indira Gandhi National Open University (IGNOU) and Amity University (India), and has recently retired as director of School of Health Sciences at Ansal University (Gurgaon, India). She has been associated with leading eye care companies such as Menicon, Johnson&Johnson , Baush +Lomb , Alcon, Essilor,

among others, as a key opinion leader, faculty, consultant or advisor.

hello@doctoreyehealth.com

Dr. Joseph Allen OD, FAAO, Dipl ABO

Dr. Monica Chaudhry MSc

In recognition of her contribution to the field of academic medical service, she has been awarded the Shreshtshree Award by the Delhi Citizen Forum, the Australian Leadership Fellowship award in 2012 and the IACLE Contact Lens Educator of the Year (Asia Pacific) award in 2015. Dr. Chaudhry was chairman of the Optometry Council of India. She has been actively involved in organizing conferences, seminars, national and international workshops, faculty development programs and many corporate training programs. She has chaired many scientific sessions and presented many papers in national and international optometry and ophthalmology conferences. She has travelled abroad extensively and attended many international trainings and conferences. She has written chapters in books and has published three books. monica.rchaudhry@gmail.com

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ADVISORY BOARD MEMBERS

Dr. Kristie Nguyen is a board-certified optometrist. She currently serves as a contract doctor for Perez and Associates and Phan-Tastic Eye Care in Altamonte Springs, Florida, USA.

Dr. Kristie Nguyen OD

After graduating in the top 10 of her high school class with honors, she went on to obtain her Bachelor of Science degree from the University of Houston, Texas. While at U of H, she volunteered at a local hospital and worked as an optometric assistant. Dr. Nguyen obtained a Doctorate of Optometry (O.D.) in 2005 from Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. She conducted her medical internships at the Chickasaw Nation Health Clinic in Ardmore, Oklahoma and the Lake Mary Eye Care in Lake Mary, Florida.

Dr. Nguyen is a member of the American Optometric Association, the Florida Optometric Association, Young ODs of America, OD Divas, Optometry Divas and the Central Florida Optometric Society. In addition, she has been an executive board member for Optometry Divas for the past two years. She is also a brand ambassador for an independent eyewear brand called Kazoku Lunettes and director of business development for an online optical company called Optazoom. She is also an independent consultant for Rodan+Fields, which is a global clinically tested skincare brand. Dr. Nguyen is married and has two beautiful daughters. She enjoys going to the beach, hanging out at Disney, and reading. kristie817@gmail.com

With almost twenty years of experience, Dr. Mark Eltis has practiced Optometry in New York, California, and Toronto. He is a graduate of the University of Waterloo School of Optometry and has taught there for over a decade.

Dr. Mark Eltis OD, FAAO

Dr. Eltis is a fellow of the American Academy of Optometry and a diplomate of the American Board of Optometry. He is also a faculty member of the Academy of Ophthalmic Education and has completed his California Glaucoma Certification at UC Berkeley. Dr. Eltis has served as an examiner for national licensing assessment in both Canada and the United States. He has presented and published internationally and has been sought as an expert on optometric issues for national television and print. In 2013, Dr. Eltis was honored as a member of the Optometric Glaucoma Society (OGS) having “demonstrated excellence in the care of patients with glaucoma through professional education and scientific investigation.” Dr. Eltis is a reviewer for over a dozen publications including Journal

Dr. Elise Brisco OD, FAAO, CCH, FCOVD

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Dr. Elise Brisco is the founder of NearSight – a new vision wellness company that is revolutionizing solutions to keep people comfortable and productive on their devices in our digital culture. Dr. Brisco has dedicated her career to helping others through her multidisciplinary wellness group and integrative optometric and homeopathic practice. She has written many articles, been a Key Opinion Leader, and has presented lectures extensively. She has been interviewed in over 400 TV, radio, internet, and print. She sold her practice in 2019 to focus on launching NearSight. She continues her mission to educate and motivate others to live their best

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of Glaucoma and Canadian Journal of Optometry. In 2017, he was recognized for his “outstanding contribution in reviewing” by the editors of Journal of Optometry and Elsevier. He is also on the editorial board of scholarly publications and is a US optometric residency program evaluator. Dr. Eltis has been a consultant for academic institutions overseas, contact lens/pharmaceutical companies, law firms, and a subject matter expert for competency evaluations. He serves on the board of directors of the Council for Healthy Eyes Canada and was elected to council at the College of Optometrists of Ontario. Dr. Eltis is currently focusing his practice on dry eye patients employing the latest diagnostic and therapeutic options. He loves connecting with optometry students and the public by sharing his eye care tips on social media. drmarkeltis@vieweyecare.com

life as a Health, Beauty and Fitness Influencer. She collaborates with wellness and fashion brands to promote healthy living through social media. You can find her on Instagram @HollywoodEyes or Facebook and YouTube Hollywood Eyes – Dr. Elise Brisco. Dr. Brisco is also the reigning Ms. Woman California United States and a runway and published model. Her platform is Healthy Living for Healthy Aging. In her personal life she is passionate about her family, boxing, fitness and travel. elisebrisco@hollywoodeyes.net


COOL OPTOMETRY |

Bespectacled Gamers… Get ready to ditch your glasses! by Hazlin Hassan

H

ardcore gamers who wear prescription glasses can now rejoice as a revolution in eye care is in sight! Adlens has come up with the VR ProOptics custom performance optics, replacing the need for users to wear glasses under a VR (visual reality) headset. Designed and manufactured in the United Kingdom, the Adlens VR ProOptics are custom prescription optical inserts for VR. The HYDRO+ anti-reflective protective lens coated optics are easy to install and integrate into your VR headset, enhancing vision in both the real and virtual worlds. They are easy to fit and remove and are designed to securely fit into your headset. Providing a maximized field of view, they enhance overall VR experience, improving optical comfort and immersion. What’s more, the lens repels grease, grime, and dust, and is scratch-resistant and water-repellent. Adlens currently provides ProOptics for Oculus Quest, Oculus Quest 2, and the Oculus RIFT-S. The ProOptics come with a 12-month replacement warranty against manufacturing defects, as well as hassle-free refunds within 30 days.

Doctor, we have an Emergensee! Think that’s pretty cool? That’s not all Adlens has created. The brand previously came up with the Emergensee eyeglasses, which

are perfect for contingencies and disasters. Aside from being a spare pair in case your glasses or lenses got lost, the Emergensee eyeglasses were also deployed in communities that lacked access to affordable eye care, as well as during disasters like earthquakes and floods. Moreover, you needn’t rush to the optician for a new pair when your prescription changes. The glasses are easily adjusted by using a dial that allows the lenses to overlap to create both near- and far-sighted prescriptions. They come with a wide range of powers from -6D to +3D diopters and are designed to correct 90% of spherical refractive errors.

EYE CARE TECH

having won the Gold Award at the Asian Innovation Awards in 2011.

A mission for better vision Adlens founder, James Chen, wanted to provide affordable glasses and primary eye care to people who struggled with untreated poor vision. Mr. Chen launched the Clearly campaign in 2016 to inspire and promote greater awareness of the global vision issue, with a mission to see a world where everyone has access to vision correction. He also founded the non-governmental organization Vision for a Nation in 2009, with the goal of providing universal access to eyeglasses, beginning with the people of Rwanda, where some 57% of the population live in poverty and are unable to afford eyeglasses. According to Vision for a Nation, there are only four optometrists and 10 ophthalmologists to serve the Rwandan population of 10 million. Thanks to Vision for a Nation, many people in Rwanda were able to receive free eye examinations and, if needed, free eyeglasses.

