Insight October 2020

INSIGHT OCT

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

60%

SLOW DOWN OF MYOPIA PROGRESSION*

EASY & EFFECTIVE NON-INVASIVE METHOD OF MYOPIA MANAGEMENT FOR YOUR CHILD AVAILABLE NOW * Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV lenses.

The SA Government is considering a new $8 million eye hospital for Adelaide.

LET'S TALK ABOUT MENTAL HEALTH Anxiety and depression among the eyecare workforce is in the spotlight once again.

35

POLITICAL STOUSH OVER PROPOSED EYE HOSPITAL

30

03

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

GETTING TO KNOW THE RANZCO PRESIDENT Professor Nitin Verma has left his mark on eyecare programs across the world.

AUSTRALIA 2020

Business as (un)usual As patient and customer demand continues to increase in Australia, we’re strengthening our clinical teams across the country.

Working our way through a significant patient backlog means safely opening up our appointment books more widely to systematically recall existing patients while prioritising care to those who need it most.

And we’re looking for ambitious and dedicated optometry professionals to join us. Together we will tackle the backlog and continue our mission to transform eye health in Australia.

To find out more about the roles we currently have on offer visit spectrum-anz.com

INSIGHT OCT

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

PUSH FOR SOUTH AUSTRALIAN GOVERNMENT TO PURSUE $8 MILLION ADELAIDE EYE HOSPITAL

The opposition Labor party is pressuring the Liberal South Australian Government to consider a proposed $8 million eye hospital for Adelaide, however Labor has been accused of dragging its feet on similar proposals during its previous 16-year term in office.

Two prominent South Australian ophthalmologists, including Australian of the year ophthalmologist Dr James Muecke, are lobbying their state government to develop Adelaide’s first dedicated public eye hospital.

The new outpatient facility would be based in the CBD and replace ophthalmology departments within larger general hospitals in Adelaide. It would also become the state’s epicentre for ophthalmology

training, clinical trials and a new interdisciplinary vision and eye research centre.

Professor Robert Casson, a consultant ophthalmologist at the Royal Adelaide Hospital and head of the discipline of ophthalmology and visual science at Adelaide University, is spearheading the project with Muecke’s support.

Casson first proposed the project in 2015, but he said bureaucratic inertia has limited progress. In recent months, he presented a detailed business case to the government, highlighting the efficiencies the hospital would generate.

“Adelaide doesn’t have a dedicated public ophthalmic hospital like some other states in

getting value for money with the current system.”

SA Health and Wellbeing Minister Stephen Wade is considering the proposal.

Australia and many other cities around the world,” he said.

“All public ophthalmic services are delivered inside large general hospitals. The cost of cataract surgery in general theatres at the Royal Adelaide Hospital, for example, is significantly greater than what it would cost in a day surgery. We are trying to point out that the state government isn’t

SA Health and Wellbeing Minister Mr Stephen Wade told Insight the state government is considering the business case as it continues to consult and investigate the best long-term strategy for eye services.

Shadow Minister for Health and Wellbeing Mr Chris Picton, of the Labor party, said the government must seriously consider the proposal, and commit substantial resources to decrease wait times for outpatient appointments and elective surgery across the board.

He said before the 2018 election Labor committed to an Adelaide eye hospital for same-day services such as cataract surgery continued page 8

TGA APPROVES GENE THERAPY FOR RETINAL CONDITION egulators approved Kymriah in 2018, a cancer treatment that uses an ex-vivo approach whereby gene manipulation occurs outside the body.

In a historical development for the eye health sector, the Therapeutics Goods Administration (TGA) has approved Australia’s first true gene therapy, indicated for a rare form of inherited retinal disease (IRD).

Luxturna, locally supplied by Novartis, secured Australian regulatory approval on 5 August.

It follows in the footsteps of the US and European markets where it was cleared in 2017 and 2018, respectively, and could pave the way for similar therapies for more common forms of IRD. The one-time therapy is indicated for the treatment of a small group of patients with IRD caused by pathogenic biallelic RPE65 mutations, who also

have sufficient viable retinal cells.

The active substance in Luxturna is voretigene neparvovec which is a modified virus containing a copy of the RPE65 gene. It delivers the non-mutated gene to the retina via a subretinal injection to restore vision and improve sight.

A TGA spokesperson confirmed that it is the first approved in-vivo gene therapy, meaning it directly infects cells in the body. Australian

Patients with mutations in both copies of the RPE65 gene may manifest as either Leber congenital amaurosis (LCA) or retinitis pigmentosa (RP).

Dr Fred Chen, an IRD clinicianresearcher at the Lions Eye Institute and the University of Western Australia, said the sector was excited about the approval. Along with other experts in the area, he was on an advisory board for Novartis for the Luxturna TGA process and is involved in a Medical continued page 8

USING MEDICARE TO DETECT GLAUCOMA Another 79,000 Australians are expected to develop glaucoma in the next five years, costing $4.3 billion. Find out how strategic initiatives, including OCT and visual fields, are mitigating this problem. page 28

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IN THIS ISSUE OCTOBER 2020

EDITORIAL

FEATURES

GENE THERAPIES AND OUR OBLIGATION TO PATIENTS The next frontier in ophthalmology and medicine has arrived in Australia following regulatory approval of Luxturna.

Australia’s first true (in-vivo) gene therapy – and the world’s first for inherited retinal disease (IRD) – is further evidence of how the eye health sector continues to break new ground while lessening the burden on patients, families, carers and society.

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ENHANCED VIEW A state-of-the-art imaging device is crucial for any credible retinal practice.

MENTAL HEALTH Suicide once rocked the sector. COVID-19 has reignited the mental health conversation.

It’s also a strong indication that the Therapeutic Goods Administration is serious about the future role of novel biologics in treating our most devastating and intractable illnesses. And this can only fuel confidence among investors, researchers and pharmaceutical companies to continue advancing gene therapy programs.

A tiny number of Australians have mutations in both copies of the RPE65 gene, making them eligible for Luxturna. But a reported price tag of US$850,000 (AU$1.18 million) means government assistance will be necessary.

In England, where some 86 people are eligible, the NHS has struck a deal with the supplier to provide the therapy at a discount rate.

There is an application before the Medical Services Advisory Committee, which determines public funding of new medical services or therapies in Australia. This is based on safety, clinical and cost-effectiveness, and total cost.

35

PRESIDENT PROFILE Professor Nitin Verma discusses his ambitions as the new RANZCO president.

37

CHANGING WORKFORCE More women than ever are seeking out careers in optometry and ophthalmology.

EVERY ISSUE 07 UPFRONT

43 MANAGEMENT

09-24 NEWS THIS MONTH

44 CLASSIFIEDS

41 ORTHOPTICS AUSTRALIA

45 CALENDAR

42 DISPENSING

46 SOAPBOX

What makes this decision important is there are another 10 gene therapies for more common IRDs in clinical trials, while other programs, such as the breakthrough CRISPR technology, are also showing promise in ophthalmology.

Companies that produce gene therapies will rightly seek to recoup their costs. It’s inevitable more will come to market, so how the government treats this case could set the tone.

Between the cost considerations, it’s important to remember such therapies have a lasting impact on patients. Surely, our obligation to provide the best possible treatments is the most important factor here.

MYLES HUME Editor

INSIGHT October 2020 5

60%

SLOW DOWN OF MYOPIA PROGRESSION*

EASY & EFFECTIVE NON-INVASIVE METHOD OF MYOPIA MANAGEMENT FOR YOUR CHILD * Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV lenses.

MiyoSmart is now available for practices who meet accreditation criteria.

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

UPFRONT Just as Insight went to print, the 4TH WORLD CONGRESS OF OPTOMETRY, scheduled to be held alongside O=MEGA21 next year, has been postponed until 2023. O=MEGA21, however, will continue as planned for an Australian and regional audience between 2-4 September 2021. The postponement was announced due to uncertainty around travel restrictions and the economic impact of COVID-19. WCO4 will be held from 8-10 September 2023 in Melbourne

n

WEIRD

with O=MEGA23. IN OTHER NEWS, face masks have given rise to a new phenomenon in the ophthalmic world.

Mask-associated dry eye (MADE) is a term that’s been coined in response to reports of ocular irritation and dryness among regular mask users, backed in a review in the journal Ophthalmology and Therapy. Loosely fit masks force exhaled air to move up and over the surface of the eye, accelerating tear film evaporation.

Centre for Ocular Research & Education director Dr Lyndon Jones said eyecare professionals were well-positioned to provide advice on appropriate mask wear. “Asking patients about their mask-

wearing experiences and providing a few helpful tips takes little time and can make a substantial difference.”

FINALLY, Optometry Australia (OA) is working with optometrists to develop evidence-based advice on telehealth.

The organisation is building on existing tele-optometry guidelines to provide more comprehensive guidance. CEO Ms Lyn Brodie believes tele-optometry can play an important part in future eyecare models. As such, OA is continuing to push for inclusion of optometry-specific telehealth items on the MBS during the pandemic period and when face-to-face care isn’t accessible.

STAT

n

WACKY

Researchers attempting to find genes involved with eye development in fruit fly embryos stumbled upon an unexpected discovery that has implications for humans. After blocking some gene expression, they found the eyes were unaffected, however the flies became sterile. Analysing genetic data in people, the researchers found an association between mutations in this gene and early menopause.

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A US train conductor is back on the job after being given a 2% chance of regaining his sight. The man was struck with the antler of a taxidermal deer head, which fell off a wall, jeopardising his ability to work. It was the worst ocular trauma his doctors had seen, but he returned to work after a major corneal procedure.

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The predation of livestock by lions – and retaliatory killings by farmers – is a global conservation challenge, however researchers have found a simple and cost-effective solution.

Lions were less likely to attack cattle when eyes were painted on their rumps. This is because many big cats are ambush predators who stalk prey. n

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The European Society of Cataract and Refractive Surgeons is live broadcasting the three-day program.

The event will be run as a hybrid model out of the Adelaide Convention Centre, with optometrists able to access online.

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INSIGHT October 2020 7

NEWS

AN EYE RESEARCH AND CLINICAL TRIALS HUB continued from page 3

and outpatient appointments within a biomedical precinct.

“The Marshall Government could have taken this idea and run with it, to the benefit of thousands of South Australians – but they chose to abandon it instead,” Picton said.

Minister Wade said the Labor proposal for a city eye hospital was announced during a caretaker period before the last election in 2018 “in a desperate attempt to hold on to power”. Labor lost the election to the Liberals that year, after 16 years in office.

“The voters saw through this, particularly after a similar promise for an eye hospital at Modbury was made in 2015 and then subsequently dumped,” Wade said.

Casson said the Labor government “dragged their feet for years” on a dedicated eye hospital. He said any real commitment would have already culminated in its development.

“It simply became a hollow election promise,” he said.

CENTRE FOR TRIALS AND RESEARCH At present, Casson said ophthalmology departments “shoehorned” into general public hospitals in Adelaide were not

adequately equipped for the high volume of ophthalmology where a large proportion of procedural work is performed in outpatient settings.

Interdisciplinary Vision and Eye Research (CIVER), which would combine several research fields in SA that could improve eye healthcare.

If the eye hospital is approved, it will become the city’s teaching hospital for registrars and junior doctors and replace ophthalmology departments within the Royal Adelaide Hospital, The Queen Elizabeth Hospital in the city’s northeast and possibly Modbury Hospital in the northwest. They would amalgamate into the proposed hospital.

“Examples of that are laser technology, the new Australian Institute for Machine Learning (University of Adelaide), which ophthalmology and optometry lend itself to beautifully with our imaged based data,” Casson said.

“We’ve identified an excellent site in the CBD in a pre-existing building that is architecturally suitable for day surgery – and our costings suggest that the fit-out for three theatres and the outpatient facilities would be about $8 million,” Casson said.

"OUR COSTINGS SUGGEST THAT THE FIT-OUT FOR THREE THEATRES AND THE OUTPATIENT FACILITIES WOULD BE ABOUT $8 MILLION" ROBERT CASSON, OPHTHALMOLOGIST AND PROJECT LEAD

“In South Australia, we also have the Centre for Nanoscale BioPhotonics, which does some really interesting work.

We have already collaborated with them for potentially new imaging technologies to obtain real-time information about retinal metabolism, as an example.

Genetics research at Flinders University would also be part of it.”

Muecke, chairman of Sight For All, applauded Casson on his vision, passion and drive to spearhead the initiative.

“We aren’t envisaging inpatients here, they would remain at the Royal Adelaide, but we are planning on optometrists working alongside ophthalmologists.

We are also planning multidisciplinary clinics, so the aim is to be optimising the patient care in an efficient way with multi– disciplinary teams to reduce waiting times.”

“A dedicated ophthalmic facility would allow timely access, increased efficiency and the highest quality of eye healthcare for the people of our state,” he said.

“It will also provide a home for Sight For All, the social impact organisation that’s fighting blindness, alleviating poverty and transforming lives here in Australia and across some of the poorest countries in the world.” n

Casson said the eye hospital would also become the epicentre for clinical eye research and trials in the state. He is also planning a yet-to-be established Centre for

GENE THERAPY A GLIMPSE OF WHAT'S TO COME continued from page 3

the US suggest it costs up to US$850,000 (AU$1.18 million) for therapy in both eyes.

Services Advisory Committee (MSAC) application.

“The MSAC approval process will determine how much the state and federal governments chip in. Part of this process is also to determine which Australian cities will become the treatment centre of Luxturna,” he said.

“The implication of the TGA approval of Luxturna is that this is the first of many other retinal gene therapies that we can ultimately offer to our patients with IRDs,” he said, adding that there are 10 other gene therapies for more common IRDs in active clinical trials.

Chen said Luxturna was tested in patients between four and 40-years old, but it would stand to offer more benefit to younger patients due to the higher volume of viable retinal cells.

He said it was unlikely Australian patients would have access to the therapy until it is funded by the government. Reports in

8

INSIGHT October 2020

A RARE CONDITION Chen said RPE65 is one of the rarest forms of IRD and can manifest at different ages.

“Currently, most states in Australia have identified a couple of patients each with this condition,” he said.

“The number of patients found depends on how much genetic testing is done. In an ideal world, all patients are tested, but in our experience, most

patients have not had genetic testing. In WA we are active in testing our patients through a clinical or research pathway facilitated by the Australian Inherited Retinal Diseases Registry so these patients can be identified.”

Dr Fred Chen, Lions Eye Institute.

Dr Jonathan Ruddle, lead of the Ocular Genetics Service at The Royal Victorian Eye and Ear Hospital and a Novartis Luxturna advisory board member, said the TGA approval was a milestone for genetic therapies in general.

“This is a first but there are a couple of other genes in Phase 3 trials overseas that are more common than RPE65 as a cause of retinal inherited disease, and when they reach our shores that’s going to change a lot more lives numerically and will make a big difference,” he said. n

NEWS

NEW HEALTH FUND DATA REVEALS PANDEMIC’S IMPACT ON EYECARE "THIS IS A TIMELY REMINDER THAT WE MUST BRING COSTS DOWN TO KEEP PREMIUMS AFFORDABLE"

The peak body representing health funds says waste within the health system and inflated pricing of medical devices needs to be addressed to keep premiums affordable, as the true extent of COVID-19 pandemic on optical and ophthalmology services was revealed in June quarter statistics.

New Australian Prudential Regulation Authority (APRA) data from 1 April to 30 June also revealed the pandemic caused the net margin of Australia’s health funds to fall to a low of 2.8%.

This compares with 4.9% in the twelve months to June 2019 and represents a 42% decline in profitability.

The June quarter bore the brunt of the impact of COVID-19 restrictions that were introduced across Australia to combat the initial wave of the virus.

The APRA data revealed a decrease of 45,265 people with general treatment ancillary coverage, which includes optical, in the June quarter. The largest net decrease in coverage, after accounting for movements across age groups, was 9,289 for people in the 20 to 24 age group.

Compared to the March quarter, optical episodes dropped 48% to 1.7 million – the most of any major ancillary category. As a result, there were only $133 million in optical benefits paid, compared with $252 million in the prior quarter.

For ophthalmology, which includes coverage for procedures like cataract surgery, episodes dropped 27% to 60,496 compared with the March quarter. This represented the largest decrease out of the major prothesis items.

In recent months, the COVID-19 response of the private health insurance sector has been called into question, following reports it initially saved $515 million on extras services, such as optical, and $500 million on postponed elective surgery during a six-week period between March and May when many health services were inaccessible.

CEO of Private Healthcare Australia Dr Rachel David said the latest APRA data put to bed any suggestion that health funds made “windfall gains” from COVID-19 restrictions. She has previously said health funds have returned savings of more than $500 million to members.

“No industry sector is immune to the impact of the COVID-19 pandemic.

IN BRIEF

Optical episodes dropped 48% in the June quarter.

This is a timely reminder that we must bring costs down to keep premiums affordable,” she said.

“The only way to do this is by addressing waste in the system, tackling the inflated pricing of medical devices, removing red tape to allow insurers to fund more care out of hospital will also reduce costs.”

She said the APRA data shows the impact COVID-19 had on savings “were modest”, and health funds have either returned savings to consumers already or are using them to fund the backlog of elective surgery.

“APRA has made it clear that health funds must retain enough capital to fund this backlog of elective surgeries and the additional healthcare needs of private patients,” she said.

“The COVID-19 restrictions did not mean the treatment for other illnesses stops.

Health funds continued to cover many procedures during this time, including emergency surgeries, pregnancies and in-hospital mental health treatment.

Health funds also fast-tracked members’ access to telehealth for physiotherapy, psychology and exercise physiology.”

According to APRA, private health insurance premium revenue fell 1.4% to $6.1 billion in the June quarter, reflecting an ongoing decline in membership, deferral of premium increases and premium concessions/holidays provided to policyholders due to COVID-19.

Meanwhile, claims costs rose 2%, mainly due to insurers recognising a total of $1.4 billion in claims liabilities to meet the cost of procedures deferred during the quarter.

