Insight August 2020

INSIGHT AUG

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

MYSELF

THE BEST PROGRESSIVE LENS FROM HOYA BY FAR. AND NEAR.

The private sector is reluctant to perform public backlog work at discount MBS rates.

DRY EYE SPARKS AUSSIE INGENUITY In the lab and clinic, Australia is punching above its weight in dry eye innovations.

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QUESTIONS OVER ELECTIVE SURGERY BLITZ

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03

COMING SOON

COUNTING THE COST OF MISSED APPOINTMENTS New industry data measures the impact of the COVID-19 lockdown on eye health.

Open to opportunity Our mission to transform eye health in Australia and New Zealand has never been more important, guiding and motivating us as we work our way through a significant patient backlog.

Our stores have opened their appointment books for routine eyecare, while recalling existing patients and prioritising care in our communities to those who need it most.

This has led to a greater need for optical professionals across our store network. From new roles in WA to partnership in QLD, opportunities are emerging across the country.

If you’re looking for your next step, with a stable business that has a strong strategy for the future, look no further.

To find out more about what’s on offer at Specsavers go to spectrum-anz.com

INSIGHT AUG

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

PRIVATE SECTOR APPREHENSIVE TO PERFORM PUBLIC SURGERY ‘BLITZ’ AT DISCOUNT RATES

Surgeons in private hospitals will be reluctant to help clear the public elective surgery backlog for the Medicare schedule fee rate, according to medical lobbyists who believe the work should be contracted as a last resort and at the standard commercial rate.

The comments from the Australian Society of Ophthalmologists (ASO) and the Australian Medical Association (AMA) follow announcements of an elective surgery blitz across Australian state health systems to tackle waiting lists in wake of the COVID-19 pandemic.

Public treatment in private hospitals and twilight and weekend surgery lists are among the key features of the programs recently unveiled by the New South Wales,

Queensland and Western Australian governments, which total $675 million collectively.

ASO president and Sydney cataract and refractive surgeon Dr Peter Sumich said public hospitals should look to perform the additional surgery themselves, saying they had both the capacity and workforce to do so if funded adequately.

“As a last resort the work could be contracted [to private hospitals] but at the usual standard commercial rate for contracts – the Veterans Affairs rate – rather than the MBS schedule fee rate,” he said.

“Many surgeons and anaesthetists would be willing to help out to clear wait lists at the standard fee, as is usually offered by public hospital

commercial rates offered during the lockdown emergency.

Surgeons do not support performing wait list reduction work at MBS rates.

contracts in normal times, but not at the emergency rates they propose after the emergency has passed.”

Sumich said he believed state health systems were attempting to use the COVID-19 crisis as an excuse to save money on surgeries and blame the pandemic for preexisting backlogs. They were also trying to use it as an opportunity to contract the work at non-

His views were echoed by AMA NSW president Dr Danielle McMullen who said private hospitals had agreements through the Commonwealth about keeping their doors open at the COVID-19 peak.

“But we would view that COVID surge work, which those agreements were built for, is a very different thing to wait list reduction work, and we wouldn’t be supportive of large-scale reduction work being done at MBS rates in the private system,” she said.

Given the size of the backlog, McMullen said the additional funding is not a complete solution.

Waiting lists were existent in NSW continued page 6

APPOINTMENTS DATA REVEALS COVID-19 IMPACT The nation’s first glimpse into the impact of reduced optometry services due to the COVID-19 lockdown has been provided in new data from Specsavers, which saw patient attendance drop by as much as 91% during the twomonth period.

In statistics provided to Insight, the optical chain has tracked the number of missed appointments and reduced Medicare services from 30 March to 31 May, as well as the number ophthalmology referrals. It is aiming to quantify the pandemic’s effect on the sector, including the subsequent backlog.

Specsavers, which only remained open for urgent and essential care across its 350 Australian optical

stores, was closed to most patients for the first time ever during the COVID-19 peak. The same was true for many other providers across both corporate and independent optometry.

Dr Benjamin Ashby, Specsavers optometry director for Australia and New Zealand, said for the past few years the company has been focussed on utilising real-world data to develop sustainable models for preventative eyecare which deliver measurable improvements in eye health outcomes for patients.

“Our data and strategies are publicly available and with approximately 40% of Australians currently choosing to have their eyes tested with our optometrists,

data samples can be easily applied to the wider sector,” he said.

“This issue of Insight [on page 43] examines the data related to COVID-19, including comparison rates before and after our practices were closed for routine care, highlighting the potential patient base that missed out on eye tests and consequent referrals.

The data can be broken down into eye condition categories and compared against prevalence rates to understand the gaps in specific patient groups.”

Now that Specsavers has reopened for routine care, Ashby said the company is continuing to track the developments of this continued page 6

EYES ON THE JOB: INJURIES AND SAFETY EYEWEAR From chemical burns to puncture wounds, most eye injuries can be prevented with the right safety eyewear.

How can optometrists and employers minimise the risk? page page 39 7

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UPFRONT Just as Insight went to print, HEALTH OFFICIALS advised all eyecare professionals across metropolitan Melbourne and the Mitchell Shire to wear a standard surgical mask when seeing patients for any reason. The updated advice from Federal Deputy Chief Medical Officer Professor Michael Kidd comes after parts of the Victorian state began a six-week lockdown on 9 July. The advice for all health professionals to wear masks in the lockdown zone – regardless of

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WEIRD

the situation – represents a shift from officials who haven't previously made recommendations on mask use for asymptomatic patients. IN OTHER NEWS CooperVision unveiled its new Biofinity toric multifocal contact lens to the local market on 7 July, providing more than 200,000 prescription options for patients who are both astigmatic and presbyopic. Professional services manager Mr Joe Tanner said: “Optometrists now have an easyto-fit lens, using familiar lens design technologies and the proven Biofinity silicone hydrogel material. Being able to reliably correct astigmatism means

there is no need to compromise visual acuity and we encourage practitioners to use this lens whenever 0.75D or more of astigmatism is present.” FINALLY, CERA researchers have contributed to a new roundtable report by the Australian Academy of Health and Medical Sciences on the future role artificial intelligence (AI) in health. With ophthalmology placed at the forefront of an AI revolution, Professor Robyn Guymer and Associate Professor Peter van Wijngaarden were among 34 contributing experts. The report Artificial Intelligence in Health: Exploring the Opportunities and Challenges was published on 4 June.

STAT

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WACKY

Australian TV personality and veterinarian Dr Chris Brown suffered a corneal ulcer after a DIY mishap during the COVID-19 lockdown. He told the Nova 96.9 radio station that he was pruning a cactus when he broke the stem, sending toxic sap into his eye. He sought treatment at the Prince of Wales Hospital in Sydney.

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WONDERFUL

Sophie, the Countess of Wessex who is married to Prince Edward, will take part in a British royal family first when she sits before sculptor Frances Segelman during a never-seen-before virtual event. It will also be the first royal sculpture Segelman has created as a tactile piece of art for blind and partially sighted people.

Published by:

Publisher Christine Clancy

Japanese researchers have found that whale sharks have thousands of tiny teeth on the skin surrounding their eyes. The unique evolutionary feature helps to protect their eyes when predators attack. The giant sea creature can also retract 50% of its eye into the socket, contradicting previous notions that it does not rely heavily on vision. n

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EYE INJURIES

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An Optometry Australia report found 21% of Australians had acquired an eye injury from a DIY project at home but only 12% always wear eye protection. Full report page 39.

Art Director Blake Storey Graphic Design Jo De Bono

WHAT’S ON

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INSIGHT August 2020 5

NEWS

WEEKEND AND TWILIGHT SURGERY PROPOSED continued from page 3

long before the pandemic and she called for a better solution that works to break the cycle.

“In the short-term, it will provide a boost but really only serves to highlight the cyclical pattern we see in elective surgery: waiting lists get long and the government of the day puts a patch on the system,” she said.

McMullen said surgeons performing public work in private hospitals would also have to take out additional indemnity insurance at great expense, because they would not be covered by a state government scheme despite performing public work.

“Surgery is more than just an operating theatre, people who have been on a public waiting list for some time are unwell and have a lot of other medical problems, and the public hospital system is often better equipped to manage those complex cases. The whole episode of care needs to be thought through and funded carefully, it’s not just about surgeons' fees in the operating theatre,” McMullen said.

YEAR-LONG BACKLOG Following the elective surgery shutdown in late March, Australian public hospitals have embarked on a gradual reintroduction of non-urgent procedures.

levels of elective surgery much sooner than planned, while working through the backlog at a quicker rate.

Referencing a study from the CovidSurg Collaborative project in May, the Royal Australasian College of Surgeons said the varying levels of surgery disruption is estimated to have created a backlog of more than 400,000 operations in Australia.

Further highlighting the issue, the college said if the hospital system increases the number of surgeries performed each week by 20% compared with pre-pandemic activity, it would still take 22 weeks to clear the backlog.

In the largest of the state government announcements, NSW Health Minister Mr Brad Hazzard committed an additional $388 million to fast-track disrupted elective surgery.

In Queensland, the government has unveiled $250 million in new spending to provide non-urgent procedures outside of regular hours.

"WAITING LISTS GET LONG AND THE GOVERNMENT OF THE DAY PUTS A PATCH ON THE SYSTEM" DANIELLE MCMULLEN, AUSTRALIAN MEDICAL ASSOCIATION NSW

“This investment will require us to expand over and beyond our usual levels of activity, plus work in partnership with the private sector,” he said. “It may take up to 12 months to clear the backlog, but could be longer if we have further disruption to our system, such as a second wave of COVID-19 cases.”

In WA, Premier Mr Mark McGowan said his government would invest $36 million, enabling the public system to perform 5,800 more procedures than was projected before COVID-19 this year.

WA health providers are implementing twilight and weekend surgery lists, increasing the hours of existing staff, and deploying additional staff.

“The significant success of WA’s wholeof-community response to COVID-19 is what has enabled our health system to return to normal sooner than expected, and this blitz will deliver excellent clinical outcomes,” McGowan said.

Queensland Deputy Premier and Minister for Health Mr Steven Miles said as of 1 June 52,240 patients were ready on elective surgery lists, with more than 90% (47,016) of those waiting within clinically recommended timeframes.

In March, the Victorian Government committed more than $60 million for additional surgery before a predicted pandemic peak. South Australia previously invested $45 million to reduce overdue waiting lists. By March, it had halved that, however, COVID-19 has since caused overdue cases to triple. n

However, the state’s modelling indicated more than 7,000 people could be waiting longer than clinically recommended by 1 July due to the pandemic.

Queensland Health director general Dr John Wakefield said the funding would allow hospitals to return to pre-COVID

THOUSANDS MISSED OUT ON EYECARE THEY WERE DUE continued from page 3

gap as it recalls patients in prioritised eye health groups.

“The data measures our patient base versus previous year data and prevalence rates to identify further opportunities to develop our eye health models," he said.

According to Specsavers, nationally there were 600,000 fewer optometry Medicare patient services from March-April compared with the same months in 2019.

Additionally, there were 40,000 fewer visual fields administered in the same period. Specsavers also recorded a 91% patient drop during the first week of its reduced care model compared with same

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INSIGHT August 2020

week-long period last year. As a result, thousands of Australians missed out on the eyecare they were due.

“From an early detection perspective, year-on-year comparison of Medicare item 10910 shows that 166,635 Australians missed out on routine eye tests in March and April 2020 due to the impacts of COVID-19,” Ashby said.

From 30 March to 31 May, he said 200,192 patients presented to Specsavers optometrists nationwide. Of those, 3,893 were referred for urgent specialist assistance and 9,298 were given nonurgent referrals. Based on that rate, in April and May, 25,208 Specsavers patients that likely had eye conditions

requiring specialist attention did not attend their appointments.

A four-week year-on-year comparison also provided insight into the postCOVID-19 backlog of patients with diabetes.

Benjamin Ashby, Specsavers.

In April 2019, Specsavers optometrists saw 13,319 patients with diabetes for eye checks. In line with the projected growth, it expected an average of 22,654 of these patients per month across 2020.

In February this year, it saw 21,197 patients with diabetes. Then in April only 1,386 patients with diabetes presented to its optometrists. n Full report and statistics on page 43.

DRY EYE REPORT

AUSSIE INGENUITY SPEARHEADS

s t n e m e c n a v dry eye ad Whether it’s in the lab, within the clinic or even online, Australians are punching above their weight in dry eye and ocular surface innovations.

Five industry professionals discuss bringing their concepts to reality.

B

reakthroughs in the understanding of dry eye disease have fuelled the fire among local researchers and innovators to strive for more accurate diagnosis and enhanced treatments.

Within five years, a Melbourne-developed point-of-care test for rapid and accurate dry eye diagnosis and subtyping could come to market. Sydney researchers are also using the tear film as a portal to diagnose other diseases with faster, less-invasive methods.

And in the clinic, an increasing number of Australian optometrists are establishing practices solely dedicated to dry eye disease, turning the traditional business model on its head.

Meanwhile, homegrown dry eye treatments, using natural ingredients such as honey, are beginning to make waves on the international stage. Tying these advances together is a new global directory, connecting dry eye patients directly with practitioners who provide personalised care.

This month Insight reviews current dry eye projects in Australia, highlighting the strength in collaboration between researchers, clinicians and industry in the search for answers to the dry eye problem.

INSIGHT August 2020 17

REPORT

NEW APPROACHES TARGETING DRY EYE SUBTYPES An explosion in global investment in dry eye research and development is paving the way for a range of new therapies, particularly those more specifically aimed at dry eye subtypes.

It’s well documented that the basis of any effective dry eye management plan involves the crucial task of determining the disease subtype.

Evaporative or aqueous-deficient? While it’s a simple concept for most eyecare professionals to grasp, accurate and timely diagnosis and subtyping remains a major clinical challenge that’s yet to be overcome.

Associate Professor Laura Downie, research leader of Downie Laboratory – an anterior eye, clinical trials and research translation unit within the University of Melbourne – has made it her mission to fill this gap in clinical knowledge.

She has led efforts to develop ADMiER, a point-of-care test for rapid and accurate dry eye diagnosis and subtyping that she hopes to bring to market by 2025.

In simple terms, the device has been designed to analyse the stretching properties of a small tear droplet, to objectively diagnose and subtype dry eye. As the first application of microfluidic extensional rheometry for ophthalmic diagnostics, it is said to be a transformative advance over current clinical tests.

With dry eye disease affecting approximately one in five adults, Downie says clinicians can now access a range of therapies to treat this chronic condition, but it’s important to know which to use at the appropriate time.

“Accurate and early diagnosis of dry eye disease is currently a major clinical challenge, as many of the current tests are invasive, timeconsuming and inaccurate,” she says.

“It is of critical importance to determine the predominant subtype, evaporative or aqueousdeficient dry eye, as this informs treatment decisions. However, currently there is no single, objective method to both diagnose and subtype dry eye disease.”

Downie is leading the novel ADMiER project in collaboration with Professor Leslie Yeo and Dr Amarin McDonnell from RMIT University.

To date, they have built a research-grade prototype and secured a strong intellectual property (patent) portfolio. An initial clinical dataset has been published that demonstrates proof-of-concept for ADMiER’s diagnostic utility.

These data were published in leading journal Ophthalmology. Downie has also presented on ADMiER’s technology at several scientific meetings, including the Association for Research in Vision and Ophthalmology (ARVO), International Ocular Surface Society meeting,

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INSIGHT August 2020

Dr Laura Downie has presented her point-of-care prototype at several scientific meetings.

Accelerating Australia Life Sciences Innovation Showcase (Sydney) and the World Congress of Inflammation (Sydney).

In 2019, the team was awarded a National Health and Medical Research Council (NHMRC) grant to support further development and commercialisation of the technology.

“This next stage of development focuses on undertaking a body of research relating to clinical validation of the device and developing and optimising a next-generation prototype,” Downie explained.

Downie and her team hope to bring the device to market within the next five years.

Looking at the broader issue of dry eye, she believes it is critically important that there continues to be innovation in the field, to improve the capacity to identify and treat the condition, and thereby ensure the best outcomes for dry eye patients.

