Insight May 2021

INSIGHT MAY

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

You are making a difference!

Thank you for joining the fight to treat myopia in children.

60%

slow down of myopia progression*

*

Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV lenses.

Optometry supply is in the spotlight again as new figures reveal high employment rates.

CHANGING THE WAY PATIENTS PAY Buy now, pay later services are scrambling to grab their share of the local optical market.

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DOES AUSTRALIA NEED MORE OPTOMETRISTS?

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Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial.

British Journal of Ophthalmology. Published Online First: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739.

OPHTHALMIC SURGERY ENTERS A NEW DIMENSION Australian surgeons reveal how a 3D visualisation system is revolutionising their work.

SAY ‘I DO’

to your new Specsavers optometry business ‘I DO’ want to be an owner in a partnership

‘I DON’T’ want to be an owner in a group

with average annual sales of $3 million per store

that has uncertain store performance

with no upfront capital investment

that requires personal bank borrowing to get started

that guarantees a fortnightly pay cheque and five weeks annual leave

that doesn’t guarantee a regular salary

delivers strong and sustainable profits

that is a mix of partner-owned stores competing with company owned stores

that’s investing over $60 million in marketing every year

that under-invests in TV, radio and print marketing

where I can make a genuine impact on community eye health

that is not committed to utilising items such as OCT as part of standard eye care

where community partnerships are real, enduring and now worth over $1 million every year

where community ‘partnerships’ may not be as real as presented

With a network of over 350 partner-owned stores producing average annual sales of $3 million each, Specsavers continues to have a growing impact on the Australian eye care landscape – and also on the lives and livelihoods of our current army of 800+ optometrists, dispensers and audiology professionals who have joined us as partners in their own stores.

Profits are strong and sustainable, investment in technology is supporting ever improving health outcomes and our community partnerships are real and enduring with more than $1 million raised and distributed every year.

So, if you are an ambitious optometrist, dispenser or optical retail professional keen to discover the benefits of a proven partnership model, talk to us today.

Visit spectrum-anz.com or contact Marie Stewart on +61 408 084 134 or marie.stewart@specsavers.com.

INSIGHT MAY

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

SUPPLY DEBATE REIGNITES AS OPTOMETRY BOASTS STRONG EMPLOYMENT RATE

New figures have revealed that optometry graduates have among the highest rates of full-time employment compared with other sectors, sparking debate over future workforce supply that will increase significantly once the first set of graduates emerge from optometry schools in Western Australia and Canberra.

According to Quality Indicators for Learning and Teaching (QILT) – which conducts the Australian Governmentfunded annual Graduate Outcomes Survey (GOS) – in 2020 around 95% of optometry graduates were employed in full-time work (over 35 hours per week), with a median salary ranging between $80,000 to $85,000.

With most new optometrists completing post-graduate courses, the full-time employment rate is one of the highest among all sectors, with

only medicine ranking higher (97%) among post-graduates. Nursing (92%), pharmacy (96%), and dentistry and business management (91%) and occupational therapy (90%) all demonstrated comparable rates.

The QILT figures have been taken from a sample of survey respondents who completed their courses from March 2019 until February 2020 and could theoretically represent some 15 graduates without a job, however the reasons for this were not contained in the data.

Universities and major industry employers have told Insight employment rates have remained high in the latest cohort who completed their courses towards the end of 2020 and have sought jobs in 2021.

University of Technology have increased by 31 students to reach 321 in 2020/21.

The median salary ranged between $80,000 to $85,000.

Four out of the five universities that currently supply the graduate market anecdotally confirmed most, if not all, graduates have secured jobs in 2021, with the remaining institution unable to provide the information until they complete a graduate survey.

Figures provided by Specsavers show that since 2018/19, combined final year cohorts from Deakin, Flinders University, University of Melbourne, UNSW and Queensland

Optometry graduate numbers are set to increase further soon as cohorts from new optometry schools at the University of Western Australia (UWA) and the University of Canberra (UC) enter the workforce. UWA’s program has enrolled 50 students in its inaugural cohort this year who will graduate in 2023. UC’s first cohort of nine master’s students are expected to graduate in 2022.

Increased supply is a contentious issue for the sector, with Optometry Australia (OA) and major employers like Specsavers in disagreement over modelling and the number of graduates necessary for a continued page 8

NEW BUYING GROUP COULD LIMIT PATIENT FREEDOM The creep of US-style managed care in Australia and reduced competition in the optical market are among major concerns raised with the competition watchdog as it considers the formation of a new buying group to collectively negotiate contracts with healthcare providers.

The Australian Society of Ophthalmologists (ASO) and Optometry Australia (OA) recently lodged submissions with the Australian Competition and Consumer Commission (ACCC), which will decide whether Honeysuckle Health can form and operate the buying group for 10 years.

Honeysuckle is an equal joint venture between nib health funds and US-based health services company

Cigna Corporation. If approved, the Honeysuckle buying group could collectively negotiate and administer contracts with hospitals, medical specialists, GPs and allied health professionals.

This would be done on behalf of ‘participants’ that may include other private health insurers, international medical and travel insurance companies, and government and semi-government payers of healthcare services.

Honeysuckle anticipates smaller private health insurers that currently outsource their contracting services to two existing buying groups are most likely to join its group. Larger players Medibank, Bupa, HCF and HBF – who conduct their own

negotiations – may be interested in purchasing bespoke aspects.

While supporters argue it could reduce out-of-pocket costs for consumers, health bodies are worried about the level of control insurers will have over clinical care pathways.

The potential size of the group is also unclear, with concerns it could have disproportionate market power.

ASO vice-president Dr Peter Sumich said Australia’s healthcare model allowed “control of the who, where and when of our private medical care”.

“US-style managed care places the insurer in the position to determine a patient’s treatment pathway. We wish to see patients continue with full choice of care as decided in continued page 8

AT THE SERVICE OF INDEPENDENTS Whether it’s digital marketing, succession planning or practice acquisition, more independents are turning to Eyecare Plus to ensure the viability of their businesses in an ever-changing optometric landscape. page 44

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IN THIS ISSUE MAY 2021

EDITORIAL

FEATURES

GIVING EARLY CAREER RESEARCHERS A FAIR GO I read a disturbing headline recently that early career researchers (ECRs) have less job security than a barista. Let that sink in and ask, how has this been allowed to happen?

There’s been plenty to celebrate for our research community lately, with 43 Australians featuring in a new ranking system of the world’s top 200 optometry researchers, topped by the UNSW’s Professor Konrad Pesudovs. We’ve also seen major companies laud Australia’s COVID-19 response, which has allowed them to progress major eye drug trials here.

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FINTECH FRENZY Buy now, pay later services are helping practices generate higher value sales.

NEXT-GEN IOL B+L’s enVista platform features an enhanced lens material and new delivery system.

But the plight of ECRs – the transition stage between PhD and senior academic positions – is concerning, and has been pushed into the spotlight following Federation University Australia PhD candidate Ms Katherine Christian’s recent survey of 658 ECRs. It revealed job insecurity, workplace culture and mentorship are impacting job satisfaction significantly.

Most concerning was the high rate at which ECRs (41.4% females and 30.7% males) claimed questionable research practices – ranging from fraud to data exclusion – had negatively impacted their careers.

Much of the stress appears to revolve around short-term contracts and a lack of funding, which can fuel uncertainty and promote an unhealthy environment to secure grants.

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PERIPHERAL PATHOLOGY Australia's first clinic to install the Optos Silverstone discusses the added benefits of SS-OCT.

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LATE-STAGE AMD Where to now for nAMD, and when can we expect a therapy for geographic atrophy?

EVERY ISSUE 07 UPFRONT

48 MANAGEMENT

09 NEWS THIS MONTH

49 CLASSIFIEDS

46 ORTHOPTICS AUSTRALIA

49 CALENDAR

47 DISPENSING

50 SOAPBOX

As Christian points out, the government is relying on further advances in these fields to underpin future economic prosperity. So maybe it should listen when she says R&D GDP expenditure should be increased to align with other OECD nations. And that research funds should be distributed through smaller and more consistent grants to support long-term career development.

Reducing PhD completion numbers may also better align with workforce demand.

It’s a hard slog to test ideas and develop researchers, especially when nothing’s ever guaranteed. But by spending less time worrying about the next cheque, ECRs can focus more on their work, which we all stand to benefit from.

MYLES HUME Editor

INSIGHT May 2021 5

Imaging ultra-wide without compromise.

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Carl Zeiss Pty Ltd, NSW 2113 AUSTRALIA. Carl Zeiss (NZ) Ltd, AUCKLAND 1026 NZ.

Choroidal Nevus Red channel separation

Proliferative Diabetic Retinopathy Green channel separation

Retinal Nerve Fibre Layer Blue channel separation

Proliferative Diabetic Retinopathy Fluorescein angiography

Geographic Atrophy FAF-Blue

ZEISS CLARUS Colour. Clarity. Complete.

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Compromising image quality may leave some pathology unseen.

The ZEISS CLARUS is the next generation fundus imaging system that provides true colour and high resolution in a 200 degree ultra-widefield image. www.zeiss.com/CLARUS

Dry Age-related Macular Degeneration FAF-Green

UPFRONT Just as Insight went to print, THE LIONS EYE INSTITUTE established a new eye clinic for children and adolescents in WA with diabetes. As part of the new Perron Paediatric Retinopathy Initiative, the clinic is a collaboration between the LEI and Perth Children’s Hospital. It also includes a significant research project to develop new therapies. LEI ophthalmologists Associate Professor Chandra Balaratnasingam and Dr Antony Clark will screen, assess and treat children for juvenile diabetic retinopathy complications. “When

n

WEIRD

you consider that almost 100% of children with type 1 diabetes will develop diabetic retinopathy in their lifetime, this is a very serious issue,” Balaratnasingam said. IN OTHER NEWS, Australian optometrists and ophthalmologists, their support staff and students and trainees are now eligible to receive a COVID-19 vaccine. The second wave – known as Phase 1b – is expected to deliver up to 14.8 million doses, including for up to 953,000 healthcare workers not included in Phase 1a. A Department of Health spokesperson confirmed all staff in a medical facility “such as administrative staff, optical dispensers and students” will be considered as part of the healthcare worker

cohort. However, people working off-site in a corporate facility will not be eligible for this phase that commenced on 22 March.

FINALLY, Dr Maria Cabrera, a researcher at the University of Sydney, Save Sight Institute, is producing a new podcast to explore topics related to eye health and answer some common questions about eye conditions.

Cabrera has released three episodes of the ‘Sydney Eye Podcast’, with the first focusing on corneal infections and contact lenses.

The second episode discusses antimicrobial resistance in corneal infections, while the third delves into herpes simplex keratitis. It’s available on Apple Podcasts, Spotify, Google Podcasts, Stitcher and YouTube.

STAT

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WACKY

The eyes of horses are home to a diverse range of fungi. Researchers from Texas A&M University used molecular-based DNA testing to identify fungi present in the eyes of five pastured mares and a group of seven stallions kept in stables and found all 24 eyes contained fungi from at least five genera at an abundance of 1% or more. The Alternaria and Aspergillus species is often identified in fungal keratitis cases.

11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreativemedia.com.au

christine.clancy@primecreative.com.au

Editor Myles Hume myles.hume@primecreative.com.au Journalist Rhiannon Bowman rhiannon.bowman@primecreative.com.au

Business Development Manager Alex Mackelden alex.mackelden@primecreative.com.au

Client Success Manager Justine Nardone justine.nardone@primecreative.com.au

WONDERFUL

Lego Braille Bricks have made their way Down Under, thanks to a partnership between Vision Australia and the Lego Foundation. Available for blind and low vision children, the bricks feature printed letters, numbers and symbols so that they can be used in a collaborative and inclusive fashion.

Published by:

Publisher Christine Clancy

The age-old mystery into the evolutionary origins of vertebrate eyes may have been solved with hagfish.

For years, hagfish eyes were thought to be different from vertebrates’, but US researchers discovered they contain many similar structural features. They believe Hagfish could now provide a better understanding of the origins of human vision with new knowledge of the early stages of vertebrate eye evolution. n

insightnews.com.au

Design Production Manager Michelle Weston

BUY NOW, PAY LATER

michelle.weston@primecreative.com.au

Around 30% of Australians now have an account with a buy now, pay later provider, equivalent to 5.8 million people. Full report page 30.

Art Director Blake Storey Graphic Design Jo De Bono

WHAT’S ON

Complete calendar page 49

Subscriptions T: 03 9690 8766 subscriptions@primecreative.com.au

THIS MONTH

NEXT MONTH

The Publisher reserves the right to alter

RANZCO WA MEETING

ASO EXPO 2021

or omit any article or advertisement

JUNE 4-6

the advertisers and contributors against

MAY 7-8

Oculoplastics surgery updates, glaucoma management amid COVID-19 and cyber security will be among topics discussed at the Grand Hyatt in Melbourne.

The 2021 Western Australia Branch Annual Scientific Meeting on Rottnest Island will feature speakers Profs Nitin Verma, Mark Gillies and Ian Constable. ranzcowa.com.au

info@asoeye.org

submitted and requires indemnity from damages or liabilities that arise from material published. © Copyright – No part of this publication be reproduced, stored in a retrieval system or transmitted in any means electronic, mechanical, photocopying, recording or otherwise without the permission of the publisher.

INSIGHT May 2021 7

NEWS

OPTOMETRY NUMBERS CONTINUE TO CLIMB continued from page 3

sustainable future. Specsavers had modelling conducted by Deloitte Access Economics (DAE) in 2018 that showed despite the onset of new optometry courses, by 2037 Australia will be more than 1,188 full-time equivalent optometrists short of meeting the nation’s requirements.

In the first of its two annual intakes in February 2021, the optical franchise recruited 120 graduates across Australia and New Zealand.

“We know there are more jobs available than graduates and we would have liked to secure an additional 75 graduates had they been available. However, the reality is that we’re all seeing a highly competitive market for graduates in both metro and regional locations, which reiterates our message that we need more optometry students coming through the system to support the industry’s recruitment needs,” communications director Mr Charles Hornor said.

Meanwhile, information OA has received paints a different picture.

“Notably our information is anecdotal only, however our perception is that most practices looking to recruit graduates have been able to do so quite readily.

Our perception is that there may be some slight easing in demand for graduates,” CEO Ms Lyn Brodie said.

She said it’s positive that, at present, the vast majority of new graduates can secure employment, and it’s something the association wished to retain. However,

OA is concerned the ongoing supply of graduates will soon outstrip demand.

“We continue to see more optometrists entering, than retiring from, the profession each year, and over the last five years there has been rapid growth in the size of the optometry workforce. Whilst it’s important to seek to match university graduation numbers to community need, there is also opportunity to be looking at how we make most effective use of our skilled workforce to meet community need in new and innovative ways.”

When newer schools begin to graduate students, Brodie said it may contribute to a tipping in the supply/demand balance: “Both of the newer schools are well positioned to support graduate supply to geographic areas where there may be undersupply currently, however, it seems likely these supply needs will be readily met by the first or second cohort of graduates.”

"WE CONTINUE TO SEE MORE OPTOMETRISTS ENTERING, THAN RETIRING FROM, THE PROFESSION EACH YEAR" LYN BRODIE, OPTOMETRY AUSTRALIA

20 years. In response to maldistribution, the company has been intentional in its placement of new graduates. While there’s less appetite to be placed in CBD locations due to COVID-19, graduate placements into regional and rural locations has more than doubled since 2018.

Ms Robyn Weinberg, group manager of human resources and training at The Optical Company, said the aging population, chronic diseases and increase of childhood myopia will increase the need for optometry.

“This increased need is likely to be supported with evolving scope of practice into the future. Added to this is the opening of programs in ACT and WA, increasing the supply to demand ratio,” she said.

“However, optometrists are also working longer and retirement in many instances is being delayed. Many people have also shifted expectations around work and family balance as a result of COVID-19 combined with planned parental leave and flexibility an increasing consideration for all industries. Overall given current factors, we are of the opinion there will be suitable levels of graduates to meet, if not exceed future demand.”

The Optometry Board of Australia’s latest figures show since 2015, registered optometrist numbers have risen from 5,114 to 6,175 today – a difference of 1,061.

Citing the DAE report, Specsavers noted on its HealthHub website that while full-time optometrists were expected to increase by more than 3,500 by 2037, the nation was still headed for an undersupply.

George & Matilda CEO Mr Chris Beer said the company had an extensive mentoring program and combined with the growing aging population, the market is growing.

In Tasmania, WA and Northern Territory, as well as regional and remote locations, there was already a shortage, while NSW and Victoria would likely be unable to meet their service requirements within the next

“We see the shortage of optometrist graduates going into the future for some time,” he said. n

FEARS COMPETITION COULD BE COMPROMISED continued from page 3

consultation with their doctor. Inevitably, insurers design care packages with a minimum viable product which may not be appropriate for all patients,” he said.

Sumich was part of an ASO delegation to Canberra who raised concerns with Health Minister Mr Greg Hunt’s office, and Labor MPs Mr Mark Butler and Ms Ged Kearney, who oversee the Health and Ageing Shadow Ministry.

“The discussions related to the creep of managed care under the trojan horse of Honeysuckle Health, Medibank vertical integration and HCF obstetric bundled care 8

INSIGHT May 2021

in this simplistic non-qualified system.”

pathways,” Sumich said. “Their response was one of concern and surprise because these individual commercial developments are not always put together to reveal the emerging patterns we all see as clinicians at the coalface.”

The ASO is also concerned Honeysuckle would compare the value of services from a provider against peers in the region.

“Many clinicians operate on different levels of complexity which sees some clinicians appear high quality, but only because they operate in a very limited range and on simple conditions," its submission said. "In other cases, highly talented and reputed clinicians, who operate on most serious and complicated conditions, are marked down

OA's submission stated larger funds and buying groups often entered low or ‘no gap’ contracting arrangements with the largest optometry providers only.

Dr Peter Sumich, ASO.

“We have concerns that a buying group, such as the proposed [Honeysuckle buying group], that includes at least one larger fund, and may potentially include multiple larger funds, by undertaking contracting arrangements for a potentially larger proportion of the health insurer market, will further compromise the capacity of smaller providers to compete fairly in the market, with the ultimate impact of reduced competition in the optometry/optical market," OA stated. n

NEWS

OCULO ACQUIRED BY EUROPEAN OPHTHALMIC DEVICE COMPANY

IN BRIEF n

Australian-owned clinical communication platform Oculo will change hands in the coming months following an announcement this week that Finnish ophthalmic diagnostics company Revenio has purchased the platform.

In a stock exchange media release on 19 March, Revenio Group Corporation said the Melbourne company is valued at AU$18.5 million and is an integral part of its strategy to strengthen its expertise in clinical eyecare software solutions.

Co-founded by Professor Jonathan Crowston and Dr Kate Taylor in conjunction with the Centre for Eye Research Australia (CERA), the Oculo platform shares clinical imaging, referrals, and other clinical correspondence securely and instantly between healthcare professionals.​ Since launching in 2015, it has grown a user base of more than seven out of 10 eyecare providers in Australia and New Zealand and has managed more than one million patients. Oculo is also the technology partner for KeepSight, the Australian Government’s first-ever national diabetes eyecare program.

Taylor said the new partnership with Revenio recognises that the team behind Oculo have built a teleophthalmology and clinical communication solution that is needed by eyecare professionals around the world.