This came as management expenses increased by 15% to $650 million in the June quarter 2020.

As a consequence, the insurance result (net margin) declined to -0.4% in the June quarter 2020, the lowest in at least the last 12 years. n

RACHEL DAVID, PRIVATE HEALTHCARE AUSTRALIA

n

ORTHO-K ACQUISITION

CooperVision has acquired orthokeratology contact lens manufacturer and distributor C&E GP Specialists.

“CooperVision is committed to providing eyecare professionals with advanced lenses and services, deep expertise and educational resources vital to expanding their options for managing myopia,” CooperVision’s Dr Juan Carlos Aragón said. “Adding the tremendous experience of GP Specialists builds upon what we have created with the acquisitions of Blanchard, Paragon, Procornea and Soflex in recent years.” Founded in 2003, GP Specialists designs and manufactures ortho-k lenses, including the iSee design. It also manufactures and distributes lens designs such as the OK-GOV series brands and OrthoTool’s designs. It will continue as a distributor of Paragon CRT lenses.

n

ZIKA VIRUS

A new study published in The New England Journal of Medicine has provided further evidence of an association between the Zika virus and eye defects in infants.

The research analysed data gathered in Colombia between 2015 and 2016 when there was a significant outbreak in the country. Of the 5,673 pregnancies with laboratory-confirmed infection, 93 infants or fetuses (2%) had brain or eye defects.

Overall, the prevalence of brain or eye defects during the outbreak was 13 per 10,000 live births compared with 8 per 10,000 live births before the outbreak and 11 per 10,000 live births after the outbreak.

The frequency of defects increased in women with symptoms early in pregnancy.

n

EYE TRACKING

Flinders University researchers have tested the cognitive skills of elderly people through eye-tracking technology, which could inform aged care policy and practice. With mild cognitive impairment compromising the ability of many elderly to communicate efficiently – particularly when filing official forms – the researchers wanted to investigate how they processed information. Their technology mapped how each person focused as they read, which can represent good and poor cognition.

“This exploratory study helped our team to identify those who needed more help in formulating their decisions,” lead researcher Kaiying Wang said.

INSIGHT October 2020 9

NEWS

NEW ELECTIVE SURGERY GUIDANCE POST INFECTION RANZCO has warned that patients diagnosed with SARS-CoV-2 in close proximity to their elective surgery may be at risk of post-operative complications, as it released new guidelines on the appropriate timing for surgery on patients who have recovered from virus infection.

Despite there not yet being a full understanding of the physiological impact of COVID-19, the college is recommending previously diagnosed patients are symptom-free for a minimum of two months before undergoing surgery, and that the cardiac and respiratory systems are subjected to a clinical review.

The updated advice, which does not preclude cataract surgery, was published by outgoing RANZCO president Associate Professor Heather Mack and Victorian branch chair Dr David van der Straaten. It was formed with counterparts from the Royal Australasian College of Surgeons, The Australian and New Zealand College of Anaesthetists and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Entitled ‘Guidance on delay to elective surgery post recovery from SARSCOV-2 infection’, the document is said to provide “good guidance for all our

Patients should be symptom-free for two months before surgery.

members in a rapidly developing field”.

The colleges point out that the severity and duration of SARS-CoV-2 infection is variable between individuals. However, there is increasing evidence of post infection impairment despite significant gaps in understanding how long the respiratory, cardiovascular and other systems may be affected.

"EVIDENCE SUGGESTS PATIENTS WHO HAD SARS-COV-2 INFECTION DIAGNOSED WITHIN SEVEN DAYS BEFORE OR UP TO 30 DAYS AFTER SURGERY ARE AT SIGNIFICANT RISK" RANZCO

to provide universal recommendations on the optimum timing of necessary, planned surgery following recovery from active infection with SARS-CoV-2. Therefore, a cautious approach is recommended.

Decisions regarding surgical timing will require careful consideration of the possible sequelae of the infection, the urgency of the required surgery and the expected physiological impact on the patient.”

As such, RANZCO and other medical colleges recommended patients undergo surgery after displaying no symptoms for eight weeks for all but minor surgical procedures.

They recommended patients have a formal clinical review prior to surgery that addresses the state of the cardiac and respiratory systems. This is for patients post-known SARS-CoV-2 infection and is especially important for those who have persisting symptoms (including fatigue) or who were hospitalised for care.

They also state that infection (communicability) recovery appears to be much quicker than physiologic recovery.

The college added: “If, on careful consideration of the nature and severity of any persisting problems, delay is considered the safer course of action for an individual patient, we recommend treatment is delayed until the balance of risks and benefits are more in the patient’s favour, even for a Category 1 (within 30 days) case.” n

“Available evidence suggests patients who had SARS-CoV-2 infection diagnosed within seven days before or up to 30 days after surgery are at significant risk of post-operative complications including increased morbidity and mortality,” the guidelines state.

“There are insufficient additional data

ONE IN 10 NEW OPTOMETRISTS FROM NZ, STUDY FINDS The lead author of a study examining the demographics and distribution of new entrants to the Australian optometry workforce is surprised that one in 10 come from New Zealand, with almost a third of them launching their career in South Australia.

In their analysis of Australian Health Practitioner Regulation Agency (AHPRA) data, Ms Jane Duffy, senior lecturer in optometry at Deakin University, and her colleagues also found graduates of Australian universities tended to commence practice in the state they trained, while 42% of overseas-trained optometrists in Australia commenced practice in Western Australia.

According to the study, published in Clinical and Experimental Optometry, the number of registered optometrists in

10

INSIGHT October 2020

Australia has increased by 30.1% during the past decade, a rate that is greater than the population growth of the country (12.1%).

overseas programs (7%) or there being insufficient information to identify the optometry qualification (2%).

This has prompted concerns about the size of the optometry workforce in the context of increasing numbers of graduating optometrists, however leading organisations within the sector disagree on the issue of workforce supply.

“The relatively large proportion of New Zealand graduates was surprising to me; also unexpected was that about 30% of them commenced practice in South Australia,” Duffy, a past member of the Optometry Board of Australia, said.

The study reviewed new entrants to the profession with regard to their qualification, whether they were qualified for therapeutic practice and their initial practice location from 1 July 2010 to 30 June 2018.

During the eight-year period, 1,680 optometrists joined the profession, with 80% from an Australian program.

In total, 11% were from the New Zealand program with the balance from

Jane Duffy, Deakin University.

“It was also interesting that, consistent with a study by Kiely et al using 2005 data, graduates of the Australian programs tend to commence work in the state that they undertook their optometry training.”

In other findings, the study stated new entrants to the optometry profession could be generalised as graduates of an Australian optometry program, female, aged in their early to mid 20s and qualified for therapeutic practice. nw

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NEWS

FITNESS TO DRIVE CHANGES FOR NSW EYECARE PROFESSIONALS AND ELDERLY MOTORISTS Transport for New South Wales has overhauled its fitness to drive certification process, which it believes will provide greater efficiencies for optometrists, ophthalmologists and other health professionals in the state.

The state government agency says the simplified system introduced in July now requires health professionals to complete the form online, with NSW motorists no longer required to take paperwork to a Service NSW Centre.

Drivers who are over the age of 75, have certain chronic medical conditions, hold an MC class licence or drive public passenger vehicles all require regular medical assessments to ensure they are fit to drive. The online forms process is expected to bring benefits to both health professionals and patients.

“The time and costs involved in handling, distributing and duplicating paperbased patient information will also be reduced, significantly improving efficiency for practices,” a Transport for NSW spokesperson said. “Two generic online forms have been replaced by 12 specialist focused online forms, removing the need

for doctors to strike out non-relevant information. The forms will also prepopulate previous assessment data and provide online links to National Assessing Fitness to Drive medical standards – making them easier for practitioners to reference while assessing a patient.”

Information submitted online will be securely and instantly transmitted to Transport for NSW and recorded for future patient case reviews and completions.

Once the information is submitted online, patients receive instant confirmation from the health professional that their report has been securely transmitted to Transport for NSW and their driving record has been updated. Doctors can email or print a copy of the completed medical assessment at any time.

For health professionals, the online form can be submitted through the Best Practice, Genie, Medical Director and MedTech patient management systems, or electronically submitted through the HealthLink portal.

HOW IT WORKS Mr Jones turns 75 in the next eight weeks.

"TIME AND COSTS INVOLVED IN HANDLING, DISTRIBUTING AND DUPLICATING PAPER-BASED PATIENT INFORMATION WILL BE REDUCED" TRANSPORT FOR NSW

Transport for NSW sends him a request to have a NSW Fitness to Drive assessment.

He attends his local GP who opens up the NSW Fitness to Drive form through the Electronic Medical Records system on his computer and types in Mr Jones’ licence number. This form shows that Mr Jones does not have any pre-existing medical conditions.

The doctor indicates on the form that Mr Jones has a vision and eye disorder, atrial fibrillation and a mild case of arthritis, and recommendation that he is fit to continue to hold his driver licence.

Mr Jones leaves the GP knowing he needs to see his optometrist. He makes the appointment with his local optometrist, who then logs into the online eyesight report form. The optometrist completes and submits the form and advises Mr Jones that his vision meets the standard to continue to hold a driver licence.

The optometrist receives real time advice which confirms the eyesight report form has been received by Transport for NSW. Mr Jones has now completed the steps to maintain his driver licence. n

AI-DRIVEN HEADSET FOR AMD SET FOR AUSTRALIAN DEBUT A US company that has incorporated dark adaptometry into a new wearable headset for age-related macular degeneration (AMD) is on the cusp of introducing the AI-guided technology to the Australian ophthalmic market.

revealed that subjective dilated fundus exam testing and photography cannot reliably enable detection of AMD – even in patients who have large drusen.

MacuLogix is launching its AdaptDx Pro device, which will be distributed in Australia by Optos pending Therapeutic Goods Administration approval.

It builds on the company’s original AdaptDx automated dark adaptometer, which is a table-top device introduced in 2014. The instrument has since been used by more than 1,000 eyecare professionals worldwide to identify and monitor AMD. The company says dark adaptometry has lessened the profession’s reliance on risk assessment by providing a tool that delivers a definitive AMD diagnosis with 90% sensitivity and specificity.

12

INSIGHT October 2020

The AdaptDx Pro headset from MacuLogix.

“Not only is this functional test highly accurate, but it also detects the disease at least three years before it can be observed clinically, giving doctors and patients time to slow down or halt progression,” the company stated.

According to MacuLogix, dark adaptometry gained attention in 2017 when a large peer-reviewed study

To overcome obstacles to adoption, MacuLogix has developed AdaptDx Pro. It includes the functionality of its tabletop dark adaptometer in a headset that features an AI-driven onboard technician named Theia. According to the company, the device creates a personal dark room so patients can take tests in any light conditions. Once the testing protocol has been chosen, Theia takes over to facilitate a reliable, consistent test by using automated instructions and adaptive feedback spoken directly to the patient.

In turn, the AdaptDx Pro helps eyecare providers diagnose and manage AMD with greater confidence and ease, the company stated. n

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DON’T MISS YOUR CHANCE TO WIN A $5,000 GRAND PRIZE OR 4 X $2,500 RUNNER UP PRIZES JUST BY ORDERING ANY TRANSITIONS LENSES In October and November, every time you order any Transitions technology you can enter to win a $5,000 Visa Prepaid Gift Card or one of four $2,500 Visa Prepaid Gift Cards.

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TRANSITIONS FOR ALL ORDER POINT OF SALE: transitions.com/eyecareprofessionals VIRTUAL TRY ON TOOL: transitions.com/VTO

Promotion starts 8:00 AM AEST 1/10/20. Ends 11:55 PM AEST 30/11/20. Open to Eyecare Professionals employed at Optical Retail Practices in Aust & NZ (excl Luxottica and Specsavers employees) who fulfil the entry/eligibility requirements. Win 1 of 4 Prepaid Visa Gift Cards valued at $2,500 or 1 Prepaid Visa Gift Card valued at $5,000. Total prize pool is $15,000. Draw 10:00 AM 7/12/20 at Lvl 2 11 York St Sydney NSW 2000. Winners notified via email by 11/12/20 and published at transitions.com/springpromo 18/12/20. Promoter is Transitions Optical Pty Ltd ABN 29 067 278 139. 283-287 Sir Donald Bradman Dr Brooklyn Park SA 5032. NSW Authority No. TP/00262, ACT Permit No. TP 20/01173 and SA Permit No. T20/1037. Full T&Cs refer to transitions.com/springpromo. Transitions, Transitions Signature, XTRActive and Vantage are registered trademarks and the Transitions logo and Transitions Light Intelligent Lenses are trademarks of Transitions Optical, Inc. used under license by Transitions Optical Limited. Light Under Control and GEN 8 are trademarks of Transitions Optical Limited. Drivewear is a registered trademark of Younger Mfg. Co. Photochromic performance is influenced by temperature, UV exposure, and lens material. © 2020 Transitions Optical Ltd. www.transitions.com

NEWS

HOMEGROWN CORNEAL TRANSPLANT DEVICE OFFERS HOPE FOR COMPLICATED PROCEDURE A team of Australian researchers has received half a million dollars in medical research funding to fast-track development of a novel surgical device that addresses a common problem in delicate corneal transplant procedures.

Corneal researchers at the Centre for Eye Research Australia (CERA) and University of Melbourne colleagues have received funding from the Victorian Medical Research Acceleration Fund (VMRAF) to accelerate the development of CorGel, an ultra-thin hydrogel film that is used to insert donor corneal tissue into a patient’s eye.

The $500,000 grant will support 18 months of preclinical work to refine and test CorGel – which dissolves safely into the body after surgery – in collaboration US eyebank EverSight.

CERA’s principal investigator Professor Mark Daniell said their goal after 18 months is to progress CorGel to a clinical trial and conduct the first human study.

The device was borne out of a challenge that had arisen in association with newer corneal transplant techniques, such

manufactured the CorGel film to be ultrathin and transparent, but tough enough to withstand surgery.

as Descemet’s Membrane Endothelial Keratoplasty (DMEK) procedure, which replaces only the endothelium. DMEK procedures have better outcomes but make for difficult surgery.

“The reason we like transplanting just the endothelial layer is that it gives quicker recovery, the vision is better and we see less rejection,” Daniell said, adding that a 30% rejection rate has dropped to about 1% with DMEK. “Rather than transplant the whole cornea, we’ve taken just a single layer of cells from the donor, with some of the Descemet’s membrane on the back. And this graft membrane tends to scroll up when we insert it into the eye.”

Unscrolling the delicate graft without causing damage is technically difficult, which reduces the chance of successful surgery. As a result, many ophthalmologists choose other surgical procedures which aren’t as effective. The CorGel device works to address this by keeping the donor corneal tissue flat when it is inserted into the eye. Daniell said engineers have

“And when you put it in water it opens up nice and flat and so it is easy to position accurately," he said.

"THIS DEVICE AIMS TO MAKE THE SURGERY SO MUCH EASIER THAT ANY CORNEAL SURGEON CAN DO IT" MARK DANIELL, CERA

The donor corneal endothelium is stuck to the CorGel film ‘scaffold’, using a light activated bio-glue, and inserted into the back of the eye. The film is made from the same material as capsules – ‘PEG’ or polyethylene glycol – and dissolves into non-toxic by-products within a few weeks.

“By that stage the cells will have attached and started to work as a corneal transplant,” Daniell said. “At the moment, about one quarter of endothelial transplants in Australia and the United States are done by DMEK – but with CorGel all of these transplants could be done this way.”

The CorGel device could make DMEK the default endothelial transplant method.

“It is technically the best surgery and this device aims to make the surgery so much easier that any corneal surgeon can do it,” Daniell said. n

GOVERNMENT TELEHEALTH ‘RETICENCE’ HINDERING RECOVERY Newly released data from Optometry Australia (OA) has revealed the detrimental impact of the first wave of the COVID-19 pandemic on the eye health sector, underlining the need for government support of telehealth optometry.

Brodie said the Federal Government’s reticence to include Medicare rebates for telehealth optometry is exacerbating the sector’s recovery, and therefore the ability to ensure quality eyecare for the whole community.

The peak professional body recently released the results of a survey it conducted in late May involving 3,290 members to understand the impact of the initial lockdown on the profession.

749,780 in the same month of 2019.

“We believe access to telehealth would have enabled many more practices to support patients during the height of the pandemic and likewise, could encourage more people to access eye healthcare."

CEO Ms Lyn Brodie said OA’s research indicated it will probably be some time before optometry, in general, returns to pre-COVID conditions.

Brodie noted consumers are increasingly embracing technology as part of their health regime and the ongoing pandemic may accelerate this.

“We believe that around 50% of optometrists in Australia are currently working fewer hours now than they were pre-COVID-19. It is critical that they can return to optimal working capacity as quickly as possible to support community eye health needs,” she said.

“It is therefore important that the government supports telehealth optometry so that we can be certain that our profession is in a strong position to meet the eye health needs of patients who are unable to access face-to-face care,” she said. n

OA revealed more than 90% of its members closed their practices or scaled back their hours at the height of the pandemic in April. At the same time, 96% of practice owners and self-employed optometrists saw their revenue decrease with a quarter having their income decline by 75% or more. The pandemic also contributed to a 74% plummet in Medicare patient consultations in April, with 192,720 performed compared with

14

INSIGHT October 2020

April was one of the toughest months nationally.

Put your digital marketing in the hands of the people who understand independent optometry Cost-effective ad campaigns with measurable results, tailored to support the growth of your practice To learn more head to myhealth1st.com.au/insight

NEWS

OPTOMETRY SCOPE-OF-PRACTICE TO BE EXAMINED IN NEW OVERSEAS STUDY SCHOLARSHIPS Optometry Australia (OA) has announced its inaugural LOOK scholarship recipients who will investigate overseas optometry models that differ from the Australian context, including expanded scope-ofpractice in the US. Optometrists Ms Nicola Mountford and Dr Shelley Hopkins will be the first to benefit from the Looking Outward on Optometric Knowledge (LOOK) program.