According to Downie, during the past two years there has been a 400% increase in the development pipeline for dry eye therapeutics.

amongst Australian eyecare clinicians in the area of dry eye disease; this is evidenced by eyecare professionals’ attendance at continuing education events, and the dry eyefocused content of many recent professional development programs.”

As in other fields of ophthalmology, Downie is seeing an increased emphasis on the use of advanced imaging technologies to provide insight into the pathophysiology of dry eye disease.

“For example, in vivo confocal microscopy of the cornea enables high-resolution imaging of dendritic cells (innate immune cells) in the living cornea, which can be used to gain insight into anterior eye inflammatory responses,” Downie notes.

“Other technologies, such as infra-red meibography, interferometry, and high-resolution anterior segment optical coherence tomography are also being employed, in clinical and/or research settings, to characterise the structural and functional sequelae of the condition."

She speculates that with this increase in global investment, a range of new dry eye therapies is expected to become available, particularly those more specifically targeted at subtypes.

“There has been increased global awareness about the importance of diagnosing and managing dry eye disease, particularly through the work of the Tear Film and Ocular surface Society (TFOS), and the publication of the International Dry Eye WorkShop II (DEWS II) reports in 2017,” she says.

“We are seeing increased engagement

DR LAURA DOWNIE Laura is an associate professor and a Dame Kate Campbell Fellow in the Department of Optometry and Vision Sciences at the University of Melbourne.

DRY EYE DIRECTORY GRABS GLOBAL ATTENTION Google rankings of a dry eye directory introduced last year have been building worldwide, connecting patients to practices who have invested in treating dry eye.

An optometrist from a little-known Australian town is behind a new dry eye website that’s helping connect sufferers with eyecare professionals here and abroad.

Mr Leigh Plowman, a dry eye sufferer himself who practises in Colac, Victoria, officially launched the Dry Eye Directory in November in response to a growing appetite among patients for dry eye information and treatment.

He says the website, which now includes practitioners from across Australia, Europe and the US, seeks to answer the perennial question: “Where do I go to get some relief?”

“Patients often talk to their pharmacist or friend about dry eyes. They may hear several eye drop recommendations and purchase them. Patients might try every available over-the-counter eye drop in search of relief. In the meantime, their dry eyes can worsen, leading to pain and reduced quality of life,” he says.

“A Google search for dry eye treatment returns results about publications but not information directing patients to optometrists to get treatment, or relief.”

With a general increase in screen time a wellknown contributing factor, and dry eye affecting younger patient demographics than previously, Plowman says now is the time for optometry practices to be proactive about diagnosing and treating the disease.

“The main reason for creating the directory was to connect patients to practices. As eyecare practitioners, it is now within our scope to offer more than just eye drops and warm compresses. Intense pulsed light (IPL) has been a game-changer in relief and treating underlying causes,” he says.

Plowman notes that dry eye treatments have become significantly more popular in journal articles and clinical literature.

“Now more than ever, practices are taking a serious interest in dry eye disease. This often involves a holistic approach to treatment, including general health and lifestyle interventions. Cosmetics and moisturisers ingredients are often discussed in a consultation,” he says.

“Dr Laura Downie has a good analogy for dry eye – she says there are 2,000 components to

Optometrist Leigh Plowman examines a patient at Otway Optical, Colac.

tears. It’s like Jenga – if a couple of components are missing, it can destabilise the whole thing.”

Plowman, who also operates Optomly – a business that offers marketing services to help independent optometrists grow their practice – says he reached out to colleagues and associates, as well as to authors who have published related journal articles, to kickstart the directory.

“There isn’t an official society of dry eye specialists but there are forums for dry eye practitioners, such as OSDocs [Ocular Surface] on Facebook that has 6,000 optometrists globally,” he says.

“Forums like OSDocs allow discussion of new research, educational tools and clinical tips for managing dry eye patients.”

This forum helped Plowman find optometrists who offer dry eye treatment to include in the directory. “To set up the directory, I was mainly looking for optometrists who have invested in dry eye equipment, products and techniques, like IPL, LipiFlow or Rexon-Eye,” he says.

So far, some optometrists have expressed their appreciation for the directory, which is a free service that Plowman has developed with his own money to date. It has a range of supporters, including Dry Eye Diva, established

by Ms Amy Sullivan, who co-founded the Tear Film & Ocular Surface Society (TFOS). Dry Eye Diva aims to “expose the toxic truth” behind beauty products and how they affect eye health.

“The directory is small but growing. Google rankings are building globally, with practitioners joining from Scotland, Italy, and the UK.” Currently Dry Eye Directory is ranked at number five on Google USA and number ten on Google Canada. Australia and New Zealand are rising too.

“This directory is a way for optometrists to get their name out there – as a profession, dry eye is within our scope. The directory can also work as a resource to refer to a passionate dry eye colleague.”

According to Google Trends, searches for dry eye disease have doubled in the last 10 years. With more people working from home on digital devices, this trend is likely to continue, Plowman says. Plowman plans to add more resources for patients and eyecare professionals in future, including webinars and other online community activities. He hopes this will help encourage a sense of community amongst eyecare professionals.

“When I was an optometry student, I recall being a patient for another student. I still remember her putting fluorescein in and doing tear breakup time. She said: ‘Wow, Leigh, your eyes are dry’. Fortunately, our access to treatments has expanded significantly since this time. We no longer have to wait for patients to try artificial tears and hope they are compliant.

Australia has great treatments like IPL, LipiFlow and more. These can be a great way to differentiate your practice,” he says.

LEIGH PLOWMAN Leigh is an independent optometrist who founded the Dry Eye Directory and operates optometry marketing service, Optomly.

INSIGHT August 2020 19

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REPORT

TAKING ADVANTAGE OF THE OCULAR SURFACE TO DIAGNOSE OTHER FORMS OF DISEASE Academic and author Dr Maria Markoulli is interested in the impact of ocular and systemic disease on the tear film and how eyecare professionals can better use this to diagnose and manage such conditions. more so in some populations than others, we have also seen an influx in tools to help us manage these conditions, both in-office and takehome therapy.”

Dr Maria Markoulli, a senior lecturer and postgraduate research coordinator at the School of Optometry and Vision Science at UNSW, says collaboration between researchers, clinicians and industry is key to helping solve the dry eye equation.

While stronger ties are forming between industry and clinical practice, Markoulli notes this has evolved alongside an explosion in research.

While a large proportion of research and development has targeted methods to diagnose and treat the disease, Markoulli is interested in discovering what else the tear film can reveal about a person’s health.

Her current research focussing on the ocular surface to diagnose systemic disease has seen her lead a team of researchers to develop a noninvasive test to detect people at risk of peripheral neuropathy, a diabetes complication.

One of Markoulli’s postgraduate students, now a postdoctoral fellow, Dr Shyam Tummanapalli, conducted the study.

“Shyam’s work found people with type 1 diabetic peripheral neuropathy – a complication that can result in recurring foot ulcers and amputation in extreme cases – have reduced levels of a protein known as ‘substance P’ in the tear film,” she says “This could form the basis of a new point-ofcare tear test, similar to devices used for the diagnosis of dry eye disease. Peripheral nerve damage in diabetes can be really debilitating, so it’s important to be able to detect it early and, while you can’t reverse it, at least you can limit its progress by better managing the diabetes.”

Markoulli says current diagnostic methods for peripheral neuropathy are either invasive, or subjective and unreliable, whereas this method of collecting and analysing tears is accessible, noninvasive, quick and objective.

The emergence of such research perhaps demonstrates why the tear film should not be underrated. For example, Markoulli says homeostasis of the tear film is a key contributor to ocular comfort; anything that impacts this equilibrium will have a downstream effect on tear film quality and, consequently, ocular surface integrity and comfort.

Local disease such as meibomian gland dysfunction (MGD), or systemic disease such as diabetes, or systemic medications like Roaccutane can affect this equilibrium.

“It is therefore incumbent on us as clinicians to conduct a thorough medical history in

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INSIGHT August 2020

Dr Maria Markoulli with UNSW colleagues Dr Shyam Tummanapalli (centre) and Professor Mark Willcox.

order to identify risk factor of dry eye disease, gauge the level of symptoms, and assess the tear film, ocular surface and adnexa, putting measures into place to minimise progression or exacerbation of symptoms in the future,” she says.

Markoulli, a global ambassador for the Tear Film and Ocular Surface Society (TFOS) and deputy editor for Clinical and Experimental Optometry, anticipates optometrists are likely to see an increase in dry eye prevalence, especially with continuing use of personal devices.

She also foresees an expansion of in-practice devices and therapeutics for MGD management.

“I am hoping in Australia we will gain more access to ocular therapeutic drugs such as the secretagogue diquafosol, so that we can better manage aqueous deficiency. I think that the management of dry eye disease will become even more personalised than it is now.”

She cites the publication of the 2017 TFOS DEWS II report, which has provided clearer guidance into the disease’s definition. It’s also shown that while a patient may present with either the aqueous deficient or the evaporative form, they may also have a hybrid of the two, requiring a modified response from the practitioner.

In terms of the treatment market, Markoulli says there has been significant growth in artificial tears, with more companies offering ‘non-preserved’ products. Other innovations are also emerging.

“IPL and low-level light therapy, longer-lasting artificial tears, and more anti-inflammatories that minimise the adverse effects that actively inhibit T cell migration are potential options for treatment," she says.

“Other possibilities include the use of biologics, for example, the use of DNase – which is currently being tested – this clears up debris such as DNA released by neutrophils which propagate inflammation, and the use of dietary modifications and supplements – such as fish oil and potentially probiotics.”

Nasal neurostimulation and nasal sprays that harness the trigeminal parasympathetic pathway to improve tear film production, and the use of mucin secretagogues are further areas of potential treatment, she says.

Alongside this, Markoulli says clinical practice has seen an influx in devices that differentiate between the different subcategories of dry eye disease.

“For example, this includes the measurement of lipid layer thickness, the objective measurement of tear break-up time, the measurement of tear film inflammatory mediators and tear film osmolarity,” she says.

“Industry has really come on board to help clinical practice with making progress in diagnosis. Similarly, with the understanding that MGD is the greatest cause of dry eye disease,

DR MARIA MARKOULLI Maria is a senior lecturer and postgrad research coordinator at UNSW SOVS, deputy editor of Clinical and Experimental Optometry and TFOS ambassador.

3x

BENEFITS1

Hydrates Protects Restores1

OPTIVE FUSION® is a dry eye formulation that contains a unique combination of ingredients1 delivering FAST 1 relief and sustained improvements1 for dry eyes.

How does it work?1-8 Optive Fusion® is an artificial tear combining Hyaluronic Acid (HA) + Carmellose Sodium (CMC) with Osmoprotectants. The individual components of Optive Fusion® coat the ocular surface with a hydrating and lubricating protective shield2,5,6 • HA is a lubricant naturally found in the eye. HA has lubricating, water retention and wound healing properties1 • CMC is a mucoadhesive agent which lubricates and protects the eye surface2,3,4 • Osmoprotectants help restore osmotic balance in the eye and hydrate the cells on the eye surface7,8

1. Simmons PA, et al. Clin Ophthalmol 2015;9:665–75. 2. Garrett Q, et al. Invest Ophthalmol Vis Sci 2007;48:1559–67. 3. Johnson, P & Lloyd-Jones, J.G, Drug Delivery Systems - Fundamentals and Techniques, Chichester, Ellis Horwood Ltd, 1987, Chapter 11, Mucoadhesive polymers in drug delivery systems, 180-189 4. Kaercher T, et al. Clin Ophthalmol 2009: 3:33-39 5. Goa KL and Benfield P. Drugs 1994;47(3):536–66. 6. Aragona P, et al. Br J Ophthalmol 2002;86:181–4.

7. Baudouin C et al. Eur J Ophthalmol 2012; 22:751-61 8. Baudouin C et al. Ocul Surf 2013;11:246-58. © 2019 Allergan. All rights reserved. ™ ® Trademark and registered trademark of Allergan, Inc. Allergan Australia Pty Ltd. 810 Pacific Highway Gordon NSW 2072. ABN 85 000 612 831.

Always read the label. Follow the directions for use. If symptoms persist, talk to your health professional.

AU-OPT-1950006 V1 Sept 2019

REPORT

OPTIMEL SECURES ITS NICHE An Australian-made product has proven to significantly reduce the severity of dry eye symptoms when compared with a conventional ocular lubricant – and its manufacturer is hinting there may be further therapies on the horizon.

Since its launch in 2015, homegrown dry eye treatment Optimel Manuka has firmly fixed its place in Australasia, seeing Melcare become one of the leading local manufacturers in chronic dry eye therapeutics. Now, its success is beginning to turn heads in overseas markets, with its introduction to Europe in 2018 and plans to start exporting to the US by October this year.

Available in eye drops for day-time use, or gel for night-time use, Optimel has carved a niche in the dry eye market by staking a claim in the middle-ground between lubricants and more invasive procedures.

Developed using proprietary pharmaceutical grade honey from Leptospermum spp (available in Australia and New Zealand), Optimel eyecare treatments are effective as adjunctive therapies for meibomian gland dysfunction, reducing conjunctival and lid margin redness, and improving meibomian gland secretion quality.

Mr Anthony Moloney is CEO of Queenslandbased Melcare Biomedical, which manufactures Optimel products. He has been a key driver in medical honey research since 1992 and says the therapy has been well received since its introduction to the Australian market five years ago.

“There are not many therapeutic agents available for treating dry eye; only lubricants, short-course steroids or short-course antibiotics. Apart from lubricants, these aren’t long-term options,” Moloney says.

“Optimel fits in between a lubricant option and interventive dry eye treatment.

It can compete directly with more serious interventions but it’s not a drug, not an antibiotic, and not steroidal. It’s in the middle-ground. And there are lower risks of complications from long-term use, unlike antibiotics or steroids.”

Moloney’s assertions have been backed in new Australian research data that has highlighted scientifically significant beneficial properties of pharmaceutical grade honey

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in managing dry eye, with improvements observed within 28 days.

Published in the British Medical Journal, the research determined that Australian-made Optimel Dry Eye Drops containing manuka honey are more effective for the treatment and management of dry eye compared with other forms of eye drops.

A double masked research study coordinated by researchers from UNSW Sydney randomly assigned 46 study participants living with mild, moderate or severe dry eye. Participants either received Optimel Dry Eye Drops, containing manuka honey, or a conventional ocular lubricant containing polyethylene glycol as a control.

Study lead, Dr Jacqueline Tan, says the study compared the effectiveness of both products. After 28 days, 42 study participants (21 in each group) completed the study, with researchers determining tear film evaporation rate showed a significantly greater reduction with the formulated eye honey drop, when compared with the control.

“After 28 days of treatment, tear film evaporation rate was significantly reduced, that is improved with the formulated honey eye drop compared with the control eye drop in our study. In addition, a greater reduction in dry eye symptoms was observed with the formulated eye drop in the study population,” Tan says.

Supporting Optimel’s niche position in the market, Moloney says clinical studies like the one conducted by UNSW are important for product credibility.

“UNSW initiated this study, but the first clinical work goes back to 2005 with Dr Julie Albietz. There is also a clinical study involving Optimel underway in Hong Kong at the moment, but it’s progress has been interrupted by COVID-19,” he says.

Manufactured in Queensland, made with Australian honey, Optimel is available in pharmacies and supplied to ophthalmologists and optometrists through local distributor, Designs For Vision.

The product, which has European conformity assessment certification, has begun to pick up global interest because there aren’t many alternatives on the market, Moloney says.

“Severe dry eye is debilitating, profound for someone who has suffered for many years. In her recent research, Dr Tan cites statistics from the Vision Eye Institute that the prevalence [of dry eye] increases with age, with around 50% of Australians aged

Queensland-based Melcare Biomedical manufactures preservative-free Optimel products.

50 and older living with dry eye,” he says.

With ATRG inclusion and suitability for long term use, the benefit of Optimel over lubricants is evident in Dr Tan’s research data showing that the severity of dry eye not only reduced, but the tear film stability improved with Optimel Dry Eye Drops.

“We now meet FDA OTC marketing requirements and expect to make Optimel available to the US in the coming months. It’s an important step for us.”