In 2011, Adlens donated 1,000 pairs of Emergensee glasses to victims in coastal Miyagi and Fukushima prefectures, two of Japan's hardest-hit areas in the Tohoku tsunami. The glasses were distributed in refugee centers and to people living in temporary housing. Many evacuees were glasses-wearers but were forced to flee their homes without their glasses. They went on sale in Japan in April 2011 as spare pairs and as part of medical kits and earthquake preparedness kits. The Emergensee glasses have also received recognition for their innovative design,

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COOL OPTOMETRY |

AOC 2022

Back with a New Vision The Asia Optometric Congress returns in full swing this year! by Joanna Lee

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s the world comes around, navigating its way from the eye of a global health storm, it is time to look upon “A New Vision” — which, coincidentally, is the theme of the 3rd Asia Optometric Congress (AOC). Indeed, it has been a while since the last congress, which was held in 2018 in Bali, Indonesia. Springing back into the thick of physical meetings, this edition of the AOC — in tandem with the 8th ASEAN Optometric Conference, will be held in Kuala Lumpur, Malaysia, at the Kuala Lumpur Convention Centre (KLCC). According to Mr. Murphy Chan, current president of the AOC, “AOC is an Asian platform not only for optometrists, but also for industrial partners, vision care practitioners, researchers, and clinicians to showcase their work and services and to support one another to upgrade optometry. It’s about networking and collaboration.” “Asia is on the rise and we need a transformation,” he continued. “The theme — ‘A New Vision’ — is about uplifting the standard of eye care in Asia. It is about looking at new approaches to eye care and addressing myopia. Beyond correcting eye power,

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having a new vision is about eye health, as well as engaging with the latest clinical approaches and technology towards managing vision conditions.” Mr. Chan also spoke about the wide gap between the developing and more developed Asian nations, which results in varying standards of eye care in each country. “We need a platform to narrow the gap,” he explained. “The AOC’s platform exists to gather our resources to enable help for one another.”

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Championing optometry in Asia Founded in Malaysia in 2007, the AOC is a non-profit professional organization that aims to promote the optometric profession in Asia. The organization later expanded its focus to ASEAN countries when the bi-annual conference was held in Singapore in 2014, and officially established to be inclusive of Asian countries/territories at the conference held in Manila, Philippines, in November 2016. The diversity that is represented in Malaysia’s melting pot of cultures is


synonymous with AOC’s objectives in reaching out to, and gathering, optometrists from various countries. A look at the AOC Membership Directory sees optometry associations from across 12 countries in Asia being represented. “Now we have close to 600 delegates and more than half are from overseas, as we have aimed for a ‘truly global’ conference,” shared Mr. Pak Seong Woon, AOC’s organizing chair, adding that apart from member countries, speakers and delegates will be coming in from Japan, Korea, Australia, Canada, Chinese Taipei, and the United States. “We are anticipating a lot of networking to take place. I know one or two countries are already organizing meetings between session breaks, before and after the conference,” he added.

A melting pot of topics Likened to a “good buffet,” a variety of interesting topics is set to fill the twoday AOC event with many sessions to look forward to.

Kicking off the sessions of talks after the keynote speeches and opening of the congress will be a session presented by AOC’s past president Dr. Kah Ooi Tan, Dr. Monica Jong, and Dr. Oliver Woo — giving participants a broad overview of Asian optometrists’ thoughts on managing Asia’s ever-growing phenomena of shortsightedness in “Practitioners’ Perception on Myopia Management in Asia – A Project by AOC.” Sharing how a framework of national eye care takes shape, Prof. Azrin Ariffin will speak about “Primary Eye Care – New Model for Malaysia.” Sports vision and vision therapy will also be added to the discourse of diverse topics at AOC; while not to be missed is a session by ophthalmic specialist Dr. Kenneth Foong, who will talk about “Dangerous Conditions Not to Miss in an Optometric Practice.” Updates on junior myopia management are on the cards, as Mr. Pascal Blaser will share about the six-year followup on MiYOSMART, an award-winning lens solution that could slow down the progression of myopia in children and

adolescents by an average rate of about 60%.

Must-not-be-missed workshops Come Day 2, participants can look forward to a buzz of interesting workshops the entire day. Mr. Woon further shared: “Our gathered feedback during the 2nd conference showed that participants desired something beyond just attending talks. So, we are angling the 3rd AOC as a ‘practical conference’ by having workshops on Day 2.” The workshops featuring experts and specialists from different countries will span across six diverse categories, such as Blindness Prevention, Specialty Contact Lenses, Vision Therapy, Ophthalmic Lenses, Pediatric Optometry, Optometry Specialty, and Oral Presentation (of Abstracts). What’s noteworthy is that the organizers have thoughtfully arranged for the repeat of each workshop session within all the categories, making the morning sessions mirror the afternoon sessions so that participants can attend the workshop sessions that they had somehow missed earlier. Participants can also gain CPD (Continuing Professional Development) points through workshop attendance.

Maximizing learning opportunities “Each participant can sign up for two blocks and altogether attend eight workshops,” Mr. Woon said. “We are also tracking who is interested in which workshops. And based on this, AOC will be able to revisit the workshops and dive deeper into the same topics in the next conference.” Another unique feature of this conference’s workshops is that participants will get access to prerecorded sessions of the particular workshop they have signed up for. “We want to get the theories out of the way to maximize their time during each session,” he added.

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COOL OPTOMETRY |

AOC 2022

AOC is also opening up its Oral Presentation sessions free of charge for optometry students to attend. “The Oral Presentations track is for the researchers among us to showcase their works. In order to encourage younger participants to present, we have categorized presenters in the below and above 35-years-old groups. In addition, we are giving out prizes for each category to spur both younger and older researchers to present,“ Mr. Woon continued. Besides the practical workshops and academic oral presentations, several sponsored sessions also look interesting, such as “Moving Beyond Myopia Correction to Control” by Dr. Kate Gifford, or how to “Start Your Ortho-K Journey with Menicon” by Dr. Jennifer Choo. There will also be a session about the “Practical Use of Lenstar Myopia with MiYOSMART.” Just don’t forget to blink when attending the Lunch Symposium to learn about “Simple Dry Eye Diagnosis Applicable in Everyday Practice” by Dr. Meng Hsien Yong. “We hope everyone will gain something that they would be able to apply back into their practice,“ enthused Mr. Woon.

A look into the AOC Vision Screening project One of the other highlights in the agenda is the unveiling of the results from the AOC Vision Screening project. This project was mooted during a previous AOC council meeting where it was proposed to create a regional vision screening project. The goal was to generate awareness of the need for quality vision care in the region via the AOC platform. Results of the vision screening with data gathered from each country represented in the AOC are anticipated to be shared during the event. The compilation and data analysis are also carried out with the aim of being written and published in either a regional or international journal. “In Asia, we only see optometrists when a problem arises, so we want to educate

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“In Asia, we only see optometrists when a problem arises, so we want to educate people about the importance of regular eye care. By the year 2050, myopia’s prevalence is slated to increase by 50% worldwide, and Asia holds a large part of the world’s population.” — Mr. Murphy Chan President, AOC

people about the importance of regular eye care. By the year 2050, myopia’s prevalence is slated to increase by 50% worldwide, and Asia holds a large part of the world’s population,” Mr. Chan explained AOC’s urgency to tackle what’s ahead. “We need the entire eye healthcare eco-system to work together to impact governmental legislations, make available educational resources to various countries, narrow the gaps in each nation’s standards of practices, and play our new roles in digitizing eye care,” he added. “AOC is not only about organizing conferences. It is really about a movement to transform eye care delivery in Asia. And we want you to join us,” Mr. Chan concluded.