OA launched the scholarship in February to fund overseas study tours that investigate optometric advancements internationally that are not available, or readily available, in Australia.

Due to COVID-19 travel restrictions, OA has awarded the scholarships to support virtual study tours and complete at least 50 hours of desktop research and remote engagement with international colleagues in two areas of interest for OA. Hopkins’ work will investigate the role of optometrists in school-based eye program. Meanwhile, Mountford, who practises at Queensland Retina Specialists, a newly established clinic in Brisbane that combines optometry and ophthalmology services, will focus on the expanded scope-of-practice in the US. There, some laser therapies, injectable drugs and minor surgical procedures have been successfully delivered by

Nicola Mountford, Queensland Retina Specialists.

optometrists in the US for more than 20 years, according to OA. “The American optometry practice model is the most different model to our own, but does it work well?,” Mountford asked.

"OPTOMETRISTS IN OKLAHOMA HAVE THE MOST EXTRA ALLOWANCES IN PRACTICE PRIVILEGES, INCLUDING INJECTABLES FOR USE IN EYELID OPERATIONS" NICOLA MOUNTFORD, SCHOLARSHIP RECIPIENT

“For example, optometrists in Oklahoma have the most extra allowances in practice privileges, including injectables for use in eyelid operations – injecting into the dermal tissue, not intravitreal injections such as those used in anti-VEGF treatments.”

incorporated in a symbiotic practice model, similar to Queensland Retina Specialists.

“I’m interested in the incorporation of optometry in diagnosing neurological disorders, finding degenerative disease and treating neuropathic pain,” Mountford said.

Meanwhile, Hopkins will investigate optometry’s role in assessing and managing children’s vision conditions through school-based eyecare programs, by comparing programs across the US, UK, Europe and Asia.

Specifically, she said her goal is to understand the strengths and weaknesses of different programs available in some states of the US. “Evaluating these programs in terms of their screening protocol, eyecare team, coverage/age groups screened, follow-up procedures, costs and funding models will help inform the development of a model that could be applied in Australia,” she told OA.

Mountford said one of the potential advantages of optometrists providing this type of treatment is as a stop-gap measure for patients in rural and remote areas, where access to specialist care can be difficult. She is also interested in bimodal modes of practice, where optometry and ophthalmology are

OA has previously identified an evolving scope-of-practice as one of the key trends shaping the future of optometry in its Optometry 2040 report, including oral therapeutics, minor surgery, prescription of and treatment with injectables, and diabetic education. n

NEW MDFA RESEARCH FUND CREATED FROM BEQUEST Macular Disease Foundation Australia (MDFA) is introducing a new $100,000 fund within its Research Grants Program, after a woman who became the primary carer for her visually impaired father bequeathed funds to the organisation.

The fund was created following the death of Ms Faye Grant who became the primary carer for her father Mr Ronald Grant when he began losing his sight to neovascular age-related macular degeneration (AMD).

With applications for its next round of research funding opening on 8 October – World Sight Day – MDFA has announced the new legacy Grant Family Fund.

Ronald lived with AMD for the last 15 years of his life. It affected both eyes, but regular eye injections saved his sight for most of that time. His vision started to deteriorate in the past four or five years of his life.

It will be available to early career researchers for innovative ‘blue sky’ research in the field of macular disease to commence projects in 2021. A total grant pool of up to $100,000 plus GST will be available, and it is anticipated that up to two grants of $50,000 for one-year projects will be awarded.

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INSIGHT October 2020

Ronald died in 2016. Faye passed away, at the age of 59, in 2019.

Faye Grant’s sister, Janette Forrester, said: “Faye loved being with Ron, she absolutely idolised Dad and it made it

really easy for her (to care for him). They were the best of mates.”

Faye also took Ron to all of his eye injection appointments and was acutely aware of how important the treatments were to the maintenance of her father’s sight.

Faye Grant with her father Ronald.

While Faye bequeathed funds to MDFA, there were no other instructions in the will.

“In discussing it with MDFA, we thought that the research fund was the best way to use Faye’s bequest. We thought that Faye would like to have spent the money that way,” Forrester said.

MDFA’s Research Grants Program has previously committed $4.1 million to 18 Australian researchers across 21 projects since 2011. n

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1. Holden, BA, Fricke, TR, Wilson, DA et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123:1036–42. Available from: doi: DOI: 10.1016/j.ophtha.2016.01.006

NEWS

TGA APPROVES ‘BREAKTHROUGH’ CONTACT LENS FROM B+L

VIBRANT NUPOLAR CAMPAIGN TAPS INTO NEW CONSUMER BEHAVIOUR In time for peak sunglass season, Younger Optics has launched a new NuPolar campaign to appeal to a shift in consumer behaviour, along with a suite of new point-of-sale materials for practice use.

According to the lens maker, quality outdoor vision solutions have become increasingly relevant as people spend time outdoors in a COVID safe manner for socialising, recreation and exercise.

Coupled with extended time outdoors and consumers’ heightened focus on health and quality of life, it says the appeal of polarised lenses has become greater.

Younger Optics’ new NuPolar campaign ‘You’ve Never Seen Better’ uses scenery images that are bright, vibrant and crisp that aim to represent the vision NuPolar polarised lenses provide for wearers.

Commenting on the initiative, Younger Optics ANZ sales and marketing manager Mr Craig Johnston said: “Now more than ever, patients want and need quality eyewear that will enhance their time outdoors.

“Not only do patients want exceptional vision and protection, they are also willing to pay for quality lenses. Eyecare professionals can be confident about recommending NuPolar for its reputation for consistent and durable quality.”

The campaign can be brought in-store with new point-of-sale. There is a choice of four different window posters – one side features striking scenery as seen through NuPolar lenses and the other side shows models wearing NuPolar.

Also available are a choice of window decals and counter cards, new patient brochure, social media content and demonstration tools.

NuPolar is available in solid, gradient, mirror and photochromic styles in a range of colours and materials. For more information and to order point-of-sale, demonstration tools and social media visit youngeroptics.com.au. n

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INSIGHT October 2020

“WE ARE EXCITED TO INCLUDE THIS BREAKTHROUGH AND INNOVATIVE NEW LENS AS PART OF OUR ROBUST PORTFOLIO OF CONTACT LENS PRODUCTS IN AUSTRALIA"

Bausch + Lomb has obtained regulatory approval to supply its new Ultra One Day daily disposable silicone hydrogel (SiHy daily) contact lenses in Australia.

The new lens design was recently cleared by the Therapeutic Goods Administration (TGA) and is now expected to be widely available to local eyecare professionals early next year.

According to the company, the lens features a next generation material called kalifilcon A, with Advanced MoistureSeal technology to deliver “a highly wettable PAOLO SASSO, surface and excellent breathability for BAUSCH + LOMB healthy lens wear”.

easy handling, UV blocking and high definition optics to meet the demands of the modernday contact lens wearer.

Ultra One Day daily disposable.

The Advanced MoistureSeal technology works with a new ComfortFeel technology, the latter of which infuses the lens with eye health ingredients such as moisturisers/ conditioners, osmoprotectants and electrolytes. This helps to deliver comfort for a full 16 hours of lens wear and support a stable and healthy ocular environment.

“The Australian TGA approved our submission for Bausch + Lomb Ultra One Day silicone hydrogel daily disposable contact lenses in approximately two weeks,” Mr Paolo Sasso, general manager of Bausch + Lomb Australia, said. “We are excited to include this breakthrough and innovative new lens as part of our robust portfolio of contact lens products in Australia. We look forward to offering Bausch + Lomb Ultra One Day to eyecare practitioners and their patients across the country in early 2021.”

With these incorporated technologies, Bausch + Lomb Ultra One Day contact lenses are said to provide a complete design of high oxygen, low modulus,

The company anticipates the lenses will be available to selected practitioners at the beginning of the fourth quarter of 2020, with a national launch in early 2021. n

CYLITE’S HP-OCT SECURES AUSTRALIAN MADE STATUS Melbourne-based OCT manufacturer Cylite has obtained certification to carry the iconic Australian Made mark.

The logo, which can now be attached to its Hyperparallel OCT (HP-OCT) system, is Australia’s most trusted and widely used country of origin symbol, underpinned by a third-party accreditation system to ensure products are certified as ‘genuinely Australian’ and made to demanding national standards.

Ms Kylee Hall, Cylite’s vice president of sales and marketing manager, said the company is proud to have met the criteria set out in the Australian Consumer Law and the AMAG Logo Code of Practice.

Cylite is working towards European approval.

The company is in the final stages of the process of applying for European regulatory approval for the device, which would pave the way for Australian registration. CEO Dr Steve Frisken added: “The Australian Made mark is recognised world-wide as a symbol

of both innovation and the highest quality workmanship. Cylite is delighted to have been awarded this mark which further enhances our ability to take our Australian-designed and manufactured HP-OCT system into global markets.” n

AUSSIE BIOPHARMA MEETS US AND EUROPEAN REGULATORS TO COMMENCE PHASE 3 TRIALS A Melbourne drug company is one step closer to starting Phase 3 clinical trials and pre-commercial development of its novel treatment for neovascular agerelated macular degeneration (nAMD).

ASX-listed biopharmaceutical company Opthea announced on 21 August that it completed meetings with the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to obtain guidance on the Phase 3 clinical development plans of OPT-302 as a treatment for nAMD. It's now on-track to initiate Phase 3 trials in early 2021.

According to Opthea, the FDA and EMA have agreed on key aspects of the proposed trial designs, including the conduct of two concurrent, global, multicentre, randomised, shamcontrolled studies evaluating OPT-302 in combination with ranibizumab (Lucentis) or aflibercept (Eylea). The company is

expecting to enroll at least 900 patients worldwide in each trial.

they received valuable guidance from the FDA and EMA.

“If successful, the investigation of OPT302 in combination with two approved standard-of-care VEGF-A inhibitors could enable OPT-302 to be administered with either Eylea or Lucentis which had combined sales for retinal diseases of US$11.9 billion (AU$16.6 b) in 2019,” the company stated.

“[Which] provides clear direction as we advance our Phase 3 registration program towards bringing OPT-302 to market,” she said.

Dr Megan Baldwin, Opthea.

Each trial will compare the clinical efficacy of OPT-302 administered with a VEGF-A inhibitor on an every fourweek and every eight-week dosing regimen to understand the durability of OPT-302 treatment effect with less frequent dosing. The company wants to submit Biologics License and Marketing Authorisation Applications with the FDA and EMA respectively, following completion of the primary efficacy phase.

Opthea CEO Dr Megan Baldwin said

“We remain focused on further demonstrating, in our Phase 3 program, the potential of OPT-302 combination therapy as a novel and transformative treatment for wet AMD patients suffering vision loss. The analysis approach for our Phase 3 clinical trials allows the initial analysis of outcomes to be evaluated in the patient group which, based on data from our Phase 2b trial, would be expected to have the best response to OPT-302 combination therapy.

“We believe this approach achieves the highest probability of success for our Phase 3 program and commercialisation strategy.” n

Secure your future as a full time Optometrist We re still hiring!

During these challenging times, George & Matilda continues to have some exciting Optometrist vacancies in the following locations across Australia: Mudgee NSW - Dubbo NSW - Whitsundays QLD G&M would be open to exploring both employment and partnership opportunities with you in these locations.

To learn more about these roles or other opportunities with G&M, please send your CV with an expression of interest for the role you are interested in to opportunities@georgeandmatilda.com.au.

We look forward to hearing from you!

NEWS

‘OPTOMETRIST’ MOST SEARCHED STEM JOB IN AUSTRALIA A new global study has revealed that ‘optometrist’ is the most Googled profession within the science, technology, engineering, and mathematics (STEM) category in Australia and New Zealand.

It is also the most popular STEM job search in Canada, Guyana (South America), South Africa, the Netherlands, Estonia, and Moldova.

CENTRAL TOPOGRAPHY MODULE FOR THE IOLMASTER 700 "CENTRAL TOPOGRAPHY IS INTEGRATED IN THE IOLMASTER 700 STANDARD MEASUREMENT AND NO EXTRA TIME IS NEEDED" FRANZISKA KLATT, ZEISS

Zeiss announced that central topography has now been integrated with the IOLMaster 700 biometry instrument as part of its latest software upgrade.

With the new module, eyecare professionals can incorporate central topography into their standard biometry routine without changes to their workflow or hardware.

According to Zeiss, the addition of central topography allows professionals to begin their workflow with greater insights and preoperatively evaluate the corneal topography of cataract patients.

International electronic and electrical supplies company RS Components, which operates in Australia, used Google’s Keyword Planner to establish the average monthly search volume in each country for nearly 100 STEM jobs.

With corneal irregularities regarded as visually relevant in the central optical zone regardless of the intraocular lens (IOL) type, they are considered particularly important for insertion of toric and multifocal lens designs.

STEM professions include astrophysicists, geneticists, microbiologists, neuroscientists, software developers, chemical engineers, optometrists, and data analysts, as well as science and maths teachers, to name a few.

“Central topography takes posterior and anterior refractive powers into account to allow clinicians to detect visually relevant central corneal asymmetries right from the start before deciding on the IOL and consulting the patient,” Zeiss Australia and New Zealand surgical cataract product manager Ms Franziska Klatt said.

In Australia, analysis of labour force data by the Department of Employment, Skills, Small and Family Business shows that between November 2014 and November 2019, employment in STEM occupations increased by 19.7%, which is 1.9 times higher than the growth rate for other occupations.

In its study, RS Components used two search terms – for example, “data analyst” and “data analyst job” – to determine the most searched for STEM job during November 2019 in each country.

Optometry Today in the UK noted that ‘optometrist’ had the fourth highest number of monthly search hits, with cancer researchers taking the top spot.

RS Components, which has 8,000 employees and operates in 32 countries, said the STEM field is growing and related jobs in the area are increasingly in demand, prompting the company to discover which jobs are the most popular.

According to the company, in the UK STEM sector is fast-growing, with research suggesting that jobs are predicted to grow at double the rate of other occupations, creating 142,000 jobs between now and 2023. n

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INSIGHT October 2020

The upgrade was released in late August.

“The scaling and hues were developed in cooperation with Douglas D. Koch and Li Wang, MD, USA and are easily and intuitively read. Central topography is integrated in the IOLMaster 700 standard measurement and no extra time is needed – measuring both eyes in less than 45 seconds.”

In addition, the latest IOLMaster software upgrade allows clinicians to send their biometry data and scleral reference images via Zeiss EQ Mobile to CALLISTO eye for computer assisted surgery.

The new software was released for existing Zeiss IOLMaster 700 devices in late August and is also available on new systems. n

TRANSITIONS OPTICAL OFFERS CASH PRIZES TO EYECARE PROFESSIONALS Transitions Optical is giving away $15,000 in cash prizes to eyecare professionals who order its products during the months of October and November.

For every order of Transitions Signature GEN 8, XTRActive, XTRActive style mirrors, Vantage and Transitions Drivewear between 1 October and 30 November 2020, eyecare professionals create the chance to win.

The grand prize is a $5,000 Visa Prepaid Gift Card, with four $2,500 gift cards as runner up prizes. The more Transitions lenses ordered by eyecare professionals, the more entries they receive to increase their chances to win.

For each order in the promotional period, entrants will need to visit transitions.com/SpringPromo to submit their details, with winners notified by 11 December.

New point-of-sale material is also available.

To support practice participation in the promotion, Transitions also has new point-of-sale material with a choice of three talent sporting different looks and different Transitions GEN 8 colours.

Available for free, practices can order posters, counter cards, dispensing mats and other point of sale materials online at transitions.com/ eyecareprofessionals. n

Glam Collection

HOYA LAUNCHES DEFOCUS MYOPIA LENS FOR CHILDREN

"Style is a way to say who you are without having to speak."

Rachel Zoe

Side View Children wearing defocus lenses had 60% less myopia progression than those wearing single-vision lenses.

Glasses cases today are as much of a fashion statement as your handbag, clutch or wallet.

Australian eyecare professionals will have access to a new myopia control spectacle lens from 1 October when Hoya Lens Australia introduces its MiyoSmart lenses with D.I.M.S. Technology.

The non-invasive myopia management method has been developed on the back of a two-year double-blind randomised clinical trial in Hong Kong that showed wearing defocus spectacle lenses daily significantly slows progression and axial elongation in myopic children aged 8 to 13. The trial concluded children wearing defocus lenses had 60% less myopia progression compared with those wearing single-vision lenses. According to Hoya, the findings provide strong evidence that defocus lenses are an effective tool to reduce myopia progression.

“This is the myopia management option that the Australian and New Zealand market has been waiting for,” Hoya Lens Australia managing director Mr Craig Chick said.

“We are proud to provide such an effective treatment with award winning technology. This product (MiyoSmart) highlights Hoya’s leadership in the optical industry.”

C

M

The new Sorella ‘Glam’ collection is a combination of contemporary design, fashion and functionality. Our aim was to produce a glamorous, luxury case designed to carry 2-3 pairs of glasses that could also double as a clutch bag for a night out.

Y

CM

MY

CY

CMY

K

One side of the case used for your glasses and the other side for your credit card, lipstick, keys etc.

The Sorella Double-Take case is a versatile statement piece that can... ‘ Take you from your desk to dinner ’

Hoya has developed the lens with its research collaborator The Hong Kong Polytechnic University.

Following years of academic studies, product design and clinical research, the lens was produced based on Defocus Incorporated Multiple Segments (D.I.M.S) Technology, which won the Grand Prize, Grand Award and Gold Medal at the 46th International Exhibition of Inventions of Geneva in April 2018.

According to Hoya, MiyoSmart lenses are an effective noninvasive method to manage myopia which can be fitted to a myopic child at any age, like regular single vision lenses. MiyoSmart’s efficacy is based on patent-protected D.I.M.S segments creating a myopic defocus effect.