“We started with a vision to transform clinical eyecare and collaboration.

We are delighted that Revenio shares this vison and are looking to expand it globally,” she said.

She said it had been an “enormous journey” since she and Crowston, the former managing director at CERA, had their first discussion.

“Eyecare is so reliant on imaging and functional assessment of the eye,” Crowston said. “More than almost any other speciality, eyecare needs to digitise care. The era of teleophthalmology is clearly upon us.

Both through Oculo and looking to the potential impact of home monitoring, I’ve seen how better tools and data can translate to better patient care."

Taylor acknowledged the industry support in getting Oculo off the ground more than five years ago. Today, the platform has more than 3,300

Kate Taylor, Oculo CEO and co-founder.

optometrists and 800 ophthalmologist users in Australia.

“We couldn’t have started without our first customers – Dr Michael Coote, who was the first ophthalmologist to sign on, Specsavers who was our first optometry customer, as well as OPSM and Bupa who collaborated on our initial betatesting,” Taylor said.

“I know that we are extremely grateful to the Oculo team for their dedication and their passion for better patient care.

Having the opportunity to work with great partners like Glaucoma Australia, Diabetes Australia, the Macular Disease Foundation Australia and Optometry Australia is a great privilege that we look forward to continuing and growing in Australia.”

According to Revenio – which supplies ophthalmic devices under the iCare brand – Oculo’s net sales in 2020 were approximately AU$1.6 million (excluding grant income). The sellers are several Australian investors and the company’s shareholding employees.

With the acquisition expected to be completed in the beginning of the second quarter of 2021, Revenio CEO Mr Jouni Toijala said software-related solutions are significantly enhancing patient eyecare pathways and the processes of eyecare professionals.

“There are tremendous opportunities in improving the productivity and quality of eyecare, and we see improving the continuum of care through secure communications and teleophthalmology with Oculo as a key,” he said.

“The acquisition of Oculo marks Revenio’s strategic direction and commitment to connecting clinical care pathways and enhancing the quality of clinical information.” n

MYOPIA PARTNERSHIP

The World Council of Optometry (WCO) and CooperVision have announced a partnership to raise awareness of myopia progression and encourage optometrists to embrace a standard of care. “Myopia is arguably the most widespread epidemic faced by the global optometry community.

Yet despite the increased prevalence and severity of the condition and its detrimental impacts on eye health, a standard of care does not exist. That is a disservice to our profession, patients and public health,” Mr Paul Folkesson, president of WCO, said.

“Together with CooperVision, which has been instrumental in creating the myopia management category over the past decade, we can make an even greater impact.”

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GRADUATES WELCOMED

Specsavers has welcomed more than 120 graduates for 2021 in its first ever ‘hybrid-virtual’ induction event. With COVID requirements still impacting travel, the optical franchise welcomed its newest cohort of optometrists across Australia and New Zealand who attended in-region at local training centres in Auckland, Western Australia, Queensland, New South Wales, South Australia and Victoria, where they tuned into a livestream from the company’s Port Melbourne headquarters. Despite the disruption of COVID-19, this year’s graduate numbers are comparable to recent years. A second induction will also take place later in the year with Deakin University’s graduating cohort

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TV CAMPAIGN

Optometry Australia (OA) commenced its ‘Good vision for life’ TV campaign to encourage Australians to prioritise their eye health and make an appointment.

Bolstered by Federal Government funding, the organisation negotiated content placement partnerships with Channel Nine and Tonic Health Media.

The Channel Nine ads featured in March, airing on The Today Show, Today Extra and 60 Minutes. It also included interviews on Today Extra with OA’s chief clinical officer Mr Luke Arundel discussing children’s vision and myopia. The Tonic Health Media deal utilised the company’s network of televisions located in 1,606 GP waiting rooms to air eye health advertisements once every 30 minutes.

INSIGHT May 2021 9

NEWS

NATIONAL CORNEAL DONATIONS ONLY SLIGHTLY DOWN DESPITE MAJOR DISRUPTION "WE ARE PROBABLY ONLY ONE OF A HANDFUL OF NATIONS IN THE WORLD THAT’S SELFSUFFICIENT AND SUSTAINABLE" GRAEME POLLOCK, LIONS EYE DONATION SERVICE

A state-by-state breakdown of eye donations (dark purple) in 2020.

The Australian Government’s latest report on organ and tissue donation shows 2,277 Australians received corneal transplants in 2020 from 1,318 donors, figures a leading eye bank director says are remarkable considering donations dropped by 50% at the peak of COVID-19 lockdowns.

Lions Eye Donation Service (LEDS) director Dr Graeme Pollock, who founded the Melbourne-based organisation in 1991, was commenting on the release of the 2020 Australian Donation and Transplantation Activity Report that found eye donations and corneal transplants were only slightly down on the year prior.

The figures show in 2020 there were 190 fewer eye donations (a 13% drop) than in 2019, and 137 fewer corneal transplants (a 6% decrease).

Pollock said the figures were strong considering corneal donations dropped by half across Australia during the initial lockdown from March through April. But that coincided with a shutdown on elective surgery, which meant only 30-50% of usual corneal surgeries were being performed.

“So, we were still able to meet demand over that period, mainly for Category 1 patients,” he said. “And in May when a lot of the lockdowns were eased, some states experienced a rebound effect in terms of the number of transplants needed, and indeed we were lucky enough to see a rapid recovery in donations to cope with that.”

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INSIGHT May 2021

However, from July to October, Pollock said lockdowns – particularly in Victoria – put pressure on donor referral systems out of hospitals, which rely on staff having donation front-of-mind.

Organ donor consent rates also dropped.

With bereavement being challenging at the best of times, this was amplified during COVID-19 with restrictions on travel and funeral numbers.

In recent months, there have also been several studies investigating the presence of COVID-19 in the eye and whether it can be transmitted via donated corneas.

With a known incubation period of 14 days, Pollock said eye banks have been taking an “ultra conservative approach” and will only accept a cornea from a previously infected COVID patient if it is donated 28 days or more after their initial diagnosis.

transmitted by transplantation of a cornea, tissue, organ and even blood, including SARS or MERS. There is an extraordinarily low risk of COVID transmission in this way, in fact no one in the world has experienced it.”

A WORLD LEADING SYSTEM The 2020 report also had a state-by-state breakdown of eye donations. Queensland had the highest rate with 419, followed

by New South Wales (368), Victoria (266), Western Australia (131), South Australia (108) and Tasmania (14).

Pollock said donations have continued to climb since mid-October, returning to 2019 levels.

“Whilst we went down about 50% at one point, in the US, for example, activity in April through to June [2020] was about 6% of pre-COVID activity, so eye banking almost shut, in fact many eye banks did, and the US has slowly recovered,” he said.

“Domestically, the US are still probably about 75% of what they were doing beforehand and, of course, they supply many international transplants as well which are down to about 15-20% of what they used to be.”

Pollock said while Australia’s eye banks (located in Brisbane, Perth, Sydney, Adelaide and Melbourne) worked independently, they had an informal network of sharing tissue on an as-needed basis. They also worked with the Auckland eye bank, with some tissue also sent to New Zealand.

“We are very fortunate in Australia that our system means we are very well-serviced for the provision of corneas and we are probably only one of a handful of nations in the world that’s self-sufficient and sustainable,” he said. n

“We also know that the preparations we use, which are similar to the preparations someone would undergo pre-operatively for eye surgery, are very effective at eliminating the virus,” he said.

“Even though there have been some virus particles detected in the cornea itself in two donors in the US – and remember in the US we are talking about tens of thousands of donors – it wasn’t very clear if that virus was living or viable,” he said.

“The bottom line is there has never been a substantiated report of coronavirus being

Dr Graeme Pollock, Lions Eye Donation Service.

60%

slow down of myopia progression*

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*

Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV lenses.

Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology. Published Online First: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739.

NEWS

AUSSIE-BASED MGD TRIAL ADVANCES TOWARDS FDA APPROVAL "AUSTRALIA’S MANAGEMENT OF THE PANDEMIC HAS MEANT LITTLE DISRUPTION TO OUR CLINICAL TRIAL PROGRAM"

Australia’s relative success at managing COVID-19 has meant an overseas biotechnology company can forge ahead with the final phase of clinical trials before its meibomian gland dysfunction (MGD) therapy is considered by US regulators.

Azura Ophthalmics, headquartered in Tel Aviv-Yafo, Israel, with operations in Australia and the US, could complete its first registration study of AZR-MD-001 by early 2022, following positive Phase 2 results announced in March.

AZR-MD-001 is designed to restore MGD – which research shows is the main cause of dry eye disease – by addressing the abnormal hyperkeratinization that blocks the glands, alters the quality of the oil and prevents the secretion of lipids into the tears. It comes in the form of a topical ointment applied to the lower lid margin twice a week before bedtime.

Azura has now commenced a registration study – the final stage before potential US Food and Drug Administration (FDA) regulatory approval – across 12 clinical research centres in Australia and New Zealand.

Mr Marc Gleeson, CEO of Azura, said Australia’s effective handling of the COVID-19 pandemic has meant the company’s clinical trial program could

A registration study has begun across 12 clinical research centres in Australia and New Zealand.

continue relatively undisrupted, which would not have been possible if trials were conducted in the US or Europe.

MARC GLEESON, AZURA OPHTHALMICS

“Meibomian gland dysfunction is a debilitating disease which has a terrible impact on millions of peoples’ lives around the world. Our goal is to get our treatment registered for use, as quickly as possible, and Australia’s management of the pandemic has meant little disruption to our clinical trial program,” he said.

government promotes clinical trials among consumers and health care providers, making it easy to get involved.”

The company said it raised AU$28 million last October to finance the registration study and FDA registration process.

Contributions from existing investors included Brandon Capital’s Medical Research Commercialisation Fund (MRCF), overseas supporters OrbiMed, TPG Biotech, and Ganot Capital.

Brandon Capital Partners is a venture capital firm that manages the MRCF, Australia and New Zealand’s largest life science investment fund. The MRCF is a collaboration between major Australian superannuation funds, the Australian and New Zealand governments, Australian state governments and over 50 medical research institutes and research hospitals.

Azura said its Phase 2 program found AZR-MD-001 showed improvements with two doses (0.5% and 1.0%). Statistically significant improvement in signs and symptoms of MGD were demonstrated relative to the control arm. After three months of treatment, 58% and 42% of patients in the 0.5% and 1.0% dose groups, respectively, became nonsymptomatic, compared to 16% of patients in the control arm. n

“Clinical trial recruitment and participation are at normal levels across Australia and New Zealand, something few countries can boast.

Trials in Australia have high enrolment rates, in part because contract research organisations offer incentives for citizens to participate and the Australian

OPTICAL DISPENSING WAGE SUBSIDY EXPANDED A fresh surge of optical practices are set to benefit from the Federal Government’s traineeship wage subsidy initiative after Prime Minister Scott Morrison removed a cap on the program and extended it for another 12 months.

The Boosting Apprenticeship Commencements (BAC) scheme – which involves a wage subsidy of up to $28,000 for new or existing employees enrolled into appropriate courses – reached its 100,000 capacity in less than five months.

However, Morrison announced on 9 March it would now become “demand driven” and expanded for a full year until 30 September 2022. This means that businesses that sign up eligible employees before 30 September 2021 can receive a 50% wage subsidy for a full 12-month period from the date

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INSIGHT May 2021

of commencement, to a maximum of $7,000 per quarter.

Previously, the payments were only going to be paid until September 2021, which meant employers missed out on potential subsidies every day they delayed subscribing an employee. Many were also required to move quickly before the program became fully subscribed.

With the number of placements now uncapped, it is estimated the demand driven expansion will generate around 70,000 new apprentice and trainee places, with the government investing around $1.2 billion.

Optical assistants enrolled in programs like the Certificate IV in Optical Dispensing are eligible. As of 14 January, a Department of Education, Skills and Employment spokesperson said there

had been more than 300 placements from employers with staff commencing optical dispensing training. However, Insight understands that number is much higher.

Hundreds of optical staff have enrolled.

Industry figures hope the scheme will encourage more employers to upskill their optical assistants and help address a shortage of qualified dispensers in Australia.

Morrison said training and skills were at the core of the government’s response to the economic challenges faced by the COVID-19 recession.

“With 100,000 new apprenticeship positions already snapped up, it highlights the confidence businesses have in the future of the Australian economy,” he said.

Minister for Employment, Skills, Small and Family Business Ms Michaelia Cash said it will help more people into jobs. n

Vac V V

584 Tors T T

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NEWS

ROYAL COMMISSION’S AGED CARE REPORT TARGETS OPTOMETRY TRAINING AND LOW VISION AIDS "WE APPLAUD THE ROYAL COMMISSION FOR MAKING THIS CRUCIAL RECOMMENDATION"

The Royal Commission into Aged Care Quality and Safety has recommended providers have arrangements with optometrists to ensure appropriate care to residents and has proposed a review of the undergraduate curricula for many allied health professions, including optometry.

Royal Commissioners Mr Tony Pagone, QC, and Ms Lynelle Briggs, AO, presented their final report on Monday 1 March, which also recommends making low vision aids and technologies more accessible for older Australians.

The damning report contained 148 recommendations made over a two-year investigation. While the government is yet to select which recommendations to adopt, Prime Minister Scott Morrison immediately pledged $452.2 million to address issues highlighted by the commission, and will provide a further response in the May budget.

In her findings, Briggs noted that providers have demonstrated “little curiosity or ambition for care improvement” and have not prioritised enablement and allied health care.

She went further than Pagone in her recommendations and proposed providers employ, or retain, at least one allied health practitioner across several disciplines, while for optometrists

The commissioners said “a paradigm shift is required” for allied health training.

DEE HOPKINS, MDFA

Australia (MDFA) has welcomed the recommendation to increase accessibility to daily living supports.

Specifically, the commissioners found that everyone living with a disability in the agedcare system should receive daily living supports – such as assistive technologies, aids and equipment – at a level equivalent to what someone under the age of 65 years would receive in the National Disability Insurance Scheme (NDIS).

Should the government adopt this recommendation, the MDFA believes more than 100,000 older Australians with low vision or blindness will have greater and more equitable access to low vision aids and technology.

and audiologists, she recommended “arrangements … to provide services as required to people receiving care”.

The commissioners also said “a paradigm shift is required” for both undergraduate and postgraduate medical, nursing and allied health training to account for the changing profile of health and ageing. As such, the report recommended the undergraduate curricula for health professionals should be reviewed by the relevant accreditation authorities, including optometry.

“We applaud the Royal Commission for making this crucial recommendation, and we implore Health Minister Greg Hunt and Prime Minister Scott Morrison to adopt it so older Australians with vision impairment can finally get the practical support they need," MDFA CEO Ms Dee Hopkins said.

Vision 2020 Australia was also supportive of the recommendations. It recently called for $37.4 million over four years to make the aged care system simpler, quicker and more affordable for older Australians with permanent vision loss to get the required technology and support. n

“The reviews should consider changes to the knowledge, skills and professional attributes so that the care needs of older people are met by health professionals,” the commissioners stated.

Meanwhile, Macular Disease Foundation

WORLD’S TOP 200 OPTOMETRY RESEARCHERS REVEALED A new website specifically created to identify and celebrate leading optometric researchers worldwide boasts more than 40 Australians, including one of the website’s co-creators.

Updated automatically every 24 hours and classified using publication metrics, it currently ranks Adelaide optometrist Professor Konrad Pesudovs first, Queensland’s Emeritus Professor Nathan Efron sixth and the late Professor Brien Holden tenth.

The 'Global Optometrist Top 200 Research Rankings' website is the brainchild of Efron, from Queensland University of Technology, Professor Philip Morgan, University of Manchester, UK; Professor Lyndon Jones, University of

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INSIGHT May 2021

Waterloo, Canada; Mr George Morgan from Imperial College London; and Dr Jason Nichols from The University of Alabama at Birmingham. The site, which also includes a search function, was created based on a paper they co-authored published in Clinical and Experimental Optometry, Optometry Australia’s journal, edited by Efron.

In the paper, they explain how they identified 480 names in an extensive global search of leading optometric researchers, which was then cut to 200.

Using a custom-designed bibliographic search tool, they were able to rank individuals by their h-index (a numerical indicator of how productive and influential a researcher is), number of

publications, years of active publishing, and number of citations.

The top 200 researchers have each published between 28 and 440 papers.

Prof Konrad Pesudovs, UNSW.

Pesudovs, affiliated with the UNSW, has the highest h-index (67) and citations (51,193). The most prolific author is Montreal's Robert Hess (442 papers), and Spain’s David Piñero is publishing at the fastest rate (17.6 papers per year).

Of the 72 institutions represented, the University of California, Berkeley, is home to the most top 200 optometrists (17) and has the highest combined h-index of top 200 optometrists (132).

Forty-three (21.5%) of the top 200 optometrists work in Australia. n

NEWS

EYEQ AND NOC ANNOUNCE EXECUTIVE RESHUFFLE

HOYA LENS AUSTRALIA AND DFV FORM MYOPIA ALLIANCE Hoya Lens Australia and Designs for Vision (DFV) are joining forces to increase awareness of myopia management strategies and aid eyecare professionals to Hoya's Ulli Hentschel grow this facet of (left) and DFV's Chris their practice.

Walters.

Announced on 2 March, it’s hoped collaboration will enable practitioners to diagnose and engage their patients, so they better understand their myopia management needs and treatment options.

The myopia segment has been a hotbed of activity and innovation in recent years, with Hoya introducing its MiyoSmart spectacle lens to the Australian market last October. Meanwhile, DFV is the local supplier of the new Myopia Master instrument produced by German firm Oculus. DFV general manager Mr Nikolas Apostolou was excited about cooperating with the lens manufacturer.

“Both Hoya and Designs for Vision are focused on supporting eyecare professionals. We’re dedicated to saving and improving visual performance,” he said.

Mr Craig Chick, managing director of Hoya Lens Australia, added: “We aim to help eyecare professionals in their quest for clinical excellence with world class measuring technologies and treatment solutions. Joint workshops, webinars and specific educational content is being developed to assist practices in expanding their myopia management business.”

Hoya’s MiyoSmart with D.I.M.S. Technology is a spectacle lens for myopia control in children and has been shown to slow the progress on average by 60%, based on results from a two-year clinical trial published in the British Journal of Ophthalmology.

The lens won the regarded Silmo d’Or Award in the vision category at the most recent Silmo Paris Optical Fair, and was previously awarded the Grand Prize, Grand Award and Gold Medal at the 46th International Exhibition of Inventions of Geneva in April 2018.

The Oculus Myopia Master is said to accurately measure the eyes’ axial length, refraction and keratometry; functions critical for myopia management. n

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INSIGHT May 2021

"THE GOAL IS TO FURTHER GROW THE COMBINED ORGANISATION TO DELIVER THE SIZE AND STRENGTH WHICH WILL ENSURE A BRIGHT BUSINESS FUTURE" RAY FORTESCUE, EYEQ OPTOMETRISTS

A new alliance between Australian optometry groups National Optical Care (NOC) and EyeQ Optometrists has sparked major personnel changes involving the CEOs of both entities.

In November 2020 it was revealed NOC was joining the EyeQ group as an unbranded franchise. NOC’s 14 locations have increased the total national network to 40 practices in all states and territories, except the Northern Territory.