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Expect some fun at the 8th ASEAN Optometric Conference In tandem, the 8th ASEAN Optometric Conference will also be held during the 3rd AOC. Expect to view posters, marvel at an ongoing exhibition, and win lucky draws — all while having morning or afternoon tea breaks. What’s more, a gala dinner will be held on the first night. Indeed, the period of lockdowns has been challenging, so it’s about time you treated yourselves to a refreshing scenery to inspire ‘A New Vision’. And Malaysia — the host country — offers just that and more… where "Rugged mountains reach dramatically for the sky, while rainforest-clad slopes sweep down to floodplains teeming with forest life.” Well, one has got to see it in person to believe it, so to speak — not forgetting to enjoy the famed Malaysian food and delicacies!

Editor’s Note: The 3rd Asia Optometry Congress, along with the 8th ASEAN Optometric Conference, will be held on November 15-16, 2022, at the Kuala Lumpur Convention Centre (KLCC), in Kuala Lumpur, Malaysia.


OPTICS |

EYE EXAM

A Peek into the Humble Eye Chart From Dr. Snellen’s fundamental groundwork in the West to Prof. Miao’s SLVA charts in the East by Nick Eustice

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ith all the technology in use in optometry today, it can be easy to overlook the tremendous thought and sophistication that have gone into the basic tools optometrists use every day — especially the eye chart.

be found not just in the optometrist’s office, but in the school nurse’s office as well, and even in driver’s license facilities: the eye chart.

As advanced imaging techniques like corneal topography and optical coherence tomography have become relatively commonplace, we focus a lot on the great leaps forward in imaging. This is in addition to innovative scleral lenses that reshape the eye, augmented reality glasses that supplement the wearer’s blind spots, and numerous other advanced tools and treatments that seemed like science fiction a few years ago.

The humble eye chart began its evolution in the Netherlands over 150 years ago when Dr. Herman Snellen developed the eponymous Snellen Chart. Still commonly in use today, the Snellen chart was the first standardized chart of its kind, establishing a consistent rubric for evaluating a patient’s visual acuity.

In a field of such technological advancement as eye care, even the most seemingly basic tools are in fact quite complex devices. And perhaps the most basic tool in the field is the one so common that it has made its way out of the clinic altogether. Such a tool can

The evolution of the eye chart

Where optometrists each previously had to design and make their own eye charts, the Snellen chart ensured that one doctor’s diagnosis would be of use for future comparisons and lens fittings by every other eye care professional using the chart. While Snellen’s chart did a great deal of good — and continues to do so, as the

most commonly-used eye chart in the world to this day — it was certainly not perfect. Toward the middle of the last century, when so many scientific and mathematical advances were having an enormous impact across the field of medicine, several pioneers began to rethink the eye chart.

Next-level eye charts in the West In the West, the improved charts with which we are most familiar are referred to as the Logarithm of the Minimum Angle of Resolution (LogMAR) charts. The first of these was developed by Dr. Ian Bailey and Dr. Jan Lovie at the National Vision Research Institute of Australia in 1976. In a paper1 published that year, authors Bailey and Lovie advocated for a logarithmic progression of character size in an eye chart, as well as uniformity in distance between the characters and their lines. While these changes seem somewhat

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OPTICS |

EYE EXAM

basic, LogMAR charts have been shown to yield more accurate and consistent assessments of a patient’s visual acuity. As Bailey and Lovie suggested, these charts are more useful in ascertaining a patient’s vision at varied distances as well, due to their absolute consistency of spatial representation. Since the development of the first LogMAR chart, the Bailey-Lovie chart, other such charts have been created for special purposes or applications. These other charts also meet the criteria for LogMAR charts. The most popular of these was developed, also by Dr. Bailey, as part of the National Eye Institute’s landmark Early Treatment Diabetic Retinopathy Study (ETDRS) in 1982.2 This set of logMAR charts has become the standard for visual assessment used in clinical trials.

Logarithmic charts from beyond the “Bamboo Curtain” Though the logMAR charts arising from Bailey and Lovie’s work in Australia are the best known in the West, they were not the first logarithmic eye charts developed. More than 10 years prior, at what would later become China’s Wenzhou Medical University, Prof. Tianrong Miao designed a different eye chart3 based on logarithmic criteria. Dr. Miao’s chart, the 5 m Standard Logarithmic Visual Acuity (5SL) Chart, was designed in 1959 and revised by Prof. Qinmei Wang in 2011. In addition to the 5SL Chart, Dr. Miao also developed a 2.5 m Standard Logarithmic Visual Acuity (2.5SL) Chart. All but identical to the 5SL chart, the 2.5SL is consistent with the 5SL chart in the core design, but the test distance is at 2.5 m for use in smaller clinics. Together, these Standard Logarithmic Visual Acuity (SLVA) charts are the standard for testing vision in Chinese clinics. Due to the political climate in China during the 1950s and 1960s, Dr. Miao’s charts spent many years with a very limited scope of use. The antiintellectual policies common during Mao Zedong’s Cultural Revolution made publishing new findings very difficult, and communication between the

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Chinese medical community and their counterparts in the West was all but impossible. The charts did not receive mainstream attention even within China until after the establishment of Wenzhou Medical University in 1978. At that time, Dr. Miao’s SLVA charts were recognized by the international medical community as being the first of their kind, independently developed before the first LogMAR charts in the West. The two SLVA charts have been in consistent use throughout China since they were first developed, both in clinical and general screening applications. In fact, they are the only charts approved by the Ministry of Health of China, and their use is required by the Ministry’s national compulsory standard for clinical practice in China. These charts use a 5-grade recording method at a measuring distance between 4.0 and 5.3 and are essentially equivalent to the recording method used with logMAR charts. Though their genesis is entirely independent, the two chart systems correspond to the same goals of establishing uniformity and consistency in visual acuity measurement.

Eye charts that don’t see eye to eye Though the two types of logarithmic charts — the ETDRS and SLVA — share a great deal in common in terms of design and metrics of evaluation, they are still distinct from one another in a number of ways. Representing two different organic systems of measurement, the two charts are often seen as equivalent but separate means of visual assessment. Due to the remarkable similarity between these two most common eye charts, used in two different parts of the world, it has, until recently, been taken as a given that the results of their visual acuity measurements would be roughly the same. 4

A preliminary report, however, seems to suggest otherwise. In findings published earlier this year, a team

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of research doctors from the Eye Hospital and School of Ophthalmology and Optometry at Wenzhou Medical University, the same university where Dr. Miao first published the SLVA charts — sought to compare the results of tests conducted with the two different types of charts. While the difference in reported visual acuity between ETDRS and SLVA charts was slight and practically identical for the purpose of evaluating patients with normal vision, there was a significant enough variation in the examinations’ acuity to show that the ETDRS provided a higher degree of precision. This difference could prove quite important in evaluating patients with various advanced vision disorders. The report concluded, however, that outside these limited applications, the ETDRS and SLVA charts produce comparable visual acuity scores for normal adults with no pathological eye disease. Therefore, in day-to-day use, both charts were found to possess a similar degree of accuracy.