The lenses also feature a low-maintenance multi-coat that is water repellent, easy to wipe and durable with UV protection, making it suitable for children.

“With the focus on educating both eyecare professionals and parents on the importance of treating myopia and the various options that are currently available, MiyoSmart will be a welcome product to help combat myopia as a safe, easy and effective, noninvasive option with proven results,” the company stated.

Eyecare professionals wanting to dispense MiyoSmart lenses will need to meet accreditation criteria. For more information, contact a Hoya Sales Consultant or 1800 500 971 (Australia) or 0800 744 692 (New Zealand). n

The simple elegance of these lovely cases would also make an ideal gift for any glasses wearer.

There are 3 colours in the range a Luxe Rose Gold, Silver & Black all with a soft grey suede fabric lining.

Our signature central divider separates and protects your glasses and the case is fastened with a hand stitched strapwith silver or gold buckles and magnetic clasps.

The cases have a hard shell with a smooth glitter acrylic exterior. Dimensions: Round Case - 17cm (L) x 7cm (W) x 6cm (D)

COMPANY

ESSILORLUXOTTICA WEIGHS UP APPEAL AFTER CASE DISMISSED

GOOGLE ACQUIRES CANADIAN SMARTGLASSES COMPANY Google has announced that it has acquired Canadian company, North, which the tech giant describes as a pioneer in human computer interfaces and smart glasses.

In a post announcing the sale, Google said North’s technical expertise will help it continue to invest in the future of ambient computing, the seamless integration of technology and everyday living.

“They’ve built a strong technology foundation, and we’re excited to have North join us in our broader efforts to build helpful devices and services,” the tech company said.

Originally known as Thalmic Labs when it launched in 2012, North’s initial focus was on a gesture-based input device, called Myo, that directly coupled neuro-muscular impulses into signals computers could understand.

It then shifted its focus to smart glasses with direct retinal projection and prescription compatibility. It released Focals 1.0, its first-generation smart glasses, last year and had been preparing over the last several months to release the second-generation version, Focals 2.0.

In a separate post, North’s three cofounders said they are winding down Focals 1.0 and will not be shipping Focals 2.0, as a result of the acquisition.

They described the acquisition as a “terrific fit” for North and that aligning with Google would significantly advance their shared vision.

In 2018, North co-founder and CEO Ms Stephanie Lake said the company set out to succeed where others have failed.

“When you buy glasses you’re weighing a combination of fit and personal expression to find the perfect pair for you.

That process is very much at odds with how consumer electronics are built and sold today,” she said. “Others have tried and failed to create smartglasses people love because they built a computer to wear on your face and made the glasses as an afterthought. We did it the other way around. We designed Focals to be glasses first and invented new technology that we could conceal inside.” n

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INSIGHT October 2020

"[THE COMPANY] IS STUDYING THE JUDGMENT AND ASSESSING ITS OPTIONS, INCLUDING THE POSSIBILITY OF FILING AN APPEAL" ESSILORLUXOTTICA

A Dutch court has dismissed an EssilorLuxottica court case demanding that its potential takeover target Grandvision disclose information over the way it conducted business during COVID-19, leaving the door open for an appeal.

The Franco-Italian eyewear giant initiated court proceedings against GrandVision – the company it is seeking to acquire in a €7.2 billion (AU$11.8 b) deal – in July amid concerns over the way GrandVision managed its business during the crisis, as well as the extent to which it is alleged to have breached obligations under a support agreement.

For the past year, EssilorLuxottica has been seeking to acquire a controlling interest in the Dutch-based multinational to control its more than 7,200 stores across 40 countries and expand its retail presence.

Reuters reported EssilorLuxottica was concerned with GrandVision’s decision to suspend payments to store owners and suppliers and to apply for state aid, without seeking its approval.

However, the Rotterdam district court dismissed the case, while GrandVision said it had always informed EssilorLuxottica about its actions.

“The court dismissed EssilorLuxottica’s

The GrandVision deal is worth AU$11.8 billion.

demands for disclosure of information from both HAL (which owns a 76.72% ownership interest) and GrandVision on how the latter company conducted business during COVID-19,” an EssilorLuxottica statement said.

“EssilorLuxottica is studying the judgment and assessing its options, including the possibility of filing an appeal against the judgment. The company remains concerned about GrandVision’s behaviour in continuing to deny access to important information related to their handling of the COVID-19 outbreak.”

GrandVision said previously announced arbitration proceedings are going ahead as planned. It is working towards regulatory approval of the sale by mid-2021. n

ALCON SURVEY SHOWS RESILIENCE OF CONTACT LENS BUSINESS A survey by contact lens maker Alcon to understand contact lens usage and care and consumer expectations post-COVID-19 found 90% of wearers expect to return to their normal wearing schedule, with 70% planning to do so before the end of this month.

The survey, conducted by research firm MarketVision and released on 29 July, polled 1,511 contact lens wearers from Australia, France, Germany, Italy and South Korea.

In other findings, the survey revealed 90% of respondents believe contact lenses enhanced their lifestyles. While 94% remained loyal to their current brand, 75% were open to talking about upgrading. Furthermore, more than 70% of wearers are willing to pay more for an innovative lens.

“This is a good opportunity for eye care

The majority of respondents remained loyal to their current brand.

professionals (ECPs) to educate their patients about new technology and how eye care needs may have changed during the pandemic,” the company stated.

The survey also demonstrated that nearly 80% of those surveyed have improved their contact lens hygiene habits during COVID-19. n

NEW 1

Coming soon

ciclosporin 900 microgram/mL

The first approved ciclosporin treatment delivered via nanomicellar technology for Dry Eye Disease in Australia* *

First TGA approved nanomicellar ciclosporin ophthalmic solution with a dry-eye related indication1

PBS Information: This product is not PBS listed

Please review Product Information before prescribing available from https://sunophthalmology.com.au/pi or Sun Pharma by calling 1800 726 229 CEQUATM ciclosporin 900 microgram/mL eye drops ampoule. Indications: Increases tear production in patients with moderate to severe keratoconjunctivitis sicca (dry eye) where prior use of artificial tears has not been sufficient. Contraindications: Hypersensitivity to the active substance or excipients. Active or suspected ocular or peri-ocular infection, malignancies or premalignant conditions Precautions: Potential for eye injury and contamination: avoided by not touching the eye or other surfaces with the ampoule tip. Contact Lenses: remove contact lenses prior and reinsert 15 minutes after administration. Careful monitoring of patients with severe keratitis is recommended.

Infections: resolve existing or suspected ocular or peri-ocular infections before initiating treatment and if an infection occurs during treatment, withhold temporarily until infection resolves. Effects on the immune system: may affect host defenses against local infections and malignancies so regular examination of the eye(s) is recommended, e.g. at least every 6 months, when used for long periods. Paediatric use: safety and efficacy is not established below the age of 18. Pregnancy: Category C Adverse effects: Very Common and Common: instillation site pain, conjunctival hyperemia and punctate keratitis. Dosage and administration: one drop twice daily (approximately 12 hours apart) into the affected eye(s). Response to treatment should be reassessed at least every 6 months. Can be used concomitantly with artificial tears, with a 15-minute interval between products. Storage: Store below 25°C. Do not freeze. Store the ampoules in the original foil pouch. Protect from light. Date of preparation: May 2020.

This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at https://www.tga.gov.au/reporting-problems.

Sun Pharma ANZ Pty Ltd ABN 17 110 871 826, Macquarie Park NSW 2113 Ph: 1800 726 229. Fax: +61 2 8008 1613. Med Info: 1800 726 229 Adverse events may be reported to Sun Pharma by either email: adverse.events.aus@sunpharma.com or phone: 1800 726 229.

Date of preparation: May 2020. CEQ05/2020ad1 Reference: 1. CEQUA™ Product Information. 2020 Feb, 2020; Available from: Sun Pharma by calling 1800 726 229.

INTERNATIONAL

OPTIMISM HIGH BUT UPTAKE LOW FOR MYOPIA CONTROL IN US A CooperVision survey has confirmed that a majority of eyecare practitioners in the US still prescribe single vision interventions, despite increasing awareness of myopia management techniques.

Harris Poll surveyed 313 US eyecare providers in June and July 2019 on behalf of CooperVision of which 62% were optometrists and 38% were ophthalmologists.

Healio reported that myopia was the most common condition seen in these practices. Seventy per cent of children in these practices were using glasses as their primary mode of vision correction, while 30% used contact lenses, most of which were soft contact lenses (92%).

Survey results showed that, in general, eyecare practitioners are aware paediatric myopia represents a growing problem.

For example, 81% of respondents regarded myopia as one of the biggest problems currently impacting children’s eyesight.

Additionally, more than half (56%) agreed that, unless successfully treated, myopia increases the risk for irreversible vision loss later in life. However, a significant proportion (44%) did not recognise the risk.

Despite the currently low use of myopia management strategies, 87% of eyecare practitioners surveyed expressed interest in using myopia control contact lenses for children in the future and, on average, would feel comfortable fitting contact lenses among children from age 11 years onward.

CooperVision also found the majority of eyecare professionals (97%) believed parents should be educated more about the ways they can help protect their children’s vision, and 84% agreed parents need to understand that intervention is more urgent the younger a child is diagnosed.

Eyecare practitioners reported that inschool eye screening was the top reason prompting parents to take their children for an eye exam (92%), and 84% would have preferred that parents spoke with them sooner about their child’s vision. n

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INSIGHT October 2020

RIVALS JOIN FORCES TO DELIVER ONE MAJOR UK OPTICAL INDUSTRY SHOW Two optical trade show organisers in the UK have joined forces to create one major event for 2021 and beyond.

UK company Media 10, organisers of 100% Optical, and the Federation of Manufacturing Opticians (FMO) have agreed to host one major annual exhibition under the 100% Optical banner at London’s ExCeL exhibition centre, commencing next year.

The agreement comes following the cancellation of FMO’s event, Optrafair 2020, which was due to take place in September but was cancelled due to COVID-19. MA Exhibitions, part of Mark Allen Group, hold the licence to run Optrafair 2020.

Media 10 and FMO’s new long-term commercial agreement means the Optrafair brand will transition to Media 10 ownership from 2021. They are in discussions on how the Optrafair brand might be incorporated as part of 100% Optical.

In a joint statement, Media 10 and FMO said the new agreement means that optical suppliers will be able to put their event marketing plans into place to support one annual event.

100% Optical, typically the largest optical event in the UK which attracts more than 9,000 visitors each year, will

Nathan Garnett, 100% Optical.

take place from 23-25 January 2021.

“I am looking forward to working with Media 10 and believe this partnership will provide both tangible benefits and cost savings to our members and other exhibitors. Now more than ever we can come together as an industry at 100% Optical and tackle the key issues facing optics today,” FMO chairman Mr Stuart Burn said.

Mr Nathan Garnett, event director for 100% Optical, said the agreement with FMO would have been reached without the current pandemic but its importance was now magnified “as the optical industry needs solidarity at this time”.

The Association of Optometrists (AOP), the official partner to 100% Optical, and Association of British Dispensing Opticians (ABDO) lent their support to the 2021 event. n

AUSTRALIA LEADS LANDMARK GLOBAL EYE HEALTH RESOLUTION Australia and Indonesia have spearheaded a new resolution that sets the global eye health agenda for the next decade, in an effort to reach the one billion people worldwide who do not have access to vital eyecare services.

The 73rd World Health Assembly (WHA) adopted the resolution which was co-sponsored by 47 countries.

Adopted at an abridged virtual sitting, it commits member states to implement the recommendations of the World Health Organization’s (WHO) first World report on vision released in October last year. “[It] sends a strong signal of worldwide interest in progressing these important public health issues. We now stand ready to work with the international

One billion people can't access vital eyecare.

community to take these commitments forward,” Federal Health Minister Mr Greg Hunt said.

Fred Hollows Foundation CEO Mr Ian Wishart said the resolution was a critical milestone for global eye health and congratulated the Australian Government for its leadership. n

DISRUPT INFLAMMATION IN DRY EYE DISEASE 1–3

Lasting symptom relief in as little as 2 weeks1-3* *In some patients with continued daily use. One drop in each eye, twice daily (approximately 12 hours apart)1

 This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at www.tga.gov.au/reporting-problems

PBS Information: This product is not PBS listed.

See approved Product Information before prescribing.

For the most up to date Product Information go to www.novartis.com.au/products/healthcare-professionals Indication: Treatment of moderate to severe dry eye disease in adults for whom prior use of artificial tears has not been sufficient. Contraindications: Patients with hypersensitivity to lifitegrast or any of its excipients. Dosage and administration: Single-dose ampoule for ophthalmic use only. Discard after use. Adults and elderly: Instil one drop in affected eye(s) using a single-use container per administration, twice a day. Paediatric population: There is no relevant use of XIIDRA in children and adolescents aged below 18 years old in the treatment of dry eye disease. Contact lenses should be removed prior to the administration of XIIDRA and may be reinserted 15 minutes following administration. Precautions: •Prior to initiating therapy, a comprehensive eye examination is recommended to determine the aetiology of the symptoms and treat any reversible underlying conditions. •Allergic-type hypersensitivity reactions, including anaphylaxis, have been reported, rarely. Immediately discontinue administration and initiate appropriate treatment if hypersensitivity reactions occur. •The safety and efficacy of XIIDRA have not been established in paediatric patients. •Use in Pregnancy: Category B1. There are no or limited amount of data from the use of lifitegrast in pregnant women. The use of XIIDRA may be considered during pregnancy, if necessary. •Lactation: It is not known whether lifitegrast, or any of its metabolites, are excreted in human milk.

Interactions: Due to the low systemic absorption, it is unlikely that lifitegrast contributes to systemic drug interactions Adverse effects: •Very common (≥10%): Eye irritation, dysguesia, eye pain, instillation site reactions, •Common (1 to 10%): Eye pruritus, lacrimation increased, vision blurred, headache. •Unknown: conjunctivitis allergic, swollen tongue, anaphylactic reaction, hypersensitivity, type IV hypersensitivity reaction, asthma, dyspnoea, pharyngeal, oedema, respiratory distress, angioedema, dermatitis allergic. Based on TGA approved Product Information dated 4 September 2020 (xii040920m).

References: 1. Xiidra Australian approved Product Information (current version). Novartis Pharmaceuticals Australia Pty Ltd. 2. Tauber J et al. Ophthalmol. 2015; 122(12): 2423–2431. 3. Holland EJ et al. Ophthalmol. 2017; 124(1): 53–60.

Novartis Pharmaceuticals Australia Pty Limited ABN 18 004 244 160. 54 Waterloo Road, Macquarie Park NSW 2113. Ph (02) 9805 3555. ®Registered Trademark.

AU-13851. McCann Health NOXI19693M. September 2020.

MEDICAL RETINA

Dr Paul Baddeley (left) and Dr Oliver Comyn assess retinal images at their St George's Eye Care clinic.

ENHANCING RETINAL PATHOLOGY DETECTION UK-trained ophthalmologist DR OLIVER COMYN made it a priority to install a state-of-the-art imaging device when he joined a well-known private hospital in New Zealand as its sole retinal specialist.

Now that piece of equipment has become an essential part of the clinic.

W

hen St George’s Eye Care appointed Dr Oliver Comyn as its first dedicated medical retina specialist, it did so with the intention of expanding its suite of services beyond cataract and glaucoma care.

Comyn arrived at his new post in Christchurch, New Zealand, in 2018 having completed vitreoretinal fellowships at the Sussex Eye Hospital and the world-renowned Moorfields Eye Hospital in London, in addition to internationally published works on diabetic eye disease and retinal imaging.

For St George’s – the first private hospital in New Zealand to invest in fulltime ophthalmologists – it was an important appointment because it meant medical and surgical retinal treatment would become a significant component of the clinic, with Comyn complementing the practice’s other consultant ophthalmologist Dr Paul Baddeley, whom he trained under in West Sussex in 2013-14.

Imaging equipment is a key tool in the repertoire of any medical retinal specialist, so upon his arrival Comyn was determined to advocate for investment in a state-of-the-art instrument that would offer superior results and usability than the existing fundus camera.

That device was the Optos California FA ultra-widefield (UWF) retinal imaging device with optomap. After stating his case, the instrument was swiftly installed and has now cemented its place as a key piece of equipment.

“The hospital recognised in order to have a comprehensive and credible retinal practice we needed something to capture images and conduct fluorescein angiography, without the need to employ a retinal photographer who could use a fundus camera effectively. We also didn’t

26

INSIGHT October 2020

want to risk acquiring poorer images with the existing camera,” he says.

“Ultra-widefield images are essential to managing retinal disease today, and widefield angiograms and the ability to do targeted laser treatment based on identifying vascular changes in the peripheral retina is part of modern retina care, so my argument was if they were serious about having a retinal specialist who could treat all patients coming through the door then this was the piece of equipment to do that.”

EASY ACQUISITION Optos California has been available to the Australasian market for five years and remains the company’s premium offering to optometry and ophthalmology practices.

It comes in three versions, with up to six imaging modalities including three-in-one colour depth imaging (colour, red-free and choroidal in a single image), as well as autofluorescence (AF), fluorescein angiography (FA) and indocyanine green angiography (ICG).

According to Optos, the California RG version has been popular among general ophthalmologists because it allows for high resolution 200° ultrawide field (UWF) colour and AF images of the retina, without the need for dilation, in as little as 0.1 seconds.

The mid-range California FA has the added benefit of UWF angiography to provide diagnostic information of the mid and far periphery for general ophthalmologists and retinal specialists.

California ICG incorporates the technology of the other two models plus interweaved ICG. This added feature is for retinal specialists to optimise management of AMD, uveitic conditions and other choroidal pathology.

According to Optos, up to 82% of the retina is captured in one

to perform an OCT scan on a patient. The optometrist sent an optomap image and it became clear why the OCT wasn’t functioning.