By joining EyeQ, NOC’s practices – primarily located on the eastern seaboard – hope to benefit from managed services provided by the EyeQ franchise network support office. The companies viewed EyeQ’s expertise in optometry and NOC’s experience in business growth as an ideal opportunity to create an alliance that leverages the strong trading conditions experienced since mid-2020.

In recent months, EyeQ’s National Office and the NOC Support Office have been working on several shared projects.

As a result of these changes, EyeQ announced its CEO Mr Ray Fortescue will now chair a new joint-committee. The committee will oversee the operations of the EyeQ Optometrists/NOC Alliance.

EyeQ Optometrists CEO Ray Fortescue (left) and National Optical Care CEO Jason Gowie.

He will remain as chairman of the EyeQ board, as well as a clinical optometrist at the EyeQ Ramsgate Beach practice.

“To support my broader focus, the current CEO of NOC, Jason Gowie, will take on the shared responsibility as CEO of both NOC and EyeQ and will report directly to me as chairman of the Executive Committee of the Alliance,” Fortescue said, adding that the changed roles will be effective 1 April.

“The goal is to further grow the combined organisation to deliver the size and strength which will ensure a bright business future. EyeQ’s ethos as Local experts in Eyecare, providing Eyes for Life and preserving the ideals of independent optometry will continue unchanged.” n

NEW STUDY ADDS WEIGHT TO CASE FOR KIDS AND CONTACT LENSES An extensive study in ocular physiology is adding to a growing body of evidence in support of contact lens wear in children for myopia control.

The study, published in the British Contact Lens Association’s peer-reviewed journal, Contact Lens and Anterior Eye, was sponsored by CooperVision and is the longest known study to report on physiological response to daily disposable soft contact lens wear in young children and adolescents.

It followed 144 children in an international multi-centre, double-masked, randomised, controlled clinical trial.

Across the six-year study period, there were no contact lens-related serious adverse events. The low incidence rate of corneal infiltrative events were similar to rates in adults wearing 1-day lenses, equivalent to 6.1 per 1000 wearing years.

The study involved 144 children.

“Ultimately, our work suggests that placing children in daily disposable contact lenses is a successful way to correct their vision, in addition to the myopia control benefits of MiSight 1 day,” Ms Jill Woods, head of clinical research for the Centre for Ocular Research & Education and the paper’s lead author, said. n

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NEWS

OPTHEA TREATS FIRST PATIENT IN PHASE 3 AMD TRIAL The first patient in the Phase 3 clinical trial of a Melbourne-based drug company’s novel therapy for neovascular age-related macular degeneration (nAMD) has been treated in the US.

endpoint of the Shore and Coast studies is the mean change in best corrected visual acuity from baseline to week 52 for OPT-302 combination therapy compared to anti-VEGF-A monotherapy.

(Lucentis) or 2.0 mg aflibercept (Eylea), compared to ranibizumab or aflibercept monotherapy, respectively.

Opthea CEO Dr Megan Baldwin said the company wants to enrol more patients in the Phase 3 trials as soon as possible.

ASX-listed biopharmaceutical company Opthea announced on 15 March that the patient, enrolled at Cumberland Valley Retina Consultants, in Maryland, had received its first-in-class VEGF-C/D ‘trap’ inhibitor called OPT-302.

“Dosing the first patient in our OPT302 Phase 3 pivotal clinical program in wet AMD marks a very important achievement for Opthea in accelerating the development of this novel VEGFC/D inhibitor therapy towards market registration,” she said.

The patient is part of two concurrent global, multi-centre, randomised, doublemasked, sham-controlled Phase 3 trials Opthea is conducting.

Topline results are expected in 2023.

Opthea will also evaluate a number of secondary endpoints, including other key measures of visual function, as well as anatomical changes in the wet AMD lesions assessed by OCT and fluorescein angiography imaging.

“We are now looking forward to quickly ramping up enrolment to meet the interest from participating clinical sites and retinal specialists. OPT-302, which has shown promising efficacy and favourable safety profiles in trials to date, is an important new treatment option which may offer patients improved outcomes when administered in combination with VEGF-A inhibitors.”

Known as Shore (an acronym for study of OPT-302 in combination with ranibizumab) and Coast (combination OPT-302 with aflibercept study), both trials will each enrol about 990 treatmentnaïve patients.

The studies will assess the efficacy and safety of intravitreal 2.0 mg OPT-302 in combination with 0.5 mg ranibizumab

Each patient will also continue to be treated for a further year to evaluate extended safety and tolerability over a twoyear period.

In addition, the company said, extended durability of the OPT-302 treatment effect on clinical outcomes with less frequent every eight-weekly dosing will be compared with OPT-302 administered on an every four-weekly dosing regimen, in combination with each VEGF-A inhibitor.

Opthea anticipates reporting top-line data in 2023. n

According to the company, the primary

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NEWS

FIVE-YEAR POST-LEAD TRIAL GARNERS POSITIVE RESULTS Nova Eye Medical has announced positive five-year follow-up data from a sub-study analysis of the multi-centre LEAD trial for its 2RT nano-pulse ophthalmic laser therapy.

Conducted from 2012 to 2018, the LEAD trial was hailed as the first time a laser intervention had been shown to reduce the rate of disease progression in selected patients with intermediate age-related macular degeneration (iAMD).

But at the time, the trial was met with a mixed response after it missed its primary end point before a post-hoc analysis later showed 2RT’s treatment effect was significant, but only in a subset of patients without reticular pseudodrusen (RPD), a fatty deposit associated with the later stages of AMD. At the time, the relevance of RPD in the pathology of AMD was not well understood, and so it wasn’t accounted for in the LEAD trial design. Specifically, the post hoc analyses showed in patients

2RT results in patients without RPD form part of a post-hoc analysis, the reduced rate of disease progression in these patients, as compared to patients in the Sham Group, is significant.

who did not have coexistent RPD, 2RT had a clinically meaningful 77% reduction in the rate of disease progression at 36 months following treatment.

In the recently published sub-study of the LEAD trial, 222 patients from the original 36-month multi-centre LEAD Trial – which enrolled 298 patients – were followed out to five years. Patients did not undergo further 2RT treatment following the 36-month mark, with the 36-60-month period observational only.

Led by the Centre for Eye Research Australia (CERA)’s Professor Robyn Guymer and published in Ophthalmology Retina, the sub-study demonstrated patients without coexistent RPD who underwent 2RT treatment (2RT Group) achieved a significant 68% reduction in the rate of disease progression at five years, as compared to a sham group.

Commenting on the significance of the results, Nova Eye Medical director Mr Tom Spurling said: “While the positive five-year

2RT ophthalmic laser therapy.

“The ability of 2RT to achieve such a marked reduction in the rate of progression to late-stage AMD over a five-year period is of immense benefit to patients in potentially deferring disease progression and thus maintaining their quality of life. It also supports our previously stated position that 2RT offers a potential breakthrough approach to the treatment of AMD.” Spurling added: “We now have a very clear picture of the patient population that we expect will benefit from our innovative 2RT technology. This forms the basis of our pivotal study design considerations and discussions with the US FDA and the filing of an Investigational Device Exemption (IDE)."

Nova Eye is commercialising 2RT through its subsidiary AlphaRET. n

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Liz Muller Optometrist, Eyecare Plus Altona

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NEWS

CLOSING THE GAP: RANZCO COMMITS TO MORE INDIGENOUS OPHTHALMOLOGISTS As Australia marked National Close the Gap Day, RANZCO reaffirmed its commitment to increasing the number of Aboriginal and Torres Strait Islander ophthalmologists.

The college is supporting the national awareness campaign – held on the third Thursday in March each year – which aims to send the federal and state governments a clear message that Australians value health equality as a fundamental right for all.

With Queensland-based Dr Kris RallahBaker (a Yuggera and Biri-Gubba-Juru/ Yuggera man) becoming the nation’s first and only Indigenous ophthalmologist a few years ago, RANZCO CEO Dr David Andrews said the college’s commitment to increasing the number of Aboriginal and Torres Strait Islander ophthalmologists in Australia “is stronger than ever”.

He said RANZCO has developed measures to encourage Aboriginal and Torres Strait Islander doctors to enrol in its Vocational Training Program. These include scholarships for doctors to attend training and participation in conferences and workshops organised for and by Aboriginal and Torres Strait Islander organisations.

Andrews added: “RANZCO’s Reconciliation Action Plan framework commits us to activities towards achieving equitable access and health outcomes for Aboriginal and Torres Strait Islander peoples.

“We are continuing to build collaborative partnerships with Aboriginal and Torres Strait Islander peoples and the health sector, seeking to further enhance our organisation’s cultural awareness and cultural safety practices.”

RANZCO states that it appreciates the challenges that arise with delivering appropriate and effective healthcare to communities. It supports a genuine partnership approach to work with governments and communities to enhance service delivery, strengthen regional networks and support Aboriginal Community Controlled Health Organisations to further embed eyecare in their service delivery models. n

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INSIGHT May 2021

SPECSAVERS LAUNCHES NEW NATIONAL LOCUM APP "THE APP IS MAKING IT EASIER FOR LOCUMS TO FIND, BOOK AND MANAGE JOBS, AND SHARE THEIR AVAILABILITY FOR EASY ALIGNMENT TO UPCOMING JOBS" CARLY PARKINSON, SPECSAVERS

Specsavers Recruitment Services (SRS) has announced the launch of a new app that acts as a notification, engagement and organisational tool to improve the way the company connects with locum optometrists across Australia.

The SRS Locum App has been developed to simplify the way locums share their availability and accept vacancies in real time.

Using a personalised calendar in the app, locums can add their available times which syncs to vacancies in their preferred areas, making it an efficient way for locums to manage their schedule and book jobs.

Through the app, locums can register to work in any Specsavers store, view and accept locum vacancies in real time, share their availability via a personal calendar and sync to vacancies in their preferred area. They will also be able to view details of previous and upcoming bookings, liaise with their dedicated consultant via the messaging service and enquire about permanent vacancies available at Specsavers.

Ms Carly Parkinson, Specsavers’s head of partner recruitment and SRS, said the new tool was designed to make it easier for locums to engage with the company.

The tool makes it easier for locums to engage with Specsavers.

“We know 2020 was a difficult year, and it’s been challenging for many locums to find the work that they want. For the first few months of 2021, we have been experiencing unprecedented demand, and the app is making it easier for locums to find, book and manage jobs, and share their availability for easy alignment to upcoming jobs,” she said.

“We anticipate the app will become a desirable tool for many locum optometrists across Australia and allow us to reach a wider locum audience, while also making it easier for our locums to book jobs and manage their workloads.”

The app is available to optometrists nationwide, with locum vacancies now available in each state and territory. n

EYE HEALTH AND PANDEMIC FEATURE IN NEW AHPRA PODCAST A new episode in a podcast series by the health regulator looks at how the coronavirus pandemic has affected eye health, in both obvious and obscure ways.

Ms Tash Miles, host of the Taking care podcast, talks to optometrists Mr Tim Martin and Mr Luke Arundel about the effects on eye health stemming from a greater reliance on technology and increased time spent indoors for work, study and social connection during COVID-19.

Apart from changes in vision, the pandemic resulted in behavioural changes, such as switching from glasses to contacts to accommodate increased mask wearing, or the reverse: some contact lens users return to glasses while at home.

“Across the profession we’ve seen

The episode covered several issues, including myopia in children.

things that have never existed before, [such as] Mask Associated Dry Eye (MADE); this just has never been an issue,” Arundel added.

Excessive screen time coupled with the limitations on face-to-face optometrist consultations has also increased the risk of more serious eye diseases developing, such as myopia. n

NEWS

AUSSIE STUDY UNCOVERS GENETIC CAUSE OF MACTEL Melbourne researchers have identified an additional seven regions in the human genome that increase the risk of macular telangiectasia type 2 (MacTel), with one particular mutation raising the likelihood of the condition five-fold.

The study out of the Walter and Eliza Hall Institute of Medical Research (WEHI) builds on their earlier work that found MacTel was associated with low levels of serine, an amino acid used in many pathways of the body.

MacTel affects one in 1,000 Australians, but because early signs of the disorder are subtle, it is difficult to diagnose.

Led by WEHI Professor Melanie Bahlo with Dr Brendan Ansell, Dr Victoria Jackson and Dr Roberto Bonelli and published in Communications Biology, the research is said to provide a new genetic risk calculator for predicting retinal disorders.

One of the most notable findings was

factors contribute to whether someone is genetically predisposed to getting MacTel in later life,” she said.

the identification of a rare mutation in a gene – called PHGDH – which dramatically increased the risk of developing MacTel. “These new findings further increase our understanding of retinal biology and the way the eye uses energy,” Bahlo said.

Bahlo said the findings could help improve diagnosis and treatment of MacTel. Prof Melanie Bahlo, WEHI.

“People with this newly discovered PHGDH mutation are five times more likely to develop MacTel than people without this genetic mutation.”

Bahlo said MacTel is a unique eye disease caused by slight changes to levels of fundamental amino acids that have no impact on any other part of the body.

“What we found is that the disease is driven by two factors; metabolic amino acid on one side and then risk factors related to the cellular health of the retina on the other side, which are probably involved in transporting crucial amino acids into the retina. Both of these

“By understanding the causes of the condition, we can tailor treatment to each individual patient to ensure the best outcomes for them,” she said.

“This disease is really hard to diagnose, so understanding the risk factors will allow clinicians to better predict and treat the condition.”

The study was conducted in collaboration with The Lowy Medical Research Institute in the US and the UK’s Moorfields Eye Hospital.

Funding was provided by the Lowy Medical Research Institute, the National Health and Medical Research Council, the John and Patricia Farrant Foundation and the Victorian Government. n

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NEWS

AUSSIES’ SHARP EYE FOR GENETIC RESEARCH SHOWCASED IN NEW GLAUCOMA STUDY "WE WEREN’T SURE UNTIL NOW THAT THE GENETIC INDICATORS WERE TRUE FOR PEOPLE OF DIFFERENT ANCESTRIES"

Australian researchers have been at the fore of the largest genetic study of glaucoma that has identified 44 new genetic variants that may lead to new treatment targets.

Ten Australian institutions involving some of the country’s most prominent glaucoma researchers were involved in the international effort which analysed genes in more than 34,000 people with glaucoma across multiple ancestries for the first time.

The results comparing the genes of people with the disease to 349,321 control subjects were published in Nature Communications recently.

In addition to identifying new genetic variants, the international consortium of researchers also confirmed 83 previously reported loci linked to glaucoma. Loci are considered “genetic street addresses”, denoting a specific location on a gene.

Lead author Mr Puya Gharahkhani, Associate Professor in the Statistical Genetics group at QIMR Berghofer Medical Research Institute in Brisbane, explained why – for the first time in a glaucoma genome-wide association study – they performed a cross-

Researchers compared genetic data from people of European, African and Asian descent.

ancestry comparison looking at genetic data from people of European, African and Asian descent.

PUYA GHARAHKHANI, QIMR BERGHOFER

indicators were true for people of different ancestries.”

Future research will focus on using these genetic loci to improve screening and diagnosis of glaucoma and, one day, to develop new treatments.

“Glaucoma is one of the most strongly genetic human diseases, which is why we are looking at the genetic architecture of the disease to find clues on how to prevent and treat it,” Professor Stuart MacGregor, the head of QIMR Berghofer’s Statistical Genetics group and co-senior researcher on the study, said.

“We’re hopeful that understanding the biological processes and knowing which genes control them could help scientists develop new drugs in the future."

They found the majority of loci that contribute to glaucoma were consistent across all three groups.

Leading Australian researchers involved were Professor Alex Hewitt, Professor David Mackey, Associate Professor Paul Healey, Professor Paul Mitchell, Professor Robert Casson and Professor Ivan Goldberg.

“Glaucoma rates are highest in African and Asian ancestry groups, but the largest genetic studies of glaucoma in the past focused on people of European ancestry,” he said.

“Those studies showed genetic tests could be used to help identify who would benefit from sight-saving early monitoring or treatment, but because of the narrow scope of the genetic data, we weren’t sure until now that the genetic

Grants from the National Health and Medical Research Council (NHMRC) of Australia and the Ophthalmic Research Institute of Australia helped support the study. n

OCULAR BENEFITS COULD CREATE NEW DEMAND FOR AUSTRALIA'S ORANGE CAPSICUM GROWERS Orange capsicums contain the richest source of the orange pigment zeaxanthin, which is vital for central vision, according to a plant physiologist at The University of Queensland (UQ).

age-related macular degeneration.

Associate Professor Tim O’Hare is helping to address the lack of zeaxanthin in Australian’s diets through research based at the Queensland Alliance for Agriculture and Food Innovation (QAAFI).

O’Hare’s comparative analysis of different fruit and vegetables identified orange capsicums as the richest source of zeaxanthin. One capsicum (typically 450 grams) was found to contain levels equivalent to 30 supplement tablets, with two milligrams of zeaxanthin the daily recommended dose, according to UQ.

“When it comes to orange zeaxanthin and health, the compound accumulates in our macula,” he said. “It protects against blue light, which is particularly damaging as it can oxidise our photoreceptors, which leads to macular degeneration.”

O’Hare’s research found zeaxanthin deficiency leaves eyes susceptible to

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INSIGHT May 2021

orange capsicums are not always available in shops, something we are looking to overcome.”

“Our bodies can’t make zeaxanthin, which means we rely exclusively on dietary sources or on artificial supplements,” he said.

“Each zeaxanthin tablet is roughly equivalent to 10 grams of orange capsicum flesh – that’s how rich the capsicums are in this pigment,” he said.

“The trouble at the moment is that

O’Hare’s analysis also compared zeaxanthin levels among the different orange capsicum varieties in Australia.

Orange capsicums contain zeaxanthin.

Eight were analysed, with seven proving to be rich sources of zeaxanthin; the eighth owes its orange colouring to a mix of red and yellow pigment but does not contain zeaxanthin. Red, yellow and green capsicums contained no zeaxanthin.

The research aims to make it agronomically viable and profitable for growers to produce more orange capsicums, and to alert consumers to their special eye health benefits, thereby creating demand. n

NEWS

AUSSIE INSTITUTIONS SPEARHEAD WORLD-FIRST INTERNATIONAL EYE LYMPHOMA REGISTRY Flinders University and the Queensland Eye Institute Foundation (QEIF) have formed a new partnership to create a world-first international registry for lymphoma in the eye.

Flinders strategic professor in eye and vision health Professor Justine Smith and QEIF CEO Professor Mark Radford are leading the project to collect key information about the rare eye cancer aimed at better understanding the effectiveness of various treatments.

Lymphoma – a blood cancer – rarely occurs inside the eye, but can affect the retina and other tissues at the back of the eye critical for vision.

“Lymphoma of the eye causes distressing symptoms, including loss of vision and severe floaters. Sadly, the largest problem for almost all patients is that this cancer usually progresses to involve the brain,” Smith said.

According to Smith and Radford, current treatments include chemotherapy, radiotherapy and even bone marrow transplantation.

understand general trends in outcomes of different treatments. Unlike clinical trials, the registry approach also provides information about medical practice in the real world.

Once the brain is affected, many patients cannot be cured.

According to the latest data from the Australian Cancer Database, only onethird of patients with lymphoma of the eye live for five years once the cancer spreads to the brain.