Melcare is also planning to release a new product later this year.

“We’ve got a new product coming out for eyelids – an emollient cream to apply to eyelids – to help manage seborrheic dermatitis often associated with blepharitis. It uses 16.5% manuka honey and will be distributed to ophthalmologists and optometrists to prescribe.”

Moloney is hopeful it will be available on the Australian market in September.

ANTHONY MOLONEY Anthony is CEO of Melcare Biomedical Pty Ltd, an Australian company that produces preservative-free eye gel to provide relief from dry eye symptoms.

REPORT

CLINICAL MODEL PUTS DRY EYE FIRST Low overheads and no refraction equipment set Perth’s first dedicated dry eye clinic apart.

So too does its patient demographic, with several teens counted among them.

When optometrist Ms Marilyn Stern opened Dry Eye WA just a few years ago, new research and technology was providing renewed hope for patients who had long-suffered from dry eye disease.

Stern, who has been practising as an optometrist since 1983 after graduating from UNSW, has previously owned her own fullscope practice in Perth and worked around the state as a locum optometrist in both independent and corporate settings. She was also the first regular fly-in fly-out optometrist for five years to service Newman, a town in the Pilbara region of Western Australia.

For 30-odd years prior to opening Perth’s first dedicated dry eye treatment clinic, she’s seen countless patients with the disease. However, for a long period the only treatment available was warm compresses and eye drops.

That changed when she attended an optometry conference and one of the trade stands had an intense pulsed light (IPL) machine, now considered one of the best forms of treatment.

Stern says she was impressed by the IPL manufacturer’s claims, and thought it represented a sound clinical and business investment. But her views were not supported by her then-employer, so she decided to set up a stand-alone dry eye clinic, with IPL being the primary piece of equipment.

“IPL treats the glands thought to be causing dry eye, but it wasn’t known [when I purchased the machine] that not all dry eye is the same. So I found that IPL doesn’t work for everyone,” she says.

“Managing patients' expectations is also challenging, as I am at pains to tell people this is not a cure. I also offer other therapies including BlephEx, Low Level LED light Therapy, Blephasteam, lid scrubs, and takehome therapies of heat packs and eyelid cleansers, and I educate patients on using heat packs and massage.”

To keep abreast with innovations and advances in the field, Stern reads industry magazines and journals, and attends relevant lectures and webinars.

“A recent webinar I watched presented by Queensland optometrist Mr Jason Holland provided clinical advice on performing gland expression three times, not just once, and I’ve adopted that advice in my clinic,” she says.

“I also read material that comes across my

Self-employed Perth optometrist Marilyn Stern conducts BlephEx eyelid treatment on a patient in her clinic.

newsfeed on dry eye and I follow TFOS – I’m looking at what they’re doing.”

In terms of establishing a dedicated dry eye clinic, Stern says there are some key differences compared with a traditional full-scope practice.

“Set up costs are far lower than starting a regular practice as you don’t have the high costs of display and stock, and basic equipment is not vast,” she says.

“Initially, I sent letters to the GPs, optometrists, and ophthalmologists in the area for a radius of 30km, dropped off business cards and referral pads to anyone who responded, but I discovered having a good website is most beneficial.”

She’s also had to overcome the anxieties associated with taking an unconventional step in her career; opening a practice that deals with only one eye condition.

“My husband feels my biggest challenge to start was self-doubt. But following on from that, the biggest challenge I face is convincing other optometrists, ophthalmologists and GPs that what I do is valid and provides great relief to many sufferers.”

“Some patients have dry eye secondary to other systemic problems, such as thyroid disease – 50% of people I see have thyroid disease – others have rheumatoid arthritis or dermatitis,” she said.

The clinic is also listed in the global Dry Eye Directory, a free service created by Victorian optometrist Leigh Plowman (see page 19).

Atypically, Stern doesn’t stock frames or contact lenses in her clinic.

“The only glasses I have here are moisture chamber spectacles, which are specifically designed to provide relief from the discomfort of dry eye symptoms. I only have six frames. I don’t provide refraction and have no refraction equipment here whatsoever.”

This has been reassuring for optometrists who refer patients knowing that they aren’t at risk of losing clientele. “This is a new concept and it has been challenging to get it up and going. It’s still a work-in-progress but I was encouraged by cities like New York, London and Los Angeles which have several dedicated dry eye clinics.

Now we know we can do something for dry eye patients, anything is possible.”

An independent optometrist, Stern says her dry eye clinic is sustainable partly because she has low outgoings.

She’s located in a small office in an office block, with low rent and no street traffic.

Her patients find her clinic through Google, or from a referral from another optometrist.

Ophthalmologists are also referring patients.

Stern’s dry eye patients are not from the typical over 50s patient demographic. She says their age is more spread, with several patients in their teens.

MARILYN STERN Marilyn is an optometrist who opened Perth’s first dedicated dry eye treatment clinic in 2017.

Go to page 50 to read Dr Brendan Cronin’s perspective on the Australian dry eye landscape.

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PRODUCT GUIDE

REFRESH EYE DROP RANGE VITA-POS VitA-POS (retinol palmitate 138 µg/g, 5g) is a smooth, preservative and phosphate-free eye ointment containing Vitamin A for night-time relief of dry eye. It stabilises the tear film and protects the ocular surface by preventing evaporation during sleep, and spreads easily over the ocular surface.

AFT PHARMACEUTICALS 1800 238 742 76 customer.service@aftpharm.com

Allergan’s Refresh eye drops range includes Refresh Tears Plus, which offer temporary relief of eye dryness, discomfort and may protect against further irritation. Refresh Contacts lubricate and rewet soft and rigid gas permeable contact lenses as well as cushion lenses prior to application, while Refresh Liquigel is for persistent dry eye. For preservative-free options, Refresh Plus (ocular lubricant) and Refresh Eye Drops both treat dry, irritated eyes.

Refresh Night Time ointment gives longer-lasting, overnight protection.

ALLERGAN 1800 252 224 australiaenquiries@allergan.com

CEQUA Cequa is a newly-approved novel aqueous, nanomicellar ophthalmic ciclosporin solution for treatment of moderate-to-severe dry eye, where prior use of artificial tears has not been sufficient. Manufactured and distributed by Sun Pharma and cleared by the Therapeutic Goods Administration in January, Cequa’s novel delivery system utilises nanomicellar technology to improve the formulation’s bioavailability. It also allows for a more than 10-fold increase in the aqueous solubility of ciclosporin. The solution works by inhibiting T-cell activation and reduces inflammation associated with dry eye disease. In two clinical studies, OTX-101-2014-001 and OTX-101-2016-001, the therapy demonstrated clinically and statistically significant improvements in tear production and ocular surface integrity over 84 days. Significant improvements were also observed for corneal staining and conjunctival staining from day 28 and 56, respectively, in the OTX-101-2016-001 trial. According to the company, the most common adverse event reported was mildly transient instillation site pain, which was resolved within five minutes.

STERILID EYECARE SOLUTIONS SteriLid is a science-based solution for daily lid hygiene which is important for those with blepharitis and dry eye, as well as those preparing for eye surgery. SteriLid is a convenient and effective way to cleanse the eyelids and eyelashes and is the first eyelid cleanser shown to kill both gram positive and gram negative bacteria.

CONTACT LENS CENTRE AUSTRALIA 1800 125 023 contactlenscentreaustralia.com.au

SUN PHARMA 1800 726 229 nic.kurstjens@sunpharma.com

OPTI-SOOTHE PRESERVATIVE-FREE EYELID WIPES The Opti-Soothe Preservative-Free Eyelid Wipes are ideal for daily gentle cleansing to assist in the removal of debris from the eyelid. The preservative-free textured wipes contain a unique formulation of Tea Tree Oil, Hyaluronic Acid, Camomile and Aloe Vera. The wipes are convenient to use on the go as they are individually wrapped and do not require rinsing after use.

AFT PHARMACEUTICALS 1800 238 742 76 customer.service@aftpharm.com

THE EYE DOCTOR HOT/COLD EYE COMPRESS The Eye Doctor has introduced the new ‘Sterileyes’ antimicrobiol protection for its Hot/Cold Eye Compress. Sterileyes is an antibacterial shield proven to kill 99.9% of bacteria. The patented solution is bound to the fibres of the mask to protect the eyes from potentially harmful bacteria. It also provides stain protection and eliminates germs that create odour. The Eye Doctor Hot/Cold Compress is designed to treat meibomian gland dysfunction. It can be used in the microwave, oven or freezer and has a removable washable cover. Used hot, it alleviates the symptoms of dry eye disease, blepharitis, chalazion, grittiness, irritation and sore eyes. Used cold, it soothes the symptoms of hay fever/allergies, inflammation, tired/ itchy/puffy/sore eyes, sinus headaches and migraines.

GOOD OPTICAL SERVICES (03) 9645 1066 goodopt@ozemail.com.au

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IDRA

Finally…a fast and effective at home treatment for Dry Eye disease

SBM Sistemi’s IDRA device incorporates all the benefits of the its Ocular Surface Analyser model, with more automation and additional features, including auto interferometry analysis, auto non-invasive tear break-up mapping, fluorescein exciter filter, eye blink rate detection and 3D meibography imaging. IDRA is extremely compact, slit lamp-mountable and can be used stand-alone with an optional base and head rest.

YOUR EXPERTISE + NULIDS SYSTEM = IMPROVED PATIENT OUTCOMES • NuLids offers a simple Doctor directed at-home dry eye therapy for your patients

BOC OPHTHALMIC INSTRUMENTS Ph. 1800 804331 Email: sales@bocinstruments.com.au

• NuLids treatments take only 1 minute a day • NuLids’ oscillating Soft Tip design works by gently stimulating and rejuvenating the patient’s Meibomian Glands

OPTI-SOOTHE MOIST HEAT MASK

• NuLids has been shown to remove scurf, improve Meibomian Gland effectiveness, and increase Meibomian output by 2x1

The Opti-Soothe Moist Heat Mask is a reusable mask that provides soothing symptom relief of dry eye, blepharitis, meibomian gland dysfunction, chalazion and styes. It utilises HydroBead technology, which absorbs moisture from the air and once heated activated, releases 10 minutes of natural consistent moist heat. The mask is easy to use, washable, and can also be used for cold therapy.

Studies have demonstrated a 65% improvement in tear film breakup time [TBUT] and an 81% increase in Meibomian Gland Yielding Liquid Secretions in less than 30 days1 C

AFT PHARMACEUTICALS 1800 238 742 76 customer.service@aftpharm.com

M

Y

INTRODUCING

CM

MY

CY

HYLO FRESH AND FORTE Preservative-free HYLO-FRESH (sodium hyaluronate 0.1% w/v, 10mL), delivers lubrication for dry eyes of moderate or medium severity, while the more viscous HYLO-FORTE (0.2% sodium hyaluronate w/v, 10mL) is ideal for the treatment of severe or chronic dry eye. HYLO drops provide a systematic approach to dry eye treatment through the unique COMOD (COntinuous MOno Dose) application system, delivering at least 300 sterile drops per bottle. Both can be used with all contact lenses, are suitable for post-surgery use, and are phosphate-free.

AFT PHARMACEUTICALS 1800 238 742 76 customer.service@aftpharm.com

CMY

K

HOT & COLD EYE COMPRESS

EVOLVE CARMELLOSE & HYPROMELLOSE EYE DROPS Both drops provide soothing relief for patients with mild, moderate or severe dry eye. It’s a unique system designed to combine the benefits of unit dose preservative-free eye drops with the convenience of a standard eye drop bottle. Once opened the bottle can be used for up to three months. Now available via the PBS.

CONTACT LENS CENTRE AUSTRALIA 1800 125 023 contactlenscentreaustralia.com.au

Sterileyes® is an antibacterial shield which kills 99.9% of bacteria. The patented solution is bound to the mask fabric to protect the eyes from potentially harmful bacteria.

• Hygienic - removable - washable cover • Microwave - Freezer - Oven Apply HOT to alleviate dry eye symptoms and COLD to soothe inflammation allergies and migraines

PRODUCT GUIDE

THERATEARS GEL

MANUKA DROPS AND GEL Optimel Manuka+ Dry Eye Drops are a front-line treatment for mild to moderate dry eye. The concentration of the high activity Manuka honey is 16.5% in a saline solution with benzoic acid as the preservative. This drop is great for reducing the symptoms of dry eye including sore, red and irritated eyes. On the other hand, the Optimel Manuka+ Forte Eye Gel contains 98% Manuka honey, is preservative free and an optometry only product. It is ideal for moderate to severe dry eye disease, particularly meibomian gland disease and blepharitis. Optimel Manuka + Forte Eye Gel has a high viscosity making it well suited for night-time use. It is best described as ‘a drop for every practice to have’.

Theratears’s unique hypotonic and electrolyte balanced formula replicates healthy tears. It is a liquid-gel formula that provides soothing, longer lasting relief and protection for night time use. It is just the right thickness to provide less blurring, non-crusting, protective film, which also makes it ideal for night time use. Theratears Gel is available in 28 single-use vials. Each vial comes in a foil pouch to ensure they are as fresh as natural tears.

CONTACT LENS CENTRE AUSTRALIA 1800 125 023 contactlenscentreaustralia.com.au

DESIGNS FOR VISION 1800 225 307 or enquiries@dfv.com.au

THERATEARS LUBRICATING EYE DROPS TheraTears Lubricant Eye Drops ‘osmocorrect’ the tear microenvironment, reducing the concentration of salt that can lead to ocular surface irritation and inflammation.

The eye drops are hypotonic, so they lower the elevated tear osmolarity - not just wetting and lubricating, but actually rehydrating dry eyes. TheraTears is the only lubricant drop that not only corrects osmolarity, but also uniquely mimics the electrolyte balance of the human tear.

OPTIVE EYE DROPS Allergan’s Optive eye drops range, available in five varieties, includes Optive Advanced Preservative Free and Optive Advanced drops, which offer temporary relief of burning, irritation and discomfort due to dry eyes, and may protect against further irritation. Optive Eye Drops and Optive Sensitive (preservative-free) provide temporary relief of eye dryness and discomfort, and may protect against further irritation. Optive Gel Drops offer instant and long-lasting relief of persistent dry eye symptoms night or day.

ALLERGAN 1800 252 224 australiaenquiries@allergan.com

CONTACT LENS CENTRE AUSTRALIA 1800 125 023 contactlenscentreaustralia.com.au

NULIDS NuLids offers fast and effective doctor directed, at-home dry eye relief.

NuLids requires only one minute a day, providing a natural, more effective alternative dry eye treatment. Its oscillating Soft Tip design works by gently stimulating and rejuvenating meibomian glands (MBs), and has been shown to remove scurf, improve meibomian gland effectiveness, and increase meibomian output by 2x1. Studies have demonstrated a 65% improvement in tear film breakup time and an 81% increase in MB yielding liquid secretions in fewer than 30 days.

NuLids is safe, comfortable and easy to use. All patients surveyed said its oscillating Soft Tip was more convenient than manual treatments.

GOOD OPTICAL SERVICES (03) 9645 1066 goodopt@ozemail.com.au

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ICP OCULAR SURFACE ANALYSER The multifunctional ICP OSA analyses the functionality and stability of tear film layers, and features advanced infrared meibography with automated detection and quantification of meibomian glands (MGs). It delivers comprehensive qualitative tests and quantification reports, including lipid layer thickness, tear meniscus height, non-invasive tear break up time, MG imaging, classification of MG dysfunction, vivid anterior eye imaging, pre and post treatment trend reports, and more. It's compact, slit lamp mountable and can be used stand-alone with an optional base and head rest.

BOC INSTRUMENTS 1800 804331 sales@bocinstruments.com.au

OCUSOFT LID SCRUB When it comes to dry, scratchy, irritated eyes, often the problem may not be the eyes, but rather the eyelids. OCuSOFT Lid Scrub effectively removes excess oil and debris from the eyelids that may lead to eye irritation, including dry eyes. It’s recommended for routine daily eyelid hygiene, while OCuSOFT Lid Scrub PLUS is an extra-strength, leaveon formula recommended for moderate to severe conditions with bacterial involvement.