“The patient had a retinal detachment the optometrist hadn’t noticed on the Optos image. This one was quite shallow and the patient had lots of other changes in their retina that were distracting,” he says.

“It’s a great tool for communicating with optometrists and trying to identify whether the patients need to be referred to an ophthalmologist.”

Due to its ability to show the peripheral retina, Comyn says California is also useful for retinal vascular disease.

“For a case of branch retinal vein occlusion, it can show what you thought was perhaps a fairly small occlusion involving the posterior pole may actually involve quite an extensive amount of the peripheral retina, and you can demonstrate that by normal colour imaging or angiography, which shows a lot more than a fundus camera. This can improve patient care by allowing you to do targeted laser to areas of retinal ischemia.”

The Optos California UWF retinal imaging device offers up to six imaging modalities.

image, allowing eyecare professionals to see 50% more compared with conventional imaging devices such as the slit lamp, indirect ophthalmascope (30°) and fundus camera (45°).

Since arriving at St George’s, Comyn has grown the retinal patient cohort to fill one clinic out of four each week, with up to 14 patients. Many visit on a regular basis for injection treatments and he also performs retinal surgery at the hospital too.

In addition to the imaging benefits, Comyn says an important factor in choosing Optos California was its usability. It meant the clinic avoided the need for heavy investment in the upskilling of the existing ophthalmic technicians and clinic nurse.

In turn, the instrument could be used to its full capability soon after installation and removed the need for pupil dilation as is necessary in traditional imaging techniques.

Also impressive, Comyn says, is California’s zoom function allowing detailed inspection of the macula, optic nerve head and small pathology.

The sophistication of this technology includes a feature where the eyecare professional can take a portion of a historical scan and overlay that with the patient’s latest scan.

He says this had benefits in monitoring disease progression including retinal lesions and choroidal nevi.

“It allows for multi-modal imaging where you can drag a colour image over a fluorescein angiogram image; this allows you to localise angiographic changes such as leaking vessels with actual retinal landmarks,” he says.

EDUCATING PATIENTS The ability to produce clear and detailed images is also said to be a powerful tool to educate patients.

“The fundus camera was rarely used before I arrived, and the staff weren’t particularly confident using it; they didn’t understand all the features and hadn’t had formal training as retinal photographers. I wanted the clinic to have a machine that enabled rapid and easy acquisition of images by the technical staff without the need for complicated training or further qualifications,” he says.

This includes cataract patients, who make up a significant proportion of cases within St George’s Eye Care. Due to the swift image acquisition of California, retinal imaging has become a standard part of the cataract work up – a measure that would be unviable if a fundus camera was the primary imaging tool.

“Our staff have been impressed with how quick it is, it doesn’t have any complicated settings, it’s easy to use and acquires really good images.

Patients also like seeing images of their eye.”

“We use the images educationally to show the effect the cataract might be having on the view of the retina and to show when there’s co-existing pathology – as there frequently is,” Comyn says.

Further, Comyn says the review software is simple to use. It’s browserbased so images can be reviewed on any computer within the practice network.

From a disease management perspective, Comyn says the 200° fieldof-view is one of California’s greatest strengths, making it possible to view almost the entire peripheral retina with steered views.

“I think it’s important to understand that optomap images don’t replace clinical examination, but they complement it. It’s good for identifying peripheral retinal pathology, such as a small retinal tear you may have otherwise missed. It’s great for assessing how well you’ve applied laser.

Sometimes patients can be difficult to examine, they can be light sensitive, blink a lot or they can struggle to get into the right position on the slit lamp for a detailed examination,” he says.

“It also combines photography, fluorescein angiography and autofluorescence imaging in a single machine. Autofluorescence is useful for looking at patients with retinal dystrophies, age-related macular degeneration and pachychoroid disorders like central serous retinopathy.”

“For example, if they have macular degeneration you can show them the features of the disease on the Optos image and explain how that might have an impact on the final outcome.

We find patients really understand what we are talking about when we show them the actual changes in their eye, it makes it much more real rather than being a theoretical idea that they can’t visualise.”

Mr Anton Tesoriero, account manager at Optos Australia, says with three different versions, California has gone from being perceived as a retina specialist product to “must have” for eyecare professionals looking to enhance diagnostic capabilities, practice efficiency and patient experience.

“More than 900 published and ongoing clinical trials, as well as thousands of case studies and testimonials, show the long-term value of optomap imaging in diagnosis, treatment planning, and patient engagement.” n

As an example of its ability to expose hard-to-spot pathology, Comyn points to a case where an optometrist contacted him about their inability

INSIGHT October 2020 27

GLAUCOMA

USING MEDICARE An additional 79,000 Australians are expected to develop glaucoma in the next five years, costing the economy $4.3 billion. Specsavers optometry director DR BENJAMIN ASHBY explains some of the strategic initiatives, including OCT and visual fields, in place to mitigate this problem.

D

espite progress in the understanding of glaucoma pathophysiology, clinical technology, and optometrists’ training and scope as primary eyecare providers, 50% of Australians with glaucoma remain undiagnosed. This is often despite the fact many who likely have the disease have recently accessed eyecare. Ultimately, the undiagnosed glaucoma rate has remained relatively unchanged for the past three decades.

This is primarily due to the nature of glaucoma, with a lack of overt signs and symptoms in early stages and with functional deficits often preceded by extensive structural damage before they manifest in a way patients can notice.

According to Dr Benjamin Ashby, optometry director at Specsavers Australia and New Zealand, early detection of glaucoma is critical to preserving vision and maintaining quality of life for patients, as well as providing a more cost-effective method to lessen the burden of the disease on the economy.

As a part of its Transforming Eye Health strategy, Specsavers has collaborated with industry stakeholders to implement several initiatives within its practices to detect and refer those with undiagnosed glaucoma.

Following extensive investigation and piloting, Specsavers invested more than $40 million to rollout optical coherence tomography (OCT) and related training across its network from 2017. The approach was deliberately to use OCT as part of a standard eye test for all patients, harnessing the clinical benefits of this imaging technology to enhance detection of asymptomatic and early stage eye disease.

“OCT has been regarded as a supplementary test for glaucoma diagnosis by optometrists rather than a case-finding tool. Its systematic use on all patients has resulted in an increase in glaucoma detection across our population,” Ashby says.

According to Specsavers, consistent application of OCT as part of the optometric consultation, together with Optometry Benchmark Reporting, clinician education and adherence to the RANZCO Referral Pathways, has been effective in increasing the rate of glaucoma detection in line with published prevalence rates for the condition. The

28

INSIGHT October 2020

Figure 1 – Glaucoma detection rates by age group from 2019 showing the impact of OCT.

graph in Figure 1 shows glaucoma detection rates as measured in 2019.

USING VISUAL FIELDS TO DETECT GLAUCOMA OCT helps to facilitate the detection of glaucoma at a stage where visual field loss is minimal, allowing the greatest opportunity for patients to maintain vision and quality of life, Ashby says.

The enhanced visibility of the retinal architecture OCT enables has been beneficial in supporting optometrists to detect early nerve fibre layer and ganglion cell loss. Equipped with this information, Ashby says the data shows optometrists have been better able to make consistent decisions to perform clinically indicated visual field assessment, interpret structural and functional correlations and then refer for ophthalmological intervention appropriately.

“From the outset we have closely monitored the rate of visual field performance before and after introduction of OCT. This was, and continues to be, the clearest first indicator of whether the technology is enhancing identification of clinical risk factors for glaucoma and other eye conditions. We measure visual field rates at a national level all the way down to the individual optometrist in any one of our practices,” he says.

In addition to this, Ashby says it has been important to understand the link between visual field performance and detection of glaucoma.

“We first analysed the correlation between visual field performance and glaucoma detection in 2017 using a dataset of 5.3 million patient outcomes.

At this time, we found the 13% visual field rate correlated with detection of glaucoma at the population prevalence (see Figure 2).

“Given the scale of the dataset and the gravity of what we had found, we made the decision to benchmark visual field performance as a point of reference, so optometrists could apply this in the context of the RANZCO Referral Pathways for Glaucoma with the aim of enhancing detection of glaucoma in their communities. This benchmark was a crucial step in drawing attention to the evidence and set a precedent as it was the first ever data-led benchmark derived for visual fields in optometric practice. Since then, we have repeated the analysis and the benchmark continues to be supported by the data.”

Figure 2 – Data from more than 1,400 optometrists reveals a strong correlation between visual fields and glaucoma referrals.

From an optometrist’s perspective, this means that if they are seeing 15 patients per day, statistically, one or two of them will require visual field testing on that same day and over a week, one or two patients will be referred for specialist follow up.

Detection of glaucoma at this rate does rely on optometrists assessing the eye both structurally and functionally, conducting visual field assessments for all patients where clinically indicated.

Ashby says Specsavers’ visual field monitoring also extends to analysing Medicare utilisation in the context of all eye health providers in Australia. The visual field trends being observed through the Medicare national dataset are reflective of the changes instigated by Specsavers in the past few years and directly correlate with increased glaucoma detection.

“Medicare funding of visual fields is an important public health lever to support detection and management of glaucoma in the community. It is vital that this government funding is used wisely to provide accessible clinical services that have a measurable impact on detection rates and effective comanagement of this endemic cause of avoidable blindness.

“Increasing rates of visual fields across optometry can only be seen in a positive light when it is linked to progress in detecting the 50% of undiagnosed glaucoma in this country. The real concern right now are the thousands of people at risk of glaucoma that have not had access to this service because of COVID-19.”

FALSE POSITIVES Adaptions in the eye test process have led to increases in detection and referral rates for glaucoma, and a significant increase from 0.55% of patients referred for glaucoma in 2017, compared with 1.26% in 2019. Ashby says this understandably raises questions about false positive referrals.

“We have sought to confirm the appropriateness of glaucoma referrals and worked with e-referral platform Oculo and ophthalmologists across Australia to identify the rate of false positives following specialist assessment,” he says.

A process has been established whereby optometrists are required to classify referral types into one of three categories: ‘new assessment’ for patients who are newly diagnosed by the optometrist and have never been seen by an ophthalmologist; ‘suspect review’ for existing probable glaucoma suspects who are being monitored for progression but have not yet started treatment; and ‘glaucoma review’ for patients with existing confirmed glaucoma.

Ophthalmologists can provide one of three diagnoses after the patient’s attendance through Oculo: ‘glaucoma’, ‘glaucoma suspect’ for patients in

Figure 3 – Ophthalmology feedback on new glaucoma referrals.

whom glaucoma was probable but not confirmed, or ‘no glaucoma’. The percentage of patients who received a diagnosis of ‘no glaucoma’ is used to determine the false positive rate. Ashby says Specsavers has now received feedback on a subset of 784 Australian patient referrals. Of the patient referrals for newly detected glaucoma, 79% were confirmed to have definite or probable glaucoma (see Figure 3).

Glaucoma surgeon and neuro-ophthalmologist Associate Professor Mitchell Lawlor from Sydney Eye Surgeons and Macquarie Street Eye Surgeons, has contributed to the emerging feedback data.

“The process of capturing and reporting on ophthalmological feedback is crucial in verifying the increasing glaucoma detection rate. Feedback on appropriateness of referrals is key to driving systematic change that ensures the right people are referred at the right time for early treatment of glaucoma.”

Ashby says while the ongoing importance of collecting feedback data is acknowledged, this initial set of outcomes compare favourably to prior studies of optometric glaucoma referrals where up to 58.3% resulted in a ‘no glaucoma’ diagnosis at the first specialist visit.

“This suggests that our systematic use of OCT has lifted detection rates of glaucoma whilst maintaining comparably high levels of referral accuracy and appropriateness.” n To see list of references for this article visit www.insightnews.com.au

INSIGHT October 2020 29

MENTAL HEALTH Eyecare professionals are often high achievers who manage businesses, patients and staff all at once. The stress and pressure can lead to psychological issues. With COVID-19 presenting new problems, Insight checks in on the sector’s mental health.

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INSIGHT October 2020

MENTAL HEALTH

S

ix years ago, the issue of mental health forced its way into the consciousness of the eye health sector unlike ever before when two Australian optometrists were lost to suicide.

Both men, who were middle-aged and practised in New South Wales, took their own lives within a six-week period. It was an unprecedented tragedy for the sector and served as a stark reminder that optometrists and other professionals within the ophthalmic workforce weren’t immune to the devastating effects of anxiety and depression.

“They were guys I had talked to on a number of occasions and they would have been well known among the sector. It was shocking because on the surface there didn’t appear to be any underlying issues, their worlds seemed much like yours and mine,” Optometry NSW/ACT CEO Mr Andrew McKinnon says, reflecting on that period.

“They came in very quick succession and it made us sit up and think this is an issue that really needs exploring, not just as a personal issue for members, their colleagues and family but from the patient viewpoint as well.”

In recent months, mental health has again worked its way to the top of the agenda for bodies like Optometry Australia (OA) and RANZCO as eyecare professionals deal with a multitude of new clinical, employment, financial and personal health issues brought on by COVID-19.

to be working at least 60 hours on average per week.

“This is particularly worrying given the clear recent Australian research showing that doctors in training who work more than 55 hours each week have double the risk of developing mental health problems and suicidal ideation,” Australian Medical Association president Dr Tony Bartone said at the time.

“One in five doctors in training felt they had personally experienced bullying, harassment, and/or discrimination in their workplace in the last 12 months.”

BUILDING RESILIENCE

Optometry NSW/ACT CEO MR ANDREW MCKINNON says he has seen optometrists at opposite ends of the career scale struggle with their mental health during the pandemic.

In perhaps the most comprehensive data on the psychological impact so far, OA surveyed 3,290 optometrists during the month of April – arguably the worst month of the crisis in a nationwide context – to provide a snapshot of optometrists’ mental state.

In light of these statistics, member bodies within the ophthalmic sector have taken note and have swiftly mobilised to support professionals that are doing it tough.

The survey indicated in April 88% of optometrists were ‘travelling ok’, which OA says is an indication of the sector’s resilience. While it’s positive to have a large proportion feeling this way, it’s important to note that 12% were struggling.

When Optometry NSW/ACT was confronted with the loss of two optometrists six years ago, it enlisted the help of organisational psychologist Ms Rachel Clements who is now helping the organisation through the COVID-19 pandemic.

Other stark findings revealed 46% of members were anxious about their future, with 61% believing it would become increasingly difficult to find employment as an optometrist, and 76% suspecting that salaries will be compromised due to over-supply.

Her previous work with the organisation has focussed on managing the mental health of optometrists who are often ‘high achievers’ focused on balancing their business and patient load. Her work has also guided optometrists in dealing with mentally unwell support staff, as well as management of patients who appear at risk of suicide.

Although sentiment may have improved in some states since the survey, the fact that 96% of practice owners or self-employed optometrists such as locums saw their revenue decrease indicates the financial strain that’s been imposed on the sector. Furthermore, 25% of those had their income decrease by 75% or more, 34% saw a decrease of 50-74%, and 30% experienced a 30-49% drop.

In August, another poll of optometrists revealed an estimated 50% of optometrists were still working fewer hours than they were pre-COVID-19.

In the medical field, which includes ophthalmologists, mental health organisation Beyond Blue conducted the country’s first ever National Mental Health Survey of Doctors and Medical Students in 2013 and found doctors and medical students are burnt-out and are more likely to experience psychological distress and suicidal thoughts than the general community.

In total, 27% of doctors and 36% of young doctors are highly likely to have a minor psychiatric disorder.

Medical students and young or female doctors are most at risk, with significant levels of stigma directed towards people with mental health problems.

Further evidence of this was highlighted in Australia’s inaugural national Medical Training Survey this year where one in eight trainees were found

In her latest initiative with Optometry NSW/ACT, Clements, who is director of psychological services at the Centre for Corporate Health in Sydney, has introduced the Resilience Box. The resource will soon be rolled out nationally to OA members, and features alongside OA webinars and podcasts she has done in recent months.

“Rachel developed the Resilience Box for a major bank and she thought it would be great for our members,” McKinnon, CEO of Optometry NSW/ACT, says. “It is designed specifically to provide people with online tools that will help them with their mental resilience.”

McKinnon says the resource comprises a series of video clips and talks through the body’s natural responses to stress. Users can also select different modules that pertain to them, such as dealing with grief, positive mental health, the importance of nutrition, the role or neurotransmitters, reducing stress and much more.

“It largely reinforces that what you’re feeling is normal and that there are ways to cope and here’s the tools to help. If you’ve been through this and it’s not helped, there’s further contact details for mental health support organisations and counselling if you want to go to the stage. The member will cover the cost of counselling individually, but they get it at a better rate than they would normally."

INSIGHT October 2020 31

MENTAL HEALTH

In his role, McKinnon says he is currently seeing mental health issues at both ends of the career scale in optometry.

He says optometry has been one of the last remaining professions that offered guaranteed job prospects for graduates, however that wasn’t necessarily the case in the current climate.

“Many graduates have been affected and that’s simply because they were the last to be hired and first to be let go in some cases, so the uncertainty and reality of job curtailment is very real for them – and it’s not a situation that has ever arisen before,” McKinnon explains.

“On the other hand, we’re seeing quite a number of older optometrists who are facing two dilemmas. The first is that their practices have been affected like everybody else’s. Secondly, a number of them have their own health issues and optometry is a very close contact profession, so there’s been a lot of concern about how close they need to get to their patients.

“A number of them thought: ‘I’m in my 60s, I was going to retire in five years so should I just do it now?’. But then they are questioning whether they are ready to retire mentally, and then there’s the question of who’s

going to buy my practice at this time.”

Mr Luke Arundel, OA’s national chief clinical officer, says the organisation’s Mental Health Support page within its COVID-19 hub to support members through this time has had more than 400 visits during the past few months.

Each of OA’s member support optometrists have undertaken mental health first aid training courses.

“AHPRA notifications, being sued, conflict with employers, employees or patients or needing assistance with helping patients suffering from domestic or child abuse are some of the other non-COVID related areas where we find member’s mental health can be adversely affected,” he says.