Charting the course for better vision testing Though the original Snellen chart brought us to a new level of consistency, where testing could be finally considered uniform throughout the world of eye care, it came from a time when the mathematical tools to create an accurate assessment of a patient’s vision weren’t yet at the eye care professional’s fingertips. The logarithmic tests in use today ensure that we have a much clearer picture of a patient’s ability to see.

References 1.

Bailey IL, Lovie JE. New design principles for visual acuity letter charts. Am J Optom Physiol Opt. 1976;53(11):740-745.

2.

Early Treatment Diabetic Retinopathy Study (ETDRS). Available at: https://clinicaltrials.gov/ ct2/show/NCT00000151. Accessed on October 20, 2022.

3.

Wang T, Huang PJ, Chen C, Liu DW, Yi JL. A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients. Int J Ophthalmol. 2021;14(4): 536-540.

4. Do the Scores from ETDRS and SLVA Charts Agree? An Analysis Based on the Acuity Psychometric Function. Available at: https:// www.researchsquare.com/article/rs-1710953/v1. Accessed on October 20, 2022.


KUDOS |

OPTOMETRY ORGANIZATION

Industr y Focus

AAOS Connecting Asian optometrists in America by Tan Sher Lynn

Dr. Kame was the first vice president of AAOS and a diplomate in the cornea and contact lens section of the American Academy of Optometry. Many of his colleagues credited him with introducing innovative ideas such as reverse geometry lens designs and one-day disposable contact lenses. This scholarship is presented to an entering fourth-year AAOS student member who demonstrates clinical excellence and extracurricular involvement. Dr. Arthur Sugino Memorial Scholarship

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s primary healthcare providers, optometrists play an important role in our society. However, you also need support in your professions in order to thrive. This is where optometric societies, such as the Asian American Optometric Society (AAOS), come into the picture by providing the support you need, including education, advocacy, and connection. Besides setting standards for excellence in the profession, these societies inform members about new research and developments in the field and assist optometrists in protecting the interest of their patients. When an optometrist belongs to an optometric society, they can tap into a broader professional network as well.

Championing Asian optometrists Formerly the Japanese American Optometric Society (JAOS) with 35 charter members, the AAOS was established in 1972. Aimed to promote and maintain a social, cultural, scientific, and educational interchange of information and experiences among its members, the AAOS is now the largest optometric society in California today — with over 225 doctors and 90 student members. Most of the members practice in Southern California, with other members located in Northern California, Nevada, Hawaii, Florida, and a few other states.

and societies around the country, including the California State Board of Optometry, the American Academy of Optometry, and the National Board of Examiners in Optometry. As the largest optometric society in California, the AAOS provides great networking opportunities, especially with its various events, such as symposiums, webinars, banquets, etc. Large turnouts at the AAOS’ popular events prove to be a great way to network with colleagues. Just recently, on October 9, 2022, the society celebrated its 50th anniversary at the Japanese American National Museum, where members enjoyed a sumptuous Japanese lunch and a museum tour.

Scholarships bestowment Throughout the years, the AAOS has presented various scholarship awards to deserving students. To obtain these scholarships, students must display exceptional qualities in their education and profession. They must also be well-rounded in many areas. Criteria taken into consideration include grade point average, extracurricular activities, research, volunteer work, professional work, publications, and future aspirations. Below are some of the coveted AAOS scholarships: Rodger T. Kame Memorial Scholarship

Many of the AAOS members are distinguished lecturers, speakers, researchers, and teachers. And a great number have held high-ranking positions in local and state associations

The Rodger T. Kame Memorial Scholarship was established by his friends and colleagues in the AAOS.

The Dr. Arthur Sugino Memorial Scholarship is awarded annually to a graduating fourth-year student at the Southern California College of Optometry for outstanding scholastic achievement throughout the four years of a professional program. This award was first established in 1974 in honor of Dr. Sugino, a visionary who, along with Dr. Takao Shishino and Dr. Rodger Kame, came up with the idea of the Japanese American Optometric Society. Dr. William Yamamoto Memorial Scholarship The Dr. William Yamamoto Memorial Scholarship is awarded annually to a graduating fourth-year student at the Southern California College of Optometry for outstanding achievement in the areas of scholarship, research, and participation in extracurricular activities. This award was established to honor one of the early members of the Japanese American Optometric Society shortly after the inception of the Dr. Arthur Sugino award. Western University Health Sciences Optometric Scholarship The AAOS scholarship for the Western University for Health Studies was first approved and established by the AAOS Board of Trustees in 2015. As a commitment to maintaining the mission of the organization, the AAOS board has made it a priority to fully fund an endowed scholarship at Western University for several years. This inaugural award recognizes a graduating senior who demonstrates academic excellence, extracurricular involvement, and leadership potential during professional school.

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COVER STORY

How Asian eye care professionals and innovations are revolutionizing the world of optometry by Nick Eustice

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ourney to the West may be China’s most beloved and enduring literary classic. Its popularity has spread throughout the far East and, indeed, the whole world as well. Written by Wu Cheng’en during the Ming dynasty, this light-hearted and whimsical novel follows a Buddhist monk named Xuanzang to the far-flung lands of the West in search of sacred texts containing mystical knowledge. Accompanied by his three animal companions — the wise and magical Monkey, the dim and clumsy Pigsy, and a fish spirit called Sandy — Xuanzang encounters a whole odyssey of trials and adventures before at last achieving his goal of finding the mystical scrolls.

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The idea of discovering secret knowledge someplace far away is a very old one. And it is certainly not one we find just in the classics of China. Nobel prize-winning author Herman Hesse flipped the original’s script when he wrote Journey to the East, a novel about Westerners traveling to Asia, themselves seeking hidden truths. And in James Hilton’s Lost Horizon, readers visited the harmonious Shangri-La, where the secrets to longevity grant the Tibetan locals virtual immortality. In the East as well as the West, adventurous works of fiction like to paint pictures of magical knowledge arising in faraway places. And though these are just stories, there

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is something to be said for paying attention to the way people elsewhere do things differently. Sure, the keys to enlightenment or immortality may not be what’s waiting just over the next hill, but our differences can help us see our own challenges from a different point of view. This is especially true when we think about medicine, and eye care in particular.

Moving forward from the East All too often, we think about the technological advances that move medicine forward coming from the


Among the most important of these advances have been those in addressing the problem of myopia. In recent years, it has come to broader international attention that East Asia has a much higher instance of myopia than elsewhere in the world. This fact was first documented by Prof. Carly Lam of The Hong Kong Polytechnic University. universities and clinics of the Western world. To be sure, since the advent of contemporary medical science, this has been the direction of that informational flow. Yet as time goes on, and the East achieves a higher level of scientific sophistication, this imbalance in the movement of ideas becomes less and less. Today, there exists in the East centers of knowledge in the field of eye care that are the equal — and sometimes even the envy — of their counterparts in the Western world. And the eye care professionals who make these centers what they are today possess a unique set of skills and knowledge that can shed a light on areas previously unexamined, or not considered, by Western experts. In this issue, we’re going to be taking a look at some of the optometrists, the innovations, and the wisdom that have been making their way to the West from the eye care communities in the East. As we grow together in this global industry, discoveries anywhere can make a big difference everywhere.

