INSIGHT October 2021

INSIGHT OCT

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

27G

Ophthalmologists are at odds with the new Cataract Clinical Care Standard for two reasons.

DRY EYE THERAPIES IN AUSTRALIA The arrival of new treatments is welcome, but Australia has often lagged behind.

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CLINICAL STANDARD DRAWS MIXED RESPONSE

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LESS INVASIVE MORE PRECISE

WHAT'S NEXT FOR GEORGE & MATILDA? The collective will soon unveil more acquisitions as independents seek security.

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INSIGHT OCT

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

CONTROVERSY OVER AUSTRALIA'S FIRST CATARACT CLINICAL CARE STANDARD

The release of the nation’s first Cataract Clinical Care Standard has been met with mixed reaction, drawing both opposition and support across the ophthalmic sector.

Ultimately, it has failed to win the support of the Australian Society of Ophthalmologists (ASO) and RANZCO, with the college citing two major issues. However, proponents of the standard have questioned the interpretation of some aspects.

Meanwhile, Optometry Australia has endorsed the final standard, along with Orthoptics Australia, among others.

The Australian Commission for Safety and Quality in Health Care (ACSQHC) has spent several years developing the inaugural Cataract Clinical Care Standard, which

determinant for surgical intervention, while 54% dismissed Snellen acuity as an appropriate measure to prioritise patients for surgery.”

was launched in August. Conjoint Professor Anne Duggan, ACSQHC chief medical officer, said it would ensure cataract treatment was appropriate and more efficient, with clear identification of patients more likely to benefit from surgery.

In a memo to fellows and trainees, president Professor Nitin Verma said RANZCO won’t endorse the standard because it didn’t agree with the inclusion of 6/12 visual acuity as a measure for cataract, and the recommendation to offer all patients bilateral same day surgery.

RANZCO applauded the ACSQHC for developing the standard, which it described as “robust”, aside from the two matters it disagreed with.

“In particular, our concern regarding Snellen acuity as a

Cataract

Clinical Care Standard August 2021

16/8/21 16/8/2 4:38 4:38pm pm

Australia’s first Cataract Clinical Care Standard has caused division.

prioritisation factor for cataract surgery does not align with any international standard,” Verma said.

“The survey of the [RANZCO] fellowship earlier this year showed that over 80% of the respondents advised that a correct acuity of 6/12 is not the most important

Further, RANZCO “strongly disagreed” with the need to routinely discuss same or following day second-eye surgery. Around 96% of respondents to the fellowship survey do not provide such a service.

“A similar percentile have views that same day sequential cataract surgery should not be offered as a routine alternative to surgery performed on separate days,” Verma said. Although he acknowledged these were only part of the standards, he said RANZCO continued page 8

NEW WARNING FOR VISITING OPHTHALMOLOGISTS The inability of visiting ophthalmologists to perform sightsaving treatments in cross border communities during lockdowns has re-emerged, prompting industry bodies to step in to rectify the issue.

The Macular Disease Foundation Australia (MDFA) recently told Insight that several ophthalmologists from Sydney – where COVID-19 cases have surged since July – had their travel exemptions rejected by ACT Health.

This meant they couldn’t attend scheduled Canberra clinics that included a significant number of patients requiring intravitreal injections.

A near identical issue

occurred last year when visiting ophthalmologists from South Australia were prevented from attending their regular clinics in the regional Victorian city of Mildura.

This was because SA health authorities refused to allow an exemption, meaning they would have had to quarantine for two weeks on return to Adelaide. It meant many Mildura patients were cut off from ophthalmological care for eight months.

As a result, ophthalmic organisations prompted calls for state governments to develop a nationally-agreed definition of an essential worker – that included healthcare professionals – as well as a nationally agreed standard for

a COVID-19 hotspot.

In the recent NSW-ACT situation, MDFA made representations to the ACT health minister’s office explaining the essential and urgent nature of intravitreal injections.

“The previous decision to decline entry was overturned but the advice to visiting ophthalmologists is to specify that travel is to undertake essential and urgent treatment that cannot be provided by other generalist providers,” MDFA CEO Ms Dee Hopkins said.

“Like everyone else, visiting specialists also have to adhere to jurisdictional restrictions.”

Hopkins has since approached RANZCO and asked the college to continued page 8

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IN THIS ISSUE OCT 2021

EDITORIAL

FEATURES

DRY EYE RIPE FOR INNOVATION For a disease that once existed on the periphery of eyecare, it’s remarkable to consider the evolution of dry eye in Australia.

Whether it’s better diagnostics and treatments, the environment, technologydependant lifestyles, or a combination of the above, eyecare practitioners are in little doubt dry eye disease (DED) is on the rise.

A pivotal moment for DED came with the publication of the 2017 TFOS DEWS II reports that provided a comprehensive synthesis of state-of-the-art in the field.

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THE LATEST IN DRY EYE Update on dry eye treatment in Australia followed by Insight’s inaugural Dry Eye Directory.

EXPANDED SUITE A new player has entered the local dry eye market with two new therapies.

DED's increased prevalence – validated through an evidence-based consensus – has provided an ideal platform for Australian eyecare professionals to launch dry eye services into their practice. In some instances, the business case is strong enough that some are establishing dedicated, standalone clinics.

More than 120 of these clinics can be found on pages 28 to 49 within the inaugural Insight Dry Eye Directory. It provides a state-by-state listing of clinics offering comprehensive dry eye services, whom other practitioners can refer to.

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STANDARDISED IMAGING Why sharing digital images from multiple devices remains a challenge in the ophthalmic sector.

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SECURITY AND GROWTH George & Matilda Eyecare is primed to sign off on several new acquisitions.

EVERY ISSUE 07 UPFRONT

63 MANAGEMENT

09 NEWS THIS MONTH

64 OPTICAL DISPENSING

61 PEOPLE ON THE MOVE

65 CLASSIFIEDS/CALENDAR

62 ORTHOPTICS AUSTRALIA

66 SOAPBOX

The directory also features more than 120 therapies available in Australia, where practitioners can discover the most suitable treatments depending on the severity of the disease. They can also easily decipher available therapies for meibomian gland dysfunction/evaporative dry eye or aqueous deficiency, and whether they are available via the PBS. The final part of the directory features a list of diagnostic devices, with a selection of these innovative gadgets only brought into the country this year.

With the ever-evolving nature of dry eye care, we hope this all-in-one resource will prove a valuable tool for local eyecare professionals. We look forward to it becoming an annual fixture in our magazine, with plans to build and expand on it in 2022.

MYLES HUME Editor

INSIGHT October 2021 5

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UPFRONT Just as Insight went to print, SPECSAVERS unveiled the winners of the respective Doug Perkins and Dame Mary Perkins medals. The company’s store in Hervey Bay Pialba, Queensland, and the Queenstown practice in New Zealand claimed the Doug Perkins Medal, an annual award recognising consistently high standards of clinical excellence and patient care. The Dame Mary Perkins Medal, introduced this year for exceptional acts of patient care, went to Ms Mariella Coluccio, of Specsavers

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WEIRD

Bankstown, with her life-saving story of a 3-year-old after being turned away from hospital multiple times. The Kiwi recipient was Ms Celeste Raisbeck, from Specsavers Rotoura, for her outreach work with the Maori community. IN OTHER NEWS, The Australian College of Optometry (ACO) is opening its eighth clinic, Knox Eye Care, in Melbourne’s east. Located in Bayswater, the practice was set to open last month, with Ms Iris Huang appointed the role of site manager and optometrist. It comes after Wyndham Eye Care, located in Hoppers Crossing, opened in June to help meet unmet demand for accessible and affordable eyecare in Melbourne’s west.

FINALLY, with cancelled conferences and travel restrictions, four Australian ophthalmic equipment suppliers are hoping to provide an alternative local opportunity to showcase their range of devices and equipment. The event, O=PEN HOUSE, has brought together BOC Instruments, Device Technologies, Designs For Vision and OptiMed who will offer special sale and showcase events at each of their showrooms in Melbourne during 8-9 October, and in Brisbane 15-16 October. A NSW event will be scheduled when COVID-19 restrictions allow. Due to lockdown requirements, bookings are essential and dates may change.

STAT

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WACKY

High profile Brit Piers Morgan has revealed a long list of symptoms after catching COVID-19 at the Euro 2020 finals, including headaches, fatigue and an inability to taste wine.

But coughing fits have also caused a posterior vitreous detachment, which has meant he is now seeing floaters.

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WONDERFUL

Vision Australia has thanked the Illawarra community in NSW for its support in helping to raise $851,153 during this year's Seeing Eye Dogs Appeal. The donations collected at Petbarn stores around Australia were enough to fund 17 guide dogs.

But the Illawarra community went beyond expectations by contributing $204,539.

Published by:

Publisher Christine Clancy

NSW Minister for Customer Service Mr Victor Dominello has been diagnosed with Bell’s palsy. He only sought medical attention after members of the public raised concerns over his “droopy eye” during a recent media conference. The politician felt pain in his skull, behind his right ear, about 48 hours earlier, before waking up with pins and needles on the right side of his tongue. n

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michelle.weston@primecreative.com.au

DEALING WITH DRY EYE It’s estimated around 85% of dry eye sufferers have the evaporative form of the disease.

Full report page 23.

WHAT’S ON

Complete calendar page 65

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The Australasian Society of Cataract and Refractive Surgeons' annual conference is going digital due to COVID-19 restrictions. The face-to-face event will return in Noosa next year.

The 52nd congress is expected to be an opportunity to look towards the next 50 years of science, ophthalmology and the college.

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INSIGHT October 2021 7

NEWS

ADDRESSING PRIORITISATION AND EFFICIENCY continued from page 3

resisted parts of the standards being used in isolation by hospitals or private health insurers to determine funding for cataract patients.

“We remain disappointed the ACSQHC have not listened to the experts when making a final decision about the standards, as apart from these issues, they are very robust,” Verma said.

ASO vice president Dr Peter Sumich said the standard was “a poke in the eye” to ophthalmologists from RANZCO and the ASO who have “universally denounced it”.

“Whilst falsely claiming to be consultative, it became clear it was a bureaucratic creation designed to allow manipulation of public hospital waiting lists to suit administrators,” Sumich said.

“It is beyond embarrassing for the ACSQHC that their document purporting to represent current standards is out of step with contemporary Australian clinical practice from day one.”

PRIORITISATION AND EFFICIENCY Professor Konrad Pesudovs, formerly foundation chair of Optometry and Vision Science at Flinders University, now SHARP Professor at UNSW, supports the standard.

He was part of the ACSQHC committee who developed the standard and said it

was the work of a group of stakeholders involved in the cataract patient pathway, not only surgeons.

“Surgeons have a very important role in performing operations, but they don’t have a role in public health, primary care or in the community,” he said.

“This is important because this is where Australia’s problem with cataract exists. We have 10 times as many people in the age groups that get cataract today than we had 30 years ago, but we don’t do any more public cataract surgery than we did then.”

He said three things were required: more public cataract surgery; ensuring the right people – most disabled – get surgery first; and greater efficiencies in service delivery.

The standard helps address the final two points – prioritisation and efficiency.

Pesudovs, whose opinions are his own and don’t represent any organisation, suggested objections to a visual acuity criterion of 6/12 may be misplaced.

activities.” Pesudovs said this was a wholly appropriate position.

“The problem of the right people not getting cataract surgery remains.

Therefore, the standard includes a section on the prioritisation for cataract surgery.”

"WE REMAIN DISAPPOINTED THE ACSQHC HAVE NOT LISTENED TO THE EXPERTS WHEN MAKING A FINAL DECISION" NITIN VERMA, RANZCO

It includes Pesudovs’ Cataract Impact Model of prioritisation, on page 28.

“We take clinical measures of vision, cataract grades and vision-related activity limitation questionnaire data and combine it in a model that ranks people in terms of need for surgery. This type of sophisticated prioritisation model can ensure the right people are directed to hospitals where RANZCO surgeons can do their job and take cataracts out,” Pesudovs said.

Regarding bilateral sequential cataract surgery, he said the standard proposed it be used more widely.

“This is a safe approach in the era of intracameral antibiotics that eliminates the issue of increased falls, and its associated mortality and morbidity, that occurs between first eye and second eye cataract surgery,” Pesudovs said.

He said it was not a recommended criterion. It reads: ”Visual acuity of 6/12 or worse may provide a useful objective measure of visual impairment but may significantly underestimate function – for example in conditions of high or low light. Glare or contrast sensitivity may be disabling without an impact on visual acuity. Some patients will have higher visual needs, such as occupational

“Bilateral sequential cataract surgery also offers significant efficiencies in terms of public hospital process in clinical appointments and admissions. This would help us to get more surgery done.” n

PATIENTS URGED TO KEEP CRUCIAL APPOINTMENTS continued from page 3

communicate to its fellows and trainees about the importance of being specific when applying for travel exemptions across Australia.

RANZCO CEO Dr David Andrews subsequently sent an alert to Australian fellows, which said the issue may have arisen due to authorities not being aware that some services, such as intravitreal injections, were urgent and essential and cannot be provided by a local health professional such as a GP. “We advise making this clear on any applications. Unfortunately, RANZCO cannot intervene for you in this process,” he said to fellows.

Meanwhile, the NSW restrictions has 8

INSIGHT October 2021

re-ignited concerns about apprehensive patients missing vital anti-VEGF appointments. The issue was a feature of lockdowns in 2020, when MDFA national research advisor Professor Paul Mitchell grew concerned that thousands of Australians were gambling with their vision.

This was exacerbated in July when, in a press conference, NSW chief health officer Dr Kerry Chant used eye checks as an example of something that could be put off during lockdown, if people weren’t experiencing “pain or other issues”.

At the time, the MDFA stepped in to clarify the matter and warn patients that any sudden changes in vision – even without pain – could be an eye emergency. It said deferring an eye

appointment in those circumstances could cause irreversible vision loss.

Dee Hopkins, MDFA.

However, the MDFA remained concerned about anecdotal reports of people cancelling eye injection appointments. At one busy Sydney clinic on a particular day in July, only 23 of 43 scheduled patients attended their appointments.

“If this is a barometer of what is happening more broadly, the implications are quite concerning,” Hopkins said at the time. “Specialist eye treatments need to continue as scheduled as they are considered to be medically essential.

“If you require injections for wet AMD or DMO or other macular conditions, it is essential that you attend your specialist appointment or discuss your treatment options with your ophthalmologist.” n

NEWS XX

WIDELY REVERED ACADEMIC OPTOMETRIST ‘WILL BE MISSED’

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The academic community, including the University of California, Berkeley School of Optometry, has paid tribute to well-known Australian expatriate Dr Tony Adams, who passed away recently.

“It is with great sadness that we announce the passing of Dr Tony Adams, who died peacefully, with family at his side,” a statement from the school said.

“Tony, who served as dean of Berkeley Optometry from 1992 to 2001, was the quintessential academic optometrist; he confronted and removed barriers, won numerous awards, and served selflessly in positions of leadership.”

Adams, who died on 16 July, completed his training at the University of Melbourne in 1962, served two years as a faculty member at Indiana University, and was then recruited to join the Berkeley faculty in 1968 at the age of 27, where he rose to prominence in both the school and the profession.

He won multiple awards and occupied prominent positions, including within the American Academy of Optometry (AAO) where he was elected to the executive board in 1990 before serving as president from 1998-2000. He also served on the editorial board of Optometry and Vision Science and he was appointed editor-inchief (2004-15).

Professor Konrad Pesudovs, formerly foundation chair of Optometry and Vision Science at Flinders University, described Adams as “Australia’s greatest optometrist”.

“To me he was a great mentor and greater friend. Tony always had time for people. I would not have achieved one-tenth of what I have without his wise counsel,” he wrote in an online tribute.

“The most extraordinary thing is that there are hundreds of people who feel like I do; that Tony was always there for us, had time, cared, didn’t judge and gave sage advice. He was a wonderful influence on many people.”

He believed Adams was probably proudest of his leadership: “He was a great leader for the profession of optometry, not just in his leadership roles at Berkeley and the AAO, but in many fora.”

In 2016, Pesudovs presented the Tony Adams Medal Lecture at Flinders University’s evidence-based optometry

IN BRIEF

Dr Tony Adams (left) with his colleague, friend, and fellow Australian Dr Ian Bailey.

conference to Adams, the inaugural recipient of the medal. Infamously, Adams was presented with a chocolate frog in lieu of the medal, which arrived a day late.

“As always Tony took this hiccup in great humour,” Pesudovs recalled.

Adams’ long list of accolades spanning decades include president, AAO (19982000); distinguished practitioner, National Academies of Practice in Optometry (1998); and president, National Board of Examiners in Optometry (1985–87).

He also received honorary doctorates from Indiana University (2011), State University of New York (1999) and Pennsylvania College of Optometry (2001); Paul Yarwood Memorial Award (2003); Prentice Medal (2003) and Eminent Service Award (2004), American Academy of Optometry; California Optometry Educator of the Year (2004); National Optometry Hall of Fame (2004); president, American Optometric Foundation (2008); and the American Academy of Optometry Life Fellowship Award (2016).

Optometry Australia awarded him Clinical and Experimental Optometry’s H. B. Collin Research Medal in 2012.

In 2014 he was inducted into the Berkeley Optometry Hall of Fame, and last year he received the inaugural UC Berkeley School of Optometry Tony Adams Lifetime Achievement Award for his “impressive, important and enduring accomplishments” to the school and the profession.

“Tony’s influence was extraordinary.

He, along with his life partner Elna, who passed earlier this year, mentored and inspired generations of students, academics, future leaders and change makers. He will be missed,” a statement from Berkeley School of Optometry said. n

DISPENSED MEDICINES

Eyecare professionals who dispense medications are being urged to familiarise themselves with a new national standard about labelling requirements. The National Standard for Labelling Dispensed Medicines has been published by the Australian Commission on Safety and Quality in Health Care and is intended for health professionals who dispense medication.

When labels are applied to medicine packaging at the point of dispensing, this is usually performed a pharmacist, but may also be done by pharmacy technicians, nurse practitioners, GPs, optometrists and dentists. The standard, which sought input from Optometry Australia, provides an evidence-based approach to presentation of medicines information, and includes 12 standards.

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AVASTIN SHORTAGE

The American Academy of Ophthalmology (AAO) has lamented the behaviour of insurance companies that are pushing ophthalmologists to use new biosimilar drugs as alternatives to Avastin that have never been tested in the eye. The move comes amid an Avastin shortage in the US, with the AAO concerned that pressure to use the biosimilars is essentially making patients “unwitting subjects in a clinical experiment”. “Even the drugs’ manufacturers have advised against injecting the alternative drugs into the eye because there is no scientific proof to support it. This development has alarmed ophthalmologists because one of the drugs may be harmful to corneal tissue,” the AAO stated.

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APPLE PATENT

Apple has reportedly won a patent for a direct retinal projector system that provides dynamic focusing for virtual reality (VR).

A direct retinal projector system scans images, pixel by pixel, directly onto the wearer's retinas. Dynamic focusing components and techniques may be used in a direct retinal projector system to dynamically and correctly focus each pixel in VR images as the images are being scanned to a subject's eyes. This allows objects and surfaces that are intended to appear at different distances to be projected into the eyes eyes at the correct depths.

INSIGHT October 2021 9

NEWS

HOPES EXPERIMENTAL OCULAR MELANOMA DRUG WILL SAVE PERTH MOTHER’S LIFE A Western Australian mother-of-three who has already lost one eye to ocular melanoma has travelled to New South Wales to receive an experimental treatment that she hopes will save her from the rare form of cancer.