With it not being possible to run clinical trials to identify best treatments – as lymphoma of the eye affects less than one person per million Australians – the researchers state the alternative approach to collecting medical information and improving treatments is a registry.

They said the information collected through a registry can be used to

Dr Alix Farrall and Prof Justine Smith.

Smith and Radford’s international registry will be the first of its kind aimed at understanding the effectiveness of various treatments for the eye cancer.

The project is being funded by QEIF’s partner organisation the South Bank Day Hospital and an Innovation Connections Grant funded by the Australian Department of Industry, Science, Energy and Resources.

Smith has also recently been involved in a first of its kind Australian study that revealed rates of brain lymphoma have quadrupled since the 1980s, with only 33% of people surviving five years after receiving this diagnosis. n

COMPANY

RODENSTOCK SALE GOING AHEAD WITH APAX ACQUISITION Funds advised by global private equity advisory firm Apax are set to acquire ophthalmic lens manufacturer Rodenstock Group in a deal reported to be worth AU$2.3 billion.

The buyer – known as Apax Funds which invests in companies across four global sectors including healthcare – has reached an agreement with Rodenstock’s shareholder Compass Group, which acquired a majority stake in the company in 2016 before taking full control in 2018.

Founded in 1877, Rodenstock is headquartered in Munich, Germany, and employs around 4,900 people worldwide, represented by sales subsidiaries and distribution partners in more than 85 countries, including Australia.

Financial details were not disclosed in the agreement, but a person familiar with the matter told Reuters the deal values Rodenstock at about €1.5 billion (AU$2.3 b), including debt.

The Apax healthcare team are said to have a good understanding of medical technology through prior investments, including companies such as Candela, a non-surgical aesthetic device company, and Acelity, a global leader in woundcare products.

“During 2020 we saw tremendous growth driven by our B.I.G. Vision technology, which helped us emerge from the COVID-19 crisis stronger than most of our competitors,” Mr Anders Hedegaard, CEO of Rodenstock, said.

“Our innovative technology enhances the value proposition that can be delivered by our opticians, who in turn are delivering optimal vision to consumers. With the support of Apax we are looking to expand our presence even further by offering our customers more excellent and innovative products.”

The transaction is subject to applicable regulatory approvals and is expected to close in the middle of 2021. n

COMMISSION CLEARS ESSILORLUXOTTICA GRANDVISION TAKEOVER "THE CLEARANCE IS CONDITIONED TO THE DIVESTMENT OF SOME OPTICAL RETAIL BUSINESSES" ESSILORLUXOTTICA

The European competition watchdog has cleared EssilorLuxottica’s acquisition of Europe’s largest retail optical chain GrandVision, on the condition that around 350 stores are divested across three countries.

EssilorLuxottica – the world’s largest supplier of ophthalmic lenses and eyewear that also has around 9,000 retail locations globally – confirmed 23 March that the European Commission (EC) had approved the takeover after a lengthy in-depth review largely impacted

by COVID-19.

The original deal, valued by financial analysts to be worth €7.2 billion (AU$11.6 billion), was expected to see EssilorLuxottica drastically increase its footprint by more than 7,200 stores and 37,000 employees across 40 countries.

However, when the commission commenced its inquiry in February 2020 it was concerned the merger may reduce competition for the wholesale supply of ophthalmic lenses and eyewear, as well as for the retail supply of optical products.

"The [EC] clearance is conditioned to the divestment of some optical retail businesses in Belgium, the Netherlands and Italy for an overall number of approximately 350 stores," the company

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INSIGHT May 2021

stated. In Belgium, the GrandOptical chain and its 35 stores will be sold but without the brand name. The purchaser will have a license while rebranding these stores to its own choice of name.

In Italy, the merged entity will divest 174 stores, which includes the whole of EssilorLuxottica’s VistaSì chain together with 72 stores from the ‘GrandVision by’ chain. The VistaSì brand will be transferred and the ‘GrandVision by’ stores will either be rebranded to VistaSì or to the purchaser’s own brand.

In the Netherlands, 142 stores from the EyeWish chain will be sold, together with the brand name. The merged entity will keep some stores from this chain and will have to rebrand them under a new name.

The deal is still dependant on competition authorities in Chile and Turkey. n

SAFILO TO INTRODUCE TWO NEW SUSTAINABLE MATERIALS FROM 2022 Safilo has announced it will begin incorporating two new sustainable materials containing recycled content into its eyewear collections.

The Italian eyewear giant revealed this month it will start using two materials by global advanced materials manufacturer Eastman – headquartered in the US – in its latest move to introduce more recycled products into its frames.

Eastman’s Acetate Renew and Tritan Renew materials form part of a broad portfolio of sustainable resins the company produces. Safilo will first use Eastman Tritan Renew in its Polaroid line in January 2022.

Rodenstock has a presence in 85 countries.

The deal is reportedly worth AU$11.6 billion.

The two materials will then be progressively rolled out across Safilo’s broad brand portfolio of optical frames

Safilo's Polaroid brand has already created a sustainable collection – pictured here.

and sunglasses, which comprises numerous licenced and proprietary products.

Safilo Group CEO Mr Angelo Trocchia said the announcement asserted the company’s commitment to sustainability and efforts to bring more recycled materials to the eyewear industry. n

RESEARCH

FACE MASK FOGGING DISTORTS PERIMETRY RESULTS A new study has found that ill-fitted face masks can cause either visual field artifacts – which may be interpreted as glaucoma progression – or low test reliability in standard automated perimetry (SAP) tests.

Researchers at University of Health Science within the Kayseri City Training and Research Hospital in Turkey tested 127 patients (59 female, 68 male) with glaucoma.

While 101 patients (79.5%) wore surgical face masks, 26 patients (20.5%) wore cloth face masks.

Low SAP reliability appeared in 23 patients (18.1%), and inferior visual field defects were present in three patients (2.4%).

masks (47.8%) than in those wearing surgical face masks (9.9%).

Small amounts of condensate were noted on the perimeter lens.

“The face mask-related fogging of eyeglasses before SAP is a strong predictor of fogging of the trial lenses-related low SAP reliability,” the researchers stated.

The researchers concluded: “Poorly fitting face masks represent a new cause of visual field artifact which may mimic pathologic field defects. Without careful attention during testing, the cause of such artifacts may not be apparent, especially as reliability indices may be normal.

Adjustments to the fit of face masks may help prevent fogging or mask slippage and increase test reliability.”

They found taping the face masks’ upper edges was an effective technique to prevent visual field artifacts and obtain good test reliability.

Face masks may affect visual field results.

In patients with low test reliability and/or visual field changes, SAP was repeated after repositioning and taping patients’ face masks. In each case, the patients’ reliability parameters improved, and inferior visual field artifacts disappeared.

“The main effects of poorly-fitting face masks on SAP reliability were increased fixation losses and false-positive errors,” the researchers concluded.

In a separate study out of Scotland in October, a 32-year-old female underwent SAP with the 24-2 SITA Fast test of the Humphrey Field Analyzer wearing an earloop surgical face mask.

Low SAP reliability was significantly higher in patients wearing cloth face

At the end of testing, it was noted that the mask had ridden up the patient’s face.

Glaucoma screening is the latest eyerelated issue to emerge from mask wearing borne out of the COVID-19 pandemic.

Last September, it was revealed widespread use of face masks had given rise to a new phenomenon dubbed maskassociated dry eye (MADE).

It followed reports of ocular irritation and dryness among regular mask users, and has been supported in a recent review published in the journal Ophthalmology and Therapy. n

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TECHNOLOGY

APP THAT CALCULATES RISK OF DIABETIC RETINOPATHY AIMS FOR 1 MILLION USERS THIS YEAR An app that helps people with diabetes measure their risk of developing diabetic retinopathy has been downloaded in multiple countries by nearly 800,000 people – and counting.

The creators behind the RetinaRisk app, which is based on an advanced algorithm that takes into consideration factors that highly impact retinopathy, such as blood glucose levels, blood pressure and gender, aim to have more than one million users in 2021.

The algorithm is based on extensive international research and has been clinically validated in more than 25,000 patients with diabetes in five countries.

Originally developed in 2009, launched in 2019, and monetised in 2020, RetinaRisk is the creation of Icelandic endocrinologist Dr Arna Gudmundsdottir, her husband (a biostatistician) and ophthalmologist Dr Einar Steffanson.

The trio also founded Risk Medical Solutions (RMS) in 2009, a health-tech company that operates the RetinaRisk app and RetinaRisk API, which allows healthcare IT systems to seamlessly incorporate RetinaRisk’s algorithm.

The setup allows hospitals and healthcare systems worldwide to prioritise highrisk patients by streamlining diabetic retinopathy eye screening. It also provides overall diabetes management, offering guidance on what types of foods to avoid to maintain blood sugar, for example.

Gudmundsdottir, who earned her medical degree in Iceland and completed residency and a fellowship at the University of Iowa before moving back to Iceland, has spent decades treating patients with diabetes.

“It’s a chronic disease, and it’s so important that the patient takes responsibility on his or her own health. If you empower the patient, their destiny is in

their own hands. That’s where the app fits so well,” Gudmundsdottir said.

Two specialists have created the app.

One year into monetising the app, the team behind RetinaRisk are seeing improvement in patients’ conditions, but it has taken persistence to reach this point. When they originally developed the algorithm in 2009, their concept failed to gain traction.

“Insurance companies weren’t interested, and doctors said they preferred seeing patients in person, using their clinical judgment instead of an algorithm. This left the team in a quandary, with a working solution but no interest from others. Fast forward to 2019 and the app-centric world was much more open to it,” Gudmundsdottir said.

RetinaRisk is available for free on iOS and Android, but charges users $1.99 per month or $19.99 per year for in-app purchases. n

A new era begins.

Become its pioneer.

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• Fast and easy operation regardless of experience.

• Unique patient experience with frame comparison and digital centration. www.zeiss.com/ instruments+technology

INTERNATIONAL

SMILE PERFORMED ON MORE THAN FOUR MILLION EYES Four million eyes have now been treated globally with Zeiss Meditec’s SMILE procedure, helping cement the company’s dominance in the laser vision correction segment where it holds 27% market share.

The procedure – officially known as small incision lenticule extraction (SMILE) – was first performed in 2007 by Professor Walter Sekundo on a sighted patient and has been commercially available since 2011.

In reaching the new milestone, the company stated that more than 2,500 practising surgeons in 80 countries now offer the surgery, including 13 centres in Australia. More than 1,300 units of the VisuMax femtosecond laser – used for the procedure – have also been built.

The company reported most SMILE users have done more lenticule extractions than other laser vision correction procedures, with the flapless surgery on the way to becoming the dominant laser correction method in some countries.

SMILE is one of Zeiss’s latest vision correction procedures, with its portfolio also including photorefractive keratectomy (PRK), laser in-situ keratomileusis (LASIK), and Presbyond for presbyopes.

Citing the Market Scope Refractive Report 2020, Zeiss states it is the market leader in the laser vision correction segment with 27.5% market share, followed by other major players such as Alcon (19.1%) and Johnson & Johnson Vision (17.9%).

During SMILE, ophthalmologists correct patients’ refractive errors using the VisuMax. With the laser, surgeons create a thin disc-shaped lenticule within the cornea which is then removed through a small incision on the surface of the cornea, achieving the desired vision correction.

According to Zeiss, it requires only one laser to perform the entire treatment, and due to the small incision, the surgery leaves the outer corneal layer largely intact. This potentially contributes to the cornea’s stability after surgery – both biomechanical and refractive – and to fast visual recovery. n

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INSIGHT May 2021

CHINA CONSIDERING CLINICAL USE OF ARTIFICIAL CORNEA "PATIENTS CAN HAVE THEIR SIGHT RESTORED TO 1.0 ACUITY IN IDEAL CASES"

Reports out of China are suggesting the nation may begin the clinical use of new self-developed artificial corneas from June 2021 – and at a fraction of the cost of the equivalent in the US.

SHI WEIYUN, SHANDONG PROVINCIAL EYE HOSPITAL

Mr Shi Weiyun, director of the Shandong Provincial Eye Hospital and also member of the National People’s Congress (NPC), China’s legislative body, told media that patients can have sight restored to 1.0 acuity with the artificial cornea.

China currently applies two artificial cornea technologies, the first being the bio-engineering method using corneas from pigs, which is the first in the world and for which China has approved three applications used for clinical treatment.

The latest research and development results of the second artificial cornea method have been reported and if things go smoothly, Shi said, “we can apply it in clinical treatment as early as June 2021”.

He also said that compared with the same cornea plant treatment in the US, the cost of the artificial cornea plant surgery is about $5,000 in China, 10% that of the cost in the US. The development is welcome news for the 20 million sight-impaired people in China.

It is welcome news for the 20 million sightimpaired people in China.

“When those cornea products are widely used in hospitals, blind people in China can regain their sight. Patients can have their sight restored to 1.0 acuity in ideal cases. We have held clinical trials on more than 30 patients and all of them have regained sight to above 0.5 acuity,” Shi reportedly said.

The news was reportedly among the top topics on China’s social media platforms.

Social media users – also known as Netizens, a portmanteau of the words internet and citizen – said that along with cornea donation channels, which have a huge supply-demand gap in China, artificial cornea technology can help more people in a more efficient way. n

GLAUCOMA EMERGING AS MOST PREVALENT EYE DISEASE IN INDIA A senior consultant ophthalmologist at India’s largest eye hospital network believes India could be the world’s capital of glaucoma, with the disease affecting 12 million people, and remaining undiagnosed in more than 90% of cases.

Dr Bindiya Hapani from Dr Agarwal's Eye Hospital, with more than 95 locations spread across 11 countries and a team of 400 doctors, said an ageing population and an increasing number of people with diabetes and refractive errors are set to make glaucoma a rapidly emerging non-communicable ocular disease in the country.

Hapani said that nearly 40 million people in India, including 1.6 million children, are blind or visually impaired, in a country which already houses 20% of the world’s blind.

Glaucoma affects 12 million Indians.

The statistics were shared in connection with World Glaucoma Week, which took place from 7-13 March this year.

“Next to cataract, and untreated refractive errors, glaucoma is the third leading cause of blindness in India,” Hapani said. n

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BUSINESS

THE WAY PATIENTS PAY Buy now, pay later is the latest trend in flexible payment services. With financial providers racing to grab their share, what impact is this having for the eyecare sector in terms of new customers, product sales and cash flow?

RHIANNON BOWMAN reports.

B

uy now, pay later (BNPL) options are rapidly imposing themselves on the healthcare sector, with optical businesses and their strong retail element proving a lucrative segment for the new form of financial service.

While BNPL plans remain a small percentage of optical industry sales, the eyecare sector’s sharpest business minds expect this to increase year-onyear in line with overall BNPL growth.

Around 30% of Australians now have an account with a BNPL provider, equivalent to 5.8 million people, according to consumer website Mozo. Now, homegrown companies like Afterpay, Openpay, Sezzle, Splitit and Zip have mushroomed into megaliths and household names.

Millennials (aged 24 to 39) were the first adopters of BNPL, and while they still account for the majority of purchases, other generations are catching up. Gen Z (aged eight to 23) account for 13% of spending on Afterpay, but it’s the fastest growing cohort – spending is increasing at 126% year-on-year.

BNPL companies have also spread into ophthalmic surgery where expensive procedures including laser eye surgery – starting at around $2,500 per eye – can now be financed through BNPL plans.

Despite the benefits its brought to businesses and consumers, consumer groups have urged caution. A 2018 review of BNPL providers found one in six users reported experiencing a negative impact, such as being overdrawn, having to delay paying bills or borrowing money from friends to meet scheduled repayments. Australian consumer advocacy group CHOICE has reported BNPL services and merchants are reaping great benefits, but some users end up paying late fees – which is effectively the same as interest.

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INSIGHT May 2021

In optometry, BNPL services like Openpay are opening up new opportunities for patients and practices alike, particularly in terms of higher value sales, while also spelling the end of the more labour intensive payment method, lay-by.

“It allows practices to focus on providing the best level patient care, and giving patients the ability to manage their repayments with peace of mind.

We know that eye conditions deteriorate without the appropriate care or treatment so it’s important for patients to have flexible options that allow them to pay smarter and avoid deferring the care they need.”

"IT MEANS WE ARE NO LONGER HAVING TO SPEND TIME CHASING UP PAYMENTS, HOLDING STOCK ASIDE OR IN STORE, AND WE RECEIVE PAYMENT FROM OPENPAY FOR THE GOODS WITHIN 24 HOURS”

AN OPEN AND SHUT CASE

KEIRA HACKETT

Ms Keira Hackett, practice manager at Kevin Hackett Optometrist in Geraldton, Western Australia, has driven the implementation of BNPL in a practice that is notching up nearly four decades in business.

KEVIN HACKETT OPTOMETRIST

“We are seeing an increase in the number of optometry practices that are offering Openpay as a flexible payment option to their patients,” Openpay’s head of health Mr Nick Grant says.

The practice, a ProVision member, first started offering Openpay to patients in 2018 when ProVision approached the provider and expressed interest in bringing the optical industry on board with its BNPL service.

“We were the first optometrist in the Midwest to start offering a buy now, pay later service, and the reaction was nothing but positive, from both staff and patients,” Hackett says.

She says one of the benefits of Openpay, compared to other BNPL services, is the patient can choose a payment schedule that works for them, rather than, for example, four equal payments over four fortnights.

The practice has always offered lay-by in store but these were becoming increasingly messy and time-consuming, with staff having to follow up payments fortnightly.

“Previously – after we had some patients enquire as to whether we would consider bringing on a buy now, pay later service – we began to look into it, especially as it seemed to be the ‘way of the future’. However, it never eventuated; we found it hard to access information from other BNPL services as, at the time, no optical groups were offering a BNPL service,” Hackett says.

“Admittedly, we were also quite nervous – none of our staff members had personally ever used a BNPL service. However, once ProVision and Openpay collaborated and we came on board, the Openpay customer service and online training portal put our minds at ease.”

She says Openpay has essentially replaced the practice’s lay-by service.

“This is a win-win. For us, it means we are no longer having to spend time chasing up payments, holding stock aside or in store, and we receive payment from Openpay for the goods within 24 hours.

“For our patients, it means that not only can they pay their purchases off over a timeframe that they select, they are also able to take their purchase straight away, rather than collect on their final lay-by payment.”

While the practice pays a minimal fee per transaction, Hackett says it is insignificant compared to the cost of bookkeeping and managing lay-by accounts.

When Kevin Hackett Optometrist initially brought on Openpay, they expected a younger demographic would utilise the service, but to their surprise, it’s being used by patients of all ages.

“Some of our older patients were initially hesitant to change from their usual lay-by to Openpay, as the idea of the new payment system was overwhelming. However, the fact that patients don’t have to download the app if they don’t wish to – they can use an email address instead – was a huge draw card, and at the end of the transaction they would comment on how simple it was,” Hackett says.

While there are no restrictions as to what patients can use Openpay to purchase, the majority of Kevin Hackett Optometrist’s Openpay sales are for prescription spectacles, sunglasses, or plano sunglasses.

“DATA SHOWS THAT BNPL PLANS ARE CONSIDERABLY HIGHER IN VALUE COMPARED TO THE AVERAGE PRACTICE PATIENT SPEND” MARGARIDA FAUSTINO PROVISION

Aside from the efficiency benefits compared with lay-by, the team in Geraldton have noted many additional positive changes in terms of sales.