Two pioneering thought leaders in Hong Kong One of the aforementioned centers of knowledge in the field of optometry that has emerged to a position of great prominence in recent years is The Hong Kong Polytechnic University. A relative newcomer to the field of optometry, the University’s School of Optometry has only been in existence for under 50 years. In that time, however, a lot has happened in the field of Optometry, and The Hong Kong Polytechnic University has been at the forefront of many of its most important advances.

One of the founders of the School of Optometry’s Centre for Myopia Research, Prof. Lam was among the first to document the unusually high number of instances of myopia — as high a number as 80% — in Hong Kong school children in the early 1990s. Upon discovering this remarkably high percentage of young people suffering from myopia in Hong Kong, Prof. Lam began to conduct further research in order to identify the potential factors that lead to myopia development in such troubling numbers. Additionally, she began the very important work of seeking out new treatments and methods of control for these myopia patients. As a result of her efforts, Prof. Lam developed a major treatment platform for myopia. Her Defocus Incorporated Multiple Segment (DIMS) lenses for use in glasses have shown great promise in controlling the progression of myopia. Using similar technology, Prof. Lam also developed a contact lens version, the Defocus Incorporated Soft Contact (DISC) lens. In trials, these methods have been shown to slow myopia progression by as much as 60% over a two-year randomized clinical trial study period. Prof. Lam has also contributed in numerous other ways to recent scholarship concerning myopia. She has authored over 50 papers on this topic alone. In addition, she has done substantial research in other related areas, especially in seeking treatments for amblyopia and binocular vision anomalies in young children. Another professor at The Hong Kong Polytechnic University’s School of Optometry whose work has been

far-reaching is Prof. Pauline Cho. Prof. Cho’s work throughout the field of optometry, notably within her specialization of orthokeratology, has been particularly impactful. Her research efforts have led to significant progress in the fitting of gas-permeable lenses for the correction of myopia. In addition to her research efforts, Prof. Cho has also been recognized for her philanthropic work in underserved minority communities in China, and in leprosy villages where eye care was previously unavailable.

Both of these doctors have become global leaders in the fight against myopia, and have led to the recognition of The Hong Kong Polytechnic University as a cutting-edge frontrunner in the fight against myopia.

WCO recognizes a Filipino optometrist for making a difference In recognition of notable achievements from another part of the East, the World Council of Optometry (WCO) has announced a special award in recognition of one of its most committed board members. In a reception held during the American Academy of Optometry’s annual meeting in San Diego, California, USA, the Council has honored the services of Dr. Carmen Abesamis-Dichoso. Dr. Abesamis-Dichoso is an optometrist from the Philippines whose specializations include myopia management, fitting special design contact lenses for keratoconus, high myopia, high astigmatism, presbyopia, post-lasik complications, postpenetrating keratoplasty, pellucid marginal degeneration (PMD), and other corneal irregularities. She served

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COVER STORY

on the Board of Directors of the WCO from 2018 to 2020, during which time she was a member of the Council’s Membership Committee, as well as its Legislative, Regulations and Standards Committee. In her capacity as a board member, Dr. Abesamis-Dichoso presented a comparative situational analysis of the varied statuses of optometry education, legislation, and standards of different countries in the Asia Pacific region. This helped the WCO to understand and track their direction, focusing their efforts to assist the countries needing help in developing the optometric profession locally, and gaining recognition from their respective governments. Dr. Abesamis-Dichoso was one of the very few Filipinos who have been able to serve on the WCO, and the Council tasked her with being their representative at the World Health Organization during the Western Pacific Regional meeting held in Manila in 2018. Dr. Abesamis-Dichoso recalled that this position allowed her to share her insights, expertise, and knowledge in optometry, and helped the Philippines to continue becoming a leader in vision care in the Asia Pacific Region. Optometry in the Philippines was put back in the spotlight of the WCO when Dr. Abesamis-Dichoso helped to organize the Asia Pacific Optometry Congress in Manila in June 2019. With more than 32 countries sending delegations to the event, this helped to raise the nation’s profile considerably during this time. As she was also serving as Treasurer of the Asia

Pacific Council of Optometry — and therefore as a member of its Executive Committee — Dr. Abesamis-Dichoso was instrumental in organizing these knowledge-sharing events. Under the Presidency of Paul Folkesson, the WCO and CooperVision hosted a global myopia management virtual event entitled "Myopia Management: Putting It Into Practice" on February 12, 2022. Dr. AbesamisDichoso was one of the chosen speakers among a panel of experts who helped the WCO advance the organization's efforts to establish a myopia management standard of care, and one of the featured leaders in the industry. The WCO brought together this dynamic group of industry leaders to discuss the importance of myopia management as a global standard of care. The combination of their keen insights brought clarity and perspective to this multifaceted issue, which is faced by millions. Through her sustained history of work with the WCO and other organizations, Dr. Abesamis-Dichoso has been a leading voice in raising the profile of optometry throughout the Asia Pacific region, and worldwide as well. This increased exposure has been of enormous benefit to patients and eye care professionals alike in combatting visual impairment through education.

Perspectives on the East We asked Dr. Abesamis-Dichoso about some of the lessons which optometrists in the West could learn from the unique experiences of their colleagues in the East. Dr. Abesamis-Dichoso first brought up the problem of myopia. “Since it has been proven that myopia is very prevalent among Asians,” she said, “researchers and practitioners from Asia — specifically in Hong Kong and China — have dedicated themselves to digging deeper into the

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‘why’ of myopia’s causes and the ‘how’ of myopia management.” On this subject, Dr. Abesamis-Dichoso thought immediately of two familiar names in this field: “Prof. Pauline Cho and Prof. Carly Lam, both from The Hong Kong Polytechnic University, have done a great deal of work in this area,” she said, “particularly orthokeratology and lens design, respectively.” Dr. Abesamis-Dichoso noted that Asians living inside and outside of Asia, regardless of differences in their environment, are proven to have longer eyeball, or axial length, than other ethnic groups. She said that the West has learned quite a lot from this difference, and how effective the different modalities of treatment are for each child, and the Asian population as a whole. This has become the benchmark for most eye care practitioners in the West. Beyond just myopia, Dr. AbesamisDichoso pointed out that a number of difficult challenges confront optometrists who practice in Asia. Cataracts are a prime example of this, as a common cause of avoidable blindness in Asia, specifically in Vietnam, Cambodia, Bangladesh, and her native Philippines. This is a unique challenge for doctors working in the less developed countries in the East. In the West, she noted, these conditions are usually detected early because primary healthcare is more affordable and available in much of the West.

Asian innovations in eye care Moving from unique challenges to technological advances, Dr. AbesamisDichoso pointed out a number of devices and technical applications that originated in Asia and have had an enormous impact worldwide. First among these, she said, are the

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highly sophisticated instruments and ophthalmic diagnostic equipment that have been developed in Japan. Japanese manufacturing firms such as Topcon, SHIN-NIPPON, INAMI, and even ophthalmic lens designs like those produced by Seiko have all come from Japan. And that country continues to be dominant in innovative medical instruments for the optical field.

platforms available, meetings are possible anytime and anywhere. It is more practical, affordable, and available than ever before. We need to dialogue, not only about the innovations from the East to the West and vice versa, but also how the neglected communities and developing countries can avail and benefit from these innovations.”

Elsewhere in the region, Dr. AbesamisDichoso drew our attention to Plano, a Singapore-based startup that provides a variety of digital tools to promote eye health. Hoping to build safeguards into one of the greatest threats to healthy vision, the smartphone, Plano has developed an app that helps children to regulate smartphone use and adopt healthy device habits, such as optimal face-to-screen distance and scheduled downtime.