Perth woman Ms Stacey Charteris is being treated with immunotherapy drug Tebentafusp as part of a trial at Sydney’s St Vincent’s Hospital.

The therapy has been found to improve overall survival rates for patients with metastatic ocular melanoma in clinical trials overseas, with St Vincent’s being the first Australian trial site.

To date, international studies have shown a 50% reduction of the risk of deaths in patients with metastasised ocular melanoma, a disease that has had no curative treatment.

“It’s the first type of drug we know can help these patients who are otherwise facing a lethal disease,” St Vincent’s head of oncology Professor Anthony Joshua said.

In 2016 at the age of 38 and pregnant with her third child, Charteris was diagnosed with ocular melanoma,

Stacey Charteris (centre) is being treated with immunotherapy drug Tebentafusp.

"IT’S THE FIRST TYPE OF DRUG WE KNOW CAN HELP THESE PATIENTS WHO ARE OTHERWISE FACING A LETHAL DISEASE"

site of cancer – were found on her liver.

ANTHONY JOSHUA, ST VINCENT’S HOSPITAL

Until recently, her family said there hadn’t been a known treatment specifically for ocular melanoma. But just as she was finishing the initial trial, she and her medical team became aware of the Tebentafusp trial at St Vincent’s.

a rare cancer that approximately 150 Australians are diagnosed with each year.

According to a Go Fund Me page that has now raised almost $28,000 for her, Charteris commenced an immunotherapy trial in Perth in February, but after several rounds she couldn’t continue because the tumours were not responding, and getting worse.

Adding to her troubles is the necessity to travel to Sydney for treatment, which is amid a strict lockdown. It has also meant she has had to leave her three children and husband behind in WA.

According to the Western Australian, she was concerned about the potential impact of radiation therapy on her unborn child at 20 weeks, so she decided to have surgery to remove the tumour and her eye.

Joshua said Tebentafusp worked by helping immune cells get close enough to cancer cells to attack them.

She was told that the likelihood of it spreading was high. Her son, Phoenix, was born on 17 May 2017 and Charteris went four years cancerfree. But following a six-monthly scan in December 2020, metastasis – the development of secondary malignant growths at a distance from a primary

“It’s like velcro between the tumour and the immune system, such that the immune system is activated to attack the tumour,” he said.

St Vincent's Hospital is the only site delivering the treatment in NSW. n

NEW STUDY SHOWS OMEGA-3 EYE DROP IS EFFECTIVE AGAINST EVAPORATIVE FORM OF DRY EYE Australasian drug company AFT Pharmaceuticals has announced results from a post-market study of its licensed dry eye therapy NovaTears + Omega-3, stating it is a significantly effective treatment for the evaporative form of the disease.

The eye drop is produced by German firm Novaliq and is said to be the first that combines the tear film stabiliser perfluorohexyloctane with a high quality, vegan-sourced omeg-3 fatty acid.

According to AFT, which is licensed to distribute the therapy in Australia and New Zealand, the recent multi-centre, single arm, post-market clinical follow-up study was designed to evaluate the safety and efficacy of NovaTears + Omega-3 (0.2%) eye drops on signs and symptoms of dry eye. It was shown to deliver clinically relevant and statistically significant improvements in dry

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INSIGHT October 2021

medicines available to specifically target this form of the disease and relieve symptoms, which include reddened and inflamed eyes and eyelid margins or encrusted eyelids.

eye symptoms in 36 patients over eight weeks, the company reported.

“The improvements were evident on a broad range of measures including total corneal staining (NEI scale) and tear film break-up time (TFBUT) over the course of the study,” AFT stated.

“Of particular interest was the meibomian gland assessment (MGD) score which improved from an entry level score of 7.1 to 3.0 (p<0.0001) over the course of the study. The latter result supports the hypothesis that the treatment might liquify meibum secretion excreted from the meibomian glands.”

According to AFT, the 2020 Vision Index showed 77% of Australians have experienced dry eye, with more than 85% suffering from some form of evaporative dry eye. But there are currently limited

Hartley Atkinson, AFT Pharmaceuticals.

AFT managing director Dr Hartley Atkinson said since launching Novaliq’s NovaTears in 2018 and NovaTears + Omega-3 in 2020, demand for the products has grown rapidly.

“In the last year alone, we have moved from the number three to number two position in the lubrication eyecare category in Australia with sales growth from the NovaTears range contributing to our growth,” he said. “This study confirms what our customers already know: NovaTears + Omega-3 and NovaTears are effective treatments that deliver significant improvements in the symptoms of DED. n

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NEWS

WATER EXPOSURE RISK TO CONTACT LENS WEAR BECOMES FOCUS OF AUSTRALIAN CAMPAIGN The UNSW School of Optometry and Vision Science (SOVS) is urging eyecare professionals to better utilise follow-up appointments to re-educate patients on safe contact lens wear.

The messaged formed part of the university’s recent campaign called ‘Lens Wear with Care 2021’, which focussed on water exposure and contact lens use.

The campaign was developed at the UNSW SOVS’s Dr Nicole Carnt and her final year Masters students Ms Danica Chua and Mr Gerry Wang. It also involved optometrists Mr Adam Samuels and Ms Stephanie Yeo who work with Carnt and their PhDs. They're focusing on developing interventions to help contact lens wearers become more adherent and hygienic, as well as research looking at the effects of contact lens information online.

Apart from the use of contact lenses during water sports like surfing and swimming, they said recent evidence had indicated that showering with contact lenses increases risk of microbial keratitis by three to seven times.

“In Australia and New Zealand, we generally have good standards of hygiene however when it comes to contact lens

"THE ATTITUDE TOWARDS SAFE LENS WEAR SHOULD BE SIMILAR TO PREVENTATIVE MEDICINE" Studies suggest one in three contact lens wearers are putting their vision at risk.

STEPHANIE YEO, UNSW

hygiene there is still room for improvement.

A study done a few years ago showed that in Australia, we have similar contact lens hygiene compliance levels as Germany and Canada. However, most countries could benefit from improved contact lens hygiene,” Yeo said.

Chua who, as part of their research project, observed contact lens wearers during clinics and found many were oblivious to the importance of hand drying and other water exposure behaviours. This lack of awareness is also consistent with research.

With the proliferation of contact lens technologies, which include for myopia control lenses and augmented virtual reality lenses that will be available in the not-sodistant future, they believe contact lens use is set to increase. The UNSW team also noted the importance of language.

The campaign chose to use the word “adherence” over “compliance”.

“Literature suggests that eyecare practitioners are not promoting safe lens wear enough, and as mentioned, promoting healthy contact lens wearing habits is a long-term task that requires a collective effort,” Yeo and Samuels said.

“Contact lens non-adherence rates range between studies and it seems that one in three contact lens wearers are putting their vision at risk. It has also been suggested that eyecare practitioners are not fully utilising follow-up visits to reeducate contact lens wearer. The attitude towards safe lens wear should be similar to preventative medicine – healthy contact lens wear is a long-term task and requires a collective effort.”

“Compliance is a more passive behaviour that suggests a more ‘doctor-centred’ model, whereas adherence is a more positive, proactive behaviour that is more patient-centric. The emphasis needs to be on understanding how to overcome the barriers instead of emphasis on a provider’s judgment.” n

The campaign was designed by Wang and

HEALTH FUND MEMBERS CAN NOW CLAIM BY TAPPING THEIR IPHONE OR APPLE WATCH AT HICAPS TERMINALS Optometrists that use the HICAPS claims and payment system can now accept digital health insurance membership cards via the Apple Wallet platform.

NAB, which owns HICAPS (Health Industry Claims and Payments Service), announced from 27 July that health fund members of Medibank, Bupa, nib, and GU Health can download their digital membership card from their health fund app and add it to their digital wallet on Apple devices.

The move allows customers to make a health insurance claim by holding their iPhone or Apple Watch near any HICAPS terminal in Australia, rather than swiping a plastic membership card.

Customers can also pay for gap payments using Apple Pay.

12

INSIGHT October 2021

NAB executive for business everyday banking Ms Tania Motton said the bank was excited to offer health practitioners, including optometrists, dentists and physiotherapists, the ability to accept digital health insurance membership cards.

“Digital technology is rapidly changing the way merchants receive payments – with more customers choosing contactless over cash. This is an exciting enhancement that will further support those who prefer a more digital experience,” she said.

“Claims made using this method help reduce the time spent on manual processing for practitioners due to forgotten plastic cards, while putting money back in customers’ bank accounts quicker.”

When patients use their digital health fund card, they receive real-time notifications about their claim within their health fund’s app.

Four health funds have subscribed.

According to NAB, when customers add a health insurance membership card to Apple Wallet, the customer identifier number is encrypted during transmission to the terminal. It is then only decrypted

by HICAPS and then passed on to the customer’s health insurer.

Apple doesn’t receive information about the health insurance claim as there is a direct, encrypted connection between the user’s device and the HICAPS terminal.

Formed in June 1998, HICAPS is part of NAB Health. More than 89,000 health practitioners use the system that is available in more than 25,000 health practices Australia-wide. n

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NEWS

SURVEY SEEKS NEW DATA ON EYECARE NURSE WORKFORCE

INFRARED LIGHT COULD REPLACE INJECTIONS TO TREAT MACULAR OEDEMA A clinical trial at Sydney Eye Hospital is evaluating the safety and efficacy of using infrared light to treat macular oedema from retinal vein occlusions, instead of the current standard treatment of eye injections.

Near infrared light treatment is thought to work by stimulating cellular metabolism and repair.

Known as NIRVO (near infrared light for the treatment of macular oedema from retinal vein occlusions), the study is being led by the Save Sight Institute (SSI) Macular Research Group (MRG) at the University of Sydney.

The project, which received support from the Ophthalmic Research Institute of Australia, recently enrolled its third participant.

According to the researchers, retinal vein occlusions typically occur in patients aged over 50 with cardiovascular risk factors such as hypertension, diabetes, high cholesterol, obesity and smoking.

They said eye injections work well but most patients need to continue them for years to maintain their vision.

The institute believes a less invasive treatment may have many advantages and be better tolerated.

The MRG recently published results from a pilot study in Diabetologia, the official journal of the European Association for the Study of Diabetes, demonstrating that near infrared light was effective and safe when treating macular oedema due to diabetic retinopathy.

"WE HOPE THE DATA COLLECTED IN THIS SURVEY WILL CONTRIBUTE TO POLICY DISCUSSIONS ABOUT THE FUTURE OF EYE HEALTH SERVICES" HEATHER MACHIN, CERA

Australia’s nurses are at the centre of a research survey that will create a snapshot of the eyecare nurse workforce and shape discussion about their future involvement in the sector.

of data about eyecare professionals, but there was no data on nurses, despite being the largest healthcare provider group, and their critical role in many settings.

Researcher and registered nurse Ms Heather Machin is leading the survey, the first of its kind in Australia, with Associate Researcher Professor Mark Daniell, both from Centre for Eye Research Australia (CERA).

The survey, titled ‘Workforce survey of Australian nurses involved in eyecare’, is supported by the Australia Ophthalmic Nurses Association.

“We know that eyecare nurses work in specialist hospitals like the Eye and Ear here in Melbourne – but we are also keen to get a fuller picture of those working in other settings like private ophthalmology practices, domiciliary care, community or Indigenous health settings, who may or may not identify as an eyecare nurse, yet they are providing care to eyecare patients,” she said.

Machin said the study would gather key information about the types of settings nurses work in when caring for people with eyecare needs, their location and the different roles performed.

The survey also wants to hear nurses’ views on issues such as training, their role in eyecare and what the profession can do to attract and retain nurses with specialist eyecare skills, Machin said.

“We hope the data collected in this survey will contribute to policy discussions about the future of eye health services in Australia and the role of nurses in how they are delivered,’’ she said.

“We hope the information gathered from this survey will form an important part of the discussion about the provision of eyecare services in Australia – and help develop new strategies to attract and retain more nurses to eyecare.’’ n

Machin said there was currently a wealth

NANODRUG MACULAR TREATMENT YIELDS ‘IMPRESSIVE RESULTS’ A leading researcher in Queensland has lauded the efficacy of a pioneering treatment for ocular neovascular disease recently trialled in animals.

According to results, 12 90-second treatment sessions with infrared light reduced the patients’ macular oedema and the subsequent requirement for eye injections.

Professor Di Yu of the University of Queensland Diamantina Institute collaborated with scientists from the Chinese Academy of Sciences and Beijing Chaoyang Hospital to challenge the current standard of treatment for agerelated macular degeneration (AMD) and diabetic retinopathy – anti-VEGF injections.

The US Diabetic Retinopathy Research Collaboration is currently recruiting for a larger study with near infrared light which may or may not confirm MRG’s findings.

They are pioneering a more complex nanodrug which not only delivers an antibody, but simultaneously combats inflammation and identified side effects.

Dr Yong Tao, chief ophthalmologist at Beijing Chaoyang Hospital, is a senior author in the study.

In their study of the novel treatment in animals, published in the journal Nature Biomedical Engineering, volumes of lesions were reduced by 95%.

“The NIRVO study may provide proof of principle for a definitive placebo controlled clinical trial which would be required before the treatment could be widely adopted,” the SSI said.

“The efficacy was superb. The new design allows the nanodrug to concentrate on lesions and deliver lasting benefits," Yu said.

“We are very excited to see what we will learn from this new potential treatment.” n

“With the impressive results, further developments are now under way to translate it into a new therapy.

14

INSIGHT October 2021

Fluorescein angiography showing the large area of hyperfluorescence of choroidal neovascularization.

n

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Starts 8:00 AM AEST 1/10/21. Ends 11:59 PM AEDT 31/12/21. Open to AUST & NZ residents 18+ who are Eyecare Professionals employed at Optical Retail Practices (except Luxottica and Specsavers employees) and who fulfil the entry/eligibility requirements. Order qualifying products for your chance to win an MG ZST Essence AUD$33,690 (owner of optical practice receives AUD$2,000 Mastercard Gift Card). Minor Prizes 10 x iWatch Series 6, 10 x AUD$500 Kathmandu Gift Cards & 10 x AUD$200 Rebel Sport Gift Cards. Total prize pool is AUD$49,190 (inc GST). Prize draw 3:00 PM AEDT 12/1/22 at Lvl 2 11 York St Sydney NSW 2000 Australia. Winners notified via email & published at xtractive.com.au 19/1/22. Promoter is Transitions Optical Pty Ltd. ABN 29 067 278 139. 283-287 Sir Donald Bradman Dr Brooklyn Park SA 5032 Australia. Authorised under NSW Authority No. TP/00262, ACT Permit No. TP 21/01386 & SA Permit No. T21/1260. For full T&Cs refer to xtractive.com.au. Transitions, Transitions Signature and XTRActive 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, GEN 8 and Transitions XTRActive Polarized 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. © 2021 Transitions Optical Ltd. www.transitions.com

NEWS

OSCAR WYLEE OPENS 100TH STORE, ENTERS CANADA

ECP TO WIN A CAR IN TRANSITIONS OPTICAL COMPETITION

Australian eyewear retailer Oscar Wylee is expanding into the Canadian market, with its first store opening in Alberta at the end of August.

a chance to win. The competition can be entered online at www.XTRActive.com. au, which features more information and the terms and conditions. Additionally, to celebrate the newly launched Transitions XTRActive new generation and Transitions XTRActive Polarized technologies, eyecare professionals receive three entries when ordering a pair of these products. For all other Transitions technologies, they receive one.

The announcement follows the opening of its 100th retail store in Australia and New Zealand recently, with 27 of those locations added to its network this year alone.

In Canada, the company is also planning to establish itself at four further locations in Halifax, Calgary and Toronto. With a focus on employee benefits, it has promised to provide its Canadian optometrists with generous daily minimums, uncapped earning potential and qualified support staff. Additionally, each new store will be fitted with top quality equipment.

The franchise’s 100th ANZ practice was in the Auckland suburb of Albany. Other recent locations include; Mornington (Victoria), Orange, (New South Wales), Fremantle, (Western Australia) and Launceston (Tasmania).

The local Australian optometry chain said it had hired more than 170 employees since the beginning of 2021 for its new stores and support office team.

“We anticipate that our continued growth will create over 400 new jobs over the year and contribute to the recovering economy and job market,” Mr Kane Ford, director of retail operations at Oscar Wylee, said.

“We are always looking for new location opportunities to expand access to eyecare across Australia and New Zealand.”

Oscar Wylee has grown rapidly since brothers Mr Jack Teoh and Mr Bob Teoh purchased the company with their investment firm and began to expand its operations.

At the time, it was a small e-commerce operation delivering glasses over the internet with no brick-and-mortar store. It opened its first physical store in 2015. n

The MG ZST Essence is worth more than $33,000 driveaway.

Transitions Optical is running a competition from 1 October to 31 December 2021 giving eyecare professionals the chance to win an MG ZST Essence worth $33,690 driveaway, in addition to other prizes.

The company is giving away $50,000 in prizes in total, which also includes 10 iWatch Series 6s, 10 $500 Kathmandu vouchers and 10 $200 Rebel Sport vouchers.

To enter the competition, eyecare professionals need to order a Transitions lens product from any optical laboratory in Australia and New Zealand.

Products include: Transitions XTRActive new generation, Transitions XTRActive Polarized, Transitions Signature GEN 8, Transitions XTRActive style mirrors and Transitions Drivewear. Each order provides

16

INSIGHT October 2021

According to the company, Transitions XTRActive Polarized features dynamic polarisation. The lens is clear and unpolarised indoors. In bright light outdoors it quickly darkens and also becomes polarised.

Transitions XTRActive new generation is 35% faster to fade back than the previous generation. It is the darkest clear to dark photochromic lens on the market.

“While many of us may not know what summer will look like this year, there is one thing we know we can do: get out and active during the warmer months,” Mr Adam McMahon, Transitions Optical key account manager for Australia and New Zealand, said. “We chose prizes we felt could be used and enjoyed during these strange times.” n

HEALTHIA EXPANDS PORTFOLIO Australian allied health group Healthia has continued its expansion into the optical market with the acquisition of John Holme Optometrist, a two-store business in North Queensland.

The ASX-listed company – which entered the optical arena in December 2020 with the acquisition of The Optical Company’s 41-store business in a $43 million agreement – confirmed the deal on 16 August.

Since its public listing in September 2018, Healthia has grown its portfolio of owned allied health businesses from 104 to 217, representing portfolio growth of 109%.

The company opened its first physical store in 2015.

The two new Transitions technologies feature in the clear to extra dark lens range which also work in the car.

John Holme Optometrist, located in Mareeba and Malanda, is joining its Eyes and Ears division, which now comprises 45 optometry stores and a wholesale eyewear frame distribution business trading as AED.

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Healthia now owns 217 allied health businesses.

“Our key target sectors of Bodies and Minds, Feet and Ankles, and Eyes and Ears have a collective addressable market of $9.8 billion,” Healthia managing director Wesley Coote said.

“We have a proven management team and a clinician and patient first culture and are excited to have these businesses joining our growing allied health network.” n

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AUSTRALIA'S SECOND NATIONAL EYE HEALTH SURVEY TO INCLUDE EAR HEALTH ELEMENT A second National Eye Health Survey has been announced – this time with an added ear health component – and will examine close to 5,000 Aboriginal and Torres Strait Islander peoples and nonAboriginal Australians over two years.