Patients can choose from convenient pre-moistened pads (30 Ct.), an instant foam pump (50 mL) or an economical Compliance Kit (includes a 50 mL bottle of OCuSOFT Lid Scrub Original Foaming Eyelid Cleanser and 100 dry, lint-free pads).

GOOD OPTICAL SERVICES (03) 9645 1066 or goodopt@ozemail.com.au

NOVATEARS NovaTears (Perfluorohexyloctane 100%, 3mL) is a unique preservative-free eye lubricant and tear film stabiliser in a multi-dose bottle, specifically designed for the relief of Evaporative Dry Eye and Meibomian gland dysfunction. NovaTears spreads quickly and easily on the eye with a long lasting effect; and has a pleasant warm silky feeling with no blurring or stinging. It contains no preservatives, phosphates, surfactants, or water and can be used for six months after opening.

AFT PHARMACEUTICALS 1800 238 742 76 customer.service@aftpharm.com

OPTIVE FUSION

Evolve® Hypromellose 0.3%

For Mild Dry Eye Evolve® Carmellose 0.5%

For Moderate Dry Eye Evolve® Eyelid Wipes

For Daily Eyelid Hygiene

Optive Fusion lubricant eye drops are an artificial tear combining hyaluronic acid (HA) and carmellose sodium (CMC) with osmoprotectants to deliver fast relief for dry eyes. Individual components of Optive Fusion coat the ocular surface with a hydrating and lubricating protective shield. HA is a lubricant naturally found in the eye that also has water retention and wound healing properties. CMC is a mucoadhesive agent, which lubricates and protects the eye surface, while osmoprotectants help restore osmotic balance and hydrate the cells on the eye surface. Optive Fusion also promotes an optimal environment for ocular surface regeneration.

ALLERGAN 1800 252 224 australiaenquiries@allergan.com

Australian Distributor: Contact Lens Centre, Australia Unit 6D 2A Westall Rd, Clayton, VIC 3168 Australia

Ph 1800 125 023

COMPANY

EYLEA BIOSIMILAR SET FOR GLOBAL CLINICAL TRIAL AND POTENTIAL MARKET SHARE A biopharmaceutical company that is developing cheaper anti-VEGF treatments is set to launch a global clinical trial of a biosimilar version of leading macular disease treatment Eylea (aflibercept).

Korean-based Samsung Bioepis has announced the Phase 3 clinical trial of SB15 will take place in eight countries, including South Korea.

According to industry sources, Korea’s health authorities gave Samsung Bioepis the go-ahead for a Phase 3 trial of SB15 following FDA approval for the trial in the US. In Korea, the trial will be conducted to evaluate the efficacy and safety of SB15 in comparison with Eylea in AMD patients registered at 10 hospitals across the country.

The decision to launch the SB15 clinical trial follows the company’s recent completion of a Phase 3 study of SB11, a biosimilar of Lucentis (ranibizumab), another commonly prescribed age-related macular degeneration (AMD) therapy.

Compared with Lucentis, which was used as the reference drug, SB11 demonstrated equivalent efficacy in terms of change in best corrected visual activity at week eight and central subfield thickness at week four.

Samsung Bioepis is now preparing to file a regulatory application seeking marketing approval for SB11.

It is aiming to capitalise on the expiration of patents for Lucentis and Eylea – both listed on the Australian Pharmaceutical Benefits Scheme – in the coming years and offer a cheaper alternative for health systems and patients in the US, Canada, Europe, Japan, and Australia.

If successfully commercialised, SB11 and SB15 would be the first biosimilar versions of Lucentis (ranibizumab) and Eylea (aflibercept), arguably two of the most commonly prescribed AMD drugs on the market. n

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ESSILORLUXOTTICA SHOWS RESISTANCE TO ECONOMIC HEADWINDS "WE ARE SEEING THE FIRST SIGNS OF RECOVERY IN ALL THE BUSINESS AREAS. THIS CONFIRMS THE RESILIENCE OF THE DEMAND FOR OUR PRODUCTS" LEONARDO DEL VECCHIO, ESSILORLUXOTTICA

The world’s largest optical company EssilorLuxottica has reopened all of its factories and most of its stores, in what executives are labelling as the first signs of recovery from the COVID-19 crisis.

At its annual shareholders’ meeting in late June, the company also provided an update on its highly anticipated acquisition of optical retail giant GrandVision and announced the launch of its first completed pair of spectacles in Italy comprising Ray-Ban frames with Essilor prescription lenses.

The Franco-Italian amalgamation, which merged the world’s largest frame manufacturer (Luxottica) with the biggest lens maker (Essilor) in 2018, reached a combined €17.4 billion in annual revenues last year.

In the first quarter of 2020 the company generated revenue of €3.7 billion, representing a year-on-year decline of 10%. The company stated that this revealed “good resistance in the current unprecedented global crisis”.

EssilorLuxottica chairman Mr Leonardo Del Vecchio and the group’s executive vice chairman Mr Hubert Sagnières said as lockdowns are gradually lifted across the world, the company has reopened all factories and most of its stores.

“We are seeing the first signs of recovery in all the business areas. This

The GrandVision acquisition is still on track.

confirms the resilience of the demand for our products and brands, as well as the strength, reliability and agility of our supply chain – even in times of crises,” they said.

In 2019, EssilorLuxottica announced plans to acquire GrandVision, one of the main optical retailers with more than 7,000 stores across 40 different countries. The European Commission is now examining the impact the deal could have on the market competition “This transaction – which has already received green light from the competition authorities in the United States, Colombia, Russia and Brazil – would help us grow our retail footprint in key areas, particularly Europe, and help us set a new global standard for the optical retail experience,” Del Vecchio and Sagnières said. n

SAFILO AND MAX MARA PART WAYS Safilo has announced that it is severing ties with Italian fashion brand Max Mara in October, ending a partnership spanning almost 23 years.

A statement said both parties had agreed to terminate the license Safilo held to produce and distribute Max Mara sunglasses and optical frames, falling several years short of the originally agreed expiry date of December 2023.

announced an early renewal of the licencing agreement that was meant to remain in place until the end of 2023.

At the time, both companies championed their shared Italian heritage, with Safilo executives stating that Max Mara had become one of the fastest growing brands in its portfolio. n

The agreement will end on 31 October 31, 2020. In 2019, Safilo reported that the Max Mara license represented less than 2% of Safilo Group’s net sales.

Safilo and Max Mara signed their first agreement in 1997, with the latter launching its first optical frames collection a year later.

In September 2016, both companies

The contract is ending short of its 2023 expiry.

RESEARCH

COUGH SIMULATION SHOWS PROTECTIVE EFFECT OF BREATH SHIELD AGAINST RESPIRATORY DROPS International ophthalmologists have developed a video simulation showing that slit lamp breath shields do not provide full protection from respiratory droplets, however droplet spread is minimised significantly when a patient is wearing a mask.

In a demonstration posted by the American Academy of Ophthalmology, Dr Tina Felfeli, Dr Efrem Mandelcorn and their colleagues used ultraviolet conditions to assess the spread of respiratory droplets when a patient coughed during a slit-lamp examination.

The simulation involved a mannequin placed at the chin rest of the slit lamp fitted with the a common commercially available breath shield measuring 9.75 inches by 10.5 inches (24.75cm by 26.67cm). The patient cough was reproduced using a latex balloon filled with fluorescent dye, which was inflated with compressed air to burst at 5psi – previously reported as the psi level for a voluntary cough.

Following the simulation, droplets were located on the upper body of the examiner and the slit lamp. Overall it demonstrated that slit lamp breath shields

In this case, droplets identified on the shoulders, arms and hands of the examiner, as well as the slit lamp,” the researchers noted.

The third step involved a properly positioned surgical mask on the mannequin. In this scenario, were only spotted on the slit lamp, and not on the examiner.

In the fourth step, an N95 mask was assessed and no droplets were found on either the examiner or the slit lamp.

Although shown to be effective, the authors noted the use of N95 masks – a limited resource – that have not been professionally fitted for routine clinic encounters is not supported.

The demonstration was filmed in ultraviolet conditions. Image: AAO

minimise but do not eliminate the spread of respiratory droplets on the examiner.

Next, the research team assessed the potential to decrease droplet spread when a patient is fitted with either a cloth, surgical or N95 mask during the exam.

“The findings highlight the need for patients to wear a mask during close clinical encounters, including a wellfitted cloth mask if it is the only available option,” the researchers concluded.

For cloth masks, droplets were identified on the hands of the examiner and the slit lamp after the coughing simulation.

“Correct positioning of the mask is critical because an improperly worn surgical mask is less effective than a correctly worn cloth mask.

Slit lamps should be cleaned between patients to prevent cross-contamination.” n

“Secondly, the simulation was repeated with the use of a surgical mask, however this was positioned incorrectly as this is a situation unfortunately encountered all too often with the use of masks

RESEARCHERS ESTABLISH DRY EYE-SLEEP APNEA LINK Dry eye disease is more prevalent in patients with obstructive sleep apnea that’s treated using a continuous positive airway pressure (CPAP) device or other nasal mask instruments.

That’s according to a new study by a US ophthalmologist who also discovered that woman with sleep apnea demonstrated higher rates.

“As eyecare providers, we need to start asking our patients whether they use a CPAP device. Dry eye disease is prevalent among this subgroup,” coauthor Dr Cynthia Matossian, who works in private practice in Pennsylvania, told Ophthalmology Times.

According to the study, women suffer from dry eye at almost double the rate of men in the US. Generally, the prevalence rates increase with age, ranging from

2% in persons aged 18 to 34 years up to 16% in those 75 years and older.

Sleep apnea affects both genders but is substantially higher among men, 13% to 14% compared with 5% to 6% among women.

Matossian and colleagues analysed data between 2013 and 2018 to identify real-world associations between dry eye and sleep apnea.

The study, which was sponsored by dry eye drug developer Sun Pharma, included adults if they had one or more claims of CPAP or other nasal mask device use during the study period, among other requirements.

A total of 330,926 patients with a median age of 53 were included in the study, 65% whom were men. Overall, 13,176 patients had dry eye

"WE NEED TO START ASKING OUR PATIENTS WHETHER THEY USE A CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE" CYNTHIA MATOSSIAN, STUDY LEAD

The study found associations with the increased incidence of dry eye in patients who used CPAP devices over time, while age, duration of mask use, gender, and certain comorbidities also played a role.

According to Matossian, the one, two, and three-year dry eye incidence rates after starting use of CPAP or another nasal mask device were 4%, 7% and 10%, respectively.

They also found dry eye was exacerbated both during the second year of use of a device compared with the general incidence of dry eye in the US, along with the length of time the device was used.

Users of the CPAP device who were women, older, or had comorbid inflammatory or metabolic conditions may experience a higher incidence of dry eye, the researchers noted. n

INSIGHT August 2020 33

TECHNOLOGY

NEW TECH PATENTS COULD SIGNAL DISRUPTION FOR RETAIL EYEWEAR US tech giant Apple has filed a patent for a new head mounted device (HMD) that it claims can correct vision electronically when the device is worn.

If the device comes to market, a Forbes report notes, the wearer won’t need to see an optometrist for their prescription because it will be detected electronically.

Apple filed the patent in the fourth quarter of 2019 and the United States Patent and Trademark Office published it in June 2020.

The patent covers “a powerful new vision correction optical system that’s able to incorporate a user’s glasses prescription into the system”, according to a patent application report.

The system will then alter the optics to address vision issues such astigmatism, farsightedness, and nearsightedness so that those who wear glasses won’t have to wear them when using Apple’s HMD. Apple notes that the user input includes a spectacles prescription and the control circuitry is configured to adjust a position of the display with the positioner based on the prescription.

Although the device may not come to market, if the technology is developed, Forbes claims the entire process of getting prescription spectacles in stores will be disrupted.

The US eyecare profession is reportedly concerned that reducing the need for eyecare visits for prescriptions will prevent the discovery of numerous eye diseases that are currently detected by early tests during prescription eye examinations.

Apple also filed a patent application in the second quarter of 2019, which was published by the US Patent Office in January 2020.

That patent relates to a mixed reality headset that will allow those with prescription glasses to put their unique lenses into a headset to eliminate the need to wear exterior glasses in the headset, which would otherwise make it bulkier and less comfortable. n

34

INSIGHT August 2020

WORLD’S FIRST SPHERICAL ARTIFICIAL EYE WITH 3D RETINA "I BELIEVE MANY TECHNOLOGIES FEATURED IN STORIES SUCH AS THOSE OF INTERGALACTIC TRAVEL, WILL ONE DAY BECOME REALITY" FAN ZHIYONG, HKUST

It's hoped nanowire light sensors could be connected to the nerves of visually impaired patients.

An international research team behind the world’s first 3D artificial eye have claimed that their technology possesses greater capabilities than existing bionic eyes and even human eyes in some instances.

Scientists at the Hong Kong University of Science and Technology (HKUST) have led development of the Electrochemical Eye (EC-Eye). It is said to replicate the structure of a natural eye for the first time and has the potential to offer sharper vision than human eyes in the future.

the team connected the nanowire light sensors to a bundle of liquid-metal wires serving as nerves behind the man-made hemispherical retina.

They successfully replicated the visual signal transmission to reflect what the eye sees on to a computer screen.

In future, they hope the nanowire light sensors could be directly connected to the nerves of the visually impaired patients.

According to HKUST, scientists have spent decades trying to replicate the biological eye, but vision provided through existing prosthetic eyes can produce poor resolution with 2D flat image sensors.

Due to the nanowires having higher density than human photoreceptors, the researchers also believe the artificial retina could receive more light signals and potentially attain a higher image resolution than the human retina.

The key technological breakthrough is a 3D artificial retina made of nanowire light sensors which mimic the photoreceptors in human retinas. Led by HKUST's Professor Fan Zhiyong and Dr Gu Leilei,

“I have always been a big fan of science fiction, and I believe many technologies featured in stories such as those of intergalactic travel, will one day become reality,” Zhiyong said. n

MONITORING EYE HEALTH REMOTELY NOW POSSIBLE WITH NEW APP A Bristol-based company has launched a smartphone app that enables eyecare professionals to monitor patients' eye health remotely.

Okko Health, founded by optometrist Dr Stephanie Campbell, has developed the software to provide personalised and remote care in between physical appointments.

According to Optician Online, the app uses sensors in smartphones – currently only iPhones but soon to be released on Android – to measure key visual indicators. It is paired with a web-based portal that can be accessed by eyecare

professionals to identify patients in need of face-to-face appointments.

Okko Health’s app is devised like a video game where patients tap on visual cues and anomalies in patterns, from which the software derives visual acuity and sensitivity to contrast.

Measurements are analysed over time to provide insights into the stability of a variety of eye conditions and provide an early warning system for urgent attention.

It has taken four years to develop and has met CE-marked standards.

It’s certified by British Standards to monitor vision. n

INTERNATIONAL

SUPPORT FOR US PRACTICES DAMAGED AMID CIVIL UNREST The American Optometric Association (AOA) has come to the aid of numerous eyecare practices across the US which were damaged during civil unrest that erupted after the death of George Floyd.

"IT’S DIFFICULT WITH THE BLOW OF COVID-19 AND HAVING TO SHUT YOUR DOORS FOR AT LEAST TWO MONTHS, THEN COMING BACK. AND NOW THIS"

The AOA Foundation, Optometry Cares and Optometry’s Fund for Disaster Relief are providing support to practices damaged by looting and vandalism in cities including Boston, San Diego and Washington, DC. Although typically used to help doctors through disasters such as fires, floods and hurricanes, the AOA Foundation stated the disaster relief fund can provide support to eyecare professionals who experienced property damage to their home or business so they can return to providing eye and vision care.

Following the unrest that started in late May and continued into June, AOA president Dr Barbara Horn said optometry should join together in united and immediate action to aid impacted doctors and their communities.

“It’s long been a priority to deliver disaster relief support whenever and wherever it’s needed by doctors of optometry, and that’s the mission today,” she told Invision Magazine.

A family that have practised in the San Francisco Bay area for 30 years and operate in four locations were among the optometry practices targeted.