Helping out the less fortunate and bringing care to underserved areas is undoubtedly an area of near-universal agreement worldwide, and the desire to help those in need may be the most universal commonality in a diverse and wide world. With this in mind, communication is not just inevitable, but desirable as well.

Yet another innovation from the East that Dr. Abesamis-Dichoso pointed out is the Virna Glaucoma Drainage Device. This novel solution for glaucoma surgery was launched in Indonesia in June 2019. Developed by the collaborative efforts of a young Indonesian ophthalmologist and researchers at the Lions Eye Institute in Western Australia, this low-cost and easy-to-use surgical device is manufactured in Indonesia and costs only $100. Inventions such as these help to bring financially viable treatments to a far broader range of patients than had ever been possible before.

The importance of communication: From East to West and back again Dr. Abesamis-Dichoso concluded by talking about the essential role of communication in our contemporary eye care landscape. “We cannot not communicate,” she said. “With virtual and other online

But communication in the world of optometry is not without obstacles, and Dr. Abesamis-Dichoso spoke about the need to keep our priorities where they belong: on working together. “Accepting and admitting that collaboration is more important than competition is the most important thing,” she said. “Cooperation can greatly bring costs down and deliver care to the targeted population. Government and non-government organizations have their own strengths and strategies they can put on the table, which can contribute to the ingredients needed to become a winning team to address preventable blindness in both regions.”

Finding the magic of working together Thus, just like our literary figures in Journey to the West, we come back with a good bit of wisdom. While it may not be magical scrolls or the secrets of immortality imagined in ShangriLa, what we find instead is something much more practical and realistic: the reminder that working together is the best way to bring health and vision to patients the world over.

Contributing Doctor Dr. Carmen Abesamis-Dichoso received her Doctor of Optometry from the Central Colleges of the Philippines in 1989, and earned her Master of Arts in Teaching from the Central Colleges of the Philippines in 2001. Her specialties include special contact lens design for keratoconus, children and high astigmatism; and visual assessment of the mentally challenged, autistic, ADHD, cerebral palsy and learning disabilities. In addition, Dr. Abesamis-Dichoso has been an orthokeratology practitioner in the Philippines since 2005. Since 1998, she has been self-employed in a private practice at Medical Plaza Makati. She was awarded Outstanding Optometrist of the Year in 2017 by the Optometric Association of the Philippines. Currently, Dr. Abesamis-Dichoso serves as the International Affairs Committee chair of the Optometric Association of the Philippines; director of the Special Olympics Opening Eyes in the Philippines; program manager of Optometric Association of the Philippines Vision Screening Program and provision of eyeglasses with the United Nations Development Program in 10 areas and four Regions in the Philippines; and chairperson of the Special Olympics Healthy Athletes Program in the Philippines. Dr. Abesamis-Dichoso is a fellow of the American Academy of Optometry; a founding fellow at the Philippine College of Optometrists; a fellow of the International Association of Contact Lens Educators; an AsiaPacific Regional advisor for the Special Olympics Opening Eyes; treasurer at the Asia-Pacific Council of Optometry; and is an Asia-Pacific Council of Optometry (APCO) representative for the World Council of Optometry, in addition to being a member of the Legislation, Registration and Standards Committee. She has also authored numerous published papers and is a popular lecturer at industry meetings. carmen.dichoso@gmail.com

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INNOVATION |

GLAUCOMA

Penned in the East

Revisiting GonioPEN, Asia’s best tool yet against glaucoma by Andrew Sweeney

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ast or west, it makes no difference — glaucoma is one of the most common issues that optometrists have to deal with. So the hunt is always on for a new type of treatment that will not only better screen for the disease, but also arrest its development. As we all know, the longer glaucoma goes undiagnosed the harder it is to treat. In the fight against glaucoma, some of the greatest innovations can be found in the East, especially when it comes to treatment, diagnosis, and most notably, screening.

Singaporean pen perfection? One of the most common methods optometrists and ophthalmologists have at their disposal in screening for glaucoma is gonioscopy, an examination of the eye’s drainage angle. Now, while this procedure is painless for the patient, it is perceived as uncomfortable as it needs to be placed against the eyeball. That’s not exactly everybody’s favorite idea of a good morning (or any other time of day for that matter). So, any new tool that’s designed to alleviate this discomfort is bound to attract attention. Singapore is something of an ocular health hub in the East, and it’s no surprise that new glaucoma innovations are coming out of the city-state — one of the most exciting of which is the GonionPEN. As the name suggests, this device is a pen-shaped camera that is designed to check patients for symptoms of glaucoma as quickly as possible with minimal discomfort. It can capture high-resolution images far faster than a conventional gonioscopy and can be used by a technician with minimal training. What’s more, it comes with

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LED-based illumination, all linked to a computer via a USB cable. One feature that highlights the intuitive nature of the GonioPEN is that it can be connected to a huge number of devices, whatever the clinician may need. It also makes it easier to explain the purpose of the device and how it works to patients, as while they may not be familiar with complicated optometry terminology, they will likely be aware of what a USB connection is.

Efficient and cost-effective The GonioPEN was developed as part of a joint initiative between researchers at Singapore’s Nanyang Technological University and the Singapore Eye Research Institute, and its creators are keen to highlight both its ease of use and cost-effectiveness. Conventional imaging devices used to screen for glaucoma can cost up to US $100,000 on average (the researchers’ report), whereas the GonioPEN combined with a microscope costs only $11,500. Think about how many clinics from East to West would be able to afford this lower price, especially in regions with economically challenged nations, such as Southeast Asia. The research team’s leader, Assoc. Prof. Murukeshan Matham, believes that the GonioPEN’s cost-effectiveness, combined with its ability to both take and retain high-quality diagnostic images, makes it an appealing choice for clinics of all sizes. Most issues that the device uncovers will be within the abilities of the average clinician to deal with, and if more complicated issues arise, then the images taken and stored by the tool can be sent immediately to a specialist for consultation. This way, the use of

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this device represents a democratization of glaucoma treatment and screening. “While only specialists are currently able to conduct a gonioscopy, with the new technology, technicians can perform it with minimal training,” Prof. Matham said when it was first launched.* “The GonioPEN's ease of use means it can be used by primary, secondary, or private eye care physicians, while its compact size makes it portable for all healthcare set-ups. The cost is also kept low because a microscope is no longer required,” he added. “With the GonioPEN, a digital camera image of a higher resolution can now be stored for future reference and retrieved easily. A technician could perform the gonioscopy before a specialist reviews the images to give an in-depth diagnosis or a second opinion. Doctors can also better track the changes in their patient's condition over time,” Prof. Matham explained further.

Will the West embrace the device any time soon? The development of the GonioPEN began four years ago and, that time, the device has attracted considerable interest in the local optometry community. When it comes to East meeting West, the adoption of this kind of technology by the occidental medical industry could be quite interesting. Time will tell if it will become a total success.

Reference * NTU Singapore and SERI invent new scope to diagnose glaucoma. Available at: https:// www.ntu.edu.sg/mae/news-events/news/detail/ntu-singapore-and-seri-invent-new-scope-todiagnose-glaucoma. Accessed on October 13, 2022.