The Centre for Vision Research at The Westmead Institute for Medical Research (WIMR) and partners, including the University of New South Wales, The George Institute for Global Health, the Brien Holden Foundation and Macquarie University, have been awarded the tender to conduct the nationwide survey, called the Australian Eye and Ear Health Survey.

It comes five years after the 2016 National Eye Health Survey, which was the first nationwide survey to determine the prevalence and major causes of vision impairment and blindness in Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians NOVA EYE MEDICAL_INSIGHT-PRINT.pdf

1

27/7/21

in city, regional and remote areas.

The Australian Government Department of Health has sponsored the call to conduct a second national eye health survey in view of increased prevalence of diabetes since the 2016 survey and the critical eye complications that may follow.

Professor Paul Mitchell, director of WIMR’s Centre for Vision Research who will lead the study, said having a thorough and accurate understanding of the prevalence of eye disease and hearing loss in Australia is essential.

“It allows us to anticipate and plan prevention and treatment approaches that address the issues of vision and hearing loss now, and well into the future,” Mitchell said.

“Our study will use new, non-invasive imaging technologies to help improve eye disease detection rates. Importantly, it will assess a broad representation of

people from across Australia. We will also look to assess potential links between eye disease/vision and hearing loss and critical health and/or social outcomes.”

Prof Paul Mitchell, WIMR.

Macquarie University has provided support to ensure ear health assessment occurs at the same time as collection of data on eye and general health measures in the survey. Professor Bamini Gopinath, Cochlear Chair in Hearing and Health at Macquarie University Hearing, will lead the survey’s ear health component.

“We have a unique opportunity to expand the scope of the Second National Eye Health Survey to also establish prevalence, risk factors and impacts of hearing loss in Australia,” Gopinath said.

“This will not only help to determine the current state of hearing health in Australia, but it will provide vital information to the government to assist in its policy development. n

1:47 pm

M IGS

Unlike other MIGS which create artificial flow, iTrack™ is a stent-free, tissue-sparing MIGS procedure that treats 360° of the outflow pathway to re-establish natural aqueous flow.

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RESEARCH

LONG COVID LINK TO CORNEAL NERVE DAMAGE Nerve fibre loss and an increase in key immune cells on the cornea may be an identifying feature of 'long COVID', suggests a small study published in the British Journal of Ophthalmology.

These changes – identified through corneal confocal microscopy (CCM) – were particularly evident among those with neurological symptoms, such as loss of taste and smell, headache, dizziness, numbness, and neuropathic pain, following COVID-19 infection, the findings show.

The study was conducted by researchers from Necmettin Erbakan University Meram Medical Faculty Hospital in Turkey and Weill Cornell Medicine-Qatar in Doha.

"To the best of our knowledge, this is the first study reporting corneal nerve loss and an increase in [dendritic cell] density in patients who have recovered from COVID-19, especially in subjects with persisting symptoms consistent with long COVID,” the researchers said.

"We show that patients with long COVID have evidence of small nerve fibre damage which relates to the severity of long COVID and neuropathic as well as musculoskeletal symptoms.

"Corneal confocal microscopy may have clinical utility as a rapid objective ophthalmic test to evaluate patients with long COVID."

These cells have a key role in the primary immune system response by capturing and presenting antigens from invading organisms.

According to the study, long COVID is characterised by several potentially debilitating symptoms that continue for more than four weeks after the acute phase of the infection has passed and aren't explained by an alternative diagnosis. Around one in 10 of all infected people will develop long COVID, and it has been suggested that small nerve fibre damage may underlie its development.

The corneal scans were compared with those of 30 healthy people who hadn't had COVID-19 infection.

Symptoms correlated strongly with corneal nerve fibre loss.

To explore this further, the researchers used a real time CCM to identify nerve damage in the cornea. Forty people who had recovered from confirmed COVID-19 infection between one and six months earlier completed a National Institute of Health and Clinical Excellence (NICE) questionnaire.

Twenty-two (55%) of the 40 COVID-19 patients had no clinical signs of pneumonia; 11 (28%) had clinical signs of pneumonia not requiring oxygen therapy; four (10%) had been admitted to hospital with pneumonia and received oxygen therapy; and three (8%) with pneumonia had been admitted to the intensive care.

The corneal scans revealed that patients with neurological symptoms four weeks after they had recovered from acute COVID-19 had greater corneal nerve fibre damage and loss, with higher numbers of dendritic cells, than those who hadn't been infected.

Those without neurological symptoms had comparable numbers of corneal nerve fibres as those who hadn't been infected with COVID-19, but higher numbers of dendritic cells.

Neurological symptoms were present at four and 12 weeks in 22 out of 40 (55%) and 13 out of 29 (45%) patients, respectively.

Participants' corneas were then scanned using CCM to look for small nerve fibre damage and the density of dendritic cells.

The questionnaire responses indicative of long COVID symptoms correlated strongly with corneal nerve fibre loss. n

CLINIC WITH OPTOMAP IMAGING CUTS VISITS BY A THIRD A study conducted at a prominent research university has found patient visits were 28 minutes shorter on average after systemic changes to its workflow, including decentralised optomap imaging.

The company behind the technology, Optos, recently released the findings as part of a clinical summary. It was based on new research out of Stanford University in the US that sought to reduce visit times for retina patients in an affiliated academic ophthalmology department.

In an article published in Retina, the researchers identified photography as a major bottleneck in patient movement and clinic efficiency.

To address this, it trained ophthalmic technicians to perform optomap imaging in addition to OCT. It also better aligned staff and doctor schedules.

To support the new workflow, the clinic also procured three additional

18

INSIGHT October 2021

Optos widefield retinal photography units, taking its total number to four. It aimed to decentralise usage by moving devices outside of the photography suite to be adjacent with exam rooms.

Ophthalmic technicians were trained to perform optomap imaging in exam lanes, bypassing the need for patients to go to the photography suite.

According to the study, prior to these changes, the average patient visit duration was 87 minutes. Four weeks after, this was reduced to 58.5, a reduction of 28.5 minutes or 33%.

From a financial perspective, the clinic reached a breakeven point on each Optos device after one year, using the instrument at least eight times per workday, which was readily exceed by its high-volume retina practice. The authors also noted other benefits including, increased patient satisfaction scores, less downtime for patients and fewer staff handoffs, and minimised

patient movement throughout the clinic.

An optomap image of a retinal detachment.

Image: Optos

“This study has shown that improving clinic efficiency can be accomplished by reducing bottlenecks in clinic workflow,” the authors said. “Reallocation of resources, including reorganising equipment and training clinic personnel for new responsibilities, is a more cost-effective solution than only focusing on capital purchases or hiring additional personnel.”

The authors also noted that the relative ease of implementation and the program benefits show similar changes can be applied to other clinics, with similar results expected.

According to Optos, a previous study in 2017 in US Ophthalmic Review found similar results. In the first year after integrating ultrawidefield (UWF) retinal imaging, the authors said 220 more patients were seen, an increase of 4.4% over the pre-UWF period, which was an average of 1.5 additional patient encounters per day. n

NEW STUDY LENDS WEIGHT TO LINK BETWEEN PANDEMIC AND MYOPIA A Hong Kong study highlighting a significant decrease in the time schoolchildren have been able to spend outdoors and a sharp increase in screen time is the latest to join mounting evidence that a rise in childhood myopia may be linked to the coronavirus pandemic.

The research published online in the British Journal of Ophthalmology follows a similar Chinese study published last year in JAMA Ophthalmology that found myopia prevalence was three times higher in sixyear-olds during the COVID-19 pandemic, giving rise to the term “quarantine myopia”.

Despite the Hong Kong study being an observational study with certain limitations, the researchers warned that their initial results show an alarming myopia progression that warrants appropriate remedial action.

“Our results serve to warn eyecare professionals, and also policymakers,

Researchers studied the eyes of 1,793 children.

educators and parents, that collective efforts are needed to prevent childhood myopia—a potential public health crisis as a result of COVID-19,” they concluded.

In what is arguably one of the world’s most densely populated cities, the researchers studied the eyes of 1,793 children, all part of the Hong Kong Children Eye Study (HKCES) – an ongoing population-based study of eye conditions among six- to eight-year-olds. Nearly

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two-thirds (1,084 children) had entered the study before the start of the pandemic and had been monitored for around three years; 709 children were recruited to the study at the start of the pandemic (December 2019 to January 2020) and were monitored for around eight months.

Around one in five children in the COVID-19 group developed myopia between January and August 2020, compared with around one in three (37%) of those in the pre-COVID-19 group over a period of three years. The researchers found the numbers of new cases of myopia were higher among children in the COVID-19 group.

The estimated one-year myopia incidence was 28%, 27%, and 26%, respectively, for six-, seven- and eight-year-olds in the COVID-19 group, compared with 17%, 16%, and 15%, for six-, seven-, and eightyear-olds in the pre-COVID-19 group. n

GLAUCOMA

IT’S ALL ABOUT THE

(aqueous) flow

When it comes to the treatment of glaucoma, there is growing evidence to suggest that the ability to re-establish the natural flow of aqueous humour plays a critical role not only in reducing IOP, but also in preserving the health of the corneal endothelium, says US ophthalmologist DR DAVID LUBECK.

I

n a healthy eye, most aqueous humour drains through the conventional outflow pathway, flowing from the anterior chamber through progressively smaller channels of the trabecular meshwork into Schlemm’s canal.

From the canal, circuitous channels, known as collector channels, connect to the episcleral vasculature, which drains into the venous system. The flow of aqueous throughout the conventional outflow pathway is dynamic and is determined by intraocular pressure (IOP), outflow resistance or facility and episcleral venous pressure, and can be described as natural aqueous flow.

the loss in ECD following glaucoma treatment.

“It is well accepted that more invasive glaucoma surgeries such as trabeculectomy and tube shunts are associated with a more significant loss of ECD,” he said.

Blockages can occur along several points of the conventional outflow pathway, including the trabecular meshwork, Schlemm’s canal and the collector channels, disrupting the natural aqueous flow and resulting in elevated IOP. It also has the consequence of depriving the eye of the nutrientrich flow of aqueous throughout the full 360 degrees of the conventional outflow pathway, thereby contributing to the pathogenesis of glaucoma.

While all MIGS devices aim to overcome the reduced outflow facility associated with glaucoma, their respective mechanisms of action are very different. Considering each of the MIGS devices, they are often categorised based on whether they require the use of a stent or implant. These microtrabecular bypass stents commonly include iStent (Glaukos) and Hydrus (Ivantis). There are also MIGS designed to remove or manipulate the trabecular meshwork tissue, referred to as goniotomy (KDB, New World Medical) or ab-interno trabeculotomy (OMNI, Sight Sciences).

The results of a prospective study presented at the 2021 meeting of the American Society of Cataract and Refractive Surgery (ASCRS) would posit another criterion for the categorisation of MIGS and glaucoma treatments: the re-establishment of natural aqueous flow, as compared to the creation of artificial flow.

Presented by doctors David M. Lubeck, MD, ABO and Robert J. Noecker, MD, MBA, ABO and awarded best paper in the session “Minimally Invasive Glaucoma Surgery (MIGS) II”, the 12-month data reported a mean change in endothelial cell density (ECD) of 3.2% (SD ±9.0%) following ab-interno canaloplasty (iTrack, Nova Eye Medical) performed in conjunction with cataract surgery – and represents one of the lowest reported rates of endothelial cell loss (ECL) of all the MIGS procedures. Refer to Table 1.

At the ASCRS meeting, Lubeck asked the question of whether it is the change in aqueous currents which is responsible for much of

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INSIGHT October 2021

Dr David Lubeck, Arbor Centers for Eye Care, Illinois.

“In the case of tube shunts, much of this loss is thought to result from the mechanical disruption caused by the shunt itself. Studies estimate ECL at between 8.0% and 18.6% at two years for tube shunt surgery and between 9.5% and 28.0% at one year for trabeculectomy.”

Examining the various MIGS procedures and their impact on the corneal endothelium, the reported rates of ECL are much lower than that of traditional glaucoma surgeries.

“Micro-trabecular bypass stents, when correctly implanted in the angle, should not negatively impact on the health of the corneal endothelium,” Lubeck said. “Further, migration of these stents is uncommon. They do create artificial flow, however, and the impact of this on the corneal endothelium may warrant further consideration. With MIGS procedures such as goniotomy, there is the additional drawback of post-operative inflammation that may disrupt the delicate environment of the corneal endothelium.”

He added: “In contrast, ab-interno canaloplasty re-establishes natural aqueous flow throughout the entire 360 degrees of the conventional outflow pathway without the use of an implant, and without the removal or damage of tissue. Theoretically it may safeguard against the risk of excessive damage to the corneal endothelium."

During the ab-interno canaloplasty procedure, 360-degree catheterization and viscodilation dilates the canal and separates the compressed tissue planes of the trabecular meshwork. It also acts

Table 1: Comparison of ECL rates between different MIGS procedures MIGS device/procedure

n

Follow-up

Mean % ECL

Samuelson T. et al (1)

505

24 months

13.1% (12.3% control)

Arriola-Villalobos et al (2)

20

12 months

13.2%

Gillman et al (3)

54

12 months

14.6%

Hydrus Microstent in conjunction with cataract surgery

Samuelson T. et al (4)

556

24 months

14.0% (10.0% control)

36 months

15.0% (11.0% control)

iTrack ab-interno canaloplasty in conjunction with cataract surgery

Lubeck et al (5)

12 months

3.2%

OMNI

Not reported

Kahook Dual Blade (KDB)

Not reported

Conventional Outflow Pathway iStent inject in conjunction with cataract surgery

77

TABLE 1 REFERENCES 1. Samuelson, T. W., Sarkisian, S. R., Jr, Lubeck, D. M., Stiles, M. C., Duh, Y. J., Romo, E. A., Giamporcaro, J. E., Hornbeak, D. M., Katz, L. J., & iStent inject Study Group (2019). Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary OpenAngle Glaucoma and Cataract: Two-Year Results. Ophthalmology, 126(6), 811–821https://doi.org/10.1016/j.ophtha.2019.03.006 2. Arriola-Villalobos, P., Martínez-de-la-Casa, J. M., Díaz-Valle, D., García-Vidal, S. E., Fernández-Pérez, C., García-Sánchez, J., & García-Feijoó, J. (2013).

Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract.

British Journal of Ophthalmology, 97(10), 1250-1255.

3. Gillmann K, Mansouri K, Ambresin A, Bravetti GE, Mermoud A. A Prospective Analysis of iStent Inject Microstent Implantation: Surgical Outcomes, Endothelial Cell Density, and Device Position at 12 Months. J Glaucoma. 2020 Aug;29(8):639-647.

4. Samuelson, T. W., Chang, D. F., Marquis, R., Flowers, B., Lim, K. S., Ahmed, I. I. K., & Pfeiffer, N. (2019). A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: the HORIZON study. Ophthalmology, 126(1), 29-37.

Subconjunctival XEN Gel Implant in combination with cataract surgery

Oddone et al (6)

40

6 months

11.3%

XEN Gel Implant as standalone procedure

Oddone et al (6)

68

6 months

5.6%

Source: Nova Eye Medical.

downstream on the collector channel ostia, pushing out herniations of trabecular meshwork tissue, which have been shown to block up to 90% of collector channels in glaucomatous eyes.

“There is no denying the improved safety profile afforded by MIGS. I would encourage my peers to consider the impact of MIGS on natural aqueous flow, and how this relates to the health of the corneal endothelium.”

5. D.M. Lubeck, MD, and R.J. Noecker, MD, unpublished data, 2021; accepted for presentation at ASCRS 2021).

6. Oddone, F., Roberti, G., Posarelli, C., Agnifili, L., Mastropasqua, L., Carnevale, C., ... & Figus, M. (2021). Endothelial Cell Density After XEN Implant Surgery: Short-term Data From the Italian XEN Glaucoma Treatment Registry (XEN-GTR). Journal of Glaucoma, 30(7), 559-565.

NOTE: This article was submitted by Nova Eye Medical. Further references are available in the online version of this article at www.insightnews.com.au.

Dr David Lubeck is Assistant Clinical Professor of Ophthalmology, UIC Eye Center, Chicago; director of advanced anterior segment surgery, Arbor Centers for Eye Care, Homewood, Illinois. Financial disclosures: consultant/speaker (Alcon, Glaukos, Nova Eye Medical). n

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DRY EYE

e y e dry s t n e m t a tre ACCESS TO

IN AUSTRALIA

New eye drop formulations are making dry eye treatment more affordable and accessible, especially for more severe sufferers. But Australia has often played catch up, as RHIANNON BOWMAN reports.

I

n one of Insight’s popular Soapbox column’s last year, Dr Brendan Cronin from the Queensland Eye Institute, expressed his views on whether enough was being done for dry eye patients in Australia.

As an example, he pointed out that while first-generation ciclosporin compounds have been available in the rest of the world for more than a decade, the first Therapeutic Goods Administration (TGA)-approved ciclosporin in Australia (Cequa) only became available last year.

Although Ikervis (another ciclosporin) and Xiidra (lifitegrast) have since expanded the suite of products available locally, Cronin pointed out that the cost of obtaining TGA approval for new medications means a small market like Australia is often overlooked by pharmaceutical companies due to the high cost of gaining an approval.

While several therapies are accessible via the Pharmaceutical Benefits Scheme (PBS), he noted Medicare has not yet adopted any procedural treatment for dry eye in the MBS schedule, meaning expenses are borne by patients.

His comments struck a chord; the column attracting thousands of views from Australian eyecare professionals.

This month, Insight invited eyecare professionals with a strong clinical presence in dry eye to weigh-in about the current dry eye treatment options and discuss what is happening to address issues around the cost of treatment.

SUPPLY NOT KEEPING UP WITH DEMAND Clinical optometrist Mr Jason Holland practises at two locations in Brisbane, The Optical Superstore and The Eye Health Centre. At the latter, he operates a co-management clinic with ophthalmologist Dr Andrew Apel to manage and review patients with diabetes, glaucoma and ongoing conditions including dry eye.

Holland says more specific treatment options are emerging.

“For many practitioners, over-the-counter lubricant eye drops have been their go-to treatment for dry eye disease for many years, and for mild cases, the DEWS II report supports this approach is appropriate,” he says.

“Initially we had a plethora of lubricants to support the aqueous layer, however, for many patients it is the lipid layer which is deficient.

In recent years there have been a number of new lipid containing products released in Australia, so I feel that we are being supported by industry in regard to innovation.”

While lubricants are good at managing symptoms, Holland says patients with more severe disease are looking for treatments to improve the underlying conditions.

“We have been lucky to have access to many devices to treat dry eye in Australia, however, there is no rebate for these procedures so the

INSIGHT October 2021 23

DRY EYE

but are accessible via the Special Access Scheme (SAS). Holland says a lot of research is being carried out into potential dry eye treatments, predominantly eye drops, with new and existing players in the ophthalmic industry vying for market share. This is particularly exciting for more severe disease sufferers who may not respond to the multitude of other eye drop therapies available, currently dominated by therapies for aqueous deficiency.

One of those is pharmaceutical company Seqirus, a subsidiary of the Melbourne-based biotechnology company CSL, which is behind two novel treatments.

This includes the aforementioned Ikervis (ciclosporin 0.1% ophthalmic emulsion), which is a treatment for severe keratitis in adult patients with dry eye disease when artificial tears are insufficient.