“We have been told numerous times that the one-on-one, confidential and professional support provided to members during these incidents has been instrumental in assisting during these very mentally stressful events and I think it is important that optometrists don’t have to tackle these challenges alone.”

WHO'S LOOKING OUT FOR OPHTHALMOLOGISTS?

RANZCO Health and Wellbeing Group co-chair DR NISHA SACHDEV says ophthalmologists need to be comfortable and stable to effectively lead a team.

COVID-19 has also been the catalyst for change at RANZCO when it comes to dealing with the mental health and wellbeing of its Fellows, trainees and associates.

In March, it formally established its first Health and Wellbeing Group which comprises a committee of 14 ophthalmologists at different stages of their careers. Together, they encourage ophthalmologists and their staff to consider health and wellbeing in a proactive manner and it has compiled resources to support them.

Sydney ophthalmologist Dr Nisha Sachdev is one of five co-chairs of the Health and Wellbeing Group. At the beginning of the pandemic as elective surgery was shut down, she says many of her colleagues struggled with a new type of stress they hadn’t encountered before.

“Ophthalmologists are a high achieving professional group. We are so used to working and when that suddenly stopped many found it difficult to deal with,” she explains. “The biggest issue is the uncertainty – as ophthalmologists and doctors we are used to certainty and consistency and so that’s what hit us the hardest.”

This was then followed by increased demand on ophthalmology services after the government lifted elective surgery restrictions, with clinics needing to prioritise the backlog of patients while complying with capacity restrictions.

Sachdev runs her own private practice City West Eye Specialists, which she founded seven years ago. She understands firsthand the stresses of being an ophthalmologist in private practice, which extends far beyond managing patients.

“When we shut down this was the first time we’d ever had minimal income with expenses, and it’s very expensive to run a practice with outgoings such as business loans, staff wages and rent on your facility,” she says.

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“But in general, financial stress is one thing, along with managing people and keeping them employed and happy. In one of my latest emails to members through the Health and Wellbeing Group, we highlighted one of the biggest issues as ophthalmologists is that, as leaders, we look after people, we lead a team, we look after our staff and patients – but who looks after us? If we are not comfortable, happy and in a stable position how can we look after and lead a team?”

Sachdev believes one underestimated trigger of stress is surgery and operating itself. She knows of several ophthalmologists who have switched to consulting-only for this reason.

As such, Melbourne ophthalmologist Dr Jacqueline Beltz addresses this issue in her podcast series called GenEye where she talks with experts, including psychologists, about the measures eye surgeons can adopt to ensure longevity in their surgical careers.

“She’s done quite a few podcasts on stress and coping with being a surgeon and mindfulness – being a surgeon is one thing when things go right, but it’s quite stressful when they don’t,” Sachdev adds.

Prior to the RANZCO Health and Wellbeing Group, Sachdev says the profession lacked a formal channel to promote mental health and wellbeing. Since its launch, the group has sent monthly emails on topical issues, which are sent to more than 1,200 Fellows and 300 trainees and allied health professionals (orthoptists and practice managers). A lot of the material has been re-published in a newly developed open section of the RANZCO website.

The group also plans to hold workshops at the annual congress, as well as state branch meetings. There are also plans for webinars and online symposium.

“One thing we have highlighted is that there are silver linings for what we have been through and we are getting through it. The Health and Wellbeing Group is making it known to ophthalmologists that it’s OK not to be OK,” she says.

“We also provide guidance for various support groups. RANZCO has an Employee Assistance Program, which is a confidential free service to do with anything in working life. It’s just a phone call away, and you can get advice on a range of issues including financial stress, management of issues within the practice and mental health and counselling advice.

“The Health and Wellbeing Group is a big step for us as a profession.”

NEW RESOURCE AN AUSTRALIAN FIRST

Clinical psychologist DR MELISSA BLACK says issues around fitness-to-practice could be a barrier for healthcare workers to seek help.

Peer Support, SAS, APS, Cogniss, UNSW and the University of Melbourne.

Through the TEN website or app, free mental health resources and tools can be accessed anonymously and provide triaged support, as well as online programs and one-on-one consultations with expert clinicians “There are lots of options for people and a centralised assessment tool allows people to get a gauge on how their mental health is tracking.

They are then presented with different options on how they can follow up depending on their level of need or preferences,” Black says.

This may include self-care tools for managing wellbeing, relaxation strategies and video resources on how to manage healthcare workerspecific issues during this time.

Dr Melissa Black is a clinical research fellow and clinical psychologist at the Black Dog Institute, the only research institute in Australia researching mental health for all ages.

She says it’s important to normalise the experience of low mood and anxiety and discuss them amongst peers.

“There’s a really good reason to experience those feelings right now, but in saying that if those feelings are persisting for longer than around two weeks, and more days than not you’re feeling sad, anxious or irritable, then that’s maybe a tell-tale sign that things might be at a point where it would be good to unpack those with someone and seek additional support,” she says.

“The same can be said for those who feel a sense of loneliness even when they’re with other people and don’t feel like you have support, or constant feelings of exhaustion. There’s also those every day routine differences; often people talk about difficulties with sleep, change in their appetite and diet, changes in their relationships, not feeling like they can switch off at the end of the day, or feel a constant need to worry about work.”

“The other really important part is being able to link people with the right amount of professional support - whether this is the kind of information you can talk about with a GP, or here’s how to access a psychiatrist or psychologist. There’s a Hand-n-Hand peer-support resource that links healthcare workers with healthcare workers. There’s also some middle ground measures, such as online cognitive behavioural therapy resources that people can access themselves that have clinical support.”

Black believes TEN would be valuable to many optometrists and ophthalmologists who work in private settings and may not have access to employee assistance programs that are often accessible in public settings.

She acknowledges that, traditionally, issues around fitness-to-practice may have been barrier for healthcare workers to seek help and disclose a mental health issue.

“There are mandatory reporting guidelines by AHPRA and I think a lot of people think they are immediately going to be struck off the register, but that’s not the case,” Black explains.

The Black Dog Institute has just unveiled the country’s first multifaceted e-health hub called the TEN (The Essential Network), which was developed by health professionals for health professionals out of the Australian Government’s $1.4 million package to support the mental health and wellbeing of the health workforce during the pandemic.

“As someone who works with mental health and healthcare workers, the main concern is around whether you can do your job safely and if there is an actual risk to the safety of patients and colleagues. It’s very much a case-by-case basis, and there’s a graded approach to that which is done in collaboration with the healthcare worker.

Black says TEN is the first time that leaders in mental health, academia, mental health research, technology and clinical care have come together to provide such assistance to healthcare workers during a crisis like COVID-19. Those involved in its development were This Way Up, The Royal Australian and New Zealand College of Psychiatrists, Hand-n-Hand

“Seeking support for your mental health actually reflects really positively on the person. Plenty of healthcare workers with anxiety and depression can do their job and do it safely with the right support.” n If you need to talk to someone or need further support, call Lifeline on 13 11 14.

SIGNS AND SYMPTOMS OF DEPRESSION These can be physical, emotional and impact on the way people think. Having one or two of these symptoms may not necessarily indicate depression, but it’s a good idea to check with a GP. You may be feeling:

n

‘It’s all my fault’.

n

Sad, teary, anxious or irritable.

Perhaps there's changes in:

n

Hopeless and negative about yourself and others.

n

Motivation.

n

Ability to find enjoyment and pleasure in things.

n

Quality of sleep (sleeping a lot, waking up a lot, or insomnia).

n

Appetite or weight.

n

Interest in sex.

n

Concentration and remembering things.

Drinking or use of drugs.

n

Alone and isolated.

n

Exhausted.

Your thinking may be negative and critical: n

‘My problems are too difficult to solve’.

n

‘Life is too hard’.

n

‘Everything’s going to go wrong’.

n

n

‘I’m no good’.

Source: Black Dog Institute

INSIGHT October 2020 33

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PROFILE

INTRODUCING THE

RANZCO PRESIDENT From individual patients to national eyecare systems, Tasmanian ophthalmologist Professor Nitin Verma has made it his mission to improve visual outcomes in developing countries. Now he’s bringing his unique knowledge to the RANZCO presidency.

T

hirty-five years ago, while on his fellowship as a young ophthalmologist in Germany, Professor Nitin Verma co-developed one of the world’s first foldable intraocular lenses (IOL) made from silicon.

Under the guidance of the renowned Dr Günter Fromberg, the lens signalled a new generation in IOL technology that could be produced at a much cheaper price, while also being conducive with the emergence of smaller incision cataract surgery.

Importantly for Verma – who was born and raised in India where he also conducted his medical training – the Fromberg-Verma (FV) silicone IOL created a new pathway for developing countries to access advanced, western-developed ophthalmic technology.

Back then, in 1985 when cataract surgery wasn’t common in developing countries, Verma implanted his FV IOL in a young Indian boy with significant ocular trauma. Last year – 34 years on – he met with a surgeon from that same hospital who informed him the boy is now a successful engineer, with the same IOL still in place.

For Verma – who assumes the RANZCO presidency this month – this anecdote encapsulates his reasons for choosing ophthalmology, leading to a career that’s made a difference on a much larger scale across the Asia-Pacific region.

“I was initially drawn to ophthalmology because it’s a fine art that can produce spectacular results. Cataracts are often the benchmark when you’re talking about outcomes in ophthalmology, and even though I’ve done plenty of procedures in my time, that’s still something that continues to fascinate me,” he says.

“Closing the gap between the developed and developing world, the haves and have nots, has always been a passion of mine. Throughout my career I’ve been interested in how we can adopt technology from advanced countries for those living in poorer countries.”

Professor Nitin Verma carries a patient called Rosita from Baucau, Timor Leste, to the operating table. She was blind and only weighed 32kg at the time.

Aboriginal and Torres Strait Islanders in the Northern Territory and providing remote emergency eyecare to people stationed in Antarctica.

For the past 18 years till now, he and his wife Anu have lived in Tasmania.

Verma practises privately at Hobart Eye Surgeons, while also fulfilling roles as a Clinical Professor at the University of Tasmania School of Medicine, and Clinical Associate Professor in Ophthalmology in the University of Sydney. He recently stepped down as head of ophthalmology at the Royal Hobart Hospital, but still continues to practise there.

FIRST EXPOSURE TO OPHTHALMOLOGY

Verma takes over the presidential reins from Associate Professor Heather Mack, the first female to hold the position in RANZCO’s 50-year history, and whom Verma has praised for improving governance standards, her attention to detail, collegiality and work ethic.

The son of an army engineer, Verma’s childhood was spent in different parts of India, with his father sent on different postings throughout the country. His father was also involved with water management projects and non-government organisations (NGOs).

Verma himself has had a long affiliation with the college as a Council member and long-term Board member, while also serving as vicepresident between 2018-19.

“To a large extent I learned a lot from my parents, and my father was also an Olympian. He represented India in sailing at the 1972 Munich Games.”

He’s also left an indelible mark on many eyecare programs across the world. The most notable include practising oculoplastics on leprosy patients in India, founding the East Timor Eye Program, overhauling the public ophthalmology service in Papua New Guinea, working with

Verma went to medical school at the Christian Medical College in Vellore, South India, and in his fourth year became enamoured with ophthalmology.

“The exact nature of ophthalmology appealed to me. Those days we

INSIGHT October 2020 35

PROFILE

were talking millimetres when other surgeons were talking in feet and inches. Even though ophthalmology was fairly underdeveloped in 19771978, one could see its future.”

As part of his internship, Verma worked at a leprosy hospital, his first major exposure to ophthalmology. This involved facial reconstruction and eye lid work in patients with lagophthalmos and facial nerve palsy.

During his ophthalmology training at the All India Institute of Medical Sciences in New Delhi, Verma continued this and was the only trainee who would conduct eye camps in leprosy colonies due to his dual oculoplastics and cataract skills.

During his early years, he met Dr Fromberg, which led to his fellowship in Germany and development of the FV IOL when he was just 27 years old.

There, his eyes were opened to the significant disparity between first and third world countries, and it got him thinking about how poorer countries could benefit from what the world has to offer.

“I believe [the FV IOL] was the second foldable IOL in the world. It was also cheap and made from silicon and it could be sterilised with autoclaving, so it was suitable for developing countries,” he says.

“It was produced when phaco was about to come on the scene. At that time incisions were large, and people were asking why we were making a flexible lens. But it wasn’t until the late 1980s that acrylic IOLs came in, and when phaco became the standard of care, flexible lenses became the standard of care, so our lens was produced a few years ahead of its time.”

After his fellowship, Verma returned to India, and in 1993 went to Papua New Guinea where he was tasked with rebooting and running the country’s ailing ophthalmology services and training program.

“In 1997, we left because I had been held up too often with guns. The third armed hold up happened when I came home one day. The guard took his time opening the gate and suddenly there were three guys around the car. They held a gun to my head and told me to get out and took the car.

“I walked home and there was a phone call from the Royal Darwin Hospital who had been asking me to work for them. They asked if I had made up my mind, and by September 1997 we left for Australia. But Papua New Guinea was one of the best parts of our life because we did so much there, we started some NGOs that are still running, and we have seen parts of the country that most locals wouldn’t have.”

In Darwin, Verma oversaw three hospitals and serviced 29 communities, where he formed a greater understanding of the eye health issues facing Aboriginal and Torres Strait Islanders.

“I’ve been Closing the Gap my entire life and we have our own gap in

New Zealand and Australia that we need to continue to work on,” he says. “[RANZCO] is one of the original endorsers of the roadmap for Closing the Gap for vision, and its annual update is launched at RANZCO Congress each year.

Soon, we’ll also be launching our Maori action plan. New Zealand is often seen as the exemplar of equality, but there’s more to be done to ensure true equity of access for Māori and Pacifika.”

BIGGER THAN OPHTHALMOLOGY Verma believes ophthalmology in Australia is well regarded internationally, underpinned by a robust health system, strong training program and some of the world’s leading professionals.

Within that, he believes RANZCO’s main function extends beyond educating ophthalmologists and the broader eye health workforce.

“It’s also education of the community and the government to ensure we can maintain the high standards of eyecare that we are used to in Australia and New Zealand,” he says.

A 1985 article in the Indian Express

“It’s important to remember it’s a much about the Fromberg-Verma IOL. bigger playing field than ophthalmology and optometry. We can’t have these standards without patient organisations, orthoptists, technicians, practice managers, ophthalmic nurses, researchers and administrators.”

In addition to new technology, artificial intelligence and new drugs, he believes one of the biggest challenges facing ophthalmology is the rapid change brought about by COVID-19 and what that will mean for the point-of-care.

“I believe the point-of-care will slowly be moved to the home. Patients will still come in for examination, but there will be a lot more home monitoring.

We need to rethink what’s going to be the new ‘business as usual’, while maintaining the same standards we’re used to.”

With a small population dispersed over vast distances, Verma says Australia faces unique challenges in terms of access to care for rural and remote communities. But he says the country needs to look beyond its borders as well.

In 2000, he set up the East Timor Eye Program, which is perhaps his most notable project yet. It set out to make Timor Leste self-sufficient in eyecare services by 2020 and eradicate preventable blindness by 2025.

“Prevalence of blindness has come down from 7.7% to 2.9%, that’s the impact of the program,” he explains.

“Very soon we will be handing the whole program over – equipment, buildings and systems – to the Ministry of Health. It’s taken 20 years in a post-conflict country to create this program from scratch, integrate it with the existing programs and health system, and make it sustainable.

Professor Nitin Verma at his East Timor Eye Program in 2017.

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INSIGHT October 2020

“I’m passionate about our workforce development within Australia and New Zealand as well as our wider areas of responsibility in improving eyecare. But we need to change our focus from going on missions, to projects that make these countries self-sufficient. If we can create basic services to address the major causes of visual problems – which are uncorrected refractive error, cataract and now the scourge of diabetes – we can empower these countries to handle their basic eye problems and the rest can be managed remotely.” n

WORKFORCE

THE CHANGING WORKFORCE In the last decade, the optometry workforce has become more feminised and younger, while in ophthalmology women are demanding greater representation and recognition. RHIANNON BOWMAN meets the women striding forward.

A

s a graduate, independent New South Wales optometrist Ms Yang Wang never envisaged a career that would allow her to run a successful business with a young family.

But as her career has progressed, she’s come to appreciate the fulfilment she continues to get from her work, while managing perhaps her most important job – motherhood.

“Optometry is an ideal career for raising a family, partly because you can plan work around family. The hours are generally nine to five, no late nights, and it’s relatively stress-free,” Wang, the mother of a two-year-old child, says. “And it’s rewarding, especially when you can establish patient contact for life.”

Today Wang – the owner and principal optometrist at Eyecare Plus Corrimal – can count herself among the majority in an Australian optometry workforce that is increasing in size, becoming more female and younger.

Aged between 30 and 34, she is one of 533 female registered optometrists in Australia, the largest age group, second only to the 25-29 cohort, which has 805

INSIGHT October 2020 37

WORKFORCE

female registered optometrists, according to Optometry Board of Australia (OBA) statistics.

Combined, women in these two age groups make up the largest contingent of a profession that is now 56% female and 44% male, according to OBA data from 1 April 2020 to 30 June 2020.

It was a different picture in 2012 when Wang and her then-boyfriend moved to Australia. Then, the profession was 47% female, 50% male, (with the remaining unspecified).

According to Optometry Australia (OA), in general, younger workforces want more flexible employment, often to fulfil caring responsibilities, and opportunities to continually learn and develop.

This is true for Wang, who grew up in New Zealand and graduated from the University of Auckland (therapeutically endorsed) in 2011, with her now-husband, Mr Roland Mak. The couple moved to Australia in 2012 due to greater job opportunities. She was attracted to working in a rural setting because she wanted exposure to a variety of ocular pathologies and to practise to her full scope.