ENLIGHTENMENT |

EYEGLASSES

Asian Fit Eyewear A guide to finding the right frames for the Asian face by Hazlin Hassan

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ptometrists understand that most Asians have a hard time finding standard frames and glasses that fit them perfectly and comfortably because of certain facial features. If your customer has a wide face or a low nose bridge, they may find themselves having to adjust their glasses each time they slide down their nose or hit their cheeks. What this means is that standard eyeglasses and sunglasses may not be the most suitable fit for them. Most Asians have a low nose bridge, and wearers often find that plastic frames end up sliding down their noses a lot — resulting in smudged

lenses, an awkward fit, and inferior vision. Thanks to Asian fit glasses, Asian wearers can get better vision, feel comfortable, and look hip and stylish. To help us find the right frames for the Asian face, we turned to Mr. Ryan Ho, optometrist and founder of the Melbourne-based RYAN ADDA eyewear, and Mr. Muhammad Aimaan Mansor, owner of Malaysia’s Hava Optique, for advice.

Frames that cater to Asians Mr. Ho and his wife Agnes, who is an

optician, have come up with a brand that understands all about eye care and optics. They aim to offer designs that are more balanced, functional yet fashionable, edgy, and uniquely in style. “I gradually built the brand RYAN ADDA throughout my 15 years of practicing as an optometrist and as an eyewear stylist for various talk shows, radio, and magazines. A lot of R&D and time were poured into the inception of this brand,” shared Mr. Ho. “Wearing the right glasses can enhance the features of your face, jaw bone, jawline, and eyebrows,” he

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ENLIGHTENMENT |

further explained. More importantly for Asians, RYAN ADDA offers a wide range of glasses and frames that fit a low nose bridge. They have three collections: the ME collection, offering a minimalistic design; the ONE collection, which is bold, loud, and colorful; and the FLIGHT collection, for those who want to look professional but with an attitude.

EYEGLASSES

sits on their nose when they put on a pair of eyeglass frames — should fit securely on the nose bridge and not pinch or leave indents. If the bridge is too small, the glasses will be too high on the nose and will pinch the wearer. “You want to make sure that it's sitting absolutely right on the fitting height where you draw the focal

“We are smack in the metropolitan city of Melbourne, where every culture and every race come together. So, we need to be able to have a collection that serves the needs of the community,” added Mr. Ho. Besides Australia, RYAN ADDA is also available in New Zealand, Malaysia, Singapore, Indonesia, and France.

Their best-selling frame in Malaysia is the Hava Aysha. “When we brought in 300 pairs of these, they were all sold out within two months.” Below, the two optometrists shared their tips on finding the right frames for the Asian face. Note the features of your customer’s nose bridge

“At the end of the day, most importantly, your customer must have a perfect fit, a well-balanced fit,” Mr. Ho explained. “It's about comfort, and the frame has to suit the needs of your customer’s lifestyle and the requirement of their prescription lenses.”

Always make the service personalized Mr. Mansor is a firm believer that frames should be personalized based on an individual’s lifestyle, face shape, and fit. point, especially if your customer is a progressive lens wearer or multifocal,” Mr. Ho pointed out. If the bridge is too large, the frames will slip down frequently. Sometimes Asian faces need an S-shaped nose bridge, rather than a U-shaped bridge. This helps elevate the glasses, as Asians tend to have flatter features compared to Caucasians. Remember that Asians tend to be myopic Mr. Ho also reminds us that Asians tend to be very myopic. Such wearers could consider the RYAN ADDA ONE Collection frames that come with a 3 mm-rim edge thickness, which helps to hide the thickness of the lens for high myope individuals.

The frame bridge — the part which

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Consider your customer’s prescription requirement

Adding value to their customers, with RYAN ADDA, Mr. Ho makes it even easier to choose the right frames. Users can test out the frames on the ZEISS Virtual Try-On platform in Zeiss Vision Center stores before purchasing them.

On the other hand, Mr. Muhammad Aimaan Mansor’s Hava Optique eyewear shop is a Malaysian brand that produces its own frame designs. Its team carries out extensive research on frame designs that suit Asians, and has come up with a frame selector system and a face-shape identifier on its website. “Most importantly, our frames are Malaysian-made and affordable as they eliminate the middleman. One plus point for Hava Optique is that, on top of being an Asian fit brand, our frames are also hijab-friendly, which most Asian fit frames are not,” Mr. Mansor shared.

Another thing to note when fitting Asian frames is that Asians also usually have a shorter temple length at around 145 mm compared to Caucasians.

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“During my working days, I have seen people buying expensive frames that don't suit them and were fitted by unqualified people,” he shared. “Most of the frames on the market are manufactured by one company and designed for Caucasians. Hence, if Asians buy these frames, we would have problems with the fitting of the frames,” he added. He said frames should fit nicely on our face and not slide down constantly, or touch our cheekbones when we smile. “Asians generally face these problems when wearing wrong-fitted frames,” he noted. Consider your customer’s high cheekbones For those with high cheekbones, the bottom of the frames might touch the


cheeks, especially when smiling or talking. “This happens due to the nose pad not resting on the nose,” explained Mr. Mansor. “Hence, the lenses cling onto the cheekbones, which also happens because Asians generally have higher cheekbones.” “Due to our low nose bridge and high cheekbones, if we adjust the frames to make it tighter, we would just bring the frame closer to our eye. This will create discomfort as our eyelashes will be touching the frame, and our prescription will be stronger than it should be, so we will get an overcorrected prescription.” Take into account the customer’s facial shape On top of that, most Asians have oval and round face shapes, whereas Caucasians have square, rectangular, and diamond-shaped faces. Some Asian faces also tend to be wider, and therefore require wider glasses. For wide or round faces, some glasses can feel tight and uncomfortable on the temple. Some of the frames may even leave a mark around the temple area. “I have seen some Asians who developed skin rashes on the temple due to sweat and tight-fitting frames,” shared Mr. Mansor. Look into customizable frames “Oakley is quite expensive as it is from overseas, but the frames can be customized,” he said. “Their nose pad can be adjusted to be thicker so that it rests on your nose perfectly.”

“There are actually a lot of Asian brands that are modified for the Asian market. So when you go to any optical shop, ask them to show you omni-fit frames. These are frames that are modified to fit everyone, including us Asians,” Mr. Mansor added. Don’t spend too much on one pair alone “The reason being is that there is no frame that fits all of our lifestyles. Frames for sports use and social use should be different. Frames for traveling and working in the office should also be different,” he advised. Mr. Mansor added that it is better to spend less on one pair in order to have at least two pairs of eyewear for different occasions, and also as a backup pair. Choose frames that look good and feel comfortable, and not necessarily bigbranded frames. “Some of the big branded frames look beautiful, but they end up being heavy and peculiar, and uncomfortable for your customers to wear in the long-term. They would end up putting those frames away and not wearing them,” he noted. Look for a frame specialist “At Hava Optique, we have trained frame specialists who are wellexperienced in choosing frames for customers,” shared Mr. Mansor. “They will take into account your lifestyle, face shape, and face fit. They have fitted over 5,000 customers in Malaysia and have developed a system to find the best fit frame.”

His final advice? Know your customer’s face shape and size before letting them choose the frames. For Muslim ladies, large frames will not fit in a hijab, and are not hijabfriendly. “Generally, sizes 51-47 are the best for women, and 56-52 are the best for men,” he concluded.