The other product, Cationorm (cationic nanoemulsion), listed on the Pharmaceutical Benefits Scheme from 1 August, is a hydrating and lubricating emulsion that protects the eye surface and relieves irritation due to persistent dry eyes.

Some believe a Medicare rebate for basic imaging like meibography could have a significant impact.

"WE HAD A PLETHORA OF LUBRICANTS TO SUPPORT THE AQUEOUS LAYER, HOWEVER, FOR MANY IT IS THE LIPID LAYER WHICH IS DEFICIENT"

JASON HOLLAND THE EYE HEALTH CENTRE

cost of therapy can be a limiting factor despite a growing demand from the community,” he says.

“Seqirus is a new company to enter the dry eye market that virtually no one has heard of before. Their mineral oil emulsion for evaporative dry eye – Cationorm – has TGA approval, and while I’ve got product samples, I want more,” Holland says.

“Ikervis is certainly going to be utilised in my practice. Having a preservative-free alternative will be wonderful for many of my patients and the once-a-day dosing is a bonus. Like most ciclosporin products, patients will need to wait 90 days to assess its effectiveness.”

Holland says there are also other major companies, which traditionally target treatments for the posterior of the eye, getting further into dry eye treatments, and directly marketing to optometrists.

One of those is Novartis, which acquired dry eye drug Xiidra (lifitegrast ophthalmic solution) in a $7.5 billion deal in 2019. It was included on the Australian Register of Therapeutics Goods (ARTG) the same year. It is a prescription treatment indicated for moderate to severe dry eye in adults for whom prior use of artificial tears has not been sufficient.

“Xiidra is designed to manage inflammation. Although the government is not restricting access to this unique product, there is a challenge in prescribing it as optometrists need to get SAS approval for every script, as per TGA rules,” Holland says.

Holland believes the TGA is not delaying access to dry eye treatments – but COVID is.

For more severe dry eye sufferers, Holland says it’s encouraging to see the rollout of novel eye drop therapies in Australia because they allow any registered optometrist with therapeutic endorsement access to treatment, without needing to outlay thousands of dollars in specialist treatment devices.

This is particularly the case for Cequa, Australia’s first approved ciclosporin eye drop. The TGA approved the prescription-only immunosuppressant, indicated to increase tear production in patients with moderate-to-severe dry eye, in February 2020.

“Eye drops like Cequa, Xiidra and now Cationorm take away the cost barrier to treatment for patients. Eye drops are not cost prohibitive, compared to other treatments, like LipiFlow or intense pulsed light (IPL) that some patients simply can’t afford.”

“Research has shown Cequa is a promising medicine – and it’s preservative-free, and TGA-approved, but since COVID hit, we can’t get stock. Patients are desperate to get more. It’s a challenge because Australia is a small market, globally,” Holland says.

Despite the prohibitive cost of some treatment options, Holland suspects that seeking a new Medicare item number for treating dry eye could be a bridge too far.

“Many of my patients have had incredible success with Cequa so I was forced to find an alternative when stock from America became limited. Initially I sourced compounded ciclosporin with an aqueous base from a local hospital, however, I am now keen to assess the effectiveness of [new drug] Ikervis as an alternative.”

He says local practitioners also hope to soon have access to Alcon’s iLux MGD treatment device for dry eye, which debuted at SECO International in 2019. “iLux is a device which practitioners can use in their clinics. It is unique in that it heats the meibomian glands from the inside like the Lipiflow device. The device then simultaneously expresses the meibomian glands,” Holland says. Other treatments, such as the ciclosporincontaining Restasis (AbbVie/Allergan), have not met with TGA approval

24

INSIGHT October 2021

“In 2015, when an MBS item number for removal of foreign body was introduced, it was a different environment politically. We need critical mass in order for a dry eye therapy to be MBS-listed, but at the moment, there might only be about 20% of optometrists who are actively treating dry eye,” Holland says.

“We might have more luck with private health funds to contribute towards the cost of procedural aspects of dry eye treatment.”

FEES AFFECT PROFIT MARGIN Ophthalmologist Dr Kenneth Ooi, from the University of Sydney’s Save Sight Institute, says Australia has experienced a slow uptake in accessing the world’s leading dry eye therapies – and there are many reasons for this.

Ooi himself is hoping to address a major unmet need by repurposing a

common cholesterol-lowering drug into a topical ocular therapy for dry eye and blepharitis, called Atorvastatin. Along with Professor Stephanie Watson, they have shown promising results in a pilot study and believe their therapy has the potential to treat both evaporative and aqueous deficient forms of the disease.

"WE’RE DEPENDENT SOMEWHAT ON PHARMACEUTICAL COMPANIES WHO WANT TO TAKE UP A LICENSE TO DISTRIBUTE IN AUSTRALIA"

Generally, Ooi says one of the main barriers to Australia accessing the most innovative therapies include licensing policies of global pharmaceutical companies, which can impact, or delay therapies being brought into Australia a lot of the time.

“We’re dependent somewhat on pharmaceutical companies who want to take up a license to distribute in Australia. Where do they see something that differentiates the potential new dry eye product? It’s a crowded market, so a new product has to have a hook,” Ooi says.

“An innovative, novel product would therefore have an increased price point and likely need a reimbursement capability. It needs to be shown to be costeffective compared to currently reimbursed therapies, so eligibility criteria, as designated by Pharmaceutical Benefits Advisory Committee (PBAC), may limit uptake of the drug to smaller patient groups via the PBS. For example, limiting reimbursed treatment to patients with an Ocular Surface Disease Index (OSDI) score greater than 30.”

Ooi says in Australia there are a limited number of companies willing to bring in a new drug.

“From an innovating company perspective, they need to recoup investment and failed products investment. It can be to the order of a 20% reinvestment strategy into new research, and $2 billion, on average, to bring a new drug to the global market,” he says.

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From a PBAC perspective, any new product brought to market must have already been reviewed and approved for Australia by the TGA and has to be cost-effective, he says.

“It’s a balance. The patient population with the eye health condition has to be large enough for the licenser, but to achieve the desired price point, the PBAC may mandate additional criteria to limit its use so that it remains cost-effective.”

Ooi says the PBAC has a remit to allow reimbursed access to alternative, cost-effective treatments. PBAC cost-effectiveness (health economics) determines the amount of reimbursement.

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“For example, if a treatment is approved for PBS reimbursement, a

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DRY EYE

"IT’S GROWING AND BECOMING MORE ACCEPTED, BUT IT SEEMS THERE IS A TWO-TIERED MODEL OF DRY EYE PRACTICE EVOLVING" DR JENNIFER RAYNER ALLEVE EYE CLINIC

But once a new therapy is introduced, Ooi says the profession has enough respected advocates in ophthalmology and optometry.

“Australia has a combination of well-trained ophthalmic and optometric eyecare providers; education on therapeutic prescribing rights takes place now at an undergraduate level in optometry; there is a lot of interest in dry eye in optometry, and where access to ophthalmology in country areas is difficult, optometrists fill this need.”

Ooi says it may be feasible to use compounding chemists to get around a lack of access to some leading products but only if the products are TGA-approved and included on the ARTG but not commercially available in Australia, or unavailable via the SAS. “For example, preservative-free formulations that are out of stock in Australia can be compounded. A drug can also be prescribed off-license/ label, but it has to be formulated and made by a compounding pharmacy that approves of its use,” he explains.

“Individual Schedule 5 TGA exemptions allow for specific individual patient drug needs but products cannot be commercialised or produced in large-scale quantities.”

TIP OF THE ICEBERG The cost of treatment is an aspect of dry eye that optometrist and co-owner of Alleve Eye Clinic in Adelaide, Dr Jennifer Rayner, knows well.

With a background in both independent and corporate optometry, she initially owned and operated a regular optometry and concurrent dry eye practice for two years, then broke away to open a clinic where she could devote her time and resources to only dry eye patients.

As a result, she established South Australia's only dedicated dry eye clinic.

It's estimated about 20% of optometrists are actively treating dry eye in Australia.

pensioner pays $6 for the product, and the government makes up the shortfall of $34, for a product that costs $40 from the licensor. If a product is not reimbursed via the PBS, then it may only be available for ‘private sale’, so the patient must pay the full price, including dispensing fees, which may be prohibitive,” he says.

“I don’t refract, or fit contact lenses – I purely diagnose and treat dry eye,” Rayner says. “Dry eye is a growing clinical field, still being recognised and, at times, dismissed. It’s a huge problem, more than people realise.”

Alleve Eye Clinic opened in 2016 and has taken a few years to get off the ground, Rayner says.

Her patient referrals come from a wide variety of sources, including GPs, optometrists, ophthalmologists, rheumatologists, dermatologists, pharmacists – and Google “because patients don’t need an official referral to see me – people are looking for a solution”.

Regulatory fees can also affect profit margin and are a consideration when deciding whether to bring a product to Australia.

“Dry eye takes time. It can be notoriously hard to treat. Diagnosis is relatively straight forward but managing patients and testing treatment options takes time. Some patients have been suffering for 15 to 20 years.

There is no one solution that works for everyone. Fortunately, the Tear Film and Ocular Surface Society (TFOS) have established treatment protocols (DEWS I and II) but it still involves trial and error for each patient,” she says.

“The parent pharmaceutical company sets in-licensing fees and negotiates fees for the licensing company purchasing the product. Then there are registration fees with the TGA and PBAC, and ongoing fees maintaining registration,” Ooi says.

Despite the inherent difficulty in finding successful solutions, Rayner says treatment options have come a long way in the last five years, with products like Optimel Manuka eye drops and gel, which feature highly in her practice’s arsenal.

He says the TGA assesses products for efficacy, safety, and whether manufacturing processes and facilities are appropriate, which results in fees being incurred.

However, she laments that even though dry eye is a growing area, practitioners don’t have an official body where they can exchange information and insight about dry eye treatments, new products, or equipment, she says.

“When reimbursing therapies via the PBS, the government is deciding how to divide money from a pool of a set size with other medications in place which already are reimbursed and work.”

“For a European approved drug, European Medicines Agency (EMA) registration paperwork and pharmacovigilance assessment is similar to Australia. For a US approved drug, FDA re-writing costs needs to be incurred. Additional safety data may be requested from regulatory authorities which add to ongoing costs.”

“It’s growing and becoming more accepted, but it seems there is a twotiered model of dry eye practice evolving. There are those offering dry eye treatment at an entry level, like myopia, and there are those who are taking the next step, like myself, with a dedicated clinic backed by an elevated knowledge of this disease.”

Ooi says Australian eyecare practitioners’ uptake of innovative treatments is generally slow, compared to their global counterparts, given that dry eye drug development is not usually done in Australia.

Rayner’s practice model assesses each patient’s dry eye disease – and financial position to afford treatment – on a case-by-case basis.

“And we tend to be conservative preferring to be presented with randomised controlled trial/real-world data and using wellestablished products,” he says.

“We clinically assess patients as part of an initial consultation under Medicare guidelines if they are eligible. We don’t bulk bill. In my experience, patients are so desperate to resolve their dry eye that they will pay out-of-

26

INSIGHT October 2021

"WE ARE SEEING THE ESTABLISHMENT OF DRY EYE CLINICS THROUGHOUT AUSTRALIA TO ASSIST PATIENTS MANAGE THIS CONDITION"

LUKE ARUNDEL OPTOMETRY AUSTRALIA

pocket, but they often say, ‘I wish my health fund would cover this’. I initially spoke to one major health fund about covering dry eye, but it was not considered big enough to cover,” Rayner says.

“Some people can’t afford the gap. We take an individual approach to cost and payment. It would be fabulous to see a Medicare rebate for basic imaging like meibography (infrared imaging of meibomian glands). Medicare should be covering meibography, much like Medicare covers a bone x-ray.

But it’s not covered.”

EMPHASIS ON EDUCATION Optometry Australia (OA)’s chief clinical officer Mr Luke Arundel says the organisation recognises that the incidence of dry eye is high with most people experiencing this condition at some time.

“The rise in dry eye is creating a need within the population for more specialised treatment, hence we are seeing the establishment of dry eye clinics throughout Australia to assist patients manage this condition. We are highly supportive of the establishment of practices dedicated to specific eye conditions and diseases,” he says.

Given the prevalence of dry eye, OA is continuing to provide education and professional development resources for its members.

In July, the US inventor of the IPL procedure, Dr Rolando Toyos, facilitated a dry eye webcast, outlining the basic concept and mechanism of IPL therapy and how it can be incorporated into dry eye treatment, and reviewing existing and new therapeutic dry eye management options available to practitioners.

Simultaneously, Arundel says OA is continually lobbying for the expansion of the MBS schedule. The organisation has a member-based Medicare Services Advisory Group to assist in this area and its policy team is in regular communication with the numerous divisions within Medicare.

But as Arundel points out, lobbying for items to be added to the MBS can be an expensive enterprise.

“Addition of procedural items to the MBS involves a large amount of effort and resources, with the first of these (item 10944: foreign body removal) successfully added to the list after eight years of lobbying from Optometry Australia.”

Arundel confirmed the organisation is not actively advocating for a procedural item for dry eye to be added to the MBS. “Currently no modifications or additions to our MBS list are being considered until the results of the MBS review for our tranche are handed down. After numerous delays (exacerbated by COVID-19) this is now anticipated to be as late as 2022.” n

PBS Information: Xalatan (latanoprost 0.005% eye drops, 2.5 mL) is listed on the PBS as antiglaucoma preparations and miotics.

Before prescribing please review Product Information available via www.aspenpharma.com.au/products or call 1300 659 646.

A first choice for glaucoma management1

✔

If clinically necessary for the treatment of your patient, prescribe by brand and disallow brand substitution2

Minimum Product Information: XALATAN® (Latanoprost 50 μg/mL) Eye Drops. Indication: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension.

Contraindications: Hypersensitivity to ingredients. Precautions: Change in eye colour due to increased iris pigmentation, heterochromia; eyelid skin darkening; eyelash and vellus hair changes; aphakia; pseudophakia; macular oedema; other types of glaucoma; contact lenses; severe or brittle asthma; herpetic keratitis; driving or using machines; elderly; children; lactation. Pregnancy: Category (B3) Interactions: other prostaglandins, thiomersal. See PI for details. Adverse Effects: Iris hyperpigmentation; eye irritation (burning, grittiness, itching, stinging and foreign body sensation); eyelash and vellus hair changes (increased length, thickness, pigmentation and number of eyelashes); mild to moderate ocular hyperaemia; punctate keratitis; punctate epithelial erosions; blepharitis; eye pain; excessive tearing; conjunctivitis; blurred vision; eyelid oedema, localised skin reaction on eyelids; myalgia, arthralgia; dizziness; headache; skin rash; eczema; bronchitis; upper respiratory tract infection; abnormal liver function. Uncommon: Iritis, uveitis; keratitis; macular oedema; photophobia; chest pain; asthma; dyspnoea.

Rare: periorbital and lid changes resulting in deepening of the eyelid sulcus; corneal calcification. See PI for details and other AEs. Dosage and Administration: One eye drop in the affected eye(s) once daily. Other eye drops should be administered at least 5 minutes apart. (Based on PI dated 2 March 2021) References: 1. NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma 2010 2. Australian Commission on Safety and Quality in Healthcare Active Ingredient Prescribing Guide - list of medicines for brand consideration December 2020 Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma. com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2021 Aspen group of companies or its licensor.

All rights reserved. Prepared: June 2021 AF05768 ASP2528

INSIGHT

Dry Eye Directory

Welcome to the inaugural Insight Dry Eye Directory, an all-in-one resource featuring clinics offering dry eye services across Australia, as well as a list of therapies and diagnostics from the country’s leading suppliers.

Banner 470x70.pdf

1

Disclaimer: The Insight Dry Eye Directory is compiled of opt-in participants. Information has been provided by clinics and suppliers themselves. If you missed out or need to update your details for next year’s directory, email myles.hume@primecreative.com.au 31/8/21 6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY NEW SOUTH WALES / ACT 1001 OPTICAL EASTGARDENS Shop 245 Westfield Pagewood, Pagewood, NSW 2022 Frank Zhang P (02) 9314 3331 W 1001optical.com.au Lubricants, meibomian gland management, co-management with ophthalmology.

ATKINS OPTOMETRIST EP GORDON 12 St Johns Ave, Gordon, NSW 2072 Sally Atkins P (02) 9498 8383

CARINA EYE CARE 40 Neich Pde, Burwood, NSW 2134 Carina Trinh P 0423 590 959 W carinaeyecare.com.au

DR OLIVER WOO OPTOMETRIST

Entry level dry eye treatment with products that range from quality lubricants, tea-tree oil based lid wipes, preservative-free hypochlorous acid eyelid cleanser (Avenova), Optimel Manuka honey gel, premium thermal eye masks, eye gel and ointment, 7eye and Ziena moisture chamber glasses and sunglasses with silicone/ foam shield, in-office lid debridement and lid expression, bulk-packs of preservative-free lubricant Hylo-Forte.

1/201-203 Rowe St, Eastwood, NSW 2122

W atkinsoptometrist.com.au We offer a range of dry eye products including preservative-free lubricants and Omega 3 supplements. We also offer in house Blephex treatments and take home lid therapy including heat masks and lid wipes and foam and Optimel drops for the treatment of blepharitis.

BONDI EYE DOCTORS Suite 2002, Level 20, Westfield Tower 1, 520 Oxford St Bondi Junction, NSW 2022 Prof Stephanie Watson P (02) 9389 0666 W bondieyedoctors.com.au Comprehensive dry eye treatments and clinical research into dry eye.

manage and treat advanced dry eye. We use the latest clinical evidence including accurate diagnosis and monitoring using a range of eye drops, as well as eyelid hygiene, steam treatments and gland expression.

CHATSWOOD OPTICAL SERVICE 2 Lindel Pl, Lindfield, NSW 2070 H. G. Roberts P 0414 941 661 W henrob22@tpg.com.au Eye drops for patients.

CONCORD EYE CARE 161 Concord Rd, North Strathfield, NSW 2137 Jenny Livanos

Dr Oliver Woo P 0412 388 166 W N/A IPL, Blephsteam, Blephex, Medmont and K5.

EASTERN SUBURBS EYE SPECIALISTS Suite 901/3 Waverley St, Bondi Junction, NSW 2022 Dr Matthew Wells P (02) 9389 4840 W eseyespecialists.com.au The latest technology in diagnostic equipment and treatments for dry eye disease including TearLab osmolarity, tear function testing, Lipiscan, punctal plugs, anti-inflammatory treatment, Blephex and Lipiflow.

EXPERT EYECARE

P (02) 8765 9600

Shop 3, 11 Mashman Ave, Kingsgrove, NSW 2208

W concordeyecare.com.au

Elias Harb

Comprehensive dry eye assessment, treatment (including IPL) and range of dry eye products available.

P (02) 8014 8933

CAPITAL EYE Suite 3B 3 Sydney Ave, Barton, ACT 2600

CUSTOM EYECARE

Dr Jack Guan

158 Darby St, Newcastle, NSW 2300

P (02) 6273 7458

Wes Butler

W capitaleye.com.au

P (02) 4927 0500

E-Light IPL, Blephasteam, MGD expression, BlephEx, punctal plugs, therapeutic eye drops.

W customeyecare.com.au

W eyecareplus.com.au/kingsgrove Dry eye disease diagnosis (Ocular Surface Analyser), phenol red thread testing, TBUT, NIBUT, meibography, Blephadex, hypochlorous acid, Optimel, Blephasteam, IPL.