“We have gained new patients since bringing on Openpay – and those that have come to us because of Openpay have returned and utilise the service each time. With so much economic uncertainty, people have become quite cautious when it comes to spending. Since offering it, we have found that people aren’t so cautious or reserved with their frame and lens choices; they are purchasing what they really want rather than cost dictating what they choose. The buy now, pay later service means money is not a barrier,” Hackett says.

BNPL is also changing consumer behaviour in other ways, evident in patient’s eyewear purchases at Kevin Hackett Optometrist.

“Not only have we noted repeat business and purchases by patients, but the timeframe in between those sales is also generally shorter than what we had previously seen, especially for the fashion-forward eyewear purchases.

Patients are returning to update their look each season and can justify it because ‘they can pay it off’,” Hackett says.

“And patients who can’t choose between two pairs of glasses don’t have to make that choice – they can purchase multiple pairs at one time.

This is something that patients previously wouldn’t really even consider as not wanting to be exorbitant but being able to pay off makes the dream more attainable.”

Lost or broken spectacles presents yet another sales opportunity.

“An emergency replacement is an unexpected expense, but rather than ‘settling’ for the cheapest option as a quick fix to get them out of trouble,

INSIGHT May 2021 31

BUSINESS

BNPL means patients can afford to get what they want – which usually means a better-quality pair,” Hackett explains.

“THE CHANCES OF REACHING NEW PATIENTS AND BECOMING EVEN MORE ATTRACTIVE TO EXISTING PATIENTS FAR OUTWEIGHS THE PARTICIPATION OR TRANSACTION COSTS”

BENEFITS – AND MISCONCEPTIONS In 2018, ProVision partnered with Openpay, recognising the upswing towards BNPL options and the potential for addressing affordability concerns for high value purchases.

Openpay was ProVision’s preferred choice and went on to become a ProVision Referral Partner, as it allowed for extended payment periods.

Ms Margarida Faustino, ProVision business coach for WA and Victoria, says their own data revealed that on average 75% of plans are over a fourmonth repayment period, supporting the need for payment terms beyond competitor Afterpay’s six-week terms, and competitive merchant fees.

PHILIP ROSE EYECARE PLUS

“We estimate that at present approximately 25% of ProVision practices are currently offering a single or multiple BNPL option,” Faustino says.

Offering the new payment solutions to patients has many benefits.

“Interest-free repayments and repayment plans that can be spaced over two to six months – pre-selected by patients to suit their circumstances – means patients do not need to compromise on the best eyecare and eyewear solutions,” Faustino explains.

“It reduces the reliance on credit card use, empowering patients to make better budgeting decisions by giving them more time to pay, which means patients can get the prescribed product or service they need today, with the comfort and peace of mind in knowing that they are able to pay over time.”

According to data from Afterpay, credit spend decreased by 10% for the year 2020, while spending on BNPL was up 60%, despite the COVID-19 crisis.

Offering BNPL payment to patients also provides practices with several opportunities. Beyond paying for frames and lenses, Faustino believes it can be a helpful platform to increase uptake of other services such as orthokeratology, dry eye treatment, and vision therapy.

“It can increase word of mouth in the community, as to your point of difference and the services you provide. By offering greater choice and payment flexibility, patients are less likely to ‘compromise’, and optometrists can provide the best level of customer care and meet a patient’s lifestyle needs.”

She also thinks giving patients options to manage their funds can help reduce any potential financial barriers or objections.

“With BNPL, practices can move away from in-practice payment plans and lay-bys, which are higher risk and have a greater drop-out rate. Data also shows that BNPL plans are considerably higher in value compared to the average practice patient spend,” she says.

Despite the myriad benefits, Faustino says misconceptions continue to swirl in the profession, but “working closely with Openpay gave ProVision and our members a greater understanding and helped dispel some of these myths”.

To clarify, Faustino says Openpay can, and is, being used across all age brackets, in both metropolitan and regional practice locations, regardless of demographic profile.

“This service is not only in demand by younger demographics. In fact, month after month, reports show 30 to 49-year-olds represent 50% of ProVision member practice plans, with a surprising 41% of plans taken up by the 50-plus age group.”

"WE’VE FOUND PATIENTS PREDOMINANTLY USE HUMM TO PURCHASE PRESCRIPTION SPECTACLES, AND OCCASIONALLY FOR SUNGLASSES” JASON RICHTER BILL WILKINSON OPTICAL CENTRE

Mr Philip Rose, national business development manager based at Eyecare Plus head office in Sydney, says Afterpay is the most popular among its practices.

“BNPL is not as popular in optometry as it is in other retail areas such as fashion and beauty – mainly because the main demographic using BNPL is younger than the usual independent optometry demographic,” he says.

“At the same time, this is also one of the major benefits, attracting new and younger patients is essential for most practices.”

Rose is aware some independent practices worry about the transaction fees but notes there is evidence patients will spend more on purchases with BNPL. “We feel that practices should offer this form of payment as in today’s environment it is like accepting payment via credit card. Payments can now also be made via smartphone,” he says.

“It also increases exposure of practices via the BNPL company’s websites – we have heard stories of practices getting referrals from the BNPL companies own websites and apps.”

A report on consumer spending trends released by Afterpay shows BNPL spending is trending up across all generations, however younger generations are leading the charge. As of November 2020, Millennial BNPL spend was up 48% since January and 80% for Gen Z.

He adds: “For independent optometrists who embrace this trend, the chances of reaching new patients and becoming even more attractive to existing patients far outweighs the participation or transaction costs.”

TRIPLE THE CHOICE

For optometrist and practice owner Ms Kylie Gough, supportive staff who were already familiar with BNPL spurred her decision to introduce it to her patients.

Independent optometry network Eyecare Plus has agreements with Afterpay, Zip, and Openpay, three of the leading BNPL providers in Australia.

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INSIGHT May 2021

STAFF ON BOARD

Gough, an Eyecare Plus member who operates practices in Nambucca Heads and Macksville in NSW, says her staff were using BNPL in their personal lives and found it convenient, and their children – young adults – were using it regularly.

more than thirty years. Originally owned and operated by the practice namesake, optometrist and long-term employee Ms Nicole Baines and her husband, optical dispenser Mr Jason Richter, purchased the practice in 2012 when Wilkinson retired.

She signed up for Afterpay and Zip about 18 months ago and says it has allowed patients greater financial flexibility.

Richter, who joined the business with 15 years’ experience as an optical dispenser, says he and Baines introduced Humm, a BNPL service, to patients at the wholly independent practice in July 2016 – almost five years ago. The first step in that decision came when Richter attended the inaugural O-Show in Melbourne that year.

“I offer a three-month lay-by, and BNPL has allowed patients to split payments, often by paying half on lay-by, and half on BNPL,” she says.

Gough described the Nambucca Valley as a lower socio-economic area where locals often live week-to-week. Despite being only 10km apart, her two practices attract a different demographic; mostly retirees and tree-changers in Nambucca Heads, and families who have been farming for generations in the area surrounding Macksville, on the Nambucca River.

“I get patients making all levels of purchases using BNPL; from basic, budget spectacles, up to premium products, which they find easier to pay off in installments,” Gough says.

“I find the book-keeping side of BNPL a minor annoyance because it doesn’t sync with my practice management software, so it can be a bit fiddly. But patient’s love it – they can take their purchase immediately, and don’t need to use their credit card.”

Aside from purchasing frames and lenses, Gough says patients also use BNPL to purchase contact lenses, low vision aids, or dry eye products.

O-SHOW STARTS THE CONVERSATION Bill Wilkinson Optical Centre in Bendigo has been in business for

Patients at the practice had started asking about alternative payment methods other than traditional lay-by, prompting Richter to start making enquiries.

“Humm offered higher limits to start with, up to $800 or $1000, for a new customer to spend, which was more than other providers. They also had facilities to take it higher again, with credit checks et cetera,” Richter says.

“Humm’s fee was only 4%, compared to other providers, which were as high as 6.5 to 7%, from memory. It also provided overnight payment, or within two business days – other providers took up to a week.”

Richter says implementing Humm was similar to applying for a bank account and the practice didn’t need to disclose any financial records.

“It hasn’t been a game-changer but it has given our patients options.

In terms of processing payment, it works quite well. Patients submit their details and are approved for a certain amount. We’ve found patients predominantly use Humm to purchase prescription spectacles, and occasionally for sunglasses,” he says. n

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Optimis Fusion® + Vitra 2® SLT | YAG | RETINA

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INTRAOCULAR LENS

WHAT’S POSSIBLE WITH THE ENVISTA IOL Bausch + Lomb’s latest version of the enVista monofocal recently became available to Australian and New Zealand surgeons along with a new preloaded delivery system. Early adopters discuss making it a go-to IOL and how it’s offering increased depth-of-field in many patients.

a “monofocal-plus” among surgeons, with a growing body of evidence demonstrating intermediate and near vision in selected patients.

Dr Dee Stephenson is one of those surgeons. She has a boutique private practice in Florida in the US and was the world’s first ophthalmologist to implant the latest enVista monofocal in 2017. She says it has maintained the original qualities that made it a go-to monofocal and toric for her many years before, while bringing even greater benefits.

T

"It’s what you would call a toric-plus or monofocal-plus because a lot of these people have great intermediate vision; it’s very functional"

With this in mind, the company’s engineers have modified the enVista platform to remove what many surgeons saw as its only major drawback by changing the ratios of two polymers that enable the lens to unfold significantly faster – which some surgeons report to take about 20 seconds*.

DR DEE STEPHENSON

he enVista family of intraocular lenses (IOL) has carved out a reputation among cataract surgeons for its robust, glistening-free material, visual clarity and predictable outcomes.

But as ophthalmologists demand greater efficiencies in the operating theatre and ease-of-use with intricate toric implantation, Bausch + Lomb (B+L) has been keen to improve the unfolding time of the hydrophobic acrylic lens that previously took between one and 2.5 minutes.

The next-generation enVista has been available as a monofocal in the US (where it is called MX60E) since 2018 and was released in Australia this year in April. The toric version was launched in the US in 2019 and will arrive here soon.

What’s even more appetising is that B+L has developed a new pre-loaded delivery system for enVista called SimplifEYE that provides a more userfriendly experience compared with its original BLIS inserter. Locally, the new IOL and injector are called the MXPLC or enVista preloaded with SimplifEYE delivery system.

In recent years in the US, enVista has also been earning a reputation as

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“People say to me I’m not using that lens because it took forever to open, but now I’ve told a lot of those naysayers in my country to try it and they are really happy with how it’s performing,” she says.

“Another great feature is how it sits in the eye; it has big broad haptics that cover 110 degrees of the capsular bag and almost acts like a capsular tension ring. So, it sits really well with very little rotation – less than five degrees, I believe. That stability is especially important in the toric form.”

A traditional enVista attribute has been its material that is said to be 25 times harder than traditional hydrophobic acrylic lenses, reducing the likelihood of scratches and abrasions.

Although it now opens faster, Stephenson says Australian surgeons can expect it to remain well-controlled, especially with the new delivery system.

consultant at The Royal Victorian Eye and Ear Hospital, made enVista a lens of choice several years ago.

“I like this lens because the outcomes are so predictable, but where it really shines is that 85% of my patients are 20/40 (6/12) vision or better at intermediate uncorrected and then I’m getting another 30% who are J1 (Jaeger 1) or better,” she says.

He was one of 11 Australian surgeons who completed a pre-launch evaluation of the enVista preloaded with SimplifEYE delivery system at the end of last year.

“Even if it is not a premium lens, it’s what you would call a toric-plus or monofocal-plus because a lot of these people have great intermediate vision; it’s very functional, especially in dim lighting, so it has been a win-win.”

EXPLOITING POSITIVE CORNEAL SPHERICAL ABERRATION Fellow Californian surgeon Dr Mitchell Shultz has also been an early adopter of the enVista technology. He says the aberration-free and aspheric lens offers edge-to-edge uniform power which makes a difference in cases where patients aren’t looking through the lens centre or with complications like zonulopathy.

“When I went back to the original enVista many years ago it did solve the PCO problem I was having with other lenses, but it was inconvenient because they were stiff to use,” he says.

“If you’ve got a toric that’s totally curled up on itself, you just can’t align it and that’s disconcerting. So, having it unfold in what feels like an instant is an enormous move forward and will really pay dividends when the toric comes out.”

"Lenses are increasingly coming out with various ways of increasing depthof-field and spherical aberration is probably the next big thing"

“In cases where the lenses aren’t necessarily centred, or later they decentre, patients never lose quality of vision with this material,” he says.

Shultz was the first to quantify the intermediate and near vision benefits after discovering unexpected results with the original enVista around eight years ago. It was unlike anything he had experienced on another platform.

“I wasn’t the only one experiencing it, but it wasn’t until I got the Tracey iTrace ray tracing technology that we were able to find some objective markers to predict which patients would have enhanced depth-of-field,” he says.

“I started to speak about it on B+L’s behalf in 2015 at which point other people started to replicate my results. Many colleagues would agree that uniformly across the platform you can expect 25% of patients to have pretty good J2 near vision and something like 70-80% J3-J4 intermediate vision, so they can function a lot of the time without glasses.”

Through corneal analysis, Shultz has elucidated that the enhanced depth-of-field is not pupil-dependant but is to do with pre-existing corneal spherical aberration.

“It comes down to patients in the +0.25 to +0.31 μm positive corneal spherical aberration range that get, on average, the most enhanced depth-offield, so it’s not necessarily the lens that’s causing it, but it’s giving the patient the best chance of depth-of-field based on their corneal aberrations.”

While enVista’s key features ensure its suitability to a broad range of patients, Stephenson says it’s useful in post-refractive patients seeking outcomes similar to their laser surgery, despite having a poor ocular surface, as well as people ineligible for multifocals or EDOFs, or who don’t want photic phenomena.

“This lens provides some leeway. Even if their vision isn’t 20/20, they are 20/30 and they see at near and intermediate and have got a quality of vision,” she says. “We all talk about 20/20 vision or better, but we forget it’s the quality of vision that’s so important; people don’t mind having to put on a pair of readers in dim light, but boy do they mind if their quality of vision at distance is not good.

“In my experience, the lens is also good for patients who have epiretinal membranes or mild macular degeneration where they may not have been 20/20 to begin with, but it still gives them really great quality. They have an added spring in their step because they are seeing better than expected after being disappointed they couldn’t have a multifocal or EDOF.” TORIC BENEFITS Aside from its fenestrated haptics and controlled unfolding, the new enVista offers a continuous 360-degree square edge design to minimise posterior capsular opacification (PCO) development. The sharp edge has been shown to reduce PCO compared to round edge designs, as demonstrated in studies.

Lower PCO rates was the one of the main reasons Australian surgeon Dr Joseph San Laureano, a principle at Melbourne Eye Centre and senior

DR JOSEPH SAN LAUREANO

With his limited use, the biggest difference San Laureano has noticed is the enhanced depth-of-field. Its association with pre-existing positive spherical aberration present in the aging cornea is a concept he believes will gain in popularity like measuring posterior corneal astigmatism.

“And now posterior astigmatism has become standard. The lenses are increasingly coming out with various ways of increasing depth-of-field and spherical aberration is probably the next big thing.”

10-FOLD IMPROVED LOADING EXPERIENCE B+L’s new SimplifEYE delivery system, developed exclusively for the enVista, is also driving greater efficiencies and safer practices in the theatre.

It allows the surgeon to deliver the lens through incisions as small as 2.2mm, with the enclosed cartridge holding an untouched IOL to ensure proper positioning and reducing the risk of damage. The seethrough device also has a bevelled tip for consistent lens folding to afford surgeons reproducible and reliable delivery into the capsular bag.

As a presbyope, San Laureano says he previously loaded the enVista under the microscope which could be an intricate process. If not done correctly, it could jam or the haptic could leave an imprint or stick to the optic, making for a fiddly procedure while the lens is in the eye.

“But all of this is gone now … it’s a 10-fold better experience for loading,” he says.

Stephenson says the surgeon can put the bevel down and screw it directly into the capsular bag, with the trailing haptic also in the bag.

“I think B+L is trying to make this universal where people don’t have to touch the implant, and having a no-fail, safe way to insert it into the eye,” she says.

“The SimplifEYE delivery system has been a great addition with a small learning curve. This empowers the operating room staff and, with just a few practise tries, they can load the lens with real confidence. All of these processes take time to learn and the more efficient you are the less stress you will have. This makes the operating room experience better for everyone.” n *May vary with surgeon technique.

INSIGHT May 2021 35

OPHTHALMIC SURGERY

IN A NEW

DIMENSION WITH 3D VISUALISATION

A new era in ophthalmic surgery has dawned with the emergence of 3D visualisation systems. Surgeons discuss how Alcon’s latest advance in this field is offering new levels of comfort, efficiency and teaching advantages in Australian operating theatres.

W

ith the rapid speed of diagnostic ocular imaging advancements during the past 20 years, ophthalmic surgeons would be forgiven for wondering why their most important tool – the surgical microscope – hasn’t evolved at the same pace.

Up until recently, the analogue microscope remained fundamentally unchanged for 50 years. But its incumbency is now being challenged with the rise of digital 3D surgical visualisation systems now offering unprecedented intraoperative views.

Chief among these technologies is Alcon’s NGenuity 3D Visualisation System. It was first introduced to Australian surgeons in 2017 and has undergone another transformation with the NGenuity 1.4 software upgrade.

While the technology was first touted as a key tool for vitreoretinal surgeons, it’s now gaining popularity among anterior segment surgeons who are reporting superior visualisation, which is proving particularly useful in their most complex cases.

Dr Nathan Kerr is a leading Australian cataract and glaucoma surgeon and recently used the system during public lists at The Royal Victorian Eye and Ear Hospital (RVEEH).

In addition to the superior visualisation, he says NGenuity can overcome musculoskeletal issues that often trouble surgeons later in their careers.

It also promotes greater cohesion between theatre staff, but he believes its biggest impact will be as a teaching tool for the next generation of ophthalmic surgeons.

“You don’t want to go back to a normal microscope after you’ve used NGenuity,” Kerr, who practises privately at Eye Surgery Associates and is a principal investigator in glaucoma at the Centre for Eye Research Australia,

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says. “For public teaching hospitals, it’s going to be revolutionary by enhancing the learning experience of surgical trainees. Being able to view immersive 3D images with edge-to-edge clarity on a highdefinition screen in real time makes the system an ideal educational tool. Plus, the surgeon and trainee can easily swap positions during a case without having to adjust the microscope eye pieces.”

In the operating room, NGenuity changes the experience for the surgeon, assistant, observing medical students/registrars/fellows and ophthalmic nurses, in myriad ways.

Dr Nathan Kerr, Royal Victorian Eye and Ear, and Eye Surgery Associates.

Firstly, the surgeon performs surgery by sitting in a neutral spine position looking at a 3D surgical screen that can be moved to a position that suits the team, instead of leaning forward and looking down the conventional microscope eye pieces. Wearing polarised glasses, every person in the theatre can watch the surgery take place, viewing the same screen as the surgeon – a marked difference over traditional surgery where often only the surgeon and assistant can easily see what’s occurring, with support staff often watching on a small monitor.

To achieve this, a 3D High Dynamic Range (HDR) camera is mounted to the microscope (regardless of the manufacturer), which then transmits to

a high-speed processor before the live 3D image is projected from a 4K OLED surgical display.