Contributing Doctors Mr. Ryan Ho first undertook a Bachelor of Science in Microbiological Sciences at the University of Kansas, USA, in 1996 before studying Optometry at the International University College of Technology Twintech, Malaysia, in 2008. He is a skilled optometrist with over 15 years of experience. His opinions on the treatment of Ortho-k, monovision, progressive lens fitting, and myopia in children have been well sought after on national television stations, such as RTM, TV3, and national newswires, as well as publications such as Bernama, The Star, and more. He has helped build Malaya Optical from a familyowned business of three generations to become a two-time award winner of the prestigious Brand Laureate Award. While he is busy running his retail practices, online store, and building an eyewear brand, Mr. Ho makes sure to spend quality time with his family as they are the inspiration behind this brand. During his leisure time, Mr. Ho enjoys riding his road bike on numerous road adventures. ryan@malayaoptical.com Mr. Muhammad Aimaan Mansor graduated in Optometry from the University of Bradford, United Kingdom, in 2015, and has worked for nine years in the optical industry. He founded the Hava Optique eyewear shop in 2018, aiming to provide the best-fit frames suited for individual lifestyles. He is also an executive member of the Association of Malaysian Optometrists. Passionate about giving optical advice to customers face-to-face as well as on Instagram, he hopes to inspire other optometrists too. Married with one child, he enjoys playing video games and badminton in his spare time. aimaanmansor@gmail.com

| November 2022

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ENLIGHTENMENT |

OPTOMETRY EDUCATION

Moving Your Practice from East to West? Check education standards and have a plan by Andrew Sweeney

C

ulture shock is a familiar concern among travelers. However, this feeling of uncertainty and anxiety when experiencing a new culture is not strictly limited to tourists. One can observe cultural differences between various communities worldwide, whether or not separated by geographical location. A Glaswegian, for example, often feels a palpable difference when they visit Scotland’s capital, Edinburgh. The same goes for someone from San Antonio, Texas, when they visit San Francisco, California. This concept also holds true in the medical field, given the considerable differences in the standards and practices worldwide. Perhaps no area of the medical community is more affected by culture shift and shock than optometry — thanks to the myriad of different regulations, standards, and educational requirements that exist worldwide. Some countries demand that an optometrist holds a degree that takes

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four years to study to practice, whereas other states view a practitioner of optometry as someone akin to a junior technician. In other countries, still, optometrists are highly restricted in what they can practice at all.

Differences between Eastern and Western optometry It might be something of a general statement to say that there are considerable differences between Eastern and Western optometry practices. However, these differences can only provoke debates and new perspectives, ultimately leading to fostering and sharing of new ideas. The differences and challenges that exist in bridging the gap between these two optometric spheres are a fascinating topic, and one of the best places to examine the issue is the United Kingdom (UK).

| November 2022

Not only is the UK a major destination for Asian optometrists, either for work or training, but the country also hosts a large ethnic minority population of Asians. In the British context, this term mainly applies to those of SouthAsian background, i.e., Indians and Pakistanis; whereas East Asian is used to describe people of Japanese and Chinese background, among others. At present, nearly 5 million people in the UK are of this origin, accounting for about 7% of the population.

Education standards may differ One member of this community is self-employed optometrist Ms. Shamina Asif, the founder of Optom Academy. This educational institution was set up specifically to cater to the needs of pre-registration optometry students, many of whom originate from abroad, generally, and South Asia, specifically.


Courses are held at the Optegra Eye Clinic at Aston University campus in Birmingham, the UK’s second-largest city. And for Ms. Asif, it’s an endeavor of passion as much as education. “I always had an element of teaching in me from a young age, so once I felt I had enough knowledge and experience I decided to pursue this passion of mine,” shared Ms. Asif. “The most rewarding part is that I help to contribute in developing great optometrists.”

has a population of 300,000 that’s notable for its ethnic and cultural diversity. Her specialties include emergency appointments, pre-cataract assessments, as well as post-cataract assessments and pediatric sight tests. In her 17 years of experience, she has encountered a variety of challenges.

Ms. Asif has worked with thousands of optometry students. She said the primary challenge one encounters when educating students is understanding the different standards and expectations that exist in different countries. For example, there are different minimum requirements for practice in the UK and the Indian subcontinent.

Of these, two remain important to note for incoming Asian optometrists to the UK, the first being that black and minority ethnicity (BAME) populations are more at risk of experiencing damaging eye conditions, such as glaucoma and diabetic retinopathy.1 In fact, one in 10 people over the age of 65 in this community will experience serious vision loss. Overall, they are less likely to attend primary eye care appointments. There are also socioeconomic barriers, such as language difficulties, higher rates of poverty, and higher rates of problem denial.

“The UK is brilliant in terms of regulation of sight testing, as only optometrists can carry out refraction and eye tests. This means you are at a certain standard and qualification before you are allowed to test the eyes of patients,” explained Ms. Asif. “I know this is not the case in many countries, like Pakistan and India.”

Secondly, and unfortunately, racist attitudes — though rare — do persist in parts of the UK. Four years ago a visitor to an optometry clinic in the town of Lanark told his optometrist, who was of South-Asian ancestry, that he would rather be seen by a ‘white person.’ He was convicted in court of a racist breach of the peace.2

“You need to know your subject inside out,” she continued. “I always recommend that prospective students look at the General Optical Council’s website for requirements and exams that they may need to sit. As the way sight-testing might be taught in other Asian countries is not the same standard as the UK, so there’s a possibility that incomers would need to upskill,” she added.

However, Ms. Asif has previously reported that racism is a diminishing issue and that in today's environment it should not put off Asian optometrists from moving to the UK. In fact, by coming to study and work in the country, they can help drive the change required to make the field more inclusive.

Overcoming challenges and keeping a positive outlook Beyond her education projects, Ms. Asif continues to work at an independent practice in the town of Walsall. It

“BAME optometrists make up a large proportion of the workforce in the UK and there are no accessibility issues,” she noted. “The only problem is that you don’t get BAME community in higher board-level positions where policies and strategies are developed,” Ms. Asif shared.

References 1.

Eye health care in Wales: Increasing awareness of eye health and primary eye health care to people from at risk Black and Minority Ethnic communities. Available at: https://media.rnib.org.uk/documents/ BME_Eye_Health_Care_in_Wales_-_Poster.pdf. Accessed on October 18, 2022.

2.

Man refuses treatment from British-Asian optician because 'Manchester attack was the last straw’. Available at: https://www.independent.co.uk/news/uk/crime/man-refuses-asian-optician-specsavermanchester-attack-last-straw-a7907261.html. Accessed on October 18, 2022.

Prepare well and plan longterm Ms. Asif strongly recommends that optometrists who wish to continue their practice, or those who are yet to begin their education, should consider the UK as an option. The country has a strong healthcare system and high training standards, as exemplified by her work as an educator. Her final tip for optometrists coming from the East to the West? Consider a long-term plan on how to set up a practice — one that you could own — in the country where you plan to work. "My team and I bought a practice that was established,” she said. “The owner was retiring, and this was a good opportunity for us. This is a good idea. Try to buy a practice where someone is retiring as you will already have a patient base when you get started,” Ms. Asif added. “Optometrists save sight and help people to see clearly, giving them a better quality of life. What could be more rewarding?” she concluded.

Contributing Doctor Ms. Shamina Asif is an optometrist based in Walsall, UK, with nearly 20 years of experience working in her field. Educated at Aston University, Birmingham, Ms. Asif was formerly head of clinical services at CrossEyes DK where she worked in clinical governance as well as optometric practice. The founder of Optom Academy, much of Ms. Asif’s work today focuses on training the next generation of optometrists in the UK. www.optomacademy.com

| November 2022

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