EYECARE PLUS BATEAU BAY Shop 20 Bateau Bay Sq, Bateau Bay, NSW 2261

A range of services to thoroughly diagnose,

... not a dry eye in sight

CLINICS Adam Li

W Eyecareplus.com.au/toronto

P (02) 4332 0032

Advice and therapeutic prescriptions for dry eyes. Tear film analysis and meibomian gland assessment, plus IPL treatment, meibomian cleansing and expression.

W rolfeoptometrists.com.au We run a full dry eye clinic including an IPL machine. Please phone us to arrange a dry eye assessment appointment.

EYECARE PLUS FORSTER

ICON EYEWEAR 28/2A Cross St, Hurstville, NSW 2220 Michael Mihailidis/Maria Dimitratos P (02) 9580 5766

EYECARE PLUS MERRYLANDS

1/12 Wharf St, Forster, NSW 2428

W iconeyewear.com.au

3 Memorial Ave, Merrylands, NSW 2160

Cana Xu

Thu & Thao Le

P (02) 6554 7817

P (02) 2963 75047

W rolfeoptometrists.com.au

W eyecareplus.com.au/merrylands

A complete dry eye clinic including an IPL machine. Please call us to arrange a dry eye assessment appointment.

Assess and diagnose dry eye as an extension of a comprehensive eye examination. We use the Oculus Keratograph as part of this assessment. Treatment options include Lipiflow, Rexon-eye and Lumenis.

Diagnostic equipment with K5M. Treatments available: therapeutic, Blephasteam, IPL.

EYECARE PLUS TAREE

EYERYS I CARE

181 Victoria St, Taree, NSW 2430

Shop 16 Westside Plaza, Broken Hill, NSW 2880

Peter McKay P (02) 6552 5044 W eyecareplus.com.au/taree Non-invasive tear assessment, meibography, IPL, meibomian gland expression, nutrition advice, lifestyle advice.

EYECARE PLUS THE JUNCTION 198 Union St, The Junction, NSW 2291

P (08) 8087 8099

Comprehensive ocular surface assessments using keratography and tear osmolarity. Time is spent on patient education and practical demonstrations. In-room treatments include eyelid margin debridement, warm compresses, lid massage, lid hygiene and meibomian gland expression.

W eyerysicare.com.au MGD expression, punctal plugs, manuka honey (Optimel), tear duct irrigation, omega-3 products, dry eye forte, Lacritec, fish oil supplements. In-office eyelid treatments, Blephadex foam, Blephadex wipes, topography. Therapeutic oral and topical medications.

EYES IN DESIGN

W rolfeoptometrists.com.au

832 Military Rd, Mosman, NSW 2088

We have a complete dry eye clinic including an IPL machine. Please call us to arrange a dry eye assessment appointment.

Gary Rodney

Nasen Udayan P (02) 4959 9222 Banner 470x70.pdf

1

31/8/21

P (02) 9635 7077 W marsdeneye.com.au

P (02) 4969 5458

Suites 3-5, 108 The Boulevarde, Toronto, NSW 2283

Lara Greig (orthoptist)

Siri Tang

Daniel Cao

EYECARE PLUS TORONTO

MARSDEN EYE SPECIALISTS 152 Marsden St, Parramatta, NSW 2150

P (02) 9969 1600 W smartvisionoptometry.com.au Tear film analysis. Corneal health analysis.

Meibomium gland analysis. All forms of dry eye testing and diagnosis and treatment.

Blephasteam and meibomian gland expression. micorexfoliation of eye lid margins. All forms of blepharitis treatment.

MENAI EYE CARE 8/62-70 Allison Cres, Menai, NSW 2234 Dianne Andrews P (02) 9543 1166 W menaieyecare.com.au Practice has therapeutically endorsed optometrist with access to a BlephEx pen, and an IPL machine for more severe dry eye, especially associated with ocular rosacea. Don’t have meibomian gland imaging yet, but are purchasing a Medmont corneal topographer for tearfilm and meibomian gland visualisation.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

NOVATEARS

®

PBS Listed

3 GAE M O ABLE L I A * AV NOW

*Please note: NovaTears® + Omega-3 is not PBS listed

NovaTears® is a unique preservative-free eye lubricant, which acts as a lipid layer substitute and evaporative barrier for improved tear film stability and quality.

Clinically validated with significant improvement in signs and symptoms with Evaporative Dry Eye Disease and Meibomian Gland Dysfunction patients1,2

For Evaporative Dry Eye & Meibomian Gland Dysfunction

Innovative water-free mode of action Lipid layer deficiency

Apply NovaTears®

Spreads quickly and easily on the lipid layer

STREAMLINED AUTHORITY CODE 6172 – NovaTears® only PBS Information: Authority Required (STREAMLINED): Severe dry eye syndrome in patients who are sensitive to preservatives in multi-dose eye drops.

References: 1. Steven, Philipp, et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease – A Prospective, Multicenter Noninterventional Study.” Journal of Ocular Pharmacology and Therapeutics 31 (8), 498-503 (2015). 2. Steven, Philipp, et al. “Semifluorinated Alkane Eye Drops for Treatment of Dry Eye Disease Due to Meibomian Gland Disease.” Journal of Ocular Pharmacology and Therapeutics. 33(9), 678-685 (2017). Sponsored by Novaliq GmbH. NovaTears ® Eye Drops (Perfluorohexyloctane 100% v/v, 3mL) are for the lubrication and relief of dry and irritated eyes. Do not use NovaTears ® with contact lenses. If using any other eye medication, allow at least 15 minutes between using the other product and applying NovaTears ®. NovaTears ® should not be used in children under 18 years. NovaTears ® should not be used while pregnant or breastfeeding. AFT Pharmaceuticals Pty Ltd, Sydney. ABN 29105636413.

For more information:

1800 2387 4276

www.aftpharm.com

mydryeyes.com.au

CLINICS MOSMAN EYE CENTRE

Dr. Nick Papadopoulos

W rjkoptometry.com.au

1A Effingham St, Mosman, NSW 2088

P (02) 9891 2020

Comprehensive dry eye clinic including IPL and advanced diagnostic techniques.

Dr Tanya Trinh

Dry eye assessment; patient counselling; inhouse and at-home treatment.

W optometristparramatta.com.au

P (02) 9969 1333

TANILBA BAY OPTOMETRIST

W mosmaneye.com.au Intense Pulsed Light (IPL): Therapy for dry eye patients, particularly those who suffer from symptoms mainly due to the meibomian gland dysfunction.

MT CORONEO PTY LTD 2 St Pauls St, Randwick, NSW 2031 Prof Minas Coroneo P (02) 9399 9211

PAUL HARVEY OPTOMETRY Shop 20 Shoppingworld, Tamworth, NSW 2340

5/77 President Wilson Walk, Tanilba Bay, NSW 2319 Neil Kearns

Paul Harvey

P 0421 027 186

P (02) 6765 2912

W tanilbabayoptometrist.com.au

W harveyoptometry.com.au

Comprehensive assessment of dry eye dysfunction including meibomian gland photography. Various low cost in-office and at home treatment options including Blephex and gland expression.

Comprehensive dry eye treatment including meibography, therapeutic care, BlephEx debridement and IPL.

W N/A Comprehensive dry eye assessment and management.

PETER D'ARCY OPTOMETRIST PO BOX 115, Bega, NSW 2550 Peter D'Arcy

NEXUS EYE CARE

P 0419 248 731

130D Main St, Blacktown, NSW 2148

W peterdarcy.com.au

Dr Chameen Samarawickrama

Evaluation and treatment using OCULUS Keratograph 5M,blephex,manuka honey, blephasteam, MG.

P (02) 9672 3055 W nexuseyecare.com.au

R AND B'S OPTOMETRIST

OPTICS

B. H. Kurtz

Mi Ja (“Midge”) Choi W Optics25@bigpond.net.au Keratograph; Blepharosteam; BlephEx; meibomian gland expression.

OPTOMETRIST PARRAMATTA Shop 9A, 103 George St, Parramatta, NSW 2150 Banner 470x70.pdf

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Banora Shopping Village, Banora Point, NSW 2486 P 0418 432 834

Emma Furniss (optometrist), A/Prof Chandra Bala (ophthalmologist), Dr Freny Kalapesi (ophthalmologist), Anna Siu (optometrist) P (02) 8319 0555 A comprehensive assessment and treatment clinic, offering the most advanced and innovative treatment modalities for all types of dry eyes including PRGF drops, Lipiflow, IPL and several options tailored to a patient's individual needs.

W tweedcityoptometrist.com Dry eye assessment and individual treatment program implemented.

P (02) 9477 5216

Level 2, 33 York St, Sydney, NSW 2000

W dryeyeinstitute.com.au

Comprehensive and specialised dry eye management from drops through to more complex treatments.

1, 14 Hunter St, Hornsby, NSW 2077

THE DRY EYE INSTITUTE

RJK OPTOMETRY

THE EYE PRACTICE 50 York St, Level 3, Sydney, NSW 2000 Dr Jim Kokkinakis P (02) 9290 1899

14 Arthur St, Coffs Harbour, NSW 2450

W theeyepractice.com.au/dry-eyes

Michael Jones

All diagnostic and therapeutic options currently available in Australia. Includes LipiView, Oculus

P (02) 6651 1139

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

Keratograph, TearView, LipiFlow, IPL, RexonEye, MG debridement and expression are just a few.

Dr Nikhil L Kumar FRANZCO P (02) 9222 9188 W visionclinicsydney.com.au

THE SPECTACLE PLACE 34 Railway Pde, Burwood, NSW 2134 Michael Warnock P (02) 9745 4497 W thespectacleplace.com.au We provide a bulk billed diagnostic consultation where the Schirmer tear test is performed. The test will indicate whether treatment from the E-Eye IRPL will be beneficial.

Comprehensive cornea subspecialist evaluation and management of dry eye syndrome, including the use of new and emerging therapeutic technologies.

3/241 Oxford St, Bondi Junction, NSW 2022 Daniel Tracton P (02) 9188 9288

WESTMEAD EYES OPTOMETRISTS T204A Westmead Hospital, Westmead, NSW 2145 Dr Kevin Trac P (02) 9635 8464 Artificial eye drops and ointments, manuka honey, hot compresses, lid scrubs, hypochlorous acid, meibomian gland expression and blephasteam, topical steroids and oral antibiotics, vitamin supplements, dietary changes, punctal plugs.

W tractonoptometrists.com.au Therapeutically-endorsed optometrist trained at UNSW. Offering the full range of dry eye treatments from over-the-counter treatments to PBS prescribed ophthalmic preparations and PBS prescriptions.

UNSW DRY EYE CLINIC Gate 14, Barker St, UNSW, NSW 2052 Kathleen Watt P (02) 9385 4624 W optometry.unsw.edu.au/ optometry-clinic/dry-eye-clinic A referral centre for the diagnosis, imaging and evidence-based management of dry eye disease. We require a referral from your eyecare practitioner or from within our own clinic.

VISION CLINIC SYDNEY Suite 605, Level 6, 229 Macquarie St, Sydney, NSW 2000

20/20 SIGHT'N'STYLE 161 Main St, Mornington, VIC 3931 George Sahely P (03) 5973 5520 W sightandstyle.com.au

W westmeadeyes.com.au

TRACTON OPTOMETRISTS

VICTORIA

Offering comprehensive dry eye testing (Oculus K5, Korb MGE, osmolarity, meibomography) and an extensive range of treatments, including Lipiflow, IPL, Blephex and therapeutics.

DIAMOND VALLEY OPTICAL Shop 15/72 Main Hurstbridge Rd, Diamond Creek, VIC 3089 Asela Senanayake P (03) 9438 3286 W diamondvalleyoptical.com.au We provide many suitable eye drops, ointments, Blephasteam, Blephex, heat masks and full IPL.

WISE EYES OPTICAL 2-4 Kenny St, Wollongong, NSW 2500

DRY EYE CENTRE

Andrew Reveley P (02) 4227 3330

142 Canterbury Rd, Heathmont, VIC 3135

W wiseeyes.com.au

Dr Nicholas Young

Dry eye assessment of MGD using antares in dedicated treatment room. We also offer Blephasteam, Blephadex and IRPL.

P (03) 9729 4077

WOONONA EYECARE 391 Princess Highway Woonona, NSW 2517 Ashleigh Peters P (02) 4284 1344 W woononaeyecare.com.au Bulk billed dry eye assessment using slit lam camera and meibography, Lumenis IPL with meibomian gland expressions, in office BlephEx treatment, in office products such as Blephadex foam, Lacritec/dry eye forte supplements.

W dryeyecentre.com.au Diagnostics: including infra-red tear metrics and osmolarity. Treatments: Intense Pulsed Light (Lumenis M22), Lipiflow, amniotic membranes, autologous serum, compounded eyedrops, lid hygiene/tear supplements, co-management for systemic diseases.

DRY EYE SPECIALISTS 467 Toorak Rd, Toorak, VIC 3142 Lucille Gergis P (03) 9826 0740 W dryeyespecialists.com.au

... not a dry eye in sight

CLINICS Comprehensive dry eye assessment using K5, Blephex treatment, Lumenis IPL, autologous serum and all dry eye drops ointment and wipes.

DRY EYE VICTORIA Level 1, 242 Hoppers Lane, Werribee, VIC 3030

P (03) 9819 7695 W eyecareconcepts.com.au Comprehensive dry eye assessment with the Oculus Keratograph 5 and Medmont Meridia, in-room dry eye treatments including IPL, and scleral lenses for severe dry eye patients.

Ophthalmologist

EYECARE PLUS BUNDOORA

P 1300 150 806

Shop 5 University Hill Town Centre, Bundoora, VIC 3083

W australianeyespecialists.com An initial full ophthalmic consultation; Oculus Keratograph to assess tear film, lid margin and ocular surface. Investigation of relevant muscle and nerve function. Therapy options: moist heat therapies, lid wash formulations and suitable topical lubricants; direct meibomian gland expression, low level light therapy and intense pulse light therapy.

Shop 2/2-20 Koornang Rd, Carnegie, VIC 3163 Khang Ta

Intense Pulse Laser (IPL) for severe dry eye.

Blephasteam, an in-store spa treatment.

Range of home remedies for mild-moderate cases and ongoing maintenance.

512 Plenty Rd, Mill Park, VIC 3082 Giorgio Campanella

37 Church St, Brighton, VIC 3186 Vicky Chang P (03) 9592 4800 W eyesonbrighton.com.au or www.dryeyegroup.com.au Full scope dry eye service, including diagnostic imaging, ocular surface disease management/ maintenance. Advanced dry eye treatments on offer include: specialty CL options for dry eyes, meibomium gland expression, Optima IPL and Lipiflow.

GRAHAM HILL EYECARE 98 Maude St, Shepparton, VIC 3630 Mark DePaola P (03) 5821 2811 W hilleyecare.com K5 mebography and dry eye assessment, IPL, blephasteam, over the counter drops, tablets and heat packs, prescription eye drops.

W eyecareplus.com.au

W evergreenoptical.com.au Comprehensive dry eye and ocular surface assessment. A range of in-practice treatments.

EYE DESIGN 538 Malvern Rd, Prahran, VIC 3181 Beverley Sacho P (03) 9533 2000

Comprehensive assessment including meibography. Treatment options discussed including numerous eye drops, eye ointments, oral supplements and treatments including heat, intense pulse light and meibomian gland expression.

IN2EYES

EYECARE PLUS MULGRAVE

Full scope dry eye service, including diagnostic imaging, ocular surface disease management/ maintenance. Advanced dry eye treatments on offer include: specialty contact lens options for dry eyes, Rexon Eye, Optima IPL and Lipiflow.

431 Police Rd, Mulgrave, VIC 3170

W eye-design.com.au Blephasteam treatment with meibomian gland expression. Eye drops, lid care products, nutritional supplements, heat packs.

Glenn Vessey P 0414 747 171

EYECARE CONCEPTS

Dr Philip Cheng 6:07 pm

511 Whitehorse Rd, Surrey Hills, VIC 3127 Jason Teh P (03) 9836 6883 W www.in2eyes.com.au or www.dryeyegroup. com.au

W eyecareplus.com.au/mulgrave Full dry eye assessment and treatments. Including Antares dry eye and meibomian gland assessments as well as eEye IPL, Blephasteam and Blephadex treatments.

Suite 14, 828 High St, Kew East, VIC 3102 31/8/21

W eyecareplus.com.au/bundoora

P (03) 9436 9644

P 0403 575 625

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P (03) 9467 7580

EYECARE PLUS MILL PARK

EVERGREEN OPTICAL

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Prerna Bhatia and Jean Walters

EYES ON BRIGHTON

KIDDIES EYE CARE 1/167 Hyde St, Yarraville, VIC 3013 Nicky Kiparissis P (03) 9448 8933 W kiddieseyecare.com.au

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

SEE THE DIFFERENCE A POSITIVE EMULSION CAN MAKE TO DRY EYES

NEW Cationorm®

more than relief.

NOW PBS LISTED

+ REPAIRS

+ RESTORES

+ HEALS

the lipid layer to reduce evaporation, lubricate and stabilise the tear film1,2

the balance of moisture in the muco-aqueous layer of the tear film1,2

the ocular surface, providing long-lasting protection1-3

PBS Information: Authority required (STREAMLINED). Refer to PBS Schedule for full authority information.

ALWAYS READ THE LABEL AND INSTRUCTIONS FOR USE. IF SYMPTOMS PERSIST, TALK TO YOUR HEALTH PROFESSIONAL. 1. Lallemand F et al. J Drug Deliv 2012:604204. 2. Daull P, et al. J Pharm Pharmacol 2014;66(4):531–41.

3. Robert P et al. Eur J Ophthalmol 2016;26(6):546–55.

Seqirus (Australia) Pty Ltd Melbourne, Victoria | Ph: 1800 642 865.

Seqirus is a trademark of Seqirus UK Limited or its affiliates. Cationorm is a registered trademark of Santen S.A.S. and distributed by Seqirus (Australia) Pty Ltd under license from Santen Pharmaceutical Asia Pte Ltd. Date of Preparation: July 2021. ANZ-Cati-21-0021.

CLINICS With the recent purchase of the Myah machine we can look at the tear later, measure tear film meniscus and measure meibomian gland loss. Offering Blephasteam, Bruder masks and dry eye advice.

OTWAY OPTICAL 143 Murray St, Colac, VIC 3250 Leigh Plowman P (03) 5231 4075

KOSMAC & CLEMENS OPTOMETRISTS

W otwayoptical.com.au

Shop 48C Strath Village Shopping Centre, 134 Condon St, Bendigo, VIC 3550 Ian Clemens

We take a holistic approach to dry eye treatment. We also offer Blephasteam and IPL.

PORTLAND EYECARE

P (03) 5441 8841

including meibography, Optimel Manuka drops, Silicon sleep shields, I-Lid'N Lash plus wipes, Blephadex wipes, Lactritec oral supplements.

64A Percy St, Portland, VIC 3305

THE OPTOMETRIST TOORONGA Shop 04, Tooronga Village, 766 Toorak Rd, Glen Iris VIC 3146 Teresa Antonios P (03) 8560 0560 W theoptometristtooronga.com.au

Diagnosis, Blephasteam expression, lacrimal lavage.

Full scope dry eye service, including diagnostic imaging, ocular surface disease management/maintenance. Advanced dry eye treatments on offer include: specialty contact lens options for dry eyes, meibomium gland expression, Optima IPL and Lipiflow.