Dr Kimberly Haw received a call from

KIMBERLY HAW, US OPTOMETRIST

Support is being provided to stores that were damaged by looting and vandalism.

her alarm system company and arrived at one of the practices to find neighbours fending off vandals.

“It’s difficult with the blow of COVID-19 and having to shut your doors for at least two months, then coming back,” she told the AOA. “And now this. How much more can you sustain?”

Another optometrist, Dr Alice Sun, in Santa Monica, California, was at home when their alarm went off. As they watched their security video feed, she told a local television station: “There were more than 50 people just rushed into our office, grabbing everything they can put their hands on.” n

MANY INDIAN EYE DOCTORS SUFFERING FROM DEPRESSION Nearly one-third of 2,355 ophthalmologists surveyed across India are suffering from mild to severe depression, according to the All India Ophthalmological Society, which conducted the survey.

As many as 504 ophthalmologists reportedly have mild depression, while 153 and 101 have moderate and severe depression, respectively.

According to the survey, which included 255 ophthalmologists from Karnataka, a total of 23 respondents have daily suicidal thoughts.

Dr Rohit Khanna, from LV Prasad

Eye Hospital, was primary author of the study.

“In Karnataka, nine doctors have severe depression. These are among the ophthalmologists who responded.

A total of 22 have moderate depression while 53 have mild depression. Among the doctors whose specialties have the highest risk are those of dentists, eye doctors and pulmonologists,” he told the Deccan Herald.

In India, ophthalmologists had to follow government orders to close their clinics and private practices in the wake of COVID-19, with only eye emergencies allowed to be tended to. n

MAJOR TURNAROUND IN CHINESE EYE HEALTH STATISTICS An emphasis on timely cataract treatment and ophthalmology training has contributed to a fall in the number of visually impaired people in China, according to a government report.

The Chinese National Health Commission recently released a white paper estimating the number of visually impaired people over the age of 50 has fallen by more than 700,000 compared with 1999, while the number of patients with serious eyesight damage has decreased by more than 500,000.

Surgeries for patients with cataracts, according to China Daily, have been the focus of campaigns during the past 20 years, with nearly 3,000 surgeries expected to be performed for every 1 million people this year. This is compared with a rate of 318 cataract surgeries per 1 million in 1999.

According to the report, more than 190,000 cataract patients from China’s poorer areas have received free treatment from March 2018 to May 31 this year.

Another 10,000 are scheduled for 2020.

Additionally, the number of Chinese ophthalmologists increased from fewer than 20,000 in 2003 to almost 45,000 by the end of 2018.

Trachoma, which previously infected up to 90% of people in rural areas 70 years ago, is now considered a rare disease, with blindness-causing trachoma eliminated in 2014, the report stated.

Mr Wang Ningli, head of national technical guidance group for blindness prevention and director of Beijing Tongren Hospital’s Department of Ophthalmology, told CGTN: “I’m touched by the achievements China has made in preventing blindness and promoting eye health over the past 21 years. We’ve set a good example for developing countries, some indications even got closer to developed countries.” n

The number of Chinese ophthalmologists has increased by 25,000 since 2003.

INSIGHT August 2020 35

BUSINESS RECOVERY

EYECARE SECTOR CHARTS RECOVERY PATH Following the COVID-19 peak, Insight issued a sentiment survey to understand the eyecare sector’s views on topics ranging from the government’s crisis response to industry confidence. Here, we reveal the findings and talk to business owners about their experiences.

W

ith a small team of three optometrists and three optical dispensers, the E Eye Place isn’t necessarily the largest or most coveted optometry practice in Western Australia.

However, like hundreds of other independent practices around Australia, it has a dedicated team that toil hard to differentiate the business and offer the full scope of services, including orthokeratology and an in-office fitting laboratory.

Established only four years ago in Port Coogee, 28km south of Perth, the E Eye Place would appear, on paper, to be one of many small businesses left exposed by the COVID-19 crisis. It did close for a short period. But in the face adversity, its owner optometrist Ms Stephanie Yeo is optimistic about the future and has no intention of taking the conservative route.

“In terms of investment plans, the pandemic did not really lead to cutbacks. We increased our headcount and also invested in some small equipment. Strategically we are still hoping to invest in even more equipment once we get more normalcy in the cashflow,” she says.

36

than 500, was designed to gauge the pandemic’s impact on the sector and quantify industry confidence. It also sought views on the government’s response to the crisis and information about factors that influence purchasing decisions.

The results paint a relatively positive picture of an industrial landscape experiencing its first recession in almost three decades. For example, more than a third of survey respondents (36% or 55 people) are still planning to explore new technologies and services in the next 12-18 months to improve their businesses.

Further, 40% said they would continue with current projects, but not make any new investments, while 24% indicated they would cut or reduce their services.

For staff recruitment, 15% said they would hope to rehire employees laid off or stood down during the lockdown period and 31% revealed they would operate with a reduced number of staff. Approximately 43% said they don’t expect to create new positions.

“We still hope to increase staff headcount even further and are looking for good quality candidates.”

Overall, in terms of the pandemic’s impact on businesses, 50% of respondents felt it had a ‘very negative’ effect, while 41% stated it was ‘somewhat negative’.

While Yeo’s confidence may come as a surprise amid the economic climate, she is not alone, according to an Eyecare Sector Sentiment Survey commissioned by Insight’s publisher Prime Creative Media from 21 May to 5 June.

The industry was split on how long it would take for their businesses to return to normal levels of service; 21% said 1-3 months, 28% answered 3-6 months; 26% 6-12 months and 19% more than 12 months.

The 11-question survey, which garnered 154 responses from ophthalmic businesses ranging from fewer than 10 staff to more

Although she’s mindful of the challenges the sector faces, Yeo has adopted a long-term view for her practice. She says having the right

INSIGHT August 2020

mindset is critical to ensure her business and staff continue moving forward, despite the turbulent market conditions.

To back this assertion, she has purchased a Zeiss iTerminal 2 centration device, IOL Master biometer and a paediatric vision screener, some of which pre-date COVID-19. She now plans to follow through on plans to upgrade another iTerminal when it’s released, and purchase a combined ultrawide and OCT. “We run a tight ship, however it is important to invest in ourselves as well as invest in technology in order to differentiate ourselves and find our place and remain relevant in the very competitive market,” Yeo explains.

“As many have said, we saw 10 years of change in one week – so to speak – when the pandemic struck. Optometry is in an interesting position where many have a hybrid identity of retail and medical domains. The retail domain is undeniably affected to a certain extent although demand for occupational specific eyewear to improve work performance (working from home, near induced eye strain) has increased.

“The pandemic highlighted our essential role in the medical domain.

It has brought to light how this domain of our profession will need to morph towards the post-COVID ‘new norm’, and have a larger role in primary eyecare and public eye health.”

30% 25% 20% 15% 10% 5% 0

1-3 months

3-6 months 6-12 months

More than Not applicable 12 months

If you have seen a downturn, how soon do you expect your business to return to previous levels?

40% 35% 30% 25% 20% 15% 10% 5% 0

Melbourne ophthalmologist Dr Laurence Sullivan.

Ms Stephanie Yeo (second from left) with her team at the E Eye Place, WA. What best describes your investment plans for the next 12-18 months.

GOVERNMENT RESPONSE In a crisis of this magnitude, businesses look to the government for certainty.

In this instance, Australian leaders have had to activate mechanisms that act as a shock absorber for the economic blow, while simultaneously formulating a clear roadmap to recovery.

While it’s an unenviable task, the sentiment survey asked respondents to rate the government’s support of the eyecare sector during the crisis.

Most respondents (50%) said the government’s support was ‘acceptable’, with 33% rating it as ‘very strong’. Just 16% said it was ‘not enough’.

Anecdotally, many businesses within the ophthalmic sector – both small and large – have labelled the JobKeeper wage subsidy as the single most important measure that ensured their survival, while many individuals have used the JobSeeker scheme to bridge the gap.

Melbourne ophthalmologist Dr Laurence Sullivan capitalised on one of the government’s other stimulus packages: the instant asset write-off threshold which increased to $150,000 from $30,000 for each asset. The measure has now been extended until the end of the year as the government looks to spur further investment.

Sullivan is corneal, cataract and refractive surgeon and a founding director of Bayside Eye Specialists, a multi-disciplinary private ophthalmology practice in East Brighton. He also established Laser Sight, a refractive surgery practice in East Melbourne and is the secretary and treasurer of the Australian Society of Ophthalmologists.

The tax write-off scheme was a motivating factor to upgrade their existing

instruments with the latest IOLMaster 700 biometry device and Humphrey Field Analyzer 3 perimeter.

“The finance industry has also given us an interest holiday and allowed us to defer payments for 12 months, so basically we can get the equipment without having to pay for it straight away,” he explains.

“It will eventually cost us but at least we have been able to upgrade the equipment without taking a big hit to our cashflow, which has obviously decreased at the moment.”

Overall Sullivan thought the government had done a good job to support small and medium-sized businesses. While his workload dropped off when all non-urgent elective surgery was suspended, he has returned to work, albeit with reduced throughput due to strict hygiene protocols.

Looking ahead, he predicts there will be further issues to work through for both public and private ophthalmology.

“With the coming recession we are expecting a downturn in throughput; a lot of patients will give up their private health insurance and not be able to afford private care, so we will see a downturn in numbers overall,” he says.

“We have renegotiated with our staff during the COVID-19 outbreak and pretty much got everyone back to fulltime work, but I really don’t know what the future is going to hold. If there is a downturn in private ophthalmology, then we are certainly going to see the waiting lists for

INSIGHT August 2020 37

BUSINESS RECOVERY

the public hospitals blow out, and I don’t know what the public hospital system is going to do about that.”

60%

BOUNCING BACK With a 97% drop in sales, VS Eyewear was a company that was hit harder than most within the eyecare sector.

50%

The second-generation Victorian-based firm was established in 2002 by brothers Mark and John Van Staveren to manufacture and supply frames to independent Australian practices.

40%

Mr John Van Staveren says he takes his hat off to both federal and state governments for the support during the crisis. Their optometry practice clients predominantly shut down their operations or reduced services to provide only urgent and essential care at the pandemic’s peak, creating a significant knock on effect for his business.

“If we didn’t have the JobKeeper we would have been laying off staff, I would have gone back on the road myself. Having JobKeeper has maintained positions and jobs for us. I’m sure this country is going to pay for it through higher taxes one day but at this point in time it’s kept people employed.”

To highlight the magnitude of the impact, Van Staveren says March sales were down 70%, April 97% and May 70%.

“But surprisingly for June we are sitting at 10% above June 2019 - and that’s with no reps on the road. So that’s been driven mainly by phone orders, people needing stock and topping back up. The reps haven’t really been welcomed back into the practices yet, but come the middle of July the appointments will start up,” he says.

30% 20% 10% 0

Very negative

Somewhat negative

Not alot of impact

We have seen some increase in business

What best characterises the effect of COVID-19 on your business at present.

50% 40% 30% 20% 10% Mr John Van Staveren of VS Eyewear in Carrum Downs, Victoria.

Van Staveren says there will be no major marketing investments for his company in the coming months, but it will continue to manufacture new models and stock as required. It also has to factor in increased cargo costs to get frames shipments to Australia.

0 Very strong

Acceptable

Not enough

How would you rate the government’s support for your industry during the COVID-19 crisis?

But in the next 12-18 months he will consider increasing the salesforce with one new position.

seven in a business with more than 500 employees and four in 51-100.

“To put that into perspective, that would increase our staffing by 15-20%,” he says.

One of the key questions asked respondents to rate on a scale of 1-5 how various information sources influenced their purchasing decisions.

“I think we have kicked the bottom of the hockey stick and it’s now heading back up, that’s my anticipation. July probably won’t be as good as last year, but I think there are signs of positivity – and if we have been a good supplier to people through tough times, we are hoping that will come back to us when the times are a little better.”

The answers were fairly evenly divided, however information directly from suppliers was considered the most influential factor, with a weighted average rating of 3.38 out of a possible 5.

OTHER FINDINGS Insight’s sentiment survey also quizzed respondents about their purchasing habits and trustworthiness of information sources in light of the COVID-19 crisis.

This was closely followed by information from trade events, which generated a weighted average of 3.03. 'Case studies about companies similar to mine' came in third at 2.94, information from third-party sources such as trade magazines and industry reports 2.79 and direct advertising from social media platforms such as Google and Facebook 2.10.

To fully appreciate this, first it is important to understand who responded to the survey and the size of the companies they worked for.

Survey participants were also asked to rate their level of trust in the several types of industry media on a scale of 1 (not trustworthy) to five (very trustworthy).

Of the 151 respondents who detailed their role within their workplace, 46% (69) stated they were in an executive position, followed by 28% (43) in operations roles. In total, 13% (19) said they were a mid-level manager and the same number said they worked in sales and marketing.

Trade magazine and periodic journals were trusted most with an average weighting of 3.66 out of 5. Social media was the lowest, with a score of 1.97, while emailed newsletters generated a strong 3.0 rating and media websites 2.73.

The majority (65% or 100 respondents) worked in a company of 1-10 people, with a further 21% (33) stating their workplace has 11-50 people. Nine respondents worked in a firm with 101-500 people,

The eyecare sector was also optimistic about the prospect of attending trade events when the government deems it safe. In total, 44% they would likely attend, 32% were very likely, and 23% not very likely. n

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INSIGHT August 2020

SAFETY EYEWEAR

INJURIES AND SAFETY EYEWEAR From chemical burns to puncture wounds, most eye injuries can be prevented with the right safety eyewear. RHIANNON BOWMAN reviews current eye injury trends and the role of optometrists and employers to minimise the risks.

P

reventable eye injuries land thousands of Australians in the optometrist's chair or hospital emergency department every year, with a number of cases resulting in permanent damage and significant vision loss.

Eye injuries can happen anytime, anywhere, but some trends are evident. An Australian white paper on eye protection and the importance of protecting vision found eye injuries in the workplace are most likely to happen on a Friday.

At home, most preventable eye injuries happen during DIY projects, car repairs or gardening and are caused by chemical burns, penetrating eye injuries and small particles.

Now evidence has started to emerge that DIY and home-based injuries are reaching new heights, potentially as a result of the COVID-19 lockdown.

This is being attributed to isolation rules, seeing people spend more time on home-based activities – without adequate eye protection.

TRENDS IN EYE INJURIES It is undisputed in the literature that ocular trauma represents a serious public health problem and is a leading cause of visual impairment.

Furthermore, it is widely quoted that 90% of injuries are preventable.

Data from Optometry Australia’s 2020 Vision Index found that 21% of Australians had acquired an eye injury from a DIY project at home but only 12% always wear eye protection for these projects.

INSIGHT August 2020 39

SAFETY EYEWEAR

Despite the risk of injury at home, 60% of all eye injuries in Australia occur in the workplace, according to a white paper published in May this year by Essilor-owned PSG Eyewear, Australia’s largest supplier of certified prescription safety glasses.

Leading eye injury expert, Ms Annette Hoskin, who authored the white paper, says that advances in eye protection design as well as improved work health and safety regulations have helped reduce work-related eye injuries.

“It’s not hard to have the right type of eye protection. But general eyewear – like regular spectacles or sunglasses – does not offer adequate protection.”

She says the severity of an eye injury can be worse if a person has an accident while wearing regular spectacles because the lens can shatter and glass fractures can penetrate the eye.

COVID-19 TRENDS

However, with thousands of people admitted to hospital each year as a result of workplace accidents, Australia is still far from solving this problem.

A study in Italy was one of the first to investigate whether the COVID-19 social distancing measures were having a significant impact on the risk of ocular trauma.

Hoskin is a Research Fellow from Save Sight Institute (University of Sydney) and Lions Eye Institute (University of Western Australia). She is also Essilor’s global standardisation manager, and Optometry Australia’s representative on Standards Australia’s committees for eye protection, spectacles and sunglasses.

It analysed data on patients presenting to an ophthalmological emergency department at a hospital in Bologna, Italy, from 10 March to 10 April 2020, compared with the same period of the previous year.

“Males are over-represented in the literature in terms of the number of injuries,” she says.