Kerr says it provides an unparalleled view with an extended depth of field, enhanced magnification, and better contrast even at low illumination.

“Cataract and complex anterior segment surgeries require excellent visualisation. Using the NGenuity system, every structure is in focus at once, from the cornea to the posterior capsule, improving depth perception and visualisation for delicate intraocular manipulations. This helps me deliver the best outcomes to my patients,” he says.

“Using a traditional analogue microscope, the centre of the view is clear but the image degrades towards the periphery. The NGenuity system provides a panoramic view with a clear image from one edge to the other.

This is especially important in microinvasive glaucoma surgery (MIGS), so I think this system is a gamer-changer for viewing angle structures and MIGS.” Kerr says it provides better depth perception than the human eye can achieve using an analogue microscope. Colour filters can customise the view and highlight ocular structures and tissue layers.

“With glaucoma stents, placement needs to be exact for them to function optimally. Having a highly magnified view of Schlemm’s canal in perfect focus enhances the ease and certainty of stent insertion. With the digital image filters, you can highlight structures like Schlemm’s canal, making it easier to visualise compared to an analogue microscope.”

Kerr has also performed several cataract surgeries with the system.

He’s found it offers much better visualisation, making it easier to perform delicate steps like polishing of the posterior capsule. Through Alcon’s Datafusion software, NGenuity connects with other systems to display key parameters – such as intraocular pressure, flow rates, and infusion pressure – on the main screen.

“It helps increase situational awareness, enhancing safety and efficiency,” he says. “By having a unified source of information on one screen, I can see all the information I need without ever taking my eye off the patient.”

During surgery, Kerr says: “The system’s highly sensitive camera enables surgery to be performed with low light illumination settings, which is safer for the retina and more comfortable for patients having surgery under topical anaesthesia.

“In the day-surgeries I operate, I’m already trying to convince them to adopt this technology so I can offer it to my private patients.”

ERGONOMIC SURGERY A common problem for ophthalmologists with traditional binocular microscopes is poor neck and back postures, leading to musculoskeletal fatigue and injuries. These have been associated with reduced surgical longevity, with the prevalence of symptoms reported to be as high as 62%.

When performing MIGS, Kerr says the patient and the microscope needs to be tilted 35 degrees toward the surgeon, which leads to an awkward and uncomfortable position for the surgeon with a conventional microscope.

“With NGenuity, because I don’t need to look down the microscope eye pieces I am able to sit upright in a comfortable position, even when the microscope is at an angle,” he says.

“Being able to look straight ahead reduces neck strain and provides a more natural position for your arms which helps reduce fatigue. The other benefit is how quickly you adjust to the system; the learning curve is minimal. Even on my first case I felt confident throughout the entire case.”

OPERATING ROOM EFFICIENCY Ms Kylie-Rae Thomas is the nurse unit manager of operating theatres at Sydney Eye Hospital where NGenuity 1.4 was trialled for three months last year.

“Following the trial, I already have a number of surgeons coming to me asking when we’re going to get NGenuity back,” she says, noting, however, that some theatre staff and surgeons have occasionally felt nauseous while

adjusting to the 3D display.

Through its advanced visualisation, she’s seen the system offer major benefits for theatre efficiency and training.

Traditionally, Thomas says nurses could only view the surgery on a small monitor, with many of the structures out of focus. They were often required to look out for cues from the surgeon or watch the monitor, but now they had become more engaged.

“This system allows you to see Dr Elisa Cornish, Sydney Eye Hospital. everything inside the eye with such precision, which gives you a greater understanding and appreciation.

You can see the surgeon’s manoeuvring around the anatomy when they’re operating, whereas you wouldn’t see those fine motorskills and techniques usually,” she says.

“You’re watching exactly what the surgeon’s doing in real time, and therefore you can be more responsive to give them the instrument they need. This technology brings you where you need to be, focused on what’s happening, we’re all invested, and can see the surgical outcome and result for the patient which is very gratifying.”

A ‘REVOLUTIONARY’ TEACHING TOOL Thomas’s Sydney Eye Hospital colleague, Dr Elisa Cornish, has also been impressed with the system’s ability to visualise structures during glaucoma surgery, particularly with the depth-of-field when conjunctival suturing during Baerveldt tube and trabeculectomy surgery. But she was most blown away by the magnification of the angle when inserting glaucoma stents.

“I showed a video of it to the stent manufacturer to demonstrate how easy it is for teaching compared to looking through the assistant’s eye piece of the microscope, they were very impressed,” she says.

Cornish is a senior clinical lecturer at the University of Sydney, which involves supervising medical students, on eye term rotation, and registrars at Sydney Eye Hospital.

While the system broadcasts the surgery live – which has teaching benefits – surgeons can also record their work to be played back in high resolution 3D in a range of teaching environments, including conferences.

“To demonstrate to junior ophthalmic trainees each step of the surgery with good visualisation has been the greatest benefit of all. I think the biggest selling point is its teaching capabilities, it would be an amazing educational tool for all types of ophthalmic surgery – teaching hospitals would be crazy not to utilise this technology,” she says.

“In addition, it offers personal insight into your own surgeries so you can assess where things go wrong – that learning capacity to refine your technique is amazing feedback for yourself and future surgeries.”

At RVEEH, Kerr notes public hospitals would be enticed by its capability to be mounted to most operating microscopes, regardless of the manufacturer, enabling hospitals to add new digital features to their existing hardware.

“I also think private day surgeries will want to provide patients and surgeons with access to the latest technologies, such as NGenuity, to enhance patient care and the experience of their surgeons,” he says. n NOTE: Opinion based on healthcare professional impressions and experience after using NGenuity 1.4 Visualisation system in surgery. The healthcare professionals did not receive compensation. References are available upon request and will feature in the online version of this article at www.insightnews.com.au.

INSIGHT May 2021 37

IMAGING

UWF guided OCT enables OCT capture even in the far periphery.

A NEW PRECEDENT IN PERIPHERAL

Optos’s ultra-widefield imaging systems are renowned for some of the most superior views of the retina, but the company recently went a step further to incorporate swept source OCT. DR DAVID SIA from Pennington Eye Clinic – Australia’s first practice to have Silverstone installed – discusses why it’s so beneficial for vitreoretinal specialists, ocular oncologists and beyond.

A

fter completing dual fellowship training in the UK and Canada, Dr David Sia returned to Australia last year to begin working in private practice alongside his medical school mate Dr Weng Chan at Pennington Eye Clinic in North Adelaide.

Armed with fellowships in vitreoretinal surgery and ocular oncology – obtained from the Royal Alexandra Hospital, Edmonton and Moorfields Eye Hospital, London – Sia was keen to put his expertise to immediate use, supported with the most advanced imaging equipment.

When Pennington Eye Clinic was established a few short years ago, it opted for the California system, Optos’s best ultra-widefield (UWF) retinal imaging device at the time. But the company soon developed a new device to incorporate swept source OCT (SS-OCT), leading to its most advanced instrument yet, Silverstone.

patients. It also provides extra information that really benefits the efficiency and workflow of our practice, along with the satisfaction of working here,” Sia says.

“With Silverstone, it’s incredibly useful to show patients what we are looking for. And performing swept source OCT over lesions that are far in the periphery is an important function we wanted to add to our armamentarium of imaging.”

TOP-OF-THE-RANGE SYSTEM

Late last year, his clinic became the first practice in Australia to install Silverstone. With the high costs of medical equipment, many practices easily become fixated on the return on investment or Medicare subsidies, but for Sia and Chan it aligns with their goal to provide optimal care for patients.

Optos states that Silverstone is the most powerful tool yet for examining the retina. With it being the only device of its kind with integrated SS-OCT, it produces a 200° single-capture image – which it calls an optomap image – in less than half a second. OCT scanning can be guided across the retina and into the far periphery.

“I think having advanced imaging equipment with such high levels of speed, resolution and capability allows us to do so much more for our

While the Silverstone is now officially available for

As an ocular oncologist, the system was an appetising prospect for Sia because for the first time ophthalmologists could easily capture OCT scans of peripheral lesions, which haven’t been readily achievable with traditional OCTs.

The Optos Silverstone device.

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sale globally, with cancellations of national congresses across Australia and New Zealand due to COVID-19, Optos has not officially launched Silverstone yet. But it hopes to do so later this year.

“In the meantime, sales enquiries and interest has been very high in our top-of-the-range device even prior to our official launch in Australia and New Zealand,” the company’s Australian managing director Mr Jason Martone says.

“Pennington Eye Clinic was the first practice to purchase and use the Silverstone in the country. Dr Chan and Dr Sia are big believers in the importance of providing their patients with the best possible care and were adamant that they have the Silverstone in their practice as it provides superior imaging for treatment, management and research relating to so many different conditions.”

While 82% of the retina is captured in the 200° optomap image – enabling eyecare professionals to see 50% more compared with the next closest imaging device – Silverstone also has an auto-montage feature that can allow up to 220°⁰of viewing, as well as image pairing for optic disc and retinal evaluation. More than 1,000 peer-reviewed studies are also said to show the long-term value of optomap imaging in diagnosis, treatment planning and patient engagement.

optomap FA of hemi-retinal vein occlusion, courtesy of Dr David Brown, Retina-Consultants of Houston, Texas.

Now, with integrated SS-OCT that offers a line scan of up to 23mm, Martone says Silverstone facilitates cross-section examination of the retina from vitreous through the choroidal-scleral interface.

huge advantage and is still able to obtain an ultra-widefield scan even through undilated pupils.”

While Optos’s devices initially have been perceived as a tool for retinal specialists, the company says Silverstone should be viewed as an asset to general ophthalmologists and eyecare professionals due to its wide range of functions. The company has incorporated its entire suite of other imaging modalities; colour, red-free, choroidal, autofluorescence (AF), fluorescein angiography (FA) and indocyanine green (ICG) angiography.

PRACTICE WORKFLOW

For Sia, the OCT functionality has been most useful in common lesions like suspicious choroidal nevi. In recent years, stronger data has been published to show that multi modal imaging, particularly OCT over the lesion, is a key part of diagnosis and management.

“It shows us subtle subretinal fluid in peripheral lesions where conventional OCTs cannot reach,” he says.

“It also helps to delineate which level the lesion or pathology is at. For example, in congenital hypertrophy of the retinal pigment epithelium (RPE), a scan can show a thickened RPE and a normal choroid layer. It’s wonderful to be able to document that and educate patients visually with a scan. Other applications include areas of subtle pigmentary change and investigating abnormal vitreoretinal interface and traction.”

ULTRA-WIDEFIELD VIEWS With respect to Silverstone’s UWF imaging capabilities, Sia has been particularly impressed with the FA and ICG angiography modalities.

He says it’s made a significant difference in medical retina work up of patients with diabetes, vascular diseases and uveitis.

“UWF fluorescein angiography is also particularly useful in patients with Von Hippel–Lindau syndrome, where they get retinal capillary hemangioblastomas. In this condition, it is important to look for all lesions in the fundi, even the most minute ones and treat them early. The UWF angiography allows you to do that really well.”

With plenty of exposure to the California device during his fellowship training, Sia has been a long-time exponent of Optos’s UWF imaging systems. In addition to medical retina and ocular oncology, he sees several benefits for other ophthalmology specialities, particularly with its ability to capture such widefield images through most cataracts and small (2mm) pupils.

“As a retinal specialist, we have most of our patients well dilated for a full fundus examination at each visit. Some practices may not dilate all their patients at each visit as dilation can affect the intraocular pressure and angle architecture,” Sia says.

“I think this is where Optos – being a scanning laser technology – has a

Dr David Sia, of Pennington Eye Clinic, says SS-OCT over lesions in the far periphery is vital for ocular oncologists.

Correct pupil dilation for a conventional fundus camera image can also consume valuable time in the clinic. Sia says this process can take around 15 minutes per case and when they’re ready, patients need to look to a particular position to be able to capture the area in the periphery.

“Even then you end up with multiple images that you have to stitch together to form a composite wide-field image to cover the entire lesion that you wish to monitor.”

Each incremental gain is important to the overall efficiency of the practice. At Pennington Eye Clinic, roughly 160 retina and oncology patients are seen each week.

Almost all are scanned with Silverstone in the work up phase. If they’re referred for a particular lesion, in the same sitting the operator will perform a SS-OCT over the lesion and macula before sending them for ophthalmic consultation. The clinic’s optometrist and ophthalmic technicians perform the scans, which has required minimal training and a small learning curve.

“Having all the imaging done right away, there’s minimal back and forth or changing between machines, and that really adds to the efficiency.

When the patient is in my room, I usually have all the information I need at my disposal to diagnose and manage as well as have a detailed discussion with them about their care, with the images and scans.”

Before the patient is sent home, Sia says having such high-quality scans work as an important demonstration tool to have a comprehensive conversation with patients about their management or surgery. In turn, patients are fully engaged in their care and do appreciate the extra visualisation of their disease. It also helps to ease anxiety in many cases.

“It makes a whole world of difference to show them what we are looking for. Other conditions outside of ocular oncology include monitoring retinoschisis. Conducting an SS-OCT scan over the area to show the patient the splitting of the retinal layers, as well as the extent of the involvement is very helpful for their understanding,” he says.

“For pre- and post-images I can show them a retinal tear, and then after performing laser, I can demonstrate how it’s been well-surrounded.”

Looking ahead, as Optos’s global team seeks to continually improve of its entire suite of devices, Sia says he is excited about the direction the company is taking. n NOTE: Dr David Sia and Dr Weng Chan have no financial disclosures and do not receive any benefits from Optos.

INSIGHT May 2021 39

MACULAR DISEASE NEWS

IN TREATING LATE-STAGE AMD As part of Macula Month this May, Insight examines drug development programs that could significantly alter the late-stage AMD therapy landscape. Leading experts also discuss why optometrists are such an important link in the success of both patient outcomes and clinical trials.

M

acular Disease Foundation Australia figures indicate about one in seven Australians – or 1.29 million people – over the age of 50 years has some evidence of age-related macular degeneration (AMD). More than 200,000 of those will experience vision impairment and around 160,000 over 80 years will experience vision loss.

While a lot of clinical detail is known about the disease, including the various stages of AMD and associated symptoms, treatment remains elusive for many patient groups.

It’s widely-known to eyecare practitioners – but less so to patients – that there are very few, if any, medical treatments for early and intermediate stages of macular degeneration, and only one of the two forms of late-stage AMD (neovascular, or wet AMD in layman’s terms) can be medically treated.

For the other form (geographic atrophy, or dry AMD), research activity is gaining momentum with a wave of promising new interventions being trialled around the world, including Australia. However, the pursuit of new therapies relies on the success of clinical trials, which are contingent upon accurate initial diagnosis and patient recruitment.

To that end, experts in Australia have helped define the earliest changes seen in atrophy so that it might be possible to start interventions earlier than what is currently occurring in trials. Defining these earlier changes of atrophy also helps eyecare professionals counsel patients as to their stage of disease.

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INCORRECT TERMINOLOGY A MAJOR BARRIER Historically, there has been considerable confusion over even basic terms in AMD. An inconsistent approach to classifying or diagnosing the disease has led to confusion in what the terms actually refer to when considering the stage of disease. For example, ‘dry AMD’ has been used to mean everything that isn’t ‘wet’ but it should be used to describe a late stage of geographic atrophy (GA).

Guymer says many trials were delayed from starting or recruiting new participants because of COVID-19.

“In the past year, we haven’t been able to recruit patients for new trials or do research to learn more about the disease. They have been on hold, but now we’re back up and running,” she says.

With restrictions easing and COVID-safe plans in place, Guymer says eyecare professionals should be aware of what clinical trials are recruiting so they can offer world-leading trials to their patients.

For Professor Robyn Guymer, deputy director of the Centre for Eye Research Australia (CERA) and head of macular research, using the right terminology continues to be a sticking point.

Further, RANZCO’s Referral Pathway for AMD Management – recently updated by a committee led by Guymer – now suggests that optometrists consider appropriate and timely referral to participating trial sites.

“Incorrect terminology makes it confusing when trying to recruit suitable AMD patients for trials. It makes it hard to work out which stage of AMD a patient is thought to have,” she says.

Guymer says digital images of cases of AMD, classified using the Beckman classification, are very helpful to determine which trial a particular patient might best suit.

For consistency and continuity, Guymer points to the Beckman classification – created in 2013 and involving input from 26 AMD experts, including Guymer – which is based upon evidence drawn from the AgeRelated Eye Disease Study (AREDS).

“OPTOMETRISTS NEED TO BE PROFICIENT AT INTERPRETING SIGNS DETECTED ON OCT SCANS, SO THAT THEY CAN APPROPRIATELY STAGE THE DISEASE AND REFER APPROPRIATELY”

As the most current clinical classification scheme for AMD, it recommends that AMD should be classified into normal ageing, early AMD, intermediate AMD, and late AMD, of which there are two types, GA and neovascular.

According to the classification, normal ageing is defined by small drusen (≤63µm) and no AMD pigmentary abnormalities. Early AMD is defined by medium drusen (>63µm and ≤125µm) and no AMD pigmentary abnormalities. Intermediate AMD is defined by large drusen (>125µm), or medium drusen (>63µm) in addition to AMD pigmentary abnormalities.

PROF ROBYN GUYMER

Late AMD is defined as either GA and/or neovascular (nAMD). It is possible for GA and nAMD to coexist; the term dry AMD should be used as a lay term for GA, Guymer says.

According to Optometry Australia (OA), recent advances in nAMD research have shown that early detection and treatment is vital for best patient outcomes and, as such, optometrists have a major role to play in management.

New imaging has also meant that biomarkers, such as reticular pseudodrusen and nascent GA, can be identified and these indicate a higher risk stage of AMD, with increased risk of progression to late AMD. OA’s 2019 AMD Clinical Practice Guide stipulates that in early AMD (medium drusen only), patients have a 3.1% chance of progressing to late AMD within five years. However, once a patient has large drusen and pigmentary abnormalities in both eyes (intermediate AMD), this risk increases to around 47.3%. If a patient presents with late AMD in one eye at baseline, the risk of progression in the other eye is slightly higher.

PATIENTS NEEDED FOR TRIALS Currently, there are no regulatory-approved treatments for GA, when the vision cells (photoreceptors) in the centre of the retina slowly die over time. According to OA, the standard of care is monitoring every six to twelve months depending on vision/driving status and the individual’s risk of progression.

However, Guymer says several trials are now recruiting patients, so optometrists should consider referral to studies if they think their patient is appropriate and interested.

One trial recruiting at CERA is the GOLDEN trial which is aiming to interfere with the body’s production of the protein called Factor B that is made in the liver and found in the eye, which may contribute to GA secondary to AMD. The trial is recruiting patients at several locations in Australia, including CERA in Melbourne, the Lions Eye Institute (LEI) in Perth, the Royal Adelaide Hospital, and Sydney Eye Hospital.

“Optometrists need to be proficient at interpreting signs detected on OCT scans, so that they can appropriately stage the disease and refer appropriately,” she says.

Guymer has also co-created a University of Melbourne e-course for optometrists and other eyecare professionals to help them upskill in how to read these scans.

For a list of current trials, visit ClinicalTrials.gov, a database of privately and publicly funded clinical studies conducted around the world. The CERA and LEI websites also list current clinical trials, including those recruiting.