200 Berkeley St, Ground Floor, Carlton, VIC 3053

RASHELLE COHEN OPTOMETRY

WARRNAMBOOL EYECARE

Dr Andrew Huhtanen (Clinic Director)

263 Glen Eira Rd, Caulfield North, VIC 3161

152 Liebig St, Warrnambool, VIC 3280

P (03) 9035 6666

Rashelle Cohen

Matthew Buckis

W healthsciences.unimelb.edu.au/eyecareclinic/home

P 0421 281 910

P (03) 5562 2244

W cfmp.com.au/rashelle-cohen-optometry

Comprehensive services for the assessment and treatment of dry eye disease and MGD, including tear film analysis (LipiView), punctal plugs, eyelid hygiene, and in-office meibomian gland expression (LipiFlow).

Oculus Keratograph dry eye assesment, Blephasteam and MG expression, Nulid treatment, range of lubricants, Optimel ointment.

W portlandandwarrnambooleyecare. com.au

W kosmacandclemens.com.au Comprehensive assessment. Oculus K5, Schirmer testing, punctal plugs, IPL treatment, anterior eye photography.

MELBOURNE EYECARE CLINIC

MYOPIA CONTROL ORTHO-K CENTRE Suite 12, 456 St Kilda Rd, Melbourne, VIC 3004

Matthew Buckis P (03) 5523 1189 W portlandandwarrnambooleyecare.com.au

SANCTUARY LAKES EYECARE Shop 18, Sanctuary Lakes Shopping Centre, Point Cook, VIC 3030 Jenkin Yau

Jimmy Huang

P (03) 9395 7530

P (03) 7036 6788

W eyecarepoint.com.au

W myopiacontrolcentre.com.au

Lumenis M22 Optima IPL, Blephex lid treatment, meibomian gland expression, tear osmolarity testing, ocular keratograph dye eye Jenvis assessment

Diagnosis of dry eye, in house treatment with Nulid, meibomian lid expression lid.

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Comprehensive diagnosis with K5, Blephasteam expression, lacrimal lavage.

WODONGA EYECARE 203 Beechworth Rd, Wodonga, VIC 3690 Kelly Gibbons P (02) 6056 4000 W wodongaeyecare.com.au Digital dry eye analysis using IDRA OSA. Lid margin debridement. BlephEx, digital heat therapy and meibomian gland expression.

Punctal plugs. Lacrimal lavage. IPL Therapy using Lumenis M22.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DON’T LET DRY EYES HOLD YOU BACK STAY FOCUSED with the Systane ® family of products

NEW

2 DROPS, 1 FOCUSED YOU 1

ALWAYS READ THE LABEL. FOLLOW THE DIRECTIONS FOR USE. IF SYMPTOMS PERSIST, TALK TO YOUR HEALTH PROFESSIONAL. ©2021 Alcon. AUS: 1800 224 153. AU-SYC-2100001

CLINICS QUEENSLAND

where this restricts or prevents the use of contact lenses.

A+ EYECARE 30 Boyanda St, Wishart, QLD 4122 Optometrist P 0403 354 212 W eyecareplus.com.au/inala Blephasteam, E Eye Laser, supplements and eye drops.

APHRODITE LIVANES OPTOMETRISTS 71 Cambridge Dr Alexandra Hills Shopping Centre, Alexandra Hills, QLD 4161 Optometrists P (07) 3824 1878 W livanes.com.au Dry eye assessment, IPL treatments, Blephasteam treatments, debriding eyelids with BlephEx, dry eye solutions – eye drops, Eyeseal goggles.

CAIRNS EYE SURGERY 77 Woodward St, Edge Hill, QLD 4870 Dr Brian Todd P (07) 4081 3000 W cairnseyesurgery.com.au For assessment, education and treatment with IPL, Blephasteam.

DAVID STEPHENSEN OPTOMETRIST 197 Beaudesert Rd, Moorooka, QLD 4105 David Stephensen P (07) 3848 8979 W dsoptom.com.au We provide well established experience in the therapeutic care of dry eye, particularly Banner 470x70.pdf

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treatments, such as the Rexon-Eye and IPL dry eye treatment.

ENVISION OPTICAL

EYECARE PLUS WILSONTON

19/7 Classic Way, Burleigh Waters, QLD 4220

407 Bridge St, Toowoomba, QLD 4350

Andrew Bowden

Justin Durkin

P (07) 5593 7844

P (07) 4633 0274

W envisionoptical.com.au

W eyecareplustoowoomba.com.au

Digital diagnosis including interferometry and meibography imaging. In-office treatment with IPL and Lipiflow.

Dry eye workshop with an Antares to provide degree of dry eye and IPL and Blephasteam treatments.

EYEBIZ OPTOMETRY CARRARA

EYEMAN.COM.AU

Shop 5 54 Manchester Rd, Carrara, QLD 4211

Shop 1, 3 Byres St, Newstead, QLD 4006

Brett Partridge

Optometrist

P (07) 5573 7630

P (07) 3216 1926 or 0408 069 075

W eyebiz.net.au

W eyeman.com.au

Full range of diagnostic procedures and treatment options.

Full scope dry eye management for persons of all ages.

EYECARE EYEWEAR

H2 VISION CENTRES

Shop 21 17-67 Cunningham St, Dalby QLD 4405

7/11-19 Chancellor Village Boulevard, Sippy Downs, QLD 4556

Tom Roger

Dr Eloise Thomas

P (07) 4669 7072

P (07) 5353 5080

W ecew.com.au

W h2visioncentres.com.au

Blephasteam, debridement, MG expression, lacrimal probing and lavage, plugs, schirmer and phenol red cotton thread, Optimel. In office treatments.

Tear film analysis, treatments inclusive of heat related compressions and expressions of the mybomian glands. Lid scrubs and Intense Pulse Light (IPL) treatments.

EYECARE PLUS MERMAID BEACH

HARRYS OPTOMETRIST

Shop 3A, 2431 Gold Coast Highway, Mermaid Beach, QLD 4218

132 Beaudesert Rd, Moorooka, QLD 4105

Jackson Yip

Harry Melides

P (07) 5526 1400

P (07) 3848 6673

W eyecareplusmermaidbeach.com.au

W harrysoptometrist.com.au

We offer leading dry eye solutions and

General dry and red eye services.

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

HERON EYECARE

MYRIAM GOLDMAN OPTOMETRIST

SIGHT SPECIALISTS

147 Russell St, Toowoomba, QLD, 4350

Level 2, 95 Nerang St, Southport, QLD 4215

Hugh Bradshaw

1/970 Logan Rd, Holland Park, QLD 4103

P (07) 4639 2378

Myriam Goldman

P (07) 5647 5777

W heroneyecare.com.au

P (07) 3394 2412

W sightspecialists.com.au

Lumenis M22 IPL, Rexon Eye QMR, BlephEx, Blephasteam, puntal plugs, therapeutic contact lenses, scleral contact lenses.

W myriamgoldman.com

Comprehensive dry eye diagnostics, Blephex, Intense Pulsed Light, manual meibomian gland expression, and prescription pharmaceutical treatments.

ISIGHT SPECIALISTS TOWNSVILLE

Drops and advice.

OPTOMETRY@COOROY 62 Maple St, Cooroy, QLD, 4563

13-15 Martinez Ave, West End, QLD 4810

Jennifer Currie

Dr William Talbot

P (07) 5442 5555

P (07) 4775 1633

W optometryatcooroy.com.au

W isighttownsville.com.au

We will consider the symptoms and causes of dry eye syndrome to determine how the condition is treated. We may evaluate using video tear film quality testing with a corneal topographer, flurorescein and lissamine green staining and the schirmer test of tear production.

Osmolarity testing, E-Eye dry eye treatment.

JUDI COEY OPTOMETRY 1/13 Bunya St, Maleny, QLD, 4552 Judi Coey P (07) 5494 2877 W judicoeyoptometry

R AND B'S OPTOMETRIST

Extensive range of ocular lubricants including natural and preservative-free.

122 Pacific Pde, Bilinga QLD 4225

LOOKING SMART OPTOMETRISTS 2/44 Pelican Waters Blvd, Pelican Waters, QLD 4551

Dr Nick Andrew

SPECSAVERS RUNAWAY BAY Shop 74, 10-12 Lae Dr, Runaway Bay, QLD, 4216 Simon Kelly P 0434 939 293 W specsavers.com.au/book runawaybay Bulk-billing, qualified and caring therapeutically endorsed optometry services seven days a week, including biomicroscopy, OCT and corneal topography. Retail of related dry eye products and extensive range of comfortable contact lenses, including orthokeratology.

B. H. Kurtz P 0418 432 834

THE EYE HEALTH CENTRE

W tweedcityoptometrist.com

44 South Station Rd, Booval, QLD 4304

Dry eye assessment and individual treatment program implemented.

David O’Neill

Phuc Q. Ngo P (07) 7328 24396

P (07) 5439 7844 W LookingSmartOptometrists.com.au Full range of dry eye treatments, including Blephsteam, prescription (PBS) prescribing, dry eye workshops.

We can also advise on IPL and work in conjunction with a local eye specialist who specialises in dry eye.

ROSSER OPTOMETRY

W theeyehealthcentre.com.au

6 New St, Nerang, QLD 4211

Comprehensive diagnostic and management from mild to complex cases.

Can triage with ophthalmologist to improve ocular surfaces before and after cataracts/ refractive surgery. In-room treatments including KG5 scans, Blephsteam, IPL and serum tears.

Sophia Gerritsma P (07) 5578 4611 W rosseroptometry.com.au Eye ointment and drops, heat packs and lid massage, in-office lid meibomian gland expression, steroidal eye drops.

... not a dry eye in sight

CLINICS THE EYE HEALTH CENTRE

THE EYEWEAR SHOP

BAROSSA EYE CLINIC

Level 11, 87 Wickham Tce, Brisbane, QLD, 4000

15G, 25 Samuel St, Camp Hill, QLD 4152

23 High St Gawler, Adelaide, SA, 5118

Minh Nguyen

Dr Deric De Wit

Jason Holland

P (07) 3395 4105

P (08) 8250 6107

P (07) 3831 8606

W theeyewearshop.com.au

W barossaeyeclinic.com

W theeyehealthcentre.com.au

Comprehensive assessment including Schirmer tear volume testing, fluorescein tear assessment, and slit lamp biomicroscope tear and eyelid assessment of conditions like Sjogren's syndrome and blepharitis. Demodex treatments such as in-clinic tea tree oil and lid cleanse, Blephasteam and expression for blepharitis/ MGD. All optometrists therapeutically endorsed.

Comprehensive dry eye assessment, Lipiview meibography scanning and lipid layer analysis. Lipiflow, Blephex treatments.

Comprehensive dry eye diagnostic services including the Keratograph 5, Tear Lab and anterior eye imaging. Optima IPL, Rexon Eye, BlephEX, punctal plugs, serum tears and Blephasteam. Also offer high quality products for at-home management.

THE EYE HEALTH CENTRE (ASPLEY) 7/1344 Gympie Rd, Aspley, QLD 4034 Andy McCormack P (07) 3863 1097

VISION OPTICS 95 Vulture St, West End, QLD 4101 Andrew Angeli

W theeyehealthcentre.com.au Dry eye clinic with IPL and Blephasteam.

Full range of therapeutic options to treat and manage dry eye in conjunction with Dr John Hogden.

THE EYE HEALTH CENTRE (WYNNUM) 93 Clara St, Wynnum, QLD, 4178

P (07) 3844 1556 W visionoptics.com.au IPL, Blephex, prescription and over the counter eye drops, omega-3 tablets, eyes masks and gland extractions.

SOUTH AUSTRALIA

Lily Luong

ALLEVE EYE CLINIC

P (07) 3026 2600

49a Stephen Tce, St Peters, SA 5069

W theeyehealthcentre.com.au

Jennifer Rayner

After learning more about your dry eye symptoms and identifying the contributing factors, we can recommend one or more of: artificial tears and medicated eye drops, punctal plugs, Blephasteam, autologous serum tears, Intense Pulsed Light.

P (08) 7225 9798 W alleveeyeclinic.com.au Diagnosis and treatment of dry eye with a holistic approach using all evidencebased tools available including IPL, topical ciclosporin, punctal plugs and manuka honey to manage the condition.

EYES & VISION MUNNO PARA 20 Munno Para Shopping City, Munno Para, SA 5115 Naima Bammann P (08) 8284 1445 W eyesandvision.com.au Diagnosis of the type of dry eye, ocular lubricant and topical medications, lid scrubs, Blephasteam and meibomian gland expression.

Other locations: • Eyes & Vision Burnside, 431 Portrush Rd, Toorak Gardens, SA 5065 – (08) 8338 5311 • Eyes & Vision Colonnades, 75 Colonnades, Noarlunga, SA 5168 – (08) 8384 6211 • Eyes & Vision Goolwa, 7 Railway Tce, Goolwa, SA, 5214 – (08) 8555 2151 • Eyes & Vision Hallett Cove, 20 Hallett Cove Shopping Centre, Hallett Cove, SA 5158 – (08) 8387 7388 • Eyes & Vision Unley, 50 Unley Shopping Centre, Unley, SA, 5061 – (08) 8271 6020

GOGGLEMAN 5A Yachtsman St, Seaford, SA 5169 David Aulert P (08) 8298 1462 W goggleman.com.au

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6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

An extensive range of dry eye eyewear designed to minimise the symptoms of dry eye conditions.

DRY EYE WA

FOR EYES OPTOMETRIST 158 High St Fremantle, WA 6160

RIVERSIDE EYE CARE

Suite 18 Riseley Corporate Centre, 135 Riseley St, Booragoon WA 6154 Marilyn Stern

P (08) 9335 3433

P (08) 6468 5296

W foreyes.com.au

W dryeyewa.com.au

Comprehensive dry eye diagnosis including osmolarity measurements. Most patients suffering from dry eye have meibomian gland dysfunction. We use the advanced Lumenis M22 IPL system in the treatment of MGD.

Unit 8/84 Onkaparinga Valley Rd, Balhannah Shopping Centre, Blahannah SA 5242 Christopher Kawecki P (08) 8389 9176 W riverside-eye-care.com Pharmaceuticals, temporary nasolacrimal plugs, permanent plugs, Blephasteam, stain analysis.

WESTERN AUSTRALIA SPECIALEYES OPTICAL 43 Rokeby Rd, Subiaco, WA, 6008 Philip Hofan P (08) 9380 4577 W specialeyesoptical.info Full scope optometry inclusive of dry eye assessment and treatment. Therapeutic eye drops and endorsed for prescription drops when required. Intense Pulsed Light (IPL), particularly useful for acne rosacea suffers who typically undiagnosed prior to treatment.

Anterior surface and lid examination including meibography and tear film analysis, Blephex for blepharitis, Blephasteam, IPL, Rexon Eye, My Mask LED light for MGD and ocular rosacea, moisture chamber spectacles, cleansers, drops, heat packs.

E EYE PLACE Shop 9/6 Calypso Pde, North Coogee, WA 6163

TASMANIA TOTAL EYECARE 99 Macquarie St, Hobart, TAS 7000 Andrew Koch

Stephanie Yeo and Annie Hwong

P (03) 6234 5709

P (08) 6191 0344

W totaleyecare.com.au

W eeyeplace.com.au

Comprehensive assessment of dry eye and blepharitis, with a broad range of treatment options including nutrition, topical treatments and Rexon-eye medical treatment to improve both evaporative dry eye and tear film insufficiency.

Equipped to provide comprehensive dry eye assessment using the Oculus K5 Jenvis report and treatment options such as Blephasteam, and stock a wide range of specialty dry eyes products.

EYECARE PLUS GLEN FORREST

ANGELO STREET OPTICAL

U4 5 Hardey Rd, Glen Forrest, WA 6071

4/53 Angelo St, South Perth, WA 6151

Dr Kristin Larson

Wayne McCarthy

P (08) 8929 89992

P (08) 9474 4653

W eyecareplus.com.au/glenforrest

W angelostoptical.com.au

A full range of ocular surface care including evaluation, daily self-care information and products and in-office treatment including the Rexon-Eye, a durable, non-invasive treatment for all forms of dry eye.

Diagnosis and treatment of evaporative (meibomian gland dysfunction) and aqueous dry eye disease aided by objective keratograph testing.

Adrian Rossiter

MARTIN’S EYECARE 1/359 Main Rd Glenorchy, TAS 7010 Martin Robinson P (03) 6272 8423 W martinseyecare.com.au Keratograph diagnostics, Lumenis IPL, Blephasteam, Blephex, wide range of pharmaceuticals.

... not a dry eye in sight

Severe

Mild

NAME

Moderate

GRADE OF DRY EYE Company

EYE DROPS EYE DROPS

THERAPIES

Nova Tears 3ml

AFT Pharmaceuticals/Good Optical Services

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Nova Tears Omega-3 3ml

AFT Pharmaceuticals/Good Optical Services

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Hylo-Fresh

AFT Pharmaceuticals/Good Optical Services

Hylo Forte 10ml

AFT Pharmaceuticals/Good Optical Services

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VitaPos Ointment 5gm

AFT Pharmaceuticals/Good Optical Services

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Systane Hydration UD Lubricant Eye Drops (30 x 0.7mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Complete Lubricant Eye Drops (10mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Ultra Preservative-Free Lubricant Eye Drops (10mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Ultra UD Lubricant Eye Drops (25 x 0.5mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Balance Lubricant Eye Drops (10mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Gel Lubricant Eye Drops (10mL)

Alcon Laboratories (Australia) Pty Ltd

Systane Original Lubricant Eye Drops (15mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Original UD Lubricant Eye Drops (28 x 0.8mL)

Alcon Laboratories (Australia) Pty Ltd

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Systane Eye Wash Rinse Solution (120mL)

Alcon Laboratories (Australia) Pty Ltd

Systane Lid Wipes Cleansing Wipes (30 pack)

Alcon Laboratories (Australia) Pty Ltd

Bion Tears UD (28 x 0.4mL)

Alcon Laboratories (Australia) Pty Ltd

Genteal Lubricant Eye Gel 0.3% (10g)

Alcon Laboratories (Australia) Pty Ltd

Genteal Lubricant Eye Drops 0.3% (10mL)

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Alcon Laboratories (Australia) Pty Ltd

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In a Wink Eye Drops 0.3% (10mL)

Alcon Laboratories (Australia) Pty Ltd

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Poly Gel UD Lubricant Eye Gel (30 x 0.5g)

Alcon Laboratories (Australia) Pty Ltd

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Poly Visc (3.5g)

Alcon Laboratories (Australia) Pty Ltd

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Poly Visc Twin Pack (2 x 3.5g)

Alcon Laboratories (Australia) Pty Ltd

Polytears (15mL)

Alcon Laboratories (Australia) Pty Ltd

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Tears Naturale Artificial Tears (15mL)

Alcon Laboratories (Australia) Pty Ltd

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HPMC PAA Gel (10g)

Alcon Laboratories (Australia) Pty Ltd

REFRESH

Allergan

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REFRESH PLUS

Allergan

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REFRESH TEARS PLUS

Allergan

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REFRESH CONTACTS

Allergan

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REFRESH LIQUIGEL

Allergan

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REFRESH NIGHT TIME

Allergan

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OPTIVE FUSION Lubricant Eye Drops

Allergan

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OPTIVE FUSION Preservative-Free Lubricant Eye Drops

Allergan

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OPTIVE Lubricant Eye Drops

Allergan

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OPTIVE ADVANCED Lubricant Eye Drops