“In the population over the age of 65, when falls are more prevalent, we are seeing more woman with eye injuries as a result of falls.

It’s becoming more of a trend.”

Hoskin notes that, anecdotally, there has been a spike in eye-related accidents during COVID-19, many of them related to DIY projects at home.

“Generally speaking, people are not aware of the dangers they may face at home. They don’t know they should be protecting their eyes,” she says.

“In the workplace, there are several visual cue’s and reminders to wear protective eyewear, such as posters and signs, but these don’t exist in the home.”

To help counter the number of eye injuries that result from DIY projects at home, Hoskin wants retail outlets to position safety eyewear directly alongside their range of tools.

“I’ve been looking at how we can get hardware stores to place eye protection beside power tools at the point-of-sale,” she says. “We need to prompt people, ‘If you buy a drill, do you have eye protection to wear with that?’ when they make their purchase.

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INSIGHT August 2020

In a letter to the editor published in May in The Royal College of Ophthalmologists journal Eye, author Marco Pellegrini notes that the study found the number of patients presenting to the emergency department with eye injuries fell by more than half during COVID-19.

According to Pellegrini, there were 354 eye injuries in the 2019 study period compared to 112 in the 2020 study period. During quarantine in Italy, the proportion of children and adolescents with eye injuries decreased (from 14.7 to 8%), while the proportion of males increased (from 66.7 to 75%).

Based on the hospital’s emergency department data, the percentage of eye injuries from falls and sports injuries had the highest decrease.

Meanwhile, injuries during home activities and injuries with plants had the highest increase – from 12.4 to 17% and from 8.5 to 10.7%, respectively.

Anecdotal evidence suggests similar trends have emerged in Australia during COVID-19.

Sydney-based ophthalmologist Dr Tim Roberts, medical director of Vision Eye Institute and a consultant at Royal North Shore Hospital, says there was a distinct change in eye-related injury patterns during the peak of the COVID-19 lockdown.

“Typically, ophthalmic emergencies at Royal North Shore Hospital result from car accidents, alcohol-related incidents, and falls,” he says.

“But during COVID-19, we saw fewer of these types of emergencies,

"THERE ARE TOO MANY PEOPLE WHO DON’T TAKE THEIR EYE SAFETY SERIOUSLY ENOUGH TO BUY OR USE SAFETY EYEWEAR FOR THEIR DIY PROJECTS"

"REGISTRARS REPORTED SEEING FEWER CONTACT-LENS INCIDENTS, AS PEOPLE WERE NOT WEARING CONTACT LENSES WHILE THEY WERE AT HOME IN ISOLATION"

"POLICY CAN HAVE A HUGE IMPACT; FOR EXAMPLE, CHANGES IN LEGISLATION DRAMATICALLY REDUCED INJURIES FROM FIREWORKS"

CAROL MARTIN

TIM ROBERTS

STEPHANIE WATSON

and an increase in DIY and home-based accidents. For example, a yoga mishap with a theraband resulted in a bleed in the eye for one patient.

“Registrars also reported seeing fewer contact-lens incidents, as people were not wearing contact lenses while they were at home in isolation. It is a complete change in the pattern of society.”

Sydney ophthalmologist and RANZCO Fellow Professor Stephanie Watson agrees more accidents are resulting from DIY activities at home since the COVID outbreak.

She recently consulted a 45-year-old man who was painting his ceiling without protective eye wear. “He held the roller brush above his head and paint dripped into his left eye,” she says.

“I also have a 72-year-old patient who tripped over and ruptured her right eye just before the COVID-19 lockdown. She lost her intraocular lens and iris and had a haemorrhage into the vitreous. I repaired her eye but post-operatively she developed raised intraocular pressure that did not respond to topical therapy.

“At the time she required urgent management for her pressure, people her age were being advised to stay at home as much as possible due to COVID-19 and access to surgical facilities were limited.”

The patient’s pressure came under control, the haemorrhage cleared and Watson is now planning sutured intraocular lens surgery to restore her vision.

At home, chemical burns from gardening or cleaning products, and penetrating eye injuries – often caused by using a lawnmower, power trimmer or edger in the garden – are most common.

Because a number of safety eyewear options exist, depending on the hazards and the environment, Hoskin recommends optometrists should be familiar with Australian Standards AS/NZS 1336 (Recommended practices for occupational eye protection), AS/NZS 1337 (Occupational eye protectors), and AS/NZS 1337.6 (Prescription eye protectors).

Employers should also be familiar with Australian Work Health and Safety Regulations, which states that it is an employer’s duty to provide suitable protective clothing and equipment to employees, including eyewear.

"GENERALLY SPEAKING, PEOPLE ARE NOT AWARE OF THE DANGERS THEY MAY FACE AT HOME." - MS ANNETTE HOSKIN

PREVENTING EYE INJURIES To prevent ocular injuries, Watson believes work needs to be done in three key areas: education, protection and policy.

“Prevention begins with education – informing the public of the risk of injury. Next there is the need for people to wear protective eye wear – this is often overlooked when ‘working at home’. Policy can have a huge impact; for example, changes in legislation dramatically reduced injuries from fireworks,” she says.

Last month a national eye health awareness campaign, JulEye, supported by a RANZCO-led charity, aimed to raise public awareness about simple measures to prevent common household eye injuries.

According to Optometry Australia (OA), eye injuries and resulting vision loss represent a major burden to society, with the direct cost of eye injuries in Australia estimated to be more than $155 million per year.

The penalty for non-compliance can be steep for an employer – up to $3 million for an offence committed by a corporate body resulting in serious injury, according to PSG’s white paper. For an employee, the injury can be incapacitating if they suffer permanent vision loss.

For example, in 2016 a company in New South Wales Hunter region was fined $240,000 after a teenage work experience student suffered permanent eye injury after welding for up to five hours. The teen was not told of the need to use welding eye protection and suffered thermal retinal burns, otherwise known as ‘flash burns’, to both eyes as a result, leaving him with a 75% bilateral visual incapacity.

This incident, and many more, highlight the severe consequences of workplace injuries and the importance of safety eyewear to prevent injury and permanent vision loss.

To assist optometrists in their role as primary healthcare providers in preventing eye injuries in the workplace, OA has produced an updated occupational optometry and safety eyewear guide, outlining changes to safety standards and prescribing safety eyewear.

According to the Australian Bureau of Statistics, more than two million Australians work in construction, mining and manufacturing industries, and the market for eye protection in Australia is currently estimated to be worth half a billion dollars annually.

Ms Annette Hoskin was the lead author of the 2020 Occupational Optometry Guide review and update. It includes information on preventing occupational eye injuries, vision assessments, eye protection products, Australian vision and eye-protection standards and screening protocols. It also advises about eye safety consultations and how to conduct workplace screenings.

Kevin Hackett Optometrist in Geraldton, a central hub for the midwest mining region in Western Australia, has a toe in that market. While the practice does not provide workplace screenings, it does provide safety eyewear for mining companies including Rio Tinto, Downer and Iluka.

Ms Carol Martin, a lab technician and optical assistant, has been part of the team for more than 27 years.

When it comes to preventing workplace eye injuries, the task is twofold; optometrists and employers both have a role to play. Hoskin says there is much more to eye safety than just telling employees to wear safety glasses.

She says the practice gets a gauge on what type of eye protection a patient may need during their consultation.

“Optometrists can help differentiate their skills and ensure adequate fit and comfort by individually fitting employees with the appropriate eye protection,” Hoskin says.

When choosing the best eye protection, it is important to understand and differentiate between low, medium and high-impact hazards, the employee’s needs, and their environment.

Common eye hazards in the workplace include high-speed small objects, low-speed large objects, and dust and airborne particles.

Chemicals, thermal energy and radiation can also be hazardous.

“When our patients are being tested, we ask them about their occupation and hobbies. That then enables us to offer safety eyewear if we feel that would benefit them for their eye safety needs and requirements,” Martin says.

The practice also dispenses safety eyewear for patients doing DIY projects at home but not all who should wear safety eyewear do so.

“There are too many people who don’t take their eye safety seriously enough to buy or use safety eyewear for their DIY projects and a lot of people don’t feel they need safety eyewear, even when they do work in areas where debris is flying around,” she says.

“We explain what can happen when or if your eye is damaged and the advantage of safety eyewear protection.”

INSIGHT August 2020 41

SAFETY EYEWEAR

“We have seen the occasional circumstance where a patient has had fine metal fragments in their eye and as a result the patient has been referred to the hospital for the fragments to be removed.”

INCORPORATING SAFETY EYEWEAR INTO PRACTICE Mr Adam Rowe owns Specs 2-4-1 Karratha, in Western Australia’s Pilbara region, home to the ‘giants’ of the mining and natural resources industry, including Rio Tinto, BHP and Fortescue.

Rowe says these companies comply to strict personal protective equipment (PPE) guidelines, including safety eyewear, and every employee must adhere to these guidelines to work on these sites.

Along with supplying safety eyewear to Karratha-based and fly-in fly-out employees, Rowe says Specs 2-4-1 also makes regular visits to inland towns.

“We go to Tom Price, Paraburdoo, Pannawonica, and all Rio Tinto mine sites offering full optometry services to the people who live and work in these towns, and we have been doing so for over 10 years,” he says.

“We not only offer safety eyewear to the Rio Tinto employees, whose safety glasses are supplied by [Essilor-owned] PSG Eyewear, but take along a huge range of optical, sunglass and kids frames for them to look at and purchase while we are there,” he says.

“We also liaise with the child health nurses in these towns who refer children with potential vision problems for us to test and correct with prescription glasses.”

A corneal metal foreign body injury, commonly associated with hammering or drilling metal. Image: Chris Barry, Lions Eye Institute.

“I personally believe that the safety eyewear industry is well-catered for these days. The ranges available are large, stylish, comfortable and as mentioned earlier, we have multiple certified suppliers to choose from so we find it really easy these days to find the right frame for all the different size faces out there.”

To successfully incorporate safety eyewear into general practice, Rowe believes experience is the key.

"THE SAFETY INDUSTRY ITSELF IS BIG BUSINESS – SAFETY EYEWEAR IS THE SAME." - MR ADAM ROWE

Rowe says Specs 2-4-1 has been operating in the Pilbara for the past 18 years and over that time he has seen the safety eyewear industry change dramatically.

“In my early years in optics, I remember when safety glasses did not even need to be certified or even compulsory – we would simply use polycarbonate or even grind CR39 to a minimum thickness at any point of the lens to two millimetres and that would be suitable,” he says.

“Nowadays safety in general, on all work sites, is priority one. We introduced a large range of certified prescription safety glasses from four different certified suppliers over the last 10 years due to the huge rise in demand from employees requiring prescription eye protectors against low and medium impact, meeting AS/NZS 1337.6.2012 standards.”

Rowe says safety on work sites is paramount: “The safety industry itself is big business – safety eyewear is the same.

“Safety eyewear for our practice, been located in Karratha, is constant and we do large numbers of prescription safety glasses every month which is financially rewarding for the practice,” he says.

In Rowe’s experience, selling a pair of safety glasses often converts into a purchase for new personal eyewear while the patient is in the practice.

“While safety eyewear ranges have become a lot larger and better looking over the years, people still like to purchase a nice pair of sunglasses or glasses for while they are not at work,” he says.

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“I believe having experience in all aspects of dispensing is very important and supplying the patient the best possible frame to suit their prescription and head. No one wants to wear bad fitting frames on a 12hour shift,” he says.

Specs 2-4-1’s experienced optometrist Mr Nick Defteros conducts all patient eye exams, both in-store and inland.

“The only specialised equipment we use, rather than standard optometry consulting room set-up, is how we do eye testing when we go to inland towns Tom Price, Paraburdoo and Pannawonica. We obviously can’t take our optometry chair with us, but we do take a phoropter and connect it to a portable phoropter stand which works perfectly, allowing Nick to offer a comprehensive standard eye test in these remote locations,” Rowe says.

Dispensing safety eyewear is very similar to dispensing normal spectacles, with one exception, he says.

“The patient’s prescription is the most important thing to consider before looking at frames but one major way dispensing safety eyewear is different is that there are a lot of wrap around frames to choose from in the safety ranges.

"Wrap around frames and progressive lenses or certain prescriptions usually don’t mix too well, that’s why I sell more of certain supplier’s frames than others.

“Some suppliers make their plastic safety frames appear to be wrap around, but they are actually flatter than they look and have been designed this way to accommodate progressive lenses better. Other safety eyewear suppliers have just brought out 8-Base curved frames which limits what prescriptions and lens designs we can put in them.”

Again, Rowe emphasises that experience is key.

“Experience and all the things I have learned over the years in optics has helped the selling of safety eyewear become successful and the growth of the safety eyewear industry overall has also helped grow my practice,” he says. n

FEATURE

COUNTING THE COST OF MISSED APPOINTMENTS The nation’s first look at the impact of reduced optometry services due to the COVID-19 lockdown has been provided in new Specsavers data. Australia and New Zealand optometry director Dr BENJAMIN ASHBY delves into the statistics and outlines a plan to manage the patient backlog.

I

Cancelled elective surgeries and the complete shutdown or reduction of optometry services featured high on a lengthy list of challenges for the eye health sector. As a result, thousands of Australians missed out on vital eyecare.

“‘Open for Care’ meant that we were focussed only on providing eye tests for those requiring urgent care. This included assessment of those patients with symptoms consistent with a high risk of vision loss that may require an emergency referral to a specialist; to those requiring red eye management and treatments; for the renewal of prescription eye drops; and for ongoing care for those with vision threatening eye conditions.”

Now, for the first time through Specsavers data gathered during the lockdown spanning 30 March to 31 May, it is possible to quantify the impact on patient services and the subsequent backlog.

Ashby said optometrists also assisted patients who had changes in vision that prevented them from functioning normally or caused anxiety, as well as helping those referred from other health professionals.

According to Dr Benjamin Ashby, optometry director for Specsavers Australia and New Zealand, 2020 was supposed to be the year when vision and eye health came to the fore in public consciousness.

Dispensing assistance was available for patients with urgent needs.

Glasses and contact lenses were posted to customers’ homes, while the company created instructional videos to help patients perform their own temporary repairs. It also deployed extended teams which helped with additional customer support needs and virtual dispensing from its Support Office.

n March, Australia faced unprecedented and immediate disruption to all services as the country battled the unknown effects of COVID-19.

Across its 350 Australian practices alone, the optical chain was anticipating the delivery of eyecare to 3.6 million patients. It had strategies in place to detect and refer 51,000 cases of glaucoma; to register 200,000 Australians living with diabetes to KeepSight, helping to protect their vision from diabetic retinopathy; and to identify and refer 56,000 people with suspected retinal conditions.

Ashby said prior years of strategy, collaboration and implementation had firmly established this trajectory of progressing Specsavers’s longterm goal of transforming eye health to eliminate avoidable vision loss for its patients.

However, this was curtailed with the emergence of COVID-19.

On 30 March 2020, like many other optometry practices, Specsavers made the difficult decision to close its doors to routine eyecare.

“Cognisant of the escalation and extension of important restrictions to flatten the curve of COVID-19, and wanting to ensure the safety of patients and staff as well as supporting the nation in time of crisis, Specsavers hibernated normal retail services and remained only open for urgent and essential care,” Ashby said.

“For the first time ever, our doors were closed to most patients,” Ashby explained. “As experienced by all eye health practitioners, COVID-19 caused a major disruption to the industry.”

The scale of interruption was evidenced in statistics supplied by Specsavers, which demonstrated, nationally, there were 600,000 fewer optometry Medicare patient services from March-April compared with the same months in 2019. Additionally, there were 40,000 fewer visual fields administered in the same period.

In the first week of its ‘Open for Care’ model, Specsavers also saw a 91% patient drop compared with same week-long period last year.

As a result, thousands of Australians missed out on the eyecare they were due.

From 30 March to 31 May, 200,192 patients presented to Specsavers optometrists nationwide. Of those, 3,893 were referred for urgent specialist assistance and 9,298 were given non-urgent referrals.