THE NEOVASCULAR AMD LANDSCAPE At the beginning of 2021, clinician-researcher Dr Fred Chen from LEI in Perth remarked that recognition of GA as a potentially treatable condition could be a key feature shaping retinal disease landscape this year.

He’s also eager to see the emergence of longer acting drugs for nAMD and new trials of port delivery systems for existing drugs, allowing longer actions.

One of those drugs is Beovu (brolucizumab), Novartis’ new intravitreal injection therapy for nAMD. Although registered on the Therapeutic Goods Administration (TGA), an application to have it PBS-listed had been denied three times – at the time of writing. The Pharmaceutical Benefits Advisory Committee considered Beovu is likely inferior to aflibercept in terms of comparative safety. While it had previously considered Beovu was noninferior in terms of comparative efficacy, it also did not accept the evidence supported less frequent dosing. (Novartis disagreed with the decision, stating it's an important treatment option, with an overall favourable benefit-risk profile).

INSIGHT May 2021 41

MACULAR DISEASE

If it’s able to clear this hurdle, Beovu would present a third major treatment option for nAMD alongside well-established PBS-approved therapies Lucentis (ranibizumab) and Eylea (aflibercept), which the government spent more than $610 million on last year.

Much of the marketing around Beovu has previously focused on its potential for extended dosing intervals in some patients based on the Hawk and Harrier trials, in which it was also reported to demonstrate non-inferior best-corrected visual acuity change from baseline at year one compared with competing therapy Eylea, which Chen described as an impressive feat.

However, he is concerned that Beovu-induced retinal artery occlusion or inflammation cannot be prevented, predicted or treated effectively.

Chen is also closely watching for the result of a study on the port delivery system with ranibizumab (Lucentis), sponsored by Hoffmann-La Roche.

“A port delivery system is a combination of new surgical technique and treatment paradigm. A small device is sutured into the eye as a theatrebased procedure that takes about half-an-hour, or just slightly longer than

yet. If successful, faricimab will be competing in the same space as Beovu for longevity and potency of the drug effect in nAMD. Elsewhere on home soil, Melbourne-based biopharmaceutical company Opthea is commencing two global Phase 3 trials (known as SHORE and COAST) with its OPT-302 therapy for nAMD. Study locations include Parramatta, Sydney, Westmead and Perth.

Both clinical studies will enrol about 990 treatment-naïve patients each and assess the efficacy and safety of intravitreal 2.0 mg OPT302 in combination with 0.5 mg ranibizumab (Lucentis) or 2.0 mg aflibercept (Eylea), compared to ranibizumab or aflibercept monotherapy, respectively. Opthea anticipates reporting top-line data in 2023.

Australia also recently became the clinical trial centre for a new molecule called EXN 407, stemming from research out of UNSW. Backed by Johnson & Johnson’s pharmaceuticals subsidiary Janssen, the novel eye drop therapy could be a radical advancement and eliminate the need for intravitreal injection delivery in future in nAMD. WHAT ABOUT GEOGRAPHIC ATROPHY?

“A SOLUTION – CONTAINING LUCENTIS IN THIS STUDY – IS INJECTED INTO THE PORT, WHICH ALLOWS THE DRUG TO BE DIFFUSED INTO THE EYE CAVITY" DR FRED CHEN

Both Guymer and Chen are optimistic that a treatment for GA could be a reality in the foreseeable future, particularly with a potential treatment approach focusing on the “complement cascade”, which is an arm of the immune system strongly implicated in AMD. The complement part of the immune system is thought to damage the retina; research has demonstrated that inhibiting the complement cascade can protect the retinas of mice. Guymer says there are trials aiming to work on the complement pathway currently under way in Australia and internationally.

While two Phase 3 trials targeting the complement protein Factor D in GA patients were not successful, a separate trial targeting a different complement protein called C3 has shown promise.

The Phase 2 trial, known as FILLY, demonstrated that intravitreal injections of APL-2 (Pegcetacoplan) in patients with AMD were well-tolerated, and preliminary data indicate a therapeutic benefit in subjects with GA, according to Apellis Pharmaceuticals, who developed the therapy.

the timeframe in cataract surgery,” Chen explains.

“A solution – containing Lucentis in this study – is injected into the port, which allows the drug to be diffused into the eye cavity. The concentration of the drug in the port will decline over six to nine months. The port stays in the eye and the participant returns for an outpatient procedure where the low concentration solution is replaced by a fresh, high concentration solution of Lucentis.”

Apellis has now introduced two Phase 3 trials (known as DERBY and OAKS) to compare the efficacy and safety of APL-2 therapy with sham injections in patients with GA secondary to AMD. Chen says based on the results of the FILLY trial, and now with DERBY and OAKS under way, this intravitreal therapy could be the breakthrough researchers are seeking.

“This could be the first treatment available for patients with GA,” Chen says.

The Hoffmann-La Roche study, which has yet to recruit in Australia, is aiming to enrol 1,000 participants and will evaluate the long-term safety and tolerability of the delivery system with ranibizumab 100 mg/mL with refill-exchanges administered every 24 or 36 weeks for approximately 144 weeks in participants with nAMD who have completed either Phase 2 Ladder study, Phase 3 Archway study or Phase 3b Velodrome study.

“There has been a delay setting up the Velodrome study in Australia due to COVID-19, but it is likely to be ready to recruit in the second half of the year,” Chen says.

In July last year, Roche announced detailed results from the Phase 3 Archway study showing the port delivery system with ranibizumab enabled more than 98% of patients to go six months between treatments for nAMD. Another study sponsored by Hoffmann-La Roche is evaluating the efficacy and safety of faricimab compared with aflibercept (Eylea) in participants with nAMD. Known as the LUCERNE study, it involves 658 participants across 144 locations, including LEI, CERA, and six sites in NSW. Designed to differentially extend treatment further than three months, Chen says the study is ongoing in Australia and no results are available

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More than 200,000 Australians with evidence of AMD will experience vision impairment.

“This drug is a modified (deuterated) version of vitamin A that inhibits formation of the toxic byproduct A2E,” he says.

In yet another treatment approach called “neuroprotection", a biodegradable implant is surgically placed into the eye so that it will slowly release a potentially protective drug.

“One drug that showed positive results in a Phase 2 trial is brimonidine, which also lowers eye pressure and is used as an eye drop in glaucoma patients,” Dunaief says.

Cell transplantation is also being tested after it was established that retinal pigment epithelial cells (RPE) degenerate in GA. “These cells are important because the photoreceptors die without them. RPE cells can be produced from other cells, then injected under the retina. Early clinical trials have suggested that this approach can be safe.

Additional Phase 1 and 2 trials are under way,” Dunaief explains.

Consistent use of AMD nomenclature could help improve clinical trial enrolment.

Guymer agrees: “This particular trial of the complement C3 inhibitor Pegcetacoplan is looking promising and could become a possible treatment within the next few years.”

Associate Professor Alex Hunyor, a retinal specialist with more than 20 years of experience in the treatment of macular diseases, shares Chen and Guymer’s enthusiasm but is cautiously optimistic.

“There are several promising treatments in the pipeline, but as we have seen with a number of therapies over the years, for neovascular AMD for example, there have been encouraging Phase 2 results and disappointingly negative Phase 3 results, so we need to wait for Phase 3 results before raising our patients’ expectations,” he says.

Hunyor is a Clinical Associate Professor and member of the Macular Research Group at the Save Sight Institute, University of Sydney. He is also chair of the Macular Disease Foundation Australia Medical Committee.

He too believes Pegcetacoplan (APL-2) by Apellis Pharmaceuticals is the most advanced clinical trial stage treatment.

“The Phase 3 DERBY and OAKS studies are due to report their top-line results in the second half of 2021. If there is a positive result, it would probably still be at least a year before regulatory approval by the Australian TGA could be achieved.”

In addition to the GOLDEN study, Hunyor is aware of at least two other international GA studies that will commence recruitment in Australia in 2021. The first is the Phase 2 ARCHER study of ANX-007 (Annexon Biosciences) which blocks the action of C1q, the initiating molecule of the classical complement cascade. The second is a Phase 1b study of ONL1204 (ONL Therapeutics), an inhibitor of fragment apoptosis stimulator (Fas) receptor-mediated cell death. Both are given by intravitreal injection.

Chen says restoring cells is more difficult: “Cell suspension trials have not had any success in restoring vision; we need to put in photoreceptor cells.”

Perhaps one of the most exciting frontiers in modern medicine is gene therapy, which could have application in late-stage AMD one day.

Ophthalmology is a leading medical field in this space, demonstrated by the success of Luxturna gene therapy for inherited retinal disease patients with the RPE65 gene mutation.

While developing a therapy for multi-gene conditions like GA is more complex, a Phase 2 clinical trial at the Columbia University Irving Medical Center in New York has commenced with the first patient receiving the therapy in December 2020. And – importantly – this trial is recruiting in Australia, Guymer says.

“IN PAST STUDIES THERE HAVE BEEN ENCOURAGING PHASE 2 RESULTS AND DISAPPOINTINGLY NEGATIVE PHASE 3 RESULTS, SO WE NEED TO WAIT FOR PHASE 3 RESULTS BEFORE RAISING OUR PATIENTS’ EXPECTATIONS” A/PROF ALEX HUNYOR

Similar to Apellis’ APL-2, another drug called Zimura, which targets the complement protein C5, slowed the growth of GA in a Phase 2 trial, and has moved on to a Phase 3 trial.

The investigational gene therapy (GT005) being studied delivers DNA that encodes for a protein that prevents the immune system from attacking cells in the retina.

While both Apellis and Zimura are injected into the vitreous, another approach is to try to inhibit specific immune cells with the oral antibiotic doxycycline – which is now in Phase 3 clinical trials – according to Dr Joshua Dunaief, Adele Niessen Professor of Ophthalmology at Scheie Eye Institute, University of Pennsylvania.

Given as a single, one-time surgical injection underneath the retina, study participants will be followed for up to a year to determine if the therapy can slow the progression of GA and monitor for side effects.

Dunaief shared an update in November 2020 on the latest research in GA in an article published online by BrightFocus Foundation, a US-based organisation that funds scientific research worldwide into Alzheimer’s, macular degeneration, and glaucoma. In an approach to limit the toxic byproducts of vision cells, Dunaief says an oral drug called ALK-001 is being tested in Phase 3 clinical trials for GA.

“Gene therapies for other eye diseases exist, but this trial is the first to test the safety and effectiveness of a gene therapy for dry macular degeneration,” principal investigator Dr Tongalp Tezel says.

Whether a breakthrough treatment for GA is discovered through injectable therapy, oral antibiotics, eye drops, biodegradable implants, cell transplant or gene therapy, success will ultimately depend on recruiting patients. n

INSIGHT May 2021 43

OPTOMETRY

es. s - Eyecare Plus, Orange and Park Nick Hansen, Hansen Optometrist

Eyecare Plus Wagga Wagga in New South Wales.

OF INDEPENDENTS AND THEIR COMMUNITIES

Whether it’s digital marketing, succession planning or practice acquisition, an increasing number of independents are turning to Eyecare Plus to ensure the viability of their business in an ever-changing optometric landscape.

H

ansen Optometrists – Eyecare Plus is the oldest continually run family group of optometry practices in Australia. Based in the regional New South Wales towns of Orange and Parkes, the two-practice business was established in 1886 as a jeweller shop where they made and sold spectacles before later performing eye tests and prescribing spectacles.

Founded by optometrists for optometrists, Eyecare Plus provides the opportunity to run an independent practice in an exclusive location. This is backed by a large range of resources, programs and promotions giving members the flexibility to choose whether they participate and the extent to which they do so.

Despite having a good reputation and enviable legacy in their local communities, principal optometrist Mr Nick Hansen sees the benefit of his practices being part of a marketing group under the Eyecare Plus banner.

He’s been a long-standing member of the network, serving on the board for more than 12 years.

Between these initiatives, for Hansen Optometrists it was during the COVID-19 peak that the value of the group spoke volumes. He believes his practices are well-placed for the future.

“One of the reasons why we originally joined, and have stayed with Eyecare Plus, is because of the support, marketing and buying power we receive being part of a large group of likeminded independent and non-competing optometry practices,” he says.

“It has become increasingly difficult for independent optometry practices to compete and stay viable in the ever-changing Australian optometric and IT landscape. A big reason why we have stayed a member of Eyecare Plus for more than a decade is because the group is at the cutting edge of professional optometric services in Australia.”

Today, Hansen Optometrists is among a 150-strong close-knit community of Eyecare Plus optometrists who meet at the bi-annual conferences, regular ‘boot camps’, and overseas educational meetings to share knowledge, information and ideas.

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“Head office gave us localised support, advice, and material help, as it did for all members. No matter what the future holds I believe that as a member of Eyecare Plus I am in a much better position to survive and thrive more than a lot of other independent practices in Australia,” Hansen says.

FIVE-STAR RATING A way Eyecare Plus has been able to validate the value it drives to practices and their communities is the Canstar Blue Awards where it has consistently outperformed corporate competitors.

In 2020, the Canstar consumer survey again awarded the network a five-star rating for overall satisfaction and after sales service, as well as four stars in all other categories, including range of products available, quality of advice, customer service and value for money.

Eyecare Plus is the only optometry group – and one of only six businesses nationwide – to be recognised with a third consecutive Canstar Blue Award. With this most recent award, it ranked ahead of optometry

chains such as Specsavers, OPSM, Optical Superstore, and Bailey Nelson.

“This is such a strong vindication of our members’ commitment to clinical optometry and local personalised service,” Eyecare Plus general manager Mr Simon Lewis says. “Our members do not have big marketing budgets, but they do have a big commitment to excellence, so it is great to see that being acknowledged by the public.”

For the awards, Canstar Blue commissions professional market research companies (Qualtrics, Colmar Brunton and Iview) to ask Australian consumers about their experiences with products or services. Awards are given to brands rated by consumers for their satisfaction level on a scale from one to 10.

It was a welcome relief for Lewis following the stresses of 2020.

“Our practices have had a tough time managing their businesses and doing the best for their staff to help patients through drought, bushfires and COVID. To be recognised with a Canstar Blue Award for the third year in a row is a thrilling result for us all,” he says.

Eyecare Plus general manager Simon Lewis says winning the Canstar Blue awards is vindication of the network's commitment to clinical optometry and local service.

Lewis adds that achieving five stars for after sales service and overall satisfaction is evidence Eyecare Plus optometrists are “creating the right impression and doing the right thing by their patients – and that consumers appreciate local service providers”.

1. S ituation analysis (where you are) – an examination of key performance indicators (KPIs) and comparing them to industry benchmark figures, together with an incremental growth demonstration tool to show how small changes can have a big impact.

“The difference a local business provides is that people can be welcomed by the same staff and be seen by the same optometrist every year – our practices are part of the local community,” he says.

2. Goals and objectives (where you want to be) – identifying strengths and weaknesses to formulate objectives that help optometrists achieve their goals.

MARKETING PLUS

3. S trategies and tactics (how to get there) – deciding which actions need to be followed to achieve goals and objectives for improved practice performance.

To help its optometrists compete with the large marketing budgets of the corporates, Eyecare Plus has a specialised marketing team working from head office to offer multi-levelled marketing services and solutions.

Marketing Plus is its marketing and communications support service providing practices with marketing tools including digital assets, from creation to implementation. The service is designed to help free up more time for practices to focus on their patients.

During the past few years, Eyecare Plus has also invested in digital marketing activities across many platforms, including Facebook, Instagram and Google Ads, aimed at connecting with current and prospective patients.

It says digital advertising has been an effective, targeted marketing tool used to reach patients based on their location, interests, and demographics.

“Our ‘Always-On’ campaign is a location-based marketing activity employed continually throughout the year to reach patients within each location of Eyecare Plus member practices,” Lewis explains.

“These national digital advertising campaigns have delivered positive results.

Cluster campaigns have enabled practices within regional and metro areas to share resources and, therefore, reduce the cost of running consistent yearround digital advertising campaigns.”

PRACTICE BENCHMARKING AND BUSINESS PLANNING

Lewis points to three elements of the Eyecare Plus Business Plan:

“A business plan must be a ‘living’ document. It must have meaning to you and be the guideline by which you manage and develop your business,” Lewis adds.

SUCCESSION PLANNING Eyecare Plus has helped many owners, from within the group and also externally, to sell their practice or acquire another.

Eyecare Plus National Office can assist owners to transition out of practice ownership, by helping to find a buyer or business partner. And for members wishing to expand with additional practices, it can help too. Lewis says succession from any business should be well planned, with some key considerations including: 1. P lan ahead for future sale – To help prepare for a future sale, buyers will need to see three years of figures, profit and loss records, and operational stats. The sale (or handover) of a practice can take 18 months or more from the time expressions of interest are initially sought.

2. S uccession plan: prior to sale – The succession plan needs to commence three to five years prior to the desired selling date in order to help the seller get the best possible return. There is a process to follow prior to going out to the market.

Lewis says it’s well understood that patient demographics and preferences differ greatly between regional and metro locations.

3. F inding a buyer – Finding a buyer who will meet expectations is not easy, especially if the selling optometrist is to be their employee for a set period as they transition out. “Working in the practice for an agreed time will help transfer goodwill to the new owner and will give them confidence that they will be mentored through the process,” Lewis says.

“Our practices will be able to compare their performance to others in the same turnover category, metro or regional and by state as well as of course national,” he says. “Benchmarking is a great tool, allowing owners and practice managers to review their practice performance monthly.”

4. C ontract clause warning – Eyecare Plus advises against signing clauses relating to exclusivity or worded as “ceasing negotiations with other interested parties”. This clause, it says, disadvantages the seller’s position and leads to a narrowing of the potential buyer market.

In terms of business planning, Lewis notes that COVID-19 has posed challenges for the optical sector, but it has also allowed time to think about current processes and practices, and how to improve them.

Lewis says the national office can prepare a summary of the practice that can be passed to a potential buyer to determine their level of interest. It can further vet the potential buyers, to avoid spending time with “tyre kickers”.

He says many practice owners may have written business plans when they started out but few would have revised them annually. An up-to-date business plan can improve a practice’s ability to meet its objectives and provide a guiding path to future success and personal reward.

Looking ahead, Eyecare Plus is aiming to continue to expand and develop new ways to improve patient engagement for its practice network.

Eyecare Plus is in the process of introducing a new benchmarking tool which practices will use to monitor and lift their performance.

To this end, the organisation is now developing an e-commerce solution to help practices improve the patient journey. n

INSIGHT May 2021 45

CLOSING THE TOP END GAP ORTHOPTIST MADELAINE MOORE MOVED TO THE NORTHERN TERRITORY TO ESCAPE THE CITY LIMITS. BUT ON HER WAY, SHE’S FOUND FULFILMENT WORKING TO IMPROVE EYE HEALTH OUTCOMES FOR INDIGENOUS COMMUNITIES.

T MADELAINE MOORE

"PATIENT SATISFACTION IS HIGH AND WE OFTEN SEE ‘SISTERS’ DANCING IN WAITING ROOMS TOGETHER AFTER DRESSING REMOVALS"

he move to Darwin as a junior orthoptist was sparked by the excitement of flying to work as opposed to sitting in Melbourne traffic.

After my first day working with Aboriginal and Torres Strait Islander patients there was a strong need for me to learn more about their way of life. A mandatory Aboriginal cultural awareness training program in orientation instilled a thorough understanding and appreciation.