Allergan

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OPTIVE ADVANCED Preservative-Free Lubricant Eye Drops

Allergan

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OPTIVE Sensitive Eye Drops

Allergan

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OPTIVE GEL DROPS Lubricant Eye Drops

Allergan

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CELLUFRESH Eye Drops

Allergan

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CELLUVISC Eye Drops

Allergan

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LIQUIFILM TEARS Eye Drops

Allergan

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Allergan

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Banner 470x70.pdf 1 Eye 31/8/21 PVA TEARS Drops

6:07 pm

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

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DRY EYE DIRECTORY

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Email

PBS-listed

Over the counter

Prescription

Contact lens friendly

Preservativefree

PARTICULARS

Eye lid

Antiinflammatory

Evaporative/ Meibomian gland dysfunction

Tear insufficiency/ Aqeuous deficiency

TREATMENT TYPE

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orders@goodoptical services.com.au orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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visioncareorders.anz@Alcon.com

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visioncareorders.anz@Alcon.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

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australiaenquiries@allergan.com

... not a dry eye in sight

THERAPIES

DEVICE/ EQUIPMENT

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Designs For Vision/Melcare

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Designs For Vision/Melcare

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Designs For Vision/Avenova

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Fluorescein strips

Device Technologies/Clement Clarke

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Allergan (including Optive Range)

Good Optical Services/Allergan

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Alcon (including Systane Range)

Good Optical Services/Alcon

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Johnson & Johnson (including Blink range)

Good Optical Services/Johnson & Johnson

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Tears Again (Liposomal Eye Spray)

Good Optical Services/Bio Revive

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BLINK CONTACTS EYE DROPS 10ML

Johnson & Johnson Vision (AMO)

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BLINK INTENSIVE TEARS PLUS GEL EYE DROPS 10ML

Johnson & Johnson Vision (AMO)

BLINK INTENSIVE TEARS PROTECTIVE EYE DROPS 0.4MLX20

Johnson & Johnson Vision (AMO)

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BLINK INTENSIVE TEARS PROTECTIVE EYE DROS, 15ML

Johnson & Johnson Vision (AMO)

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BLINK N CLEAN LENS DROPS 15ML

Johnson & Johnson Vision (AMO)

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Optimel Manuka+ Dry Eye drops

Jubelee Eyecare Supplies

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Optimel Manuka+ Forte Eye Gel

Jubelee Eyecare Supplies

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Optimel Manuka+ Eyelid Cream

Jubelee Eyecare Supplies

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Xiidra (lifitegrast)

Novartis Pharmaceuticals Australia Pty Limited

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Xalin Fresh single dose eye drop

OptiMed

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Xalin Hydrate eye drop

OptiMed

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Xalin Eye Gel

OptiMed

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Xalin Night Gel

OptiMed

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Bruder Hygenic Eyelid solution SPRAY (HA 0.02%) Glass bottle (NICNAS registered)

OptiMed

BlephaDex Foam (NICNAS registered)

OptiMed

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Cationorm Multi Dose 10mL

Seqirus

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Cationorm Single Unit Ampoules x 30

Seqirus

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Ikervis (1mg/mL ciclosporin) Single Unit Ampoules x30

Seqirus

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IRCAL Eye Ointment

Allergan

Viscotears Eye Gel

Bausch + Lomb Australia

Viscotears Eye Gel PF

Bausch + Lomb Australia

Optimel Manuka + Antibacterial Drops Optimel Manuka + Forte Gel Optimel Manuka+ Eyelid Cream

Designs For Vision/Melcare

Avenova

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Severe

Moderate

NAME

Mild

Company

GRADE OF DRY EYE

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SBM Activa

BOC Instruments

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Epicon LC

Capricornia

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Katt Miniscleral

Capricornia

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ARITA MEIBOMIAN GLAND COMPRESSING FORCEPS

Designs For Vision/Albert Heiss

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E>Eye (Intense Pulsed Light therapy)

Designs For Vision/ESW-Vision

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Oasis Punctal Plugs

Designs For Vision/Oasis

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Mastrota Meibonian Gland Paddle

Designs For Vision/PRICON

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Mastrota Forcep

Designs For Vision/PRICON

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Punctal Plugs - Temporary occlusion

Device Technologies/BVI Extend range

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Device Technologies/Eagle Vision

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Device Technologies/Katena

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Punctal Plugs - Permanent occlusion Banner 470x70.pdf 1 31/8/21 6:07 pm Epilation forceps

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

DRY EYE DIRECTORY

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Email

PBS-listed

Over the counter

Prescription

Contact lens friendly

Preservativefree

PARTICULARS

Eye lid

Antiinflammatory

Evaporative/ Meibomian gland dysfunction

Tear insufficiency/ Aqeuous deficiency

TREATMENT TYPE

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ausorders@bausch.com

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ausorders@bausch.com

australiaenquiries@allergan.com

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info@dfv.com.au

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info@dfv.com.au

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info@dfv.com.au

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info@dfv.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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customers@device.com.au

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orders@goodoptical services.com.au

orders@goodoptical services.com.au Mkayrouz@ITS.JNJ.COM

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Mkayrouz@ITS.JNJ.COM

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Mkayrouz@ITS.JNJ.COM

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Mkayrouz@ITS.JNJ.COM

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Mkayrouz@ITS.JNJ.COM

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manager@jubelee.com

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manager@jubelee.com

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manager@jubelee.com

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sales@optimed.com.au

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sales@optimed.com.au

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sales@optimed.com.au

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sales@optimed.com.au

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sales@optimed.com.au

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medinfo.phauno@novartis.com

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aunz.medicalinformation@seqirus.com aunz.medicalinformation@seqirus.com aunz.medicalinformation@seqirus.com

sales@bocinstruments.com.au

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info@capcl.com.au

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sales@optimed.com.au •

info@capcl.com.au info@dfv.com.au

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info@dfv.com.au info@dfv.com.au

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info@dfv.com.au

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info@dfv.com.au •

customers@device.com.au

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customers@device.com.au

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customers@device.com.au

... not a dry eye in sight

THERAPIES

WIPE/ MASK

Debridement equipment, spuds etc

Device Technologies/Katena

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Gland expression Forceps

Device Technologies/Katena

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Nulids MDG Machine

Good Optical Services/NuSight Medical USA

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Ocusoft Compliance Kit 50ml + 100 Pads

Good Optical Services/OCuSOFT USA

Ocusoft Hypochlor Gel 59ml

Good Optical Services/OCuSOFT USA

Ocusoft Hypochlor Spray 59ml

Good Optical Services/OCuSOFT USA

Ocusoft Lid Scrub Bottle 50ml

Good Optical Services/OCuSOFT USA

Ocusoft Oust Demodex Foam 50ml

Good Optical Services/OCuSOFT USA

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Ocusoft Oust Demodex Sachets 30's

Good Optical Services/OCuSOFT USA

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Ocusoft Platinum Plus 50ml

Good Optical Services/OCuSOFT USA

Ocusoft Plus Bottle 50ml

Good Optical Services/OCuSOFT USA

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Ocusoft Plus Sachets 30's

Good Optical Services/OCuSOFT USA

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Ocusoft Sachets 30's

Good Optical Services/OCuSOFT USA

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LipiFlow Thermal Pulsation System

Johnson & Johnson Vision

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Bleph-Ex

Optimed

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Blephadex Applicator (in office use only) NICNAS registered

Optimed

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Thermaye Plus IPL

Optimed

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Severe

Mild

Moderate

NAME

Company

GRADE OF DRY EYE

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Designs For Vision/Eye Eco

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Designs For Vision/Eye Eco

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Eye Eco Tranquileyes Advanced XL Kit (moist heat therapy)

Designs For Vision/Eye Eco

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Eye-Eco Eye Seals

Designs For Vision/Eye Eco

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Eye-Eco EyeCloud

Designs For Vision/Eye Eco

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Eye-Eco Quartz & Onyx for lagophthalmos

Designs For Vision/Eye Eco

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I-LID'N'LASH Cleansing Wipes

Designs For Vision/I-MED Pharma

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I-LID'N'LASH PLUS Antiseptic Cleansing Wipes

Designs For Vision/I-MED Pharma

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The Eye Doctor Allergy Mask

Good Optical Services/The Body Doctor UK

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The Eye Doctor Antibacterial Stye Relief Compress (Single eye patch)

Good Optical Services/The Body Doctor UK

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The Eye Doctor Lid Wipes Sachets 20's

Good Optical Services/The Body Doctor UK

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The Eye Doctor Liquid Lid Cleanser (Argon & Coconut Oil/Micellar Water)

Good Optical Services/The Body Doctor UK

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The Eye Doctor Sterileyes Antibacterial Click'N'Go Travel Mask

Good Optical Services/The Body Doctor UK

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The Eye Doctor Sterileyes Antibacterial Hot/Cold Eye Compress

Good Optical Services/The Body Doctor UK

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The Eye Doctor Tea Tree Lid Wipes 20's

Good Optical Services/The Body Doctor UK

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BlephaDex Wipe (regular and PRO) NICNAS registered

OptiMed

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Bruder Eye compress

OptiMed

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Bruder Eye wipe (NICNAS registered)

OptiMed

Bruder Eyeleave Eye compress

OptiMed

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OptiMed

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OptiMed

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Opti-Soothe Preservative-free Eyelid Wipes

AFT Pharmaceuticals/Good Optical Services

Optisoothe Tea Tree Eyelid Wipes 20's

AFT Pharmaceuticals/Good Optical Services

Opti-Soothe Moist Heat Mask Reusable mask

AFT Pharmaceuticals/Good Optical Services

Eye Eco Advanced Tea Tree Foaming Facial Cleanser

Designs For Vision/Eye Eco

Eye Eco D.E.R.M. Mask Eye Eco Tea Tree Foaming Facial Cleanser

Eye Gienie compress (NICNAS registered) Banner 470x70.pdf 1 31/8/21 6:07 pm OptiMed USB Eye warmer (NICNAS registered)

e: goodopt@ozemail.com.au p: +61 3 9645 1066 / f: +61 3 9681 7976 www.goodopticalservices.com.au

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DRY EYE DIRECTORY

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

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orders@goodoptical services.com.au

customers@device.com.au customers@device.com.au

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sales@optimed.com.au sales@optimed.com.au

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DYates7@ITS.JNJ.com

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Email

PBS-listed

Over the counter

Prescription

Contact lens friendly

Preservativefree

PARTICULARS

Eye lid

Antiinflammatory

Evaporative/ Meibomian gland dysfunction

Tear insufficiency/ Aqeuous deficiency

TREATMENT TYPE

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orders@goodopticalservices.com.au

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orders@goodopticalservices.com.au

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orders@goodopticalservices.com.au

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info@dfv.com.au

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info@dfv.com.au

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info@dfv.com.au

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info@dfv.com.au info@dfv.com.au info@dfv.com.au info@dfv.com.au

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orders@goodopticalservices.com.au

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orders@goodopticalservices.com.au

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orders@goodopticalservices.com.au

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orders@goodopticalservices.com.au sales@optimed.com.au

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orders@goodopticalservices.com.au

orders@goodopticalservices.com.au

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sales@optimed.com.au

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sales@optimed.com.au

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sales@optimed.com.au

... not a dry eye in sight

DIAGNOSTICS

Blinking rate/ quality

Tear meniscus height

Lipid layer thickness

Meimbography

NAME

Company

EYE DROPS

DIAGNOSTIC CAPABILITY

DSLC200 & DEM100

BOC Instruments

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SBM IDRA

BOC Instruments

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SBM MGD

BOC Instruments

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SBM OSA

BOC Instruments

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SBM Tearscope

BOC Instruments

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FLUORO TOUCH STERILE FLUOROSCEIN STRIPS (300 Pack)

Designs For Vision/Madhu

ESW-Vision Tearcheck

Designs For Vision/ESW-Vision

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I-Pen

Designs For Vision/I-MED Pharma

TEAR TOUCH BLUE SCHIRMER TEST (100 Pack)

Designs For Vision/Madhu

OCULUS Keratograph 5M (+ JENVIS Pro software)

Designs For Vision/Oculus

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Topcon MYAH – Axial length, corneal topography, basic lens fit, dry eye suite

Device Technologies/Topcon

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Topcon SL-D701 – slitlamp w/ DC4 camera for gland imaging

Device Technologies/Topcon

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Topcon CA-800 – corneal topography, basic lens fit, dry eye suite

Device Technologies/Topcon

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LipiScan

Johnson & Johnson Vision

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LipiView II

Johnson & Johnson Vision

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MGE (Meibomian Gland Evaluator)

Johnson & Johnson Vision

Mediworks D130 (available with S360 slit lamp)

OptiMed

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“Eyecare Plus develop and manage essential digital marketing and national promotions that help grow my practice, so we can focus on caring for our patients.”

Liz Muller Optometrist, Eyecare Plus Altona

Multi Award Winning Practices Looking to buy, sell or join contact Philip Rose 0416 807 546 or philip.rose@eyecareplus.com.au

Email

Blepharitis examination

Measuring/ tracking symptoms

Meibomian Gland performance/ functionality/ expression tool

Ocular surface staining

Tear osmolarity

Schirmer test

Bulbar redness

Tear break up time

Interferometry

DRY EYE DIRECTORY

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sales@bocinstruments.com.au

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sales@bocinstruments.com.au sales@bocinstruments.com.au

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DRY EYE

Melbourne optometrist Jason Teh performing dry eye diagnostics on a patient at his practice.

t i k l o o t e y e y dr

NEW ADDITIONS TO THE

Pharmaceutical company Seqirus has introduced two novel eye drops that Australian eyecare professionals can now add to their suite of dry eye therapies. Melbourne optometrist Mr Jason Teh discusses how they will fit into the treatment landscape.

A

s someone with long-term lived experience of dry eye disease (DED) and an optometrist with a special interest in the area, Mr Jason Teh is acutely aware of the challenges and opportunities that exist within the Australian dry eye treatment market.

It’s a complicated landscape. In some cases, Australia has forged ahead with early adoption of interventions like intense pulsed light therapy for meibomian gland dysfunction (MGD) and a range of manuka honey treatments that were developed locally. However, as the owner of independent Melbourne practice In2Eyes Optometry and director of Dry Eye Group – a dedicated service established in 2016 by a four-strong team of optometrists – Teh has watched the market evolve overseas, while Australian optometrists either wait or struggle to obtain easy access to innovative ophthalmic solutions. Part of the problem is the relatively small size of the national market and high cost of obtaining Therapeutic Goods Administration (TGA) approval and Pharmaceutical Benefits Scheme (PBS) listing, which can place Australia further down the list of priorities for suppliers.

Another challenge is the imbalance in over-the-counter products that are dominated by eye drops for aqueous deficiency when, in reality, as many as 85% of DED patients may have the evaporative form of the disease, or MGD, and would benefit from therapies targeting all three layers of the tear film. In recent months, pharmaceutical company Seqirus has made its first foray into the local eyecare market with two in-licensed products that may go some way towards addressing these issues. The company describes itself as a leading provider of essential vaccines and pharmaceuticals, and is a subsidiary of the Melbourne biotechnology company CSL that was contracted to manufacture the AstraZeneca COVID-19 vaccine.

The first of these treatments is a preservative-free, hydrating and lubricating emulsion called Cationorm, which was approved by the TGA in July 2019. The multi dose (10mL) bottle was recently listed on the PBS,

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INSIGHT October 2021

while the single-dose ampoules (30 x 0.4mL) aren’t listed.

Teh believes the artificial tear provides another therapy option for a wide range of patients because it can sustainably supplement all three layers of the tear film, particularly the lipid layer, preventing tear evaporation, as well as the mucin layer, which facilitates protection and healing of the epithelial layer. As such, it can help address the underlying aetiology of the disease.

Seqirus’s second therapy is called Ikervis (ciclosporin 1 mg/mL eye drops emulsion ampoule), which was TGA-approved in December last year. It’s a ciclosporin product, which Teh says optometrists are particularly excited about after limitations in access to other forms of the anti-inflammatory therapy in recent times.

While both treatments have been available in other international markets for several years, Teh says the introduction of new treatment options in Australia comes at an important time for DED patients.

Before the pandemic, he says there was a noticeable trend in younger patients being diagnosed, driven by increased digital device use and environmental factors, including air conditioning, ceiling fans and forced air heating systems, which can all lower humidity and exacerbate tear evaporation.

More recently, however, poorly fitted face masks amid COVID-19 have

Cationorm is a preservative-free, hydrating and lubricating emulsion.

caused evaporative stress on the ocular surface, causing symptoms in patients who never previously experienced DED. Moreover, the surge in virtual remote learning and working from home to minimise the spread of COVID-19 has driven a substantial increase in the use of digital media.

People are blinking less during extended visual tasks, which is known to precipitate and exacerbate the disease.

“Now, because we screen everyone coming through our practice for dry eye, we know MGD is the number one cause of dryness; even if it’s autoimmune based, you're probably going to have MGD,” Teh, who himself has lived with dry eye for more than 25 years, explains.

“Over the years, we have seen a lot of people in their late 20s, early 30s and even more lately in their teens with MGD. They probably weren’t aware of these changes because MGD doesn’t develop overnight. The great challenge is that early dry eye is often asymptomatic, but patients don’t start to complain until the tear system breaks down to a level that, clinically, isn’t ideal. It's a bit like the glaucoma story.”

COVERING ALL BASES Due to the high prevalence of evaporative dry eye and MGD, Teh says Cationorm is a welcome addition to the optometrist’s toolkit.

According to Seqirus, it treats DED caused by prolonged use of contact lenses or environmental conditions. It adopts “cationic nanoemulsion technology”, which is said to optimise the interaction of the eye drop with the different layers of the tear film and the ocular surface.

Through electrostatic interactions between the positively charged oil nanodroplets and the negatively charged ocular surface epithelium, the treatment is designed to allow for improved residence time through its bioadhesive properties.

The company says the preservative-free drop repairs the lipid layer to reduce evaporation and lubricate and stabilise the tear film; restores the balance of the moisture in the muco-aqueous layer; and heals the ocular surface providing long-lasting protection. Administered as one drop, up to four times daily, it is suitable for use with contact lenses.

Until now, Teh says there have been few over-the-counter preservativefree eye drops that can treat all three layers of the tear film in Australia.

“It’s interesting if you look at all eye drops in the pharmacy today.

Conservatively, 80% of those will treat aqueous deficiency dry eye and won't have that oily emulsion to treat evaporative dry eye, but evaporative dry eye is the major cause of all dry eye out there, so the percentages are out of balance, they should be the other way around; 80% of drops on the shelf should have some sort of oil component to it,” he says.

“Cationorm offers optometrists and ophthalmologists another preservative-free treatment option for DED patients, which protects the ocular surface and relieves discomfort and irritation due to dry eye caused by prolonged use of contact lenses or environmental conditions. It is available over-the-counter and has demonstrated safety and efficacy.

compliance issues.”

Industry figures also believe Ikervis could fill an unmet need for patients with DED, who, to date, have faced challenges in accessing ciclosporin products in Australia. Some have sought to alleviate this by having ciclosporin compounded in certain pharmacies, but this service is reported to have dried up in many areas and there can be inconsistencies with the formulations.

There has also been barriers to sourcing effective treatments for more severe cases due to the need for optometrists Jason Teh, In2Eyes Optometry. to co-manage patients with ophthalmologists and access therapies under the TGA’s Special Access Scheme.