INSIGHT August 2020 43

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REFERRAL VOLUME COMPARISON CHART

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In April and May, 25,208 patients that likely required specialist attention did not attend their appointments.

detections of glaucoma and other degenerative eye conditions BasedREFERRAL on this, inVOLUME April and May, 25,208 Specsavers patients that COMPARISON CHART ESTIMATED EYE CONDITIONS are OF identified. likely7000 had eye conditions requiring specialist attention did not attend INCIDENCE 6000 IN PATIENTS NOT SEEN IN APRIL OR MAY their5000 appointments.

“Specsavers is now detecting more than 40,000 patients with glaucoma each year, in line with prevalence rates,” he said.

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A four-week year-on-year comparison also indicates the post-COVID-19 backlog of patients with diabetes.

“Half of the patients are newly diagnosed and, according to Glaucoma Australia, where 66% of referrals come from Specsavers, their average age of referral has decreased from 80-89 to 60-69 years old since we’ve introduced measures to detect glaucoma earlier.” al

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He continued: “Thankfully, the fight against COVID-19 is being won and the necessary closures and restrictions to eyecare set to flatten the curve Feb-20 Mar-20 Apr-20 May-20 In April 2019, Specsavers optometrists saw 13,319 patients with diabetes AprilareMay(at time of writing 15 June 2020) being lifted by Federal and State Governments. As we know from the data, there is pent-up demand for for their vital diabetes eye checks. The company had just got behind optometric services and this has put many patients not seen at risk.”

Diabetes Australia’s KeepSight initiative as a co-funder alongside the Federal Government, Novartis and Bayer and, in subsequent months, it Ashby said Specsavers is focussed on providing a safe environment saw a steady increase of patients with diabetes. for patients as routine care resumes. As the company has stood up employees and started to offer services to more members of the public, In line with the projected growth of diabetes eye checks, Specsavers it is providing patients and staff with a modified practice environment that expected to see an average of 22,654 patients with diabetes per month ESTIMATED INCIDENCE OF EYE CONDITIONS IN PATIENTS NOT SEEN IN APRIL OR MAY follows health department guidelines. across 2020.

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7000 In February this year, it cared for 21,197 patients with diabetes. Then in 6000 5000 April, only 1,386 patients with diabetes presented to its optometrists. Of 4000 those, 3000 only 670 patients were registered to KeepSight from Specsavers 2000 1000 over the 0four-week period compared with 7,632 in February.

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This trend was seen nationwide across all optometry professionals, as reflected in the use of Medicare item 10915, which was used 10.7% more year-on-year in February but then 9.2% less than 2019 in March and 75.6% less than 2019 in April. April May Simply comparing 10915 for 2019 versus 2020, it has been established that at least 2,190 patients with diabetes missed out on dilated eye examinations in March and 15,714 in April, indicating the backlog of patients with diabetes that are now in need of prioritised care.

SPECIALIST CARE REFERRALS Specsavers data also indicates some interesting findings in the percentages of patients referred for specialist care, demonstrating the urgency of the patients who received eye tests during the lockdown period.

April 2019 saw 6% of patients being referred for urgent eyecare. This rose to 11.9% in April 2020, showing that while patients for general testing significantly decreased, a higher proportion required urgent care.

From an early detection perspective, a year-on-year comparison of Medicare item 10910 shows that 166,635 Australians missed out on routine eye tests in March and April 2020 due to the impacts of COVID-19.

Ashby said that not only is prescribing glasses and contact lenses important for the quality of life and long-term eye health, but this patient base is where – through a systematic approach to eyecare – early, initial

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Specsavers is also working on a recall model which engages those in Australian communities who need prioritising for care. This involves prioritising recalling patients with risk factors such as diabetes who have missed their original appointment. Similarly, it will manage those with other eye conditions such as glaucoma while also factoring in bookings for day-today cases where unusual or previously unknown conditions often present.

“Since reopening for routine eyecare, the data has surprised and given a positive outlook on what we might expect for the rest of 2020,” Ashby said.

“At this stage, Australians seem to be prioritising eyecare and pent-up demand has seen our numbers start to increase again. In the week of writing this, Specsavers national patient volume is uniformly increasing and patients with diabetes make up 6.8%, in line with population prevalence – an important indicator that we are seeing patients present in the right proportions.

“As restrictions continue to lift and as it becomes safer for at-risk patients to confidently leave their homes, we are anticipating further growth of patients.”

Ashby said the company had a long way to go and it’s implementing strategies to best tackle the pent-up demand for optometric services to ensure an increase of positive eye health outcomes.

“As I’m sure many optometrists will relate, COVID-19 has been a tangible reminder as to why we do what we do. Never before has optometry been so important and never before have we seen such proportions of patients in need of urgent care,” he said.

“Given the quantity of Australians in need of eyecare at the moment, I believe we should expect a big year ahead. That might just make 2020 the great year for optometry and public eye health that we always hoped it would be. n

INSIDE AN ORTHOPTIC-LED CATARACT CLINIC A NEW CLINIC LED BY UPSKILLED ORTHOPTISTS IS HELPING A LEADING MELBOURNE HOSPITAL REDUCE CATARACT WAIT TIMES AND STREAMLINE FOLLOW UP APPOINTMENTS. JULIE TAYLOR REFLECTS ON ITS SUCCESSES AND FUTURE PLANS.

T JULIE TAYLOR

THE ORTHOPTISTS WHO ARE WORKING ON THE CLINIC ARE LOVING THE CHALLENGE AND THE CHANCE TO PROVIDE A SERVICE OF THE HIGHEST STANDARD

he Royal Victorian Eye and Ear Hospital has been proactive in seeking and supporting nonmedical models of care in the ambulatory services setting to offset the workload from the traditional medical model. These alternate models of care have been employed where there are recognised service gaps including high demand and/or medical workforce shortages.

A success story for the hospital has been the development of an orthoptic led post-operative cataract clinic (OSOP) in response to a program funded by Better Care Victoria to identify and embed innovation across our health service.

The primary objectives for developing the OSOP clinic model was specifically to reduce appointment wait times and streamline follow up appointments for our post-operative cataract patients.

For the 664 patients who have been through the clinic since late 2017 we have achieved: • 93% patient satisfaction rate with OSOP clinic.

• 84% of respondents felt the time spent in clinic was ‘about right’ with the average time spent in OSOP ranging from 45-86 minutes.

• 86% of respondents happy to be reviewed by an orthoptist instead of a doctor.

The format of the OSOP clinic is specifically for the assessment of routine, three-week post-operative cataract patients by credentialed orthoptists, with the aim to discharge patients to a community provider where there are no clinical concerns.

To determine suitability for discharge, assessment of these patients is undertaken against a clinic-specific pro forma designed by the medical staff which is inclusive of ocular history, visual acuity, best corrected visual acuity, retinal examination (via Optos imaging) and a complete slit lamp examination.

Any patient who is noted at this three-week visit to have reduced vision, refractive surprise, post-operative inflammation, retinal changes or any

other concerns, are immediately transferred to the doctor-led cataract clinic that runs concurrently with OSOP. The benefit of this clinical rostering format is that the patient is never at a disadvantage to their care should they require medical intervention.

In addition, this direct relationship with the ophthalmologists also provides the opportunity for the ongoing exchange of clinical information and development of clinical skills for our OSOP orthoptists.

Even with the fantastic results we have achieved and the positive response from staff involved, what is now most exciting about this clinical innovation is that it has continued to evolve and expand.

What started as a very successful non-medical post-operative cataract clinic model running fortnightly, has now evolved into the review of patients for both post-operative cataract care and post-operative pterygium care and runs three sessions per week.

With expansion comes the need to have more orthoptists credentialed to undertake assessments.

Since the program’s inception, we had three specially trained and credentialed orthoptists, with a further three credentialed over the past 12 months due to clinical demand, and another three currently in training.

Credentialed OSOP clinic orthoptists (from left) Husna Maruf, Melissa Tchea and Julie Taylor.

paves the way for future similar projects utilising the skills and knowledge of our allied ophthalmic healthcare providers to improve services.

As an OSOP credentialed senior orthoptist at The Eye and Ear, I believe this program has been a win-win for all involved. The patients are appreciative of the exceptional service they receive, referring practitioners are being kept in the loop as to their patient’s ocular status, and the orthoptists who are working on the clinic are loving the challenge and the chance to provide a service of the highest standard.

The process for training and credentialing is four-pronged, inclusive of group training sessions, one-on-one training sessions with ophthalmologists, knowledge of theory and principles, with a key addition to our training program being the ability to provide a mentoring program where credentialed orthoptists mentor the orthoptists-in-training.

The future is looking bright for the clinic. Where do we see ourselves in 12 months? We are looking to have our entire Eye and Ear orthoptic workforce trained to undertake this level of assessment so that is where I am hoping we can get to. n

Oversight of the program continues to be provided by the Surgical Ophthalmology workforce – headed by Dr Anton Van Heerden, Head of Surgical Ophthalmology Services at The Eye and Ear. He says the introduction of our orthoptic-led clinics has allowed the hospital to improve clinical efficiencies, reduce wait times and maintain clinical excellence. He believes this initiative also

ABOUT THE AUTHOR: JULIE TAYLOR is a grade 3, senior orthoptist and oculo-plastics clinic liaison.

She has worked at the Royal Victorian Eye and Ear Hospital for over 20 years and specialises in competency and credentialing packages.

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

INSIGHT August 2020 45

DISPENSING

COMPARING MEASUREMENT TECHNIQUES: PART 2 RANGING FROM RULERS THROUGH TO TOWER-BASED SYSTEMS, GRANT HANNAFORD EXAMINES THE VARIOUS MEASURING TECHNIQUES AND SYSTEMS USED IN PRACTICE AND HOW THEY STACK UP.

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art one of this column discussed the ways that accuracy and precision may influence the results of measurements in practice.

So how does this relate to our day-today practice? It is after all, a somewhat abstract concept that seems more at home in a lab than in an optical practice.

GRANT HANNAFORD

WE SHOULD ALL CONSIDER OURSELVES TO BE PERFORMING SCIENTIFIC MEASUREMENTS ON A DAILY BASIS. WITH THIS MINDSET WE WILL BE ABLE TO APPROACH EACH PATIENT AS A UNIQUE CASE

In reality, we should all consider ourselves to be performing scientific measurements on a daily basis. With this mindset we will be able to approach each patient as a unique case rather than another face in the crowd and ensure their lenses are fit as close to the ideal fitting point as possible.

Now that we have a feeling for precision in measurements, we can look at how these techniques compare. This can be a fairly emotive issue as practitioners may mistake a discussion of precision as a critique of their performance. This is absolutely not the case. Looking at the accuracy of the various methods from the previous article provides a glimpse of the differences in precision and therefore, the potential sources of error that must be overcome in order to produce accurate data.

We are all familiar with manual techniques such as rulers and measurement jigs that are mounted on the spectacle frame. Essentially they are the same, simply providing a scale for measurement and have come in many forms over the last 50 years. The primary difference between these two methods is the ruler is hand-held by the operator while measurement jigs are mounted on the patient’s frame. Mounting the ruler or scale on the frame we are able to remove a potential source of error due to hand movement from the operator, though there is still an issue with parallax error. These manual methods have been found to have significant dependence on the training of the operator, with experienced operators having the best results. Nonetheless the range of values generated, even by skilled operators, can vary by over 4mm ([1-3]) for the same patient which makes this style of measurement unreliable for lenses requiring higher precision.

App-based measurement systems tend to be developed by established

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Figure 1: Top and side view of simple construction for multi camera system (based on 2009 patent [5]).

lens laboratories or independent sources such as developers on the app store.

These types of apps often use a reference device to obtain their measurements like a frame mounted jig or, for the apps aimed at the home user, a credit card.

By placing a reference of known dimensions into an image, the relationship between a known element and the unknown facial parameters provides a ratio for determining lengths etc. Devices from lens labs that are built for purpose deliver far more consistent results than an ad-hoc system like credit cards. Angular measurements and CRR data are not usually included in the lab-based systems and are not included in the ad-hoc (credit card) systems. ‘Tru vision’ and similar features found on modern phones can use the depth detection feature to develop a model through simple trigonometric relationships as well as ratios as used in the other methods. These tend to be very susceptible to angular issues like head rotation, cant and tilt. We have observed errors of over 8mm in measurements induced by head movements of less than 10 degrees, while these features present interesting potential they are perhaps not mature enough to deliver reasonable accuracy at this point.

Tower based systems use a similar theory regarding trigonometric relationships to develop data [4-6]. In single camera systems a known element like a frame jig provides the ‘base’ of a triangle from which data is drawn. Multiple camera systems reverse this concept by placing the ‘known’ part of the system

on the measuring unit itself in the form of camera angles and distance between cameras (see Fig 1). In essence, these systems aim to provide greater accuracy by reducing the number of variables, degrees of motion/freedom and hence overall uncertainty.

Ultimately the purpose of these attempts to increase accuracy is so the benefits of more precise lens design and generation may be realised while minimising the effects of small changes in frame placement as the patient takes their glasses on and off.

The development of these systems is covered more comprehensively in a webinar on our website. n REFERENCES: 1. McMahon, T.T., E.L. Irving, and C. Lee, Accuracy and repeatability of self-measurement of interpupillary distance.

Optom Vis Sci, 2012. 89(6): p. 901-7.

2. Brooks, C.W. and I.M. Borish, System for ophthalmic dispensing. 3rd ed. 2007, St. Louis, Mo.: Butterworth Heinemann. xx, 665 p.

3. Holland, B.J. and J. Siderov, Repeatability of measurements of interpupillary distance. Ophthalmic Physiol Opt, 1999. 19(1): p. 74-8.

4. Altheimer, H., METHOD AND SYSTEM FOR OPTIMIZING A SPECTACLE LENS BASED ON INDIVIDUAL PARAMETERS OF A WEARER, U.P. Office, Editor. 2014, Rodenstock GmbH, Munich (DE): USA. 5. Rodenstock, Device and method for deterimining optical parameters US20090021693A1.pdf. 2009.

6. GMBH, C.Z.V.I., BILDAUFNAHMESYSTEM UND ANPASSSYSTEM. 2018.

GRANT HANNAFORD is the co-founder and director of the Academy of Advanced Ophthalmic Optics. He has been practicing in optics for more than two decades and works with optometry and dispensing students, as well as industry professionals.

MANAGEMENT

PATIENT RECORDS – ACCESS AND OWNERSHIP FROM CYBER SECURITY TO PROTECTING BUSINESS INTERESTS, THERE ARE A HOST OF CONSIDERATIONS SURROUNDING PATIENT RECORDS. KAREN CROUCH DRILLS DOWN INTO THIS CRUCIAL FACET OF PRACTICE MANAGEMENT.

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n light of recent announcements about cyberattacks by state-controlled sources, it is timely to consider the sanctity of patient records, including access and ownership rights.

KAREN CROUCH

WHEN A CLINICIAN CEASES WORK IN A PARTICULAR PRACTICE, THEY MAY SEEK TO TAKE COPIES OF CERTAIN PATIENT RECORDS IN THE HOPE OF ENTICING THOSE PERSONS

Practice records are the life blood of a business, not to mention legal requirements and criticality of ready access. Consequently, they are vital to ensure efficient patient and practice management. While records are undisputed assets of the practice, access to and ownership in particular, may differ.

Introduction of e-health records has increased accessibility to patient information as they permit review by patients. This source of valuable information is also hyperlinked to various other websites and computer applications.

Of course, before developing a library of patient records as part of a new/existing practice start up, owners must carefully consider technological aspects of record retention, assured availability and secure storage. An experienced IT provider will provide relevant options on information management such as cloud, hosted or native applications to select from.

Back up of records is naturally a critical factor in such considerations as ready access to patient information, recent and/ or historical, is an essential element of quality healthcare.

Apart from ready, reliable access to records, security of computer applications is another vital consideration. This is regardless of whether they are remotely located or housed in-practice, particularly in light of frequent incidence of ‘hacking’.

Having ensured safe storage, accessibility and back up, owners need to heed legal requirements. In determining reasonable and legally defensible entitlements of owners and clinicians, various ‘engagement’ scenarios are worthy of deeper consideration: Employee: a clinician engaged under typical employer-employee conditions (formal employment contract), which will, for instance, include payment of superannuation by the practice owner.