The ophthalmology team at Royal Darwin Hospital (RDH) is the eye hub for the Northern Territory’s Top End. The Top End includes three regional hospitals, RDH, Katherine Hospital, Gove Hospital and approximately 50 Aboriginal communities. Due to the large geographical area our team services, we find ourselves on small aircrafts most weeks to visit these locations.

Flying during the wet season can have its hiccups, and occasionally the clinic is cancelled due to cyclone warnings or ‘sorry business’ – which refers to a funeral in the community.

The general comment rotating registrars or visiting specialists mention is the significant advancement of disease and delayed patient presentation. This may be caused by limited access to eye services due to remoteness of living and cultural values which may place health lower on their priority list.

Other cultural challenges we face when working with our Aboriginal patients include poor compliance, whether it is due to patient’s health values or an appointment notification lost in transit, particularly if the patient is moving through various communities.

A shift in language is also often required when informing a patient of a procedure as they have no cultural knowledge or words for things such as cataracts, refraction etc. It is recommended to utilise images and meaning based interpretation to maximise comprehension of the procedure. And of course, with the advanced progression of eye disease comes increased challenges, particularly in the operating theatre.

Regularly, surgeons are facing dense

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cataracts with a history of trauma.

Contrary to these challenges is that on the first day post-operation, patient satisfaction is high, and we often see ‘sisters’ dancing in waiting rooms together after dressing removals.

Over the years of the NT outreach program, the three regional hospitals have become equipped with resources to deliver baseline eye assessments and treatments, including intravitreal injections, various laser treatment and routine surgeries.

Government initiatives have also provided a high percentage of the community health centres with a slit lamp and retinal camera. Historically, patients were flown into RDH to have a basic test such as an OCT. Due to excessive expenditure on patient travel, procurement of this essential diagnostic equipment in all regional hospitals was complete, enabling our team to service patients nearer to their home.

In recent years, with improvements in patient travel processes, including patients' willingness to travel, the remote services model has evolved to spend increased time in our regional hospitals and decreased time in small Aboriginal health centres. After reviewing previous models, our team found a high percentage of patients were referred to their regional hospital for further diagnostics or treatment.

Since the remodelling, we have decreased duplicate patient episodes.

This new model would not be achievable without optometrists who spend more extended periods in community healthcare centres to provide screening and monitoring services to the community patients.

Like other regional places, recruiting an orthoptic workforce is a challenge.

Our team has two orthoptists and an optical technician to support a team of nine ophthalmologists of varying levels; infrequently, the orthoptists work together due to our outreach program.

We co-work with an excellent nursing team; however, some days can feel overwhelming when you have no one

Madelaine Moore and Dr Shanil Dhanji in the Northern Territory.

to share the problematic cases with, during an overbooked clinic. With a supportive group of ophthalmologists, the growth potential and responsibility as a junior orthoptist is unmatched.

The experience equips us with efficiency, adaptability and all-round orthoptic skills, as well as learning the fundamentals of clinic management.

Working regionally and with our remote Aboriginal patients has its challenges; however, this is outweighed by the personalities we meet.

Each month we go on a new adventure, pinch ourselves when we land on the untouched coastlines of the NT, and play our small part in ‘Closing the Gap.’ n

ABOUT THE AUTHOR: MADELAINE MOORE is an orthoptist and Indigenous eye health coordinator working in Royal Darwin Hospital, Northern territory. She has a Bachelor of Health Sciences/ Master of Orthoptics (La Trobe University) and a Postgraduate in Health Service Management (Griffith University).

ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au

DISPENSING

ESTABLISHING PROCESSES FOR RESULTS IN THE WORKSHOP WELL-ESTABLISHED PROCESSES CAN BE THE DIFFERENCE BETWEEN PROVIDING QUALITY SERVICE OR POOR OUTCOMES. IT’S ALSO AN EFFECTIVE TOOL FOR TRAINING AND DEVELOPMENT, WRITES BRUCE WAIN.

O BRUCE WAIN

"DEVOTING TIME TO EMBEDDING PROCESSES WILL ULTIMATELY DELIVER BETTER RESULTS AND, IMPORTANTLY, MORE TIME ATTENDING TO THE CUSTOMER"

perating efficient and effective workshops is a ‘combination’ of operator skills, equipment reliability and resource availability, bounded in wellestablished processes. Volumes and job types can all impact this equilibrium; with complex prescriptions and demanding customers placing more pressure on workshops. The already effective workshop has the right process to achieve their ‘combination’ every time. For the nearlyefficient workshops, devoting time to embedding processes will ultimately deliver better results and, importantly, more time attending to the customer.

The first point to consider is establishing a process framework by using simple flow-diagrams to identify what needs to be done. Then, steps to define the necessary tasks should be drawn up with clear written instructions and even supporting images and diagrams.

In pursuit of becoming a more effective workshop, are you aware of expectations for high-quality workshop results to deliver the best customer service? Are written steps still appropriate for current operations? It may be time to establish or review current processes.

ESTABLISHING PROCESSES At our New Zealand training workshop, students’ skill levels dictate our processes – most have not experienced a workshop environment. Effective workshops consider this when new dispensers or technicians join their practice.

We include clear operator instructions and demonstrations for equipment and tools. While our resources are donated, effective workshops have clear steps for ordering and replacement.

Student numbers control our ‘jobbing volumes’, which is favourable for our situation rather than in a practice workshop where the number of customer’s orders often dictates workflow.

Effective workshops would follow established steps when customer demands arise. One workshop I contacted said that fitting lenses to a client’s own frame has two main demands: 1. Time without their spectacles and;

2. E nsuring that the frame is not damaged or broken.

Effective written steps for this include: •C hecking the frame to ensure it’s of reasonable condition to be reglazed; •E nsuring the spectacles can be glazed in a reasonable timeframe; •E xtremely careful handling of the spectacle frame.

A process’s complexity will be commensurate with operator skills and level of automation, as well as types and volume of jobbing. The main theme should be to keep the process very simple without contributing to confusion, poor quality or customer service delays.

STEPS WITHIN A PROCESS Each step should highlight any complexities and allow time for accurate completion. An example is using a focimeter to measure and ‘dot’ a lens, ensuring correct optics as per prescription — sphere, cylinder, axis or prism.

Negating potential errors at this early stage requires clear steps with appropriate quality assurance measures.

For example, basic steps for marking uncut single-vision lenses (telescopic focimeter): 1. A djust focimeter eyepiece to your setting – further instructions on page XX 2. M ove frame table down away from lens – see Figure X … etc to step 11 Accurate focimeter measurement steps facilitate accurately ‘dotted’ lenses.

Reducing any likelihood of errors, your steps should deliver the customer’s correct prescription, corresponding lenses (correct optics) and correct frame. As these constitute initial steps to complete a pair of spectacles, the need for accuracy is critical.

Preparing lenses for edging – with frame tracing or manually cutting a template – also requires clear steps. An example would be to proceed with blocking only once the template and lens are clearly marked with a nasal mark, for alignment purposes.

When edging lenses – manual or automatic – effective guidelines would include: starting with the right lens, placing lenses in the correct place in the tray; that is, as you look at the tray right lens is on the left.

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8

Clear diagrams for steps such as edging help to produce better outcomes.

Further steps need to explain; attaching a template or nominating a correct trace; clamping lenses; machine operation; and edged lens removal. Different workshop technologies dictate the complexity of instructions for operators.

Final and quality checking is an everyday process. Clear instructions on this, along with appropriate optical standards (AS /NZS ISO 21987 - Ophthalmic optics - Mounted spectacle lenses), avoids customer issues later down the track.

CREATING NEW STANDARDS Writing clear steps promotes quality by enhancing accuracy and embedding quality control, while also reducing errors.

It’s also an effective tool for training and furthering development of workplace skills.

One workshop commented: “We have a set procedure when glazing. It means anyone can take over at any stage and know what has/hasn’t been done. This reduces the risk of rejects leading to client dissatisfaction.”

Finally, it’s good practice management amending steps as operator skills evolve, new products emerge, and technologies improve. New steps need to achieve outcomes effectively and effectively to become the new ‘standard’.

Benefits are gained through effective processes not only for the workshop but throughout the practice. n

BRUCE WAIN has been in the optical industry for more than 50 years. He has extensive experience and teaching in all aspects of optical technology and workshop skills.

INSIGHT May 2021 47

MANAGEMENT

WORKPLACE BULLYING REGULATIONS LAST MONTH’S COLUMN ON WORKPLACE BULLYING FOCUSED ON HOW TO IDENTIFY THE PROBLEM AND MANAGE COMPLAINTS. THIS MONTH, KAREN CROUCH DELVES INTO FAIR WORK REGULATIONS AND EMPLOYERS’ LEGAL OBLIGATIONS.

R KAREN CROUCH

"THE FWC CAN REQUEST COPIES OF DOCUMENTATION REGARDING GRIEVANCE AND COMPLAINT HANDLING PROCEDURES"

ecent complaints about workplace culture in parliament offices are a pertinent reminder that no working environment is immune to bullying. It’s also been brought into sharper focus with the release of the second Medical Training Survey in which around one in four ophthalmology trainees stated they had experienced bullying, harassment and/or discrimination at work.

Bullying may take many different forms.

Regardless, it must be discouraged to protect staff self-esteem and ensure healthy employee relationships. This is easier said than done because it’s often more convenient to simply hope or assume it will pass away, or that the victim will adapt, desist from repetition of the practice or accept the prevailing situation.

THE REGULATORY SCENE When the the Fair Work Act 2009 was introduced, the government committed to undertaking a review within two years of its full implementation. On 22 December 2011 the minister announced an independent panel of three experts to conduct a post-implementation review of the legislation in accordance with this commitment.

From 2012, various regulatory changes have come into play including a new Fair Work Commission (FWC) anti-bullying jurisdiction. From 1 January 2014 a ‘worker’ who believes they have been bullied while at work may submit an application to the FWC for an order to stop the bullying.

The definition of ‘worker’ is particularly important for employers to note.

Specifically, a worker is defined as an individual who performs work in any capacity, including as an employee, contractor, subcontractor, outworker, apprentice, trainee, student gaining work experience or volunteer.

Also noteworthy is that amendments have been drafted to exclude reasonable management action – such as disciplinary, if justified – from being deemed bullying.

With regard to the types of orders FWC may make, it must be to prevent further

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bullying. Other than an order requiring payment of a pecuniary amount the FWC may consider ordering individuals or groups of individuals to stop the specified behaviour, reviewing an employer’s bullying policy, and provision of information, support and training.

As each case and workplace may be unique, issued orders are likely to vary.

FWC’S ANTI-BULLYING JURISDICTION Employers are encouraged to ensure staff responsible for managing workplace complaints and responding to employee grievances are provided with training on prevention and responding.

Under the new jurisdiction, and as part of the information gathering stage, FWC can request copies of documentation regarding grievance and complaint handling procedures.

Knowing such resources may be requested by the FWC, employers are urged to review their policies and procedures to ensure compliance with work health and safety obligations and consistency with language contained in the Amendment Act. When reviewing bullying policies and complaints handling procedures, employers should download a copy of the Safe Work Australia Guidelines on Preventing and Responding to Workplace Bullying from the Safe Work Australia website and consult the AntiBullying section of the FWC website for current information and resources.

PREVENTATIVE ACTION Apart from legal and regulatory aspects, it is pertinent to review some of the salient issues which may assist in discouraging such behaviour.

Invariably, corrective action occurs after an event which fails to adequately address staff complaints.

Prevention can only be effective if potentially dangerous situations are detected prior to occurrence and, most meaningfully, if the frequently declared practice culture clearly identifies such behaviour as abhorrent and unacceptable.

It is also practical for owners,

A worker who believes they've been bullied may ask the FWC for an order to stop the bullying.

supervisors and managers to be aware that bullying can be administered by a male or female employee against another male or female as there is a view that incidents mainly occur between senior males pressuring females.

The other basic feature of human behaviour that underpins this activity and indeed all relations between employees and employers of all genders and/or cultural persuasions is respect. If junior or middle management employees, in particular, feel respected for their efforts regardless of their level of competency or performance, staff are more likely to appreciate the caring environment and increase their efforts to excel in their duties.

Bullying can occur in many forms, one being sexual harassment. And sadly, recent complaints have highlighted the tendency of junior staff to refrain from reporting sexual exploitation for fear of losing their employment which highlights the need for a meaningful grievance policy which will not deter staff from reporting such behaviour regardless of seniority. n

KAREN CROUCH is Managing Director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal and financial management of practices. Contact Karen on M: (02) 0433233478 email kcrouch@hpcnsw. com.au or visit www.hpcgroup.com.au.

2021 CALENDAR MAY 2021 RANZCO WA BRANCH SCIENTIFIC MEETING Rottnest Island, WA 7 – 8 May ranzcowa.com.au

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9TH WORLD GLAUCOMA E-CONGRESS Japan 30 June – 3 July worldglaucomacongress.org

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NOVEMBER 2021 RANZCO ANNUAL SCIENTIFIC CONGRESS Brisbane, Australia 19 – 23 November ranzco.edu

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SPECSAVERS – YOUR CAREER, NO LIMITS Specsavers Graduate Program – Western Australia The Specsavers Graduate Recruitment team currently have a number of exciting vacancies available in Western Australia. Whether it be for a new challenge, or perhaps starting afresh and relocating for a different lifestyle – a move to Western Australia could be your first step in strengthening your professional career. All Specsavers stores are equipped with the latest optometry equipment including OCT, and you will gain exposure to a wide range of pathology across a loyal patient base. Furthermore, If you relocate with friends, you can avail of our generous ‘Go with a Friend’ incentive. If you believe in providing best value eye care, and exceeding the customer’s expectations then contact: apac.graduateteam@specsavers.com

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Specsavers Highest ever Mobile Optometry package $180,000 Specsavers is looking for experienced optometrists with an interest in travelling Australia to join our mobile optometry team.

Positions are currently available to join our team in Western Australia, South Australia, Newcastle, Australian Capital Territory and Queensland, offering a desired work/life balance and our highest ever $180K package. Join Specsavers today and work with state-ofthe-art technology and professionally trained teams.

Optometrist Joint Venture partnership opportunity, Specsavers Mt Isa, QLD Specsavers has an exciting opportunity for an experienced Optometrist to join as a JVP in our brand-new store coming to Mt Isa. Affectionally known as the ‘oasis of the outback’ Mt Isa is ideally situated in Queensland’s North, nestled among the ochre-red Selwyn Ranges, on the banks of the Leichhardt River, Mount Isa is a bustling melting pot of culture and industry and home to one the most productive single mines. With an initial investment of only $1/share, sign-on and relocation bonus and market rate salary + share of the store profits this is an opportunity not to be missed.

Full-time Opportunity – New Zealand Thinking of a sea change, or want to return to NZ? With 56 stores across New Zealand Specsavers has an abundance of opportunities for experienced optometrists. Whether you enjoy the hustle and bustle of city life, or prefer the relaxed outdoor lifestyle, we can offer you the perfect location. At Specsavers you will be working with the latest technology, including an OCT in every Specsavers NZ store.

Full-time Opportunity – Specsavers Darwin, NT Specsavers Darwin North are currently recruiting for a 2 year Fixed Term experienced Optometrist, paying a highly competitive salary of up to $175,000 package (including relocation allowance and up to $40k bonuses, paid half yearly). Keen to live where it’s summer all year round? What about affordable housing and safe communities? Darwin could be the place for you! Darwin is the capital city of the Northern Territory and offers a warm tropical, multicultural, laid back lifestyle, as the gateway to attractions like the world heritage Kakadu National Park, there is always adventure on offer. With access to state of the art market leading technology, including OCT and Nidek Equipment. You will have the opportunity to work with a variety of patient demographic, including regular pathology and indigenous care.

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SO LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership (JVP) enquiries: Marie Stewart – Recruitment Consultant

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SOAPBOX

STOP UNDER-ESTIMATING HEALTHCARE ISOLATION location you are often the first port of call for emergency presentations. So being available and able to provide specialist medical care outside of the city provides huge professional and personal satisfaction, but it also saves the patient time, stress and the social and economic costs of traveling to the city.

For retinal surgery, I am also able to save patients having to stay in Brisbane for one to two weeks until gas in the eye reduces enough for them to safely travel over the Great Dividing Range, to avoid gas expansion and permanent blindness.

Unfortunately, there is still further healthcare inequality for patients who cannot afford the out-of-pocket costs for private healthcare, which is especially true for ophthalmology.

W

hile 71% of Australians live in metropolitan areas of Australia, it is important to remember country people have poorer access to health services, shorter life expectancy, and up to 1.4 times the burden of disease compared to people living in major cities.

The proportion of people who do not have a specialist nearby increases from 6% in major cities, to 22% for inner regional areas, 30% in outer regional areas, and 58% for remote and very remote areas.

Growing up in rural Queensland I knew all too well the difficulties country people face trying to travel to the city for a specialist opinion, having to take a friend or family member to drive them, navigating unfamiliar streets and paying for expensive parking.

I myself remember getting my first pair of glasses for myopia when I was 14 from a visiting optometrist to my country town, being able to read car number plates and signs across the street clearly for the first time in years, and just how grateful I was that the running outreach clinic saved us a two-hour return car trip.

Providing healthcare to regional Australia is an important issue, and we can all play a role in reducing healthcare isolation to people who

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live outside of the major cities. I was working as a vet in the Kimberley when I decided to go back to university to study medicine. My goal was to become an ophthalmologist and establish a practice in a regional centre. Thankfully all this transpired, and I am now the first full time vitreoretinal specialist in Toowoomba, west of Brisbane, which has a population of around 163,000, and a catchment population of around 300,000 people.

Despite the issues with access to healthcare, country people living in small towns and non-urban areas generally experience higher levels of life satisfaction compared to those living in urban areas, and have increased community participation, social cohesion and informal support from their communities.

Working in the country also gives you more exposure to serious pathology and there is the opportunity to work in a shared care model of health care between optometrists and ophthalmologists.

This is especially true for diabetic retinopathy screening, with diabetes being more common in outer reginal and remote areas (7%) compared to major cities (5.6%).

Trauma is also 2.5 times higher in rural areas, and if you work in a rural

There are eye surgeons who do outreach clinics in regional centres, but outside of the southeast corner of the state, Townsville and Cairns, there is no permanent public ophthalmology service.

This is disappointing, especially in Toowoomba with such a large catchment area. With time and further lobbying of local health services and state government, funding could be made so patients who are disadvantaged not only by distance but also by finance, can have access to services closer to where they live.

From my perspective, this makes particular sense for urgent and blinding conditions such as retinal detachments, trauma, and chronic conditions like macular degeneration and diabetic maculopathy that can require monthly intravitreal injections of anti-VEGF for treatment. n References can be found in the online version of this article at www. insightnews.com.au Name: Dr Andrew McAllister Qualifications: BVSc(Hons) MBBS(Hons) MMed(OphthSc) FRANZCO Business: Toowoomba Retina and Eye Specialists Position: Retinal surgeon and physician Location: Toowoomba Years in the profession: 1 year as a consultant, 11 years as a doctor

GROWING UP IN RURAL QUEENSLAND I KNEW ALL TOO WELL THE DIFFICULTIES COUNTRY PEOPLE FACE TRYING TO TRAVEL TO THE CITY FOR A SPECIALIST OPINION

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