As a first-time business owner and parent, she says that timing is important when managing family life with running Eyecare Plus Corrimal with her husband.

Supportive staff, who are also female, have helped and the support of a group such as Eyecare Plus has been invaluable, Wang says. And after taking a brief time out of the business on maternity leave, she eased back into her professional role, working one day a week and slowly building up.

"OPTOMETRY, AS A CAREER, OFFERS AN OPPORTUNITY FOR WORKLIFE BALANCE, AND THAT’S VALUABLE" MS YANG WANG PRACTICE OWNER

Balancing parenthood and operating a successful practice, throughout a pandemic and upcoming practice renovations – in the same year – is no small feat. Attributes she didn’t initially appreciate, such as the flexible hours, help make it a rewarding career choice.

“Getting the balance right means utilising and maximising your time at work, and at home, and prioritising what’s important – don’t fuss over the little things,” she says.

“Optometry, as a career, offers an opportunity for work-life balance, and that’s valuable.”

LEADING BY EXAMPLE For ophthalmologist Associate Professor Anne Brooks, the biggest hurdle she has overcome in her career is work-life balance. It’s a challenge she highlighted in an interview with RANZCO to celebrate International Women’s Day in 2018, and one she believes continues to top the list for most ophthalmologists, regardless of gender.

“Life is always a balancing act and ophthalmology is a very involved profession. Beyond the clinical, many of us work in research, run businesses, do administration, teach and serve on committees and advisory boards,” Brooks says.

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INSIGHT October 2020

"LIFE IS ALWAYS A BALANCING ACT AND OPHTHALMOLOGY IS A VERY INVOLVED PROFESSION" A/PROF ANNE BROOKS COLLEGE MEDAL RECIPIENT

“Finding time to balance the myriad of ‘home’ roles in addition to these is difficult. The balancing act has traditionally been one done by women more than men, and while this is still probably the case, many men are now trying to achieve balance too. That is a good thing.”

Highly regarded in ophthalmology and teaching, Brooks has received RANZCO’s award for Excellence in Training eight times and in 2019 became the first female to be awarded the College Medal, RANZCO’s highest honour, following 28 male awardees.

“It is a great honour to have been recognised in this way, and something I had never dreamed of. It has increased the respect of my colleagues,” Brooks, who works in private practice and at the Royal Victorian Eye and Ear Hospital, and specialises in glaucoma and cataract, says.

“I am hopeful that it will inspire more nominations from colleagues that recognise the outstanding work being done by so many other women in the College. We don’t work for recognition, but it is nice to receive it.”

The award was presented by RANZCO’s president Associate Professor Heather Mack, the first female president in the college’s 50-year history who ends her two-year tenure this month.

The achievements of both Brooks and Mack in a traditionally maledominated profession may help to demonstrate how the profession is changing.

However, the figures suggest there is some way to go until ophthalmology reaches parity. Although numbers are trending upwards, Australian Government figures from 2016 show males represented 79.5% of clinicians, and were aged 54 years on average. By contrast, females represented 20.5% of clinicians and were aged 48 years on average, six years younger than their male counterparts.

In 2016, there were 95 male trainees and 51 female. Today, RANZCO boasts 80 female trainees, and 298 female Fellows.

Despite this, female representation is increasing in ophthalmology, coinciding with RANZCO releasing a 2019-2020 Women in Ophthalmology Strategic Plan in late 2018.

Although only indirectly involved, Brooks says one rationale of the strategic plan was to focus the efforts of the Women in Ophthalmology (WIO) Advisory Group.

“The WIO Advisory Group is about 20 Fellows and trainees who have an interest in taking a more hands-on approach to gender issues.

Determining what to do, how to start and how to measure success really drove the need for a plan,” she says.

The strategic plan was a communication tool to articulate to members what the WIO want to achieve and how this can occur, and was seen as a way to democratise decision making in terms of deciding focus areas, Brooks says.

“The plan was put together by asking Women in Ophthalmology Luncheon participants at the 2018 annual RANZCO Scientific Congress to identify all areas of concern and then hone these down. All refined ideas were then circulated via a survey, open to all female Fellows and trainees,

and there was a request to rank these. The top three areas became the three pillars of the plan: awareness, recognition and engagement.”

“The processes for obtaining training posts, jobs and College positions has become more transparent, so things have changed for the better.

To illustrate the strategic plan in action, Brooks points to the recent accomplishment of a high-achieving colleague.

“Having our first female RANZCO president and more female representation at Congress is real evidence of breaking through the glass ceiling. I believe with the right support, women can have a very satisfying career and achieve just as much in ophthalmology as men,” she says.

“Professor Justine Smith, a Matthew Flinders Distinguished Professor at Flinders University, is an internationally recognised expert in the causes, effects and treatment of uveitis. Her work is both clinical and by research,” Brooks says.

“She was recently appointed as the first female editor-in-chief of the RANZCO Journal Clinical and Experimental Ophthalmology and is the first female editor-in-chief of a major ophthalmology journal.”

In her role training the next generation, Brooks says young female ophthalmologists largely aspire to subspecialisation, which usually involves a period of training overseas, but this has currently been affected

by COVID-19.

BREAKING THE GLASS CEILING Dr Alina Zeldovich is an anterior segment ophthalmologist, business owner and director at Eye Associates in Macquarie Street, Sydney. She’s also from a refugee family who arrived in Australia without knowing a word of English.

She has overcome many hurdles to become a high-achieving member of the ophthalmic community, which also involves roles within RANZCO. She believes ophthalmology has traditionally been a difficult career to enter because of a lack of government-funded training positions.

“While there have traditionally been obstacles that affected women in particular, this is certainly changing. I think the glass ceiling is gradually being broken and many changes have occurred since I started my training in 2002, which have helped advance the careers’ of women,” she says.

Research on gender differences amongst Australian and New Zealand ophthalmologists’ experiences of the workplace, published in 2019, showed that female ophthalmologists worked fewer hours, mainly in the private sector, to fulfil their greater family commitments.

Female ophthalmologists reported additional obstacles to career advancement and were more likely to report experiencing discrimination in the workplace.

Now, a shift towards increased flexibility, including part time training, and increased participation in College initiatives, is changing dynamics within the profession.

“A lot of work has gone into remodelling the RANZCO training program, this is also better for women. In particular, there has been focus on making the process more transparent by having clear guidelines on training admission requirements and training completion,” Zeldovich says.

“In most training programs part time training is permitted and this has really made things better for those who have a family. There are now larger practices with multiple associates or directors, which makes covering one another easier and this enables women to work sessions with flexible hours. It is always better to be able to spread on-call around more people.”

For Zeldovich, part time training also has other benefits for women.

“Doing exams during training rather than beforehand now means that no one is waiting for a position having invested time and money into passing the exams without being guaranteed one,” Zeldovich says.

“Women are also encouraged to participate on committees and special interest groups within the College. There is a Women in Ophthalmology network that runs in every state in Australia and New Zealand where women can get together to work through issues and provide support and collegiality.”

Under a Board initiative from 2015, RANZCO has encouraged 35% female representation on committees, which has been achieved in most states, Zeldovich says.

As previously mentioned, Zeldovich has had to overcome her own obstacles, including immigrating to a foreign country as the daughter of refugees who migrated from the Soviet Union to Australia in the late 1970s when she was pre-school aged.

Wanting to pursue a career that could have a significant impact on people’s lives – and coming from a family of doctors, including three of her four grandparents and both parents, who had to retrain in Australia – Zeldovich chose ophthalmology, where her career aspirations continue to grow.

Outside of her consultation rooms, Zeldovich is an active member of her profession; she was a co-convenor for RANZCO’s annual Congress in Sydney last year and is currently the vice chair of its NSW branch and a federal council member.

"THERE ARE MANY PATHS FOR WOMEN IN OPHTHALMOLOGY THAT ARE NOT NECESSARILY AVAILABLE IN OTHER SURGICAL SPECIALTIES" DR ALINA ZELDOVICH OPHTHALMOLOGIST

“It was a career highlight to be the co-convenor for the last RANZCO Congress. It was the largest Congress to date and had a female chair of the Scientific Committee, as well as the first female College Medal recipient and female RANZCO president,” she says.

“I aspire to be part of the College’s strategic plan and see its future as an advocacy body, an organisation which unites ophthalmic services and offers both members and the community valuable information on eyecare.”

A lecturer with the University of Sydney’s Faculty of Medicine and completing an MBA at UNSW Business School, Zeldovich hopes to gain business knowledge to help run organisations and promote eye health.

In addition to this, she has co-founded a business called Beamers that produces children’s sunglasses. It was established due to concerns that 80% of UV damage occurs before age 18, and is currently working with the World Society of Paediatric Ophthalmology and Strabismus on a consensus statement to be released later this year.

As her career to date demonstrates, Zeldovich credits ophthalmology for the range of options it presents.

“The most challenging part is the many years of training and exams, however after this there are many career options, from working in the public system to working in private or a combination of both. There is also the flexibility of working full time or part time, in one or several practices, and the ability to participate in research, work as a surgeon or not operate at all, be involved in RANZCO, or teach and mentor peers. There are many paths for women in ophthalmology that are not necessarily available in other surgical specialties.”

INSIGHT October 2020 39

WORKFORCE

"ALMOST ALL QUERIES OPTOMETRY AUSTRALIA RECEIVES REGARDING TAKING EXTENDED LEAVE OR A CAREER BREAK AS RESULT OF CAREGIVING AND/ OR PARENTAL RESPONSIBILITIES, ARE FROM FEMALE OPTOMETRISTS" MS SOPHIE KOH PROSESSIONAL SERVICES ADVISOR

FOCUS ON FLEXIBILITY AND EQUALITY According to a study published in Clinical and Experimental Optometry in August, the number of registered optometrists in Australia has increased by 30.1% during the past decade, a rate that is greater than the population growth of the country (12.1%).

The study also found that new entrants to the optometry profession could be generalised as graduates of an Australian optometry program, female, aged in their early‐to mid 20s and qualified for therapeutic practice.

OA CEO Ms Lyn Brodie says the growing optometry workforce is favouring flexible employment.

“Over the last decade we have seen increasing feminisation of the optometry workforce, and an increase in the proportion of the workforce that is made up of younger cohorts. ‘Female optometrists’ and ‘young optometrists’ are, of course, not homogenous groups. However, as it is common across many professions, there appears to be a particular demand from women, and increasingly men, for more flexible employment conditions, often in order to enable them to fulfil caring responsibilities,” she says.

OA has been working to create a more open discussion across the sector on what is needed to create more flexible work conditions that work for optometrists and their employers.

“In the recent past we have worked with FlexAgility to provide advice, case studies and an education session addressing rights with regard to flexible work requests and examples of optometrists working outside typical full-time, standard practice hours arrangements. We also continue to support members one-on-one in their negotiations for flexible working arrangements,” Brodie says.

“There are promising examples across the sector of more flexible approaches being taken to employment arrangements. As the profession continues to evolve, we feel it will need to do better in accommodating flexible work, but also that changing technologies and practice hours may support ever-more flexible arrangements.”

In conjunction with the optometry workforce tipping to a female majority, so too is OA’s membership, albeit only marginally, Brodie says. The organisation is responding by providing women-centric advice on its website and through its member support services.

Brodie acknowledges the strong female leadership across the profession in academia, clinical practice, management and leadership roles in larger service providers and within the governance of entities that support optometrists, such as OA. “We recognise the need to continue to support women to pursue fulfilling careers and leadership roles within optometry. The Women in Optometry section on our website has been created to support women’s career development. We offer support via advice available to all our members

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on our website, and one-on-one guidance and support via our Member Support team, around progressing a career in optometry, negotiating working arrangements and pursuing leadership in the sector.”

One of the people providing that support is national professional services advisor and optometrist Ms Sophie Koh. She says the topics that younger female optometrists contact OA for advice about are broad.

“It ranges from career and contract advice to everyday professional, clinical, or legal issues with patients or their workplace. Generally, there are no major gender differences across the broad topics our membership reach out to us for,” Koh says.

"AS THE PROFESSION CONTINUES TO EVOLVE, WE FEEL IT WILL NEED TO DO BETTER IN ACCOMMODATING FLEXIBLE WORK" MS LYN BRODIE OPTOMETRY AUSTRALIA

“However, as women in Australia still take on the lion’s share of care responsibilities in the family, whether that is looking after aging parents or children, almost all queries Optometry Australia receives regarding the topic of taking extended leave or a career break as result of caregiving and/or parental responsibilities, are from female optometrists.”

For a new parent, Koh says, the immediate questions are regarding the logistics of maintaining AHPRA registration, keeping up with CPD requirements and clinical hours to stay registered, while on an extended break.

“We also have a number of female members living overseas whilst being the main carer for young children, so upkeeping registration requirements can be complex.”

Koh says members returning to the workforce after several years contact OA for advice on returning to the sector; others have questions regarding working as a locum.

“There are also everyday HR and workplace flexibility questions that may arise due to maternity leave or returning to work. We help both employees and employers needing such advice,” Koh says. n

LOW VISION SERVICES AND BORDER RESTRICTIONS THE LOGISTICAL HEADACHES ASSOCIATED WITH COVID-19 RESTRICTIONS ARE MOST PRONOUNCED IN BORDER COMMUNITIES. ORTHOPTIST MEAGAN ANDERSON DISCUSSES THE IMPACT IT IS HAVING ON LOW VISION CLIENTS AND CLINICIANS.

A

s an orthoptist working on the New South Wales and Victorian border, I can only describe this as being a case of doing what you can, while you can.

MEAGAN ANDERSON

"A NUMBER OF CLIENTS HAVE REFUSED OUR SERVICES PURELY BECAUSE WE ARE FROM THE 'BORDER BUBBLE'"

The border community sees itself as one, albeit with separate driving laws and constant competition for which side has the best coffee; and the health impacts are starting to become more apparent with increasing restrictions and heightened anxiety to follow the rules and exercise common sense as much as we can.

The sometimes vaguely-worded border permits for both clients and clinicians – and increased travel times for local and surrounding areas attempting to access essential health services (which are usually only present on one side of the border) – have led many community members to effectively become “hermits”.

They are avoiding health services because it is proving just too difficult to access. The associated risks of developing further eye and general health complications are high and have been reported elsewhere.

As a low vision orthoptist, my role incorporates functional vision assessments, strategy and equipment recommendations, and counselling through vision loss. The rates of depression and anxiety skyrocket with any form of vision loss, more so in this current COVID-19 climate.

Trialling magnifiers and other reading devices is not appropriate via telehealth; for both the client’s (and clinician’s) peace of mind, a physical trial is required, particularly for funded equipment via the Department of Veteran’s Affairs or the NDIS. The delivery, repairs and trial of devices, and the personal protective equipment (PPE) and increased time required to ensure our equipment and personnel do not inadvertently spread the virus, has become even more of a logistical nightmare in recent months.

Home visits are traditionally utilised because they provide better context

of the client’s home and lighting environment and communication is easier when demonstrating strategies; for example, when watching television, and how to find and cut up food when the chopping board is in a dark corner of the kitchen. This is especially useful for our more rural clients, as our region covers a 200km radius (100,000km2 area), and access to equipment is otherwise extremely limited. In a single comprehensive session we will often assess, set up and provide training on equipment.

The travel restrictions, and particularly the inability to physically attend agedcare facilities, has restricted our efficiency in this area, and a number of clients have refused our services purely because we are from the “border bubble”.

Telehealth has been utilised as much as possible, but only works when the person on the other end has enough vision to see how to use their phone and/or computer in the first place. Additionally, “black holes” in internet coverage still exist in many areas, with some relying on just a crackly landline phone.

Joint telehealth and shorter face-to-face appointments have been utilised to some effect. Telehealth sessions provide time to counsel on the medical and functional aspects of vision loss, providing an opportunity to discuss and encourage ongoing reviews with clients who may have been otherwise told “there was nothing more they could do” and had refused to have another check-up for several years. Telehealth sessions have also provided an opportunity for clearer communication, strategies and training, ensuring they are as well supported as possible.

There have been other unexpected benefits via telehealth: one client in a particularly inaccessible area had a joint session via HealthDirect using the local nursing district; by explaining her inability to see her medication and daily glucose levels we were able to brainstorm strategies to ensure she would be supported as much as possible in both ocular and general health within her home environment.

The pandemic has created new challenges for the low vision sector.

The increased collaboration between our local low vision services, family members and friends (living locally and/or across the country), external health providers (especially hospital rehabilitation services and occupational therapists), and optometrists and ophthalmology clinics both during and outside appointments has become the largest benefit, from my point of view.

Many services previously unaware of the recent technological updates have had a crash course in equipment and software, particularly with clients with a visual and/or cognitive inability to read and are now stuck at home with nothing else to do.

It has been a hard few months, and will continue to be, but this period is making us all into more efficient clinicians. n

ABOUT THE AUTHOR: MEAGAN ANDERSON is the Vision Australia Orthoptist in Albury (NSW) and Shepparton (VIC). She has a Bachelor of Health Sciences/Master of Clinical Vision Sciences degree (University of Sydney).

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 October 2020 41

DISPENSING

MATCHING LENS AND FRAME CURVES POOR LENS CURVE AND FRAME COMBINATIONS CAN LEAD TO DISSATISFIED CUSTOMERS AND TIME-WASTING REMAKES IN THE LABORATORY. MURRAY O’BRIEN DETAILS SOME OF THE MOST IMPORTANT CONSIDERATIONS IN THIS AREA.

F

ront curve selection to ensure the best solution for each frame and lens combination is crucial to successful optical dispensing.

Making the wrong choice or, more commonly, not making a choice at all can cause heartache, cost money and lose customers.

MURRAY O’BRIEN

It can also assist your laboratory in saving costly and time-wasting remakes.

"THE ACTUAL PROFILE OF THE LENS MAKES A HUGE DIFFERENCE TO HOW ACCOMMODATING A FRAME WILL BE TO A RANGE OF LENS CURVES"

In this article I hope to offer some practical advice on front curve selection.