Staff so employed do not have any rights

to remove or copy records or even view out of curiosity or other casual reasons for any purpose other than the normal course of their daily duties.

Contractor: a clinician engaged as an individual or through their personal entity to provide healthcare services to all patients of the practice, utilising all business facilities and resources, regardless of whether patients were introduced by the owner or contractor.

It is worth noting that, in the optometry sector, verbal agreements with ‘contractor clinicians’ are not uncommon.

Practice records are an integral part of any Contractors do not have an entitlement healthcare business. to remove or copy patient records during or after their employment. responsibilities, these conflicting interests Licensee: a clinician engaged to may result in a dispute, particularly provide services to his/her own patients between owners and contractors. (introduced by the licensee, not the A few other facts are worthy of note: practice), utilising practice facilities and Practices must facilitate access to patient resources. This category is invariably records to allow clinicians to provide covered by a formal Facilities (or similar) reliable, fully informed healthcare services.

Agreement as terms and conditions Without inferring any wrongdoing, if a differ markedly from those of contractors (departing) clinician decides to extract or employees. In this circumstance, all copies of selected or several patient patient records remain the property of records for his/her personal future benefit, the licensee and may be removed if the it could be relatively easy to do so without licensed clinician leaves the practice. raising suspicion.

The primary benefit of patient records, There is no specific, optometry industry apart from ensuring accurate historical related legislation dealing with these and healthcare information, is to develop matters, particularly in the absence of and grow business, whether for practices formal contract documentation. or for individual clinicians who may So, what is the best approach to avoid operate on a part time basis at more than possible disputes? one practice.

The most practical and prudent solution So, naturally, when a clinician ceases is to execute written contracts that clearly work in a particular practice, they and unambiguously define both parties’ may seek to take copies of certain rights. Such contracts usually contain patient records in the hope of enticing certain restrictive covenants to protect those persons to their new place of practice owners’ businesses. For example, employment. In instances where high the employee/contractor clinician agrees quality service has been consistently not to be involved, directly or indirectly, provided to the patient, the attending in another practice which competes with clinician will invariably seek to build on the owner’s business and is within a goodwill and retain the custom of their reasonable time and radius. n regular patients who may prefer to be serviced by a proven supplier.

Conversely, the owner may wish to retain such records to secure the ongoing custom of those patients who promote success of the business. When a written contract has not clearly defined rights and

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 her on 0433 233 478, kcrouch@hpcnsw.com.au or www. hpcgroup.com.au.

INSIGHT August 2020 47

SPECSAVERS – YOUR CAREER, NO LIMITS Full/part-time optometrist opportunities across QLD/NT

All Specsa ve stores rs no with O w CT

Whether your heart lies on golden, sandy beaches, tropical rainforests or somewhere in between, Queensland has a piece of paradise with your name on it! Specsavers can offer an excellent work environment, market leading equipment – including OCT in every store, experienced retail support teams and a host of professional development opportunities. There are a range of full-time, part-time and contract positions available in the region so, whether you are looking for the security of a permanent position or the flexibility of a fixed-term contract, Specsavers has you covered.

Graduate recruitment The Specsavers Graduate Recruitment team are currently recruiting for vacancies in Perth, WA. If you relocate with friends, you will be eligible for our ‘Go with a Friend’ incentive. Whether it be for a new challenge, or perhaps starting afresh and relocating for 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. If you believe in providing best value eye care and exceeding the customer’s expectations, then contact us and find out more.

Western Australia Mobile Optometry Team Specsavers is currently seeing amazing growth of our location within WA, and from growth comes opportunity! We have roles available in our growing Mobile Optometry Team working across Perth, other beautiful coastal and regional locations. We are looking for optometrists with a minimum of 2 years’ experience who have the desire and flexibility to travel and all travel and self-contained accommodation whilst on assignment will be provided (subject to requirement), plus we offer a salary package of $150,000 with five weeks annual leave.

Partner Recruitment – Joint Venture Partnership opportunity – Specsavers Dubbo, NSW Specsavers is currently on the lookout for an experienced optometrist to join us as a joint venture partner in our Dubbo, NSW store.

The store is located within Dubbo Square and expanded at the end of 2019. The store itself is 188 sqm in size and boasts 10 dispense desks, four testing rooms, dedicated audiology room, staff room and office, and over 1,170 frames on display. Since opening in 2011, the store has built a loyal database of patients and become a reputable eyecare provider in the area.

Queensland and Northern Territory locum stints available Specsavers Queensland and Northern Territory are seeking experienced locum optometrists starting from August for durations from three weeks to five months. With current government border regulations, optometrists from VIC are excluded, but we are still gathering expressions of interest.

SP EC TR VISI UM T -A NZ .CO M

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: Maria Savva – Partner Recruitment Manager

maria.savva@specsavers.com or 0401 353 587 NSW/ACT, SA & WA enquiries: Madeleine Curran – Recruitment Consultant

madeleine.curran@specsavers.com or 0437 840 749 QLD/NT & VIC/TAS enquiries: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134 Locum employment enquiries: Cindy Marshall – Locum Team Leader

cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries:

apac.graduateteam@specsavers.com

Your travel, accommodation, and car hire (where required) will be provided, along with a dedicated professional team who are passionate about eye health and excellent service.

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Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

We have a dynamic team of two optometrists and four dispensing optometric assistants.

Eyecare Plus provides business support and marketing services to over 155 clinically focused independent full scope optometry practices throughout Australia. Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment, including an OCT in the majority of our practices.

We will be advertising for this position locally from August 2020 with a view to commencement in September. This position offers a chance for a complete change of scenery and a unique opportunity to experience the great aspects of the laid back Territory lifestyle.

Eyecare Plus offers three membership options; branded, co-branded and unbranded.

Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training. We also actively assist Optometrists and Dispensers who are looking to establish their own practice.

If you are looking to buy, or sell, an optometry practice, please contact us.

For more information call Philip Rose: 0416 807 546 or email: Philip.rose@eyecareplus.com.au.

OPTICAL DISPENSER – WARNERS BAY, NSW An established independent optometry practice in the suburb of Warners Bay, NSW is looking for an enthusiastic, hard-working dispenser to join our friendly team. The successful applicant should have the following skills and attributes: Optical Dispenser qualifications with a passion for providing the highest customer service and aftercare. An ability to build rapport and demonstrate good interpersonal skills when dealing with customers. Able to show initiative, be punctual and reliable.

The position can be Full-Time or Part-Time with 4.5 days/week; Tue to Fri 8.30am – 5.30pm & Sat 8.30am – 12.30pm available. You will need to be flexible to work shifts to cover other staff that are on leave.

Please forward your resume to lakesideoptical@bigpond.com

OPTOMETRIC ASSISTANT- ALICE SPRINGS A Permanent-Part-Time Optometric Assistant position with 30-35 hours per week is available.

An exciting position is becoming available at Eyecare Plus Alice Springs. The successful applicant will work in our busy Alice Springs practice. Pre and post screening tests, optical dispensing and reception/administrative duties will be the main duties carried out.

Early expressions of interest and a detailed CV can be emailed to: Bill Robertson: alicesprings@eyecareplus.com.au

CASUAL OPTICAL DISPENSER – GOLD COAST Eyecare Plus Mermaid Beach have a primary focus on eye health. We pride ourselves on putting our patients first and exceeding patient expectations. We are currently seeking an experienced, energetic, enthusiastic and highly motivated Optical Dispenser to join our busy team.

The applicant should have good organisational skills and excellent communication skills.

A passion for delivering outstanding customer service in a health focused practice and a willingness to learn and broaden your skills is essential. To be considered you must have experience selling prescription eyewear and contact lenses. Be confident with eyewear adjustments and face measurements as well as know how to sell multicoat, Transitions, premium progressive lenses, prescription sunglasses and multiple pairs. Due to the nature of the business, high attention to detail is essential. You will need to be available to work Thursday nights and attend occasional training sessions outside of work hours. If you think you are the perfect fit for our friendly dedicated team, we would love to hear from you.

Please email your CV to Shaina Zheng: s.zheng@eyecareplus.com.au CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/ OPTICAL DISPENSER / SALES ASSISTANT: Warners Bay, NSW. Alice Springs, NT.

Mermaid Beach, QLD.

2020/21 CALENDAR AUGUST 2020 RANZCO QUEENSLAND BRANCH MEETING Brisbane, Australia 15 August ranzco.edu

SEPTEMBER 2020 TFOS 2020 CONFERENCE Cernobbio, Italy 9 – 12 September tfos2020.tearfilm.org

RANZCO BOARD MEETING Australia 12 September ranzco.edu

CONGRESS OF OPHTHALMOLOGY AND OPTOMETRY CHINA Shanghai, China 18 – 20 September cooc.org.cn

VISION EXPO – EAST & WEST Las Vegas, USA 23 – 26 September east.visionexpo.com

EUROPEAN ASSOCIATION FOR VISION AND EYE RESEARCH CONGRESS Nice, France 24 – 26 September ever2020.org

OCTOBER 2020 20TH EURETINA CONGRESS Amsterdam, Netherlands, 1 – 4 October euretina.org

SILMO PARIS Paris, France 2 – 5 October silmoparis.com

EUROPEAN SOCIETY OF CATARACT AND REFRACTIVE SURGEONS CONGRESS Amsterdam, Netherlands 3 – 7 October escrs.org

AMERICAN ACADEMY OF OPTOMETRY MEETING Nashville, USA 7 – 10 October academymeeting.org

Adelaide, Australia 19 – 21 November optometry.org

AUSCRS 2020 Noosa, Australia 22 – 25 November www.auscrs.org.au

SILMO BANGKOK Bangkok, Thailand 25 – 27 November silmobangkok.com

FEBRUARY 2021 MIDO EYEWEAR SHOW Milan, Italy 6 – 8 February mido.com silmobangkok.com

MARCH 2021

AUSTRALIAN VISION CONVENTION 2021 Brisbane, Australia.

27 – 28 March optometryqldnt.org.au silmobangkok.com

CONFERENCE OF THE GERMAN SOCIETY OF OPHTHALMOLOGY Berlin, Germany 8 – 11 October dog.org

RANZCO COUNCIL MEETING Australia 9 October ranzco.edu

INTERNATIONAL OPTICAL FAIR Tokyo, Japan 27 – 29 October ioft.jp

NOVEMBER 2020 ASIA-PACIFIC VITREO-RETINA SOCIETY CONGRESS Taipei, Taiwan 6 – 8 November 2020.apvrs.org

OPTOMETRY NSW/ACT CANBERRA CONFERENCE Canberra, Australia 8 November optometry.org.au

5TH WCPOS Amsterdam, Netherlands 2 – 4 October wspos.org

OV/SA BLUE SKY CONGRESS 2020

To list an event in our calendar email: myles.hume@primecreative.com.au

DECEMBER 2020

APRIL 2021

BARCELONA SPECS 14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS 2020 Brussels, Belgium 14 – 16 December egs2020.org

JANUARY 2021 OPTI 2021 Stuttgart, Germany 8 – 10 January opti.de

GLOBAL SPECIALTY LENS SYMPOSIUM Las Vegas, USA 20 – 23 January na.eventscloud.com/

100% OPTICAL London, UK 23 – 25 January 100percentoptical.com

EUROPEAN MEETING OF YOUNG OPHTHALMOLOGISTS Brussels, Belgium 30 – 31 January emyo2020@seauton-international

Barcelona, Spain 10 – 11 April barcelonaspecs.com

JULY 2021 APOTS MEETING Bali, Indonesia 1 – 4 July apots2020.com apots2020.com

JULY 2021

OPHTHALMOLOGY UPDATES! Sydney, Australia 28 – 29 August ophthalmologyupdates.com

AUGUST 2021 5TH ASIA-PACIFIC GLAUCOMA CONGRESS Kuala Lumpur, Malaysia 13 – 15 August apgc2020.org

AAO ANNUAL MEETING Las Vegas, USA 14 – 17 November aao.org

INSIGHT August 2020 49

SOAPBOX

DRY EYE TREATMENT IN AUSTRALIA cautery, there are essentially no dry eye treatments that are subsidised for Australian dry eye sufferers.

Whilst we are missing some of the newer treatments for dry eye, the use of some antiquated treatments still persists.

Formaldehyde was only removed as an ingredient for baby shampoo in 2013 in the US and later in some countries, yet some practitioners continue to recommend its use for eyelid hygiene.

Baby shampoo may be designed not to sting the eyes, but it isn’t designed to specifically go in them. Gentler but more effective lid hygiene preparations exist that are much more effective against Demodex and trials comparing baby shampoo to dedicated eyelid cleansers have shown baby shampoo to be inferior.

D

ry eye remains a very common presentation to primary eyecare practitioners in Australia. Many experienced practitioners feel that the incidence of dry eye is increasing significantly. This is a complex and multifactorial disease which begs the question: Are we doing enough for our patients and how could we do better?

In some areas, Australia leads the world in the uptake and development of new dry eye treatments. Australia was one of the first countries to have widespread adoption of intense pulsed light for the treatment of meibomian gland dysfunction and the range of Optimel Manuka Honey eye treatments were also developed in Australia.

The Therapeutic Goods Administration (TGA) and the Pharmaceutical Benefits Scheme (PBS) play a vital role in keeping our patient’s safe and our health system effective. However, the cost of obtaining TGA approval for new medications means a small market like Australia is often overlooked by pharmaceutical companies due to the high cost of gaining TGA approval. This is particularly problematic for medications with low sales volumes such as dry eye medications as compared to new diabetic drugs.

Australia has been lucky to have had Sun Pharma recently obtain TGA approval for Cequa, a new nanomicellar 0.09% ciclosporin preparation.

However, first generation ciclosporin compounds have been available in

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INSIGHT August 2020

the rest of the world for over a decade and Cequa is the first TGA-approved ciclosporin in Australia.

Even once medications such as Cequa are approved, this does not grant an automatic subsidy under the PBS, meaning our patients must pay significant out of pocket costs for their medications. There are other examples of ophthalmic solutions for dry eye disease that have been available in other countries for many years, but are yet to be released in Australia.

Whilst TGA approval for some of these medications may be under way, approval is never guaranteed. Even most nonpreserved lubricants are only approved for subsidy under the PBS where the patient is “sensitive to the preservatives in multi-dose eye drops”.

Given the well documented and frequent ocular surface issues caused by benzalkonium chloride – surely the PBS should be supporting the use of lubricating drops that don’t contain preservatives. The availability of other non-preserved medications such as steroids, NSAID’s and glaucoma preparations are also limited by the above factors.

Similarly, Medicare has not yet adopted any procedural treatment for dry eye in the MBS schedule. This means the expense of procedures such as intense pulsed light, Rexon and LipiFlow must be entirely borne by our patients. In fact, except for punctal plugs and

The administration of topical androgens has long been identified as a potential treatment for dry eye and meibomian gland dysfunction. This is borne out of both laboratory research and epidemiologically by the fact that the vast majority of people presenting with meibomian gland dysfunction are postmenopausal women. This represents an opportunity for Australia regarding investigation into androgen treatments for dry eye and meibomian gland dysfunction and represents a fabulous opportunity for Australia to return to being at the forefront of dry eye treatment worldwide.

Dry eye is not a topic that frequently garners significant media attention, however, the reduction in quality of life that sufferers endure is significant and often lifelong. Eyecare professionals need to ensure that patients with dry eye disease are not ignored and that the medications we have available to us, as well as the subsidies they receive are commensurate with the significant burden of disease that patients have to live with. n Name: Dr Brendan Cronin Qualifications: MBBS (Hons), DipOphthSci, B.Com, LLB, FRANZCO Workplace: Queensland Eye Institute Position: Ophthalmologist, Corneal & Anterior Segment Surgeon & Director of Education at the Queensland Eye Institute Location: Brisbane Years in profession: 16

THE COST OF OBTAINING TGA APPROVAL FOR NEW MEDICATIONS MEANS A SMALL MARKET LIKE AUSTRALIA IS OFTEN OVERLOOKED BY PHARMACEUTICAL COMPANIES

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