But to understand the issue, it’s important to note some of the problems that arise from poor lens curve and frame combinations: 1. Flat lenses into a frame with a high eye wire curve makes the temple ends too wide (loose fit on the head).

2. Highly curved lenses into a frame with a flattish eye wire curve makes the temple ends too close (tight fit on the head).

3. Spectacles become unattractive or optically inappropriate. This is due to the extreme adjustment required because the frame is being distorted by inappropriate lenses.

4. Poor lens fitting results where the lenses are too highly curved for the frame design and tend to ‘pop’ along the upper eye wire.

5. Uncomfortable visual effects from inappropriate curves or inappropriate or extreme forced adjustment.

WHEN SHOULD I THINK ABOUT IT? When the frame rep comes to your practice and lays out the new and exciting stock, what are the range of prescriptions you think these frames will take? The major considerations are: Frame shape: The actual profile of the lens makes a huge difference to how accommodating a frame will be to a range of lens curves. Perfectly round is the easiest shape of all.

The closer any of the edges of the shape are to being straight, the less

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INSIGHT October 2020

accommodating the frame will be to getting a good lens fit with the widest range of prescriptions. The very shallow, oblong shapes of 15 or so years ago were by far the most troublesome frames for optical mechanics to fit from a shape basis.

Frame material: Make sure the frame material being offered in the frame is easily adjustable. Cellulose acetate, monel and stainless steel are frame materials that are generally very easy to manipulate.

Some thinner titanium frames tend to be very springy and adding extra curve in the frame with the frame benders can be very difficult. Some injection moulded plastics are impossible to adjust and cast titanium can be so stiff and brittle that they are unadjustable.

If the frames are not easily adjustable, give them a miss, even if they look great, they will cause you heartache and grief in the end.

Frame construction: Before purchasing frames, have a good look at the construction. If the frame is very flat, will you be able to add some curve to the eye wires and then be able to adjust the temples out?

Sometimes if you come across a new design ask the rep if you can test the adjustability. It’s better to be safe than sorry being stuck with a frame that can’t be adjusted appropriately and easily.

THE PRESCRIPTION The dispenser must be fully aware of the patient prescription before becoming too involved in looking at frames.

If the prescription is at the higher end of the range, let’s say over three dioptres, we may have to give serious thought to the front curve.

As the customer tries on each frame, have a look at the frame closely and think about the practicalities of getting their lenses into the frame and what refractive index or design lens we may need to use for the best fit.

Use a lens clock and measure the shape of the insert lens. That will give an idea of the ideal front curve that will

Correct front curve selection can prevent remakes in the lab.

give a nice fit without much adjustment being required.

How far will the customer’s new lenses stray from the insert curve if we make them from 1.5 index? Will we need to specify a four base rather than the normal six base? Will we need to do 1.6 index and use an aspheric design lens to make it even flatter?

In some cases with minus lenses we may need to stay away from aspheric designs as they will be too flat for a given frame and render the sides too wide.

In conclusion, all we can do in such a brief article is to encourage you to think. Look at the frame, look at the Rx. Use your experience to consider how the lab will make the lenses then think about if you need to ensure some extra specifications to make the completed spectacles as good as they can be. n

MURRAY O’BRIEN owns Designed Eyes in Rosebud, Victoria, where he works in full retail optics. He is also past president of the Australian Dispensing Opticians Association (Vic) and has previously worked in lens fitting work, specialising in rimless.

MANAGEMENT

INFORMED MEDICAL CONSENT INFORMED CONSENT CAN BE A COMPLEX AREA OF MEDICINE, ESPECIALLY WHEN THE PATIENT IS INCAPABLE OF DOING SO THEMSELVES. KAREN CROUCH SAYS PRACTITIONERS NEED TO UNDERSTAND THEIR RIGHTS AND RESPONSIBILITIES.

I

t is imperative to obtain consent – or permission to proceed – from a patient prior to providing medical treatment.

KAREN CROUCH

"FAILURE TO OBTAIN AN INFORMED CONSENT PRIOR TO TREATMENT COULD LEAD TO A CLAIM OF ASSAULT AGAINST THE PRACTITIONER"

It is of greater importance that the permission to proceed with the recommended treatment is an “informed consent”. A patient must understand all of the issues associated with the treatment before they can make a proper and informed decision to proceed.

Issues that should be discussed with a patient include the nature and consequence of treatment, risks involved, alternatives available and the possible impact of not receiving the treatment at all.

Failure to obtain an informed consent prior to treatment could lead to a claim of assault against the practitioner.

However, there are certain instances where the patient is unable to consent.

In such situations, it is important to understand whether consent is necessary in the particular circumstance and from whom an alternative form of consent could or should be obtained.

Where immediate treatment is necessary to save a person’s life or to prevent serious injury, and that person is incapable of giving consent (for example, a patient is rushed into the emergency ward with serious head injuries and is not sufficiently lucid as a result), the practitioner may proceed with medical treatment without consent.

This is assuming that the treatment administered is, in the opinion of the practitioner, the most appropriate to apply.

However, despite the dire situation described herein, the presence of an unequivocal written direction not to treat in the manner required may prevent the practitioner from proceeding.

This is a complex area of the law and practitioners may need to obtain further advice before proceeding in these circumstances.

When it is not a life-threatening situation and there is reasonable time to identify and contact the ‘person responsible’ for

Practitioners are required to discuss the nature and consequences of treatment with patients.

the patient, the following rules apply: The following person/s or authority are responsible for: A minor: • Where the minor has a parent or guardian – the parent or guardian.

• Where the minor is in the care of the state – Department of Community Services.

A person over 16 years (In accordance with the Guardianship Act 1987 hierarchy): • Guardian.

• Appointed Guardian.

• Spouse or de facto.

• Carer.

• Close relative or friend.

When obtaining consent from the person responsible it is important to provide him/her with the same information that would be provided to the patient so that the person responsible can make an informed decision on behalf of the patient.

There is no obligation to accept the position of ‘person responsible’ and a person may decline in writing to take on this role.

A practitioner is also entitled to certify, in writing, that a particular person is

incapable of assuming the role of ‘person responsible’ where they feel that person is unsuitable to perform the role. A supporting reason for the certification is recommended to address any subsequent challenge to the opinion.

In the case of minor treatment, and where the person responsible cannot be found, a medical practitioner may make the decision to go ahead with treatment as long as it is necessary, appropriate (for example they would clearly qualify as a ‘minor’ treatment), and there is no objection from the patient.

It is important for medical practitioners to understand their rights and responsibilities in relation to medical consent.

This can be a very complex area of medicine/law and you should contact your medical defence organisation, otherwise known as MDO, when encountering a situation you are unsure of. n

KAREN CROUCH is Managing Director of Health Practice Creations, a company that assists with practice set ups, administrative, legal and financial management. Contact Karen on 0433 233 478, by email kcrouch@hpcnsw.com.au or visit www. hpcgroup.com.au

INSIGHT October 2020 43

SPECSAVERS – YOUR CAREER, NO LIMITS A

ll SRS – Optical Assistants and Dispensers available across Australia Specsa ve stores rs At Specsavers, our vision is to passionately provide the best value eye care to everyone, simply, clearly and now w ith OC affordably, exceeding customer expectations every time. We are currently seeking dedicated and experienced T optical assistants and dispensers to join our Specsavers family. We have full and part-time opportunities available across Australia. We will provide you with a fantastic working environment with a supportive team and the opportunity to deliver optimal patient care.

Full/Part-time and fixed-term Optometrists, multiple locations across QLD/NT 2020 has certainly brought some challenges, but now we are seeing the light at the end of the tunnel. Our stores are busier than they have ever been, and we are looking for passionate and patient-focused optometrists to join our Specsavers family to help us continue to deliver quality and cost effective eyecare to our communities across regional QLD and the NT. 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 fixed-term positions available.

Graduate Optometrists – Darwin, NT The Specsavers Graduate Recruitment team is currently recruiting two graduate optometrists to join their teams in Darwin.

If you are looking to make a difference in a smaller community, for a new challenge, or perhaps a fresh start – a move to Darwin could be the opportunity for you! If you want to make a genuine impact, and deliver patient-centric, evidence-based preventative eye care and work collaboratively to manage health outcomes, then we urge you to talk to us about how you can join the mission to transform eye health. Also, if you relocate with a friend, you will avail of our ‘Go with a Friend’ incentive.

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

Optometrist JVP Opportunity – Hobart, TAS: An incredible opportunity to become a Joint Venture Partner in our Hobart store! Specsavers Hobart is located within The Cat and Fiddle Arcade, which houses over 70 specialty stores including H&M, Target and Myer. The store itself is 164 sqm in size, and boasts eight dispense desks, four test-rooms and three pre-test rooms, with over 1,160 frames on display.

cindy.marshall@specsavers.com or 0450 609 872

Specsavers Recruitment Services – Locums across Australia and New Zealand: Specsavers Recruitment Services (SRS) is the in-house recruitment support to Specsavers 400+ stores across ANZ. The team is made up of seven experienced recruiters who act as the liaison between you and our stores to secure you the greatest opportunity to work in locations that suit your needs best, in either a full, part-time, casual or locum roles. The team will manage every stage of the recruitment and placement process. They’ll work with you to find suitable matches – ensuring opportunities with Specsavers are always at your fingertips. To find out more about our services please contact us today.

Graduate employment enquiries: apac.graduateteam@specsavers.com

*

New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

chris.rickard@specsavers.com or 0275 795 499

Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

Orthokeratology and other forms of contact lenses.

Eyecare Plus provides business support and marketing services to over 150 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.

This is a very effective small team and a great opportunity to make your mark in a friendly and professional practice.

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.

OPTOMETRIST – GAWLER, SA Eyecare Plus Gawler is currently seeking an optometrist to join the practice with very flexible working hours available. Enjoy professional autonomy in a full scope practice with all the latest equipment and support from an experienced team.

To apply please contact Chris via phone on (08) 8522 7611 or via email; gawler@eyecareplus.com.au OPTOMETRIST – GOLD COAST The practice is located in the Miami One Centre, a short distance from the beach, and has a very good level of equipment and excellent support staff.

A broad base of patients makes for an interesting clinical profile, and a high level of autonomy, with patient care being the primary focus. There is a full range of clinical optometry services offered to patients, including

To Apply: Please apply with your CV and cover letter to Mark Overton, Ideology Consulting. mark@ideologyconsulting.com.au PRACTICE RETIREMENT – NSW REGIONAL HUB, INLAND MID-NORTH COAST LOCATION The practice has been established for 40 years. The owner, who has operated this clinically driven practice from its foundation, is now looking to pass the practice into the hands of a new community minded owner.

With a turnover well above $600k, this practice is now available on very favourable terms. If desired, the premises can also be acquired, or a long term lease will be offered.

The practice has an excellent local reputation with a loyal patient base and exceptional relationships with local General Practitioners and Ophthalmologists, receiving a consistent level of referrals.

This regional administrative centre has great infrastructure with an airport and large higher education facilities. Easy access to the coast and Sydney makes this an attractive location.

Contact Philip Rose: philip.rose@eyecareplus.com.au or 0416 807 546 CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/ OPTOMETRIST: Miami, QLD. Gawler, SA. Practice Retirement, NSW.

20/21 CALENDAR OCTOBER 2020 20TH EURETINA VIRTUAL CONGRESS Amsterdam, Netherlands, 2 – 4 October euretina.org

38TH CONGRESS OF THE ESCRS (VIRTUAL) Amsterdam, Netherlands 2 – 4 October escrs.org

AMERICAN ACADEMY OF OPTOMETRY MEETING (VIRTUAL) Nashville, USA 7 – 22 October academymeeting.org

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

OV/SA BLUE SKY CONGRESS 2020 Adelaide, Australia 20 – 21 November optometry.org

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

DECEMBER 2020 14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS

EUROPEAN MEETING OF YOUNG OPHTHALMOLOGISTS

5TH ASIA-PACIFIC GLAUCOMA CONGRESS

Brussels, Belgium 30 – 31 January emyo2020@seauton-international

Kuala Lumpur, Malaysia 13 – 15 August apgc2020.org

FEBRUARY 2021

SEPTEMBER 2021

MIDO EYEWEAR SHOW

O=MEGA21

Milan, Italy 6 – 8 February mido.com

Melbourne, Australia

silmobangkok.com

MARCH 2021

OA VIC BRANCH JULY SCIENTIFIC MEETING Victoria, Australia 27 March orthoptics.org.au

118TH CONFERENCE OF THE GERMAN SOCIETY OF OPHTHALMOLOGY

Brussels, Belgium 14 – 16 December egs2020.org

AUSTRALIAN VISION CONVENTION 2021

Berlin, Germany 8 – 11 October dog.org

JANUARY 2021

Gold Coast, Australia 27 – 28 March optometryqldnt.org.au

RANZCO COUNCIL MEETING Australia 9 October ranzco.edu

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

NOVEMBER 2020 OPTOMETRY NSW/ACT CANBERRA CONFERENCE Canberra, Australia 8 November optometry.org.au

OA ONLINE WEEK Australia 14 – 15 November orthoptics.org.au

OPTI 2021

silmobangkok.com

Stuttgart, Germany 8 – 10 January opti.de

BARCELONA SPECS

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

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

CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: ASIAAUSTRALIA Bangkok, Thailand 29 – 30 January cophyaa.comtecmed.com

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

2 – 4 September omega21.com.au

SILMO PARIS Paris, France 24 – 27 September en.silmoparis.com

EUROPEAN ASSOCIATION FOR VISION AND EYE RESEARCH CONGRESS Nice, France 30 September – 2 October ever2020.org

OCTOBER 2021

APRIL 2021

AUSCRS 2021 Barcelona, Spain 10 – 11 April barcelonaspecs.com

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

Noosa, Australia 20 – 23 October www.auscrs.org.au

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

AUGUST 2021 DECEMBER 2021

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

14TH ASIA-PACIFIC VITREORETINA SOCIETY (APVRS) CONGRESS Chinese Taipei 10 – 12 December 2021.apvrs.org

INSIGHT October 2020 45

SOAPBOX

ADDRESSING BLINK INEFFICIENCY and Trokel. Direct-recorded IOP etc.

Arch Ophthalmol 1969) and so are adverse for patients with or at risk for developing a baropathic disease such as glaucoma, axial and degenerative myopia, as well as keratoconus and other ectatic diseases.

A

lthough blink efficiency is an essential part of the lacrimal functional unit, it has too frequently not received enough attention from clinicians who are focused on remediating other tear dysfunctions.1 However, researchers have been increasingly interested in blink performance with multiple studies showing how anomalies, such as an abnormally high ratio of incomplete blinks, can detract significantly from blink efficiency and efforts to reduce dry eye or dry contact lens symptoms.

Incomplete blinks increase ocular surface exposure and impair meibomian gland secretion. Because complaints of discomfort and dryness are very common, blink efficiency exercises have great potential for helping many patients. However, to achieve good outcomes, the action of giving patients a handout with detailed instructions for improving blink efficiency, most definitely needs to be supported by an explanation of the importance of efficient blinking in the maintenance of tear functions by the practitioner involved.

Guidance as to how exercises can be performed appropriately is also required. Consulting room time can be saved if support staff are trained to competently demonstrate an efficient blink practice session so that patients can go home having learnt how to perform blink efficiency exercises as specified in their handout (complete,

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INSIGHT October 2020

soft, brief and natural looking).

Having multiple descriptors for these specifications helps. For example, if a patient’s initial efforts are not soft enough (too much hard squeeze force involved) then describing the desired soft complete blink as light, relaxed and gentle can improve their understanding of what is required. It can help to add the comment that while their initial squeeze blink effort for ‘completeness’ was good for completeness, such hard squeeze blinks take too long as well as looking unnatural when compared to complete, soft, brief and natural looking blinks.

In addition, it can be worth noting that hard squeeze blinks can attract the wrong kind of attention from work colleagues or family members who observe a blink practice session.

Tim Ho recently had a patient who asked for a letter which explained why he was practising squeeze blink closures. The patient’s lawyer is defending the patient against a sexual harassment claim made by one of the patient’s co-workers.

Nevertheless, there are many adherents to prescribing blink exercises which involve frequent sessions of voluntary prolonged ‘squeeze’ or ‘forced’ blinks and this approach has been supported by a very recent study (Kim et al. Therapeutic benefits etc.

Cont Lens Ant Eye 2020). However, squeeze blink exercises involve intraocular pressure elevations of as much as 90mmHg (Coleman

Squeezed blinks have been shown to increase lipid secretion in unselected subjects but for patients with obstructed meibomian glands that outcome is less likely. Squeeze blinks may actually have an adverse overall effect with initial increased lipid flow from some unobstructed glands being the limit of benefit. The lipid reservoir in glands can be too easily depleted because gland recovery to normal lipid reservoir levels for optimally functioning glands which have been emptied has been found to take over two hours. Consequently, ‘squeezed’ lipid flow appears likely to be followed by a relapse to an absence or major reduction of flow during a very extended gland recovery period.

Practising blinks which are complete, brief, soft and natural looking has the potential to be immediately therapeutic because complete blinks increase tear layer thickness, help to distribute mucin over a desiccated epithelium, and improve lipid flow according to the normal capacity for complete blinks to promote secretion. In addition, they promote the establishment of a motor memory of efficient blinking which helps to compensate for low blink rates that occur during periods involving reading and screen-based activities.

Unfortunately, squeeze blinking practice sessions have the potential to destroy that kind of motor memory.

Copies of the updated Blink Efficiency Exercises handout are available from: c.mcmonnies@unsw.edu.au. n 1. McMonnies CW. Diagnosis and remediation of blink inefficiency. Cont Lens Ant Eye; Published ahead of print May 2020.

Name: Charles McMonnies Qualifications: DSC Workplace: School of Optometry and Vision Science, University of New South Wales Position: Honorary Professor Location: Sydney Years In The Profession: 58

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