“Improving access to severe DED treatments that are readily available in-pharmacy with a script, will help to enable optometrists and ophthalmologists to effectively manage this disease,” Teh says.

In March, Ikervis was also positively recommended for listing on the PBS by the Pharmaceutical Benefits Advisory Committee.

If subsidised, Teh believes this will generate significant cost savings for patients.

Ms Danielle Dowell, Seqirus head of commercial in Australia and New Zealand, says the company is excited to enter the eyecare space for the first time with Cationorm and Ikervis.

“Our research with people with dry eye disease, with optometrists and ophthalmologists, confirmed that despite a large number of products on the market, there was still a high level of unmet need for dry eye disease," she says.

“At the heart of our in-license business is delivering innovative products to Australia and addressing unmet need. So, first and foremost, we look at the clinical need, the patient need, and the clinician need. We undertake a diligent assessment to ensure we deliver solutions that work for both Australians and clinicians, and of course work in the Australian market." n

“It also has the bioadhesive properties to target all three layers of the tear film; these types of eye drops are hard to come by and aren’t readily available at all pharmacies.

“Hopefully it will be something practitioners, ophthalmologists and even pharmacists consider as another treatment option, for those seeking dry eye disease symptom relief.”

IMPROVING ACCESS Ikervis is a once-daily ciclosporin 0.1% ophthalmic emulsion for the treatment of severe keratitis in adult patients with DED that has not improved despite treatment with tear substitutes.

Teh says DED products containing ciclosporin – traditionally used for autoimmune dysfunction – are ideal for those living with severe DED due to their ability to modulate inflammation, a key factor in DED. “Patients only need to use it once a day. They can put a drop in before going to bed and fall asleep, which may help address potential

Ikervis is a once-daily ciclosporin 0.1% ophthalmic emulsion.

INSIGHT October 2021 51

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IMAGING

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Insight investigates the major challenges of accessing and sharing digital images captured on multiple ophthalmic devices, and whether proprietary interests take precedence over clinical convenience.

T

he story of how Australia wound up with a network of inconsistent railway gauges, the result of each state establishing its own independent system, with little or no forethought about future interconnection between states and capital cities, is part of national folklore.

In some respects, ophthalmic imaging equipment has developed in a similar vein, with manufacturers giving little consideration to interoperability.

Experts agree that up until the last 10 to 15 years, technology hasn’t been able to support interoperability like it can today, so the demand for standardised image formatting wasn’t front-of-mind.

three key factors: lack of demand from industry end users; lack of enforcement by peak bodies; and a lack of desire to cooperate from companies who have business models that have historically been built around directing customers towards specific products, while offering only a basic level of functionality with other manufacturer's devices,” they said.

“As cloud-based storage has become more common, secure, and affordable, the full potential of its application to clinical care – including research – has become evident. With that, the shortcomings of the current lack of standardisation have become increasingly apparent.”

But that began to change when Digital Imaging and Communications in Medicine (DICOM) standards – for the communication and management of medical imaging information – gathered momentum in the early 2000s.

CONSENSUS ON CHALLENGES OF SILOED DATA

Earlier this year, RANZCO endorsed a recommendation by the American Academy of Ophthalmology (AAO), the world’s largest ophthalmic association, urging manufacturers to implement the DICOM standard to facilitate an easier exchange of digital imaging data.

“Perhaps the most important challenge is the ability to view and analyse the raw data that is being captured on these devices when the images and reports they produce are delivered in different formats and require specific applications for them to be useful,” they say.

Mr Anton Pretorius and Mr Walter Palomino, senior software engineers at Topcon Healthcare ANZ, say discussion about standardisation in the ophthalmic device market has been on the table since at least 2011.

This, they add, has a direct impact on a clinician’s ability to provide efficient patient care.

“The lack of compliance can be attributed to a combination of

Pretorius and Palomino are familiar with the major challenges modern eyecare practices face in terms of sharing, compiling, and accessing images captured on multiple ophthalmic devices.

“The biggest impact is felt by the patient because their data is siloed by disparate sources, disconnected clinical systems, and the

INSIGHT October 2021 53

IMAGING

“All this device data represents a great opportunity for medical research to be able to improve the quality of care given to patients, facilitate clinical trials and develop new therapeutics. Today, getting access to this data in a manner that is conducive to research is extraordinarily expensive and manual, purely because many devices don’t provide machine-readable data that can be then analysed at scale.”

Mr Renato Antolovich, retina and glaucoma marketing manager for Zeiss Medical Technology ANZ, says the transmission of image and other patient data needs to be performed securely and reliably, to meet patient data privacy obligations and sufficient access to data for clinicians – at the same time.

Advocates say agreeing on image sharing protocols will not only improve efficiencies, but will lead to better co-management and improved patient outcomes.

subsequent need for manual processes to review and assess data. The impact of disconnected clinical systems is felt again when this data needs to be moved offsite for a second opinion or referral to secondary care,” Pretorius and Palomino say.

Clinicians and staff are forced to revert to manual processes that are slower, more expensive and more resource intensive. It requires the duplication of patient data in soft and/or hard copy for different applications, which can result in a decline in the quality and usefulness of an image through lost resolution.

“It also creates additional costs to the business in the form of staff time to service the manual processes required to plug holes where technology falls short, as well as the cost in creating the resources themselves. The flow-on effect on the patient is care that is slow and inefficient,” Pretorius and Palomino say.

The challenges they describe are daily setbacks ophthalmologists know only too well.

RANZCO ophthalmic surgeon and CEO of Melbourne-based medical technology manufacturer Nebula Health Dr Chandrashan Perera says they leave room for human error.

“Each device comes with its own proprietary software, as such you need multiple programs open and switch between them with the risk of opening the wrong patient’s file,” Perera says. “We need to become accustomed to using multiple different pieces of software, then continually learn the updates. We manually need to transcribe the results from the machines into the patient’s electronic medical record, which is a potential transcription error.”

He agrees that the result of incompatible technology can be measured in time and cost.

“Patients often end up with multiple unnecessary repeated tests. If a patient has had a recent scan at an optometrist before referral, and we were able to use those scans as a baseline for future scans, then it would be unnecessary to scan the patient again at the clinic. However, at the moment, if the patient requires ongoing follow-up, then I am obliged to take another scan so that I have a baseline scan that my machine can compare against for future reference,” Perera says.

“If a patient is transferred to another practice, you lose the ability for the machines to be able to calculate long-term trends, and instead the data is treated as two separate chunks of data.”

This is vital for tests like visual fields. Perera says the loss of longitudinal information when shifting providers risks worse outcomes.

But the negative impact of incompatible technology is not only limited to patients and practitioners. Medical research is hampered immensely, he says.

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INSIGHT October 2021

“Standardisation of file format and transmission protocols for medical data is a prerequisite to enable this, so clinicians have access to the full data set and are best supported to provide optimal clinical care,” Antolovich says. “The better the data exchange works – enabled by a sufficient level of interoperability – the better the collaboration amongst involved clinicians becomes, leading to higher efficiency and improved quality of patient care.”

IMPETUS FOR STANDARDISATION In the absence of interoperability, Perera says ophthalmologists rely on manual processes to extract data.

“Some vendors provide software that works only with their software – thus tying you into one device vendor. Other vendors that provide multi-device support are limited by the type of data they can access from certain vendors,” he says.

How did we reach this point? He believes the answer lies in a combination of a lack of demand, together with potential commercial issues.

“It has been noted in many areas of health, devices tend to limit interoperability. Partially this is due to increased technical requirements from the vendor, but also results from vendors trying to improve their competitive position. We have seen however in other specialties such as radiology where open standards have the potential to help both vendors and care providers,” he says.

Pretorius and Palomino agree the DICOM protocol presents the most straight-forward pathway to achieving efficient sharing of patient data in eyecare.

They say that, applied properly, it would enable the seamless transfer of patient data between different sites and deliver uniformity to how patient data is assessed and used, regardless of the hardware and software available at different sites.

Dr Ben Ashby, director of optometry for Specsavers ANZ, shares the same thinking. The optical franchise supports an industry-wide move towards standardisation in digital imaging.

“We have been investing in standardisation across all our Australian and New Zealand practices for some years now. This includes DICOMcompliant OCTs in every practice. As a result, more than four million patient examinations every year include digital images and OCT that meet these standards,” Ashby says.

“We strongly believe in the value of standardisation to provide the best collaborative care with ophthalmology. Agreeing on image sharing protocols will not only improve efficiencies within the health sector, but it will lead to better co-management and improved patient outcomes, which is always the driving force underpinning any clinical or digital transformation.”

But it could be a long road ahead, with some manufacturers still choosing to encrypt clinical data, Pretorius and Palomino say.

“This can result in all-in lock-in situations that dictate device and software selection for a clinical business. This means that clinics and sites who do not use the same devices and software end up with a static data set and are unable to manipulate the raw data, scroll through data slices or interact with the imaging in any way, thereby necessitating the need for a second set of scans.

"IMAGES OR SCANS NEED TO BE COMPATIBLE TO AN EXTENT THAT ENABLES UNIFORM CORE VIEWING REQUIREMENTS WHEN USING A SINGLE PLATFORM" ANTON PRETORIUS TOPCON HEALTHCARE ANZ

"OPHTHALMOLOGISTS ARE STARTING TO UNDERSTAND THE BENEFITS OF INTEROPERABILITY IN THEIR OWN CLINICAL CONTEXT" DR CHANDRASHAN PERERA OPHTHALMIC SURGEON & NEBULA HEALTH

“These tactics are typically employed by manufacturers to ensure longterm financial commitment from customers. Now that technology can deliver the ability to share patient data virtually and securely between locations, expectations of clinicians and patients is driving demand away from siloed clinical business systems towards open source, standardised data.”

core viewing requirements when using a single platform, such as Topcon Harmony,” they say. “Data management platforms, such as Harmony, do more than simply facilitate simultaneous viewing of images and live data manipulation – they give clinicians a comprehensive data management solution which delivers benefits to a clinical business that far outweigh what DICOM could deliver in and of itself.”

Expectations are one thing; reality is another. As Pretorius and Palomino explain, the main challenge to vendor-neutral connectivity is how each different device encrypts patient data.

Antolovich from Zeiss says there’s no doubt that DICOM is a must.

DICOM has been widely adopted in medicine, with radiology as the pioneer.

Ophthalmology started in the early 2000s with an initiative of the AAO to make use of a range of industry standards such as HL7 and DICOM.

With hundreds of devices on the market, having the functionality that allows not only simultaneous viewing, but also manipulation of raw data is the biggest technical challenge.

“Images or scans need to be compatible to an extent that enables uniform

“Zeiss has been an active participant in this space for the last 15 years driving standardisation and interoperability. As a result, all Zeiss devices of the latest generation come with a DICOM interface,” he says.

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IMAGING

"EXPECTATIONS OF CLINICIANS AND PATIENTS IS DRIVING DEMAND AWAY FROM SILOED CLINICAL BUSINESS SYSTEMS TOWARDS OPEN SOURCE, STANDARDISED DATA" WALTER PALOMINO TOPCON HEALTHCARE ANZ

“It’s important to note that when innovations come to the market, standards may not yet exist and must be developed. Also, established standards need continuous updates during the maturation process of the technology so that the standard continues to represent the full functionality possible. Thus, standardisation and interoperability are a constant effort. Zeiss regards interoperability and data standardisation as an enabler for the advancement of medical care and is therefore further contributing to this work.”

'IT'S A PROBLEM WE NEED TO OVERCOME' The concept of DICOM compatibility and associated sharing of digital imaging is a subject Mr Michael Yapp has been working on for many years as part of Centre for Eye Health’s (CFEH) collaborative care programs.

Yapp is a qualified and therapeutically-endorsed optometrist, and while not an expert in DICOM standards, in his role as head of clinical operations at CFEH in Sydney he has been involved in working with multiple imaging devices from various distributors as well as contributing to publications in trade magazines on this topic.

data? That’s putting it too strongly, but it limits clinicians’ ability to provide effective collaborative care,” Yapp says.

Melbourne firm Cylite, which has innovated the Hyperparallel OCT, notes that the DICOM standard is incredibly complex, and comes with multiple challenges.

When designing its own device, the company chose to make its Cylite Focus software a common platform, and is planning to provide linkages to practice management systems and to support DICOM. “Our guiding principle is the acquired data belongs to the user and not us. We will do all we can to give our users access to the data they need to manage their patients and advance research.”

However, the company notes that the DICOM standard does not always support natively all instrument-specific data types (Information Object Definition) that instruments produce, for example corneal topography, biometry data, perimetry.

Even if the standard does support the data format, the DICOM PACS/ viewing platform being used must also support these IODs and often they do not support those from specialty areas outside of radiology “Standards like DICOM tend to reduce things to the lowest common denominator. If your instrument has extended functionality that other instruments do not support, then it probably won’t be supported in the standard,” the company stated.

“Integrating older instruments can also pose challenges – most newer instruments at least output a useable electronic file and many use DICOM but there’s sometimes nothing that you can do if an instrument doesn’t have an ethernet port for example.”

"ZEISS REGARDS INTEROPERABILITY AND DATA STANDARDISATION AS AN ENABLER FOR THE ADVANCEMENT OF MEDICAL CARE"

“[The] Centre for Eye Health is an intermediary care facility, bridging between optometry and ophthalmology. Under a collaborative care model, we share patient care with Westmead and Prince of Wales Hospitals as well as community optometrists and ophthalmologists, so it’s important to have the ability to share imaging to assist with both diagnosis and management,” he says.

RENATO ANTOLOVICH ZEISS ANZ

Yapp says while DICOM standards have been around for a long time, compliance varies as most ophthalmic devices conform to DICOM in different ways.

“One major benefit of the standards is being able to view multiple instruments and different models of the same type of instruments in the same platforms. This helps in analysing all the data for a specific visit but, in particular, assists in the ability to perform change analysis – measuring change and making direct comparisons over a period to make more informed judgements,” he says.

Yapp says part of the problem is overcoming issues with file sizes and rules around data privacy.

“It’s a problem we need to overcome because clinicians can offer a much better standard of collaborative care if they can perform change analysis, and that would benefit greatly from different data sources being compatible.

“For example, a patient with macular degeneration may have an OCT scan to establish how much fluid is leaking into the macula, using a protocol incorporating 61-line scans. Three months later, another scan on the same machine will show if the leaking has gotten better or worse. But if the scan is done on a different machine in a physically different location, the clinician won’t be able to accurately demonstrate change analysis because they won’t be able to make a direct comparison of the two scans.”

Yapp says an increase in collaborative care is driving the need for open access to data.

“Is standard of care compromised without universal access to patient

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INSIGHT October 2021

WHERE TO FROM HERE? For Pretorius and Palomino, the future prevalence and evolution of digital and cloud-based solutions in clinical practice will be driven by three key factors.

Firstly, the sheer volume of patient data passing through clinical practices and the need for systems that will allow for effective management and security.

Secondly, seamless access to technology, like AI and machine learning, to support clinical decision making and diagnosis as demand on clinical time increases.

And thirdly, consumer choice – specifically, the ability to meet the real needs of the consumer and customise solutions that respond directly to the business needs and preferences.

“Data management platforms like Topcon Harmony are addressing one of the biggest challenges facing the eyecare sector – access to data. As platforms like Harmony start to become the norm in clinical businesses, expectations of what they can deliver will also grow. What we understand to be comprehensive data management today will evolve to continue meeting changing user needs, as well as in response to potential that is

unlocked by technology,” Pretorius and Palomino say.

Perera is a proponent of widespread adoption of imaging standards, including DICOM and the Fast Healthcare Interoperability Resource (FHIR, pronounced "fire"). FHIR is a standard describing data formats and an application programming interface for exchanging electronic health records.

"IT LIMITS CLINICIANS’ ABILITY TO PROVIDE EFFECTIVE COLLABORATIVE CARE"

“Formalised standards are ideal, but even having files which contain the required information, together with documentation from the manufacturer as to how third-party vendors can access that data without having to rely on any manufacturer-specific software would be a great starting point,” he says.

“Ultimately however, the industry is moving towards utilisation of DICOM standards, which allows far more standardisation across the different devices and manufacturers – allowing for data to be accessed far more readily.”

How this area of eyecare will play out remains to be seen but Perera suspects there will be a slow transition period from device manufacturers given the technical challenges to overcome and initial reticence to give up a potential competitive edge through vendor lock-ins.

“Ophthalmologists are starting to understand the benefits of interoperability in their own clinical context, such as the ability to switch to the best device available on the market without having to discard their old data. Furthermore, peak body groups such as the American Academy of Ophthalmology are also helping to push the demand for interoperability,” Perera says.

“As the demand for devices with interoperability grows, device manufacturers that offer interoperability are likely to see increased

MICHAEL YAPP CENTRE FOR EYE HEALTH

commercial interest in the purchase of their devices.”

Antolovich from Zeiss confirms the growing market demand for interoperability: “The conversations we have with our customers are going beyond the product’s capabilities to share and exchange data.

“This is the reason why we further concentrate on interoperability and extend our software solution – which is currently Zeiss Forum – in the direction of a cloud module, so that customers can take advantage of the technology and achieve more efficient and higher levels of patient care.”

Ultimately, Yapp predicts that because propriety interests will not abate, and imaging technology is a competitive space, manufacturers will continue to invest in and develop software platforms that can provide access to scans and images from multiple devices, such as Topcon Harmony, Pliny, and Zeiss Forum. n

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OPTOMETRY

y t i r u c e s g n i d Fin h & groINwTHEtCOVID ERA George & Matilda Eyecare is primed to sign off on several new acquisitions as more independents see the value and safety of joining a collective in uncertain times. hours. It made a lot of great optometrists and businesspeople realise the downside of being by themselves,” he says. er Chris Beer. any in George St, with G&M found Margaret Lam, of theeyecarecomp

I

ndependent optometrists know well the burdens of business administration, while trying to work through full appointment books.

Tasks like payroll, recruitment and patient recalls can either fall off the to-do list or eat into evenings or weekends. Taking a holiday can even be tinged with guilt.

Many were already stretched beyond their capacity, but COVID-19 and yo-yoing lockdowns have created all new back-office problems with landlords, lenders, suppliers and human resources. These were fraught issues most hadn’t encountered all at once, fuelling anxiety and consuming valuable time that could have otherwise been spent with patients.

Mr Luke Algar is the head of partnerships for George & Matilda Eyecare (G&M). The collective was established in 2016 by prominent industry figure Mr Chris Beer who devised a model focusing on partnering with high performing, community-focussed independents.

Since the pandemic, Algar has been building a comprehensive pipeline of potential acquisitions, many whom approached G&M seeking security in turbulent times and for new ways to run more profitable and efficient businesses.

“COVID created urgent jobs on top of other urgent jobs, dealing with supply chain, reps, PPE, communicating with patients about opening

58

INSIGHT October 2021

“When people have looked at their options, I think G&M has been uniquely placed because we know optometrists don’t want to lose their freedom and flexibility of being an independent – things like appointment durations and the way they care for their patients – but what they do want is someone to lighten the load, while also offering expertise and sophisticated platforms that add value and help to grow their business.”

In five years, G&M has taken its network to around 90 practices. Algar says two more in Queensland are set to join soon, one in North Lakes and the other in Atherton. But the company expects this to ramp up considerably, after recently refinancing and securing a significant line of credit from one of the big four banks.

He says standing up to the scrutiny of a major financial institution is indicative of company’s fiscal health and capacity for growth. G&M also used COVID-19 as an opportunity to re-examine its financial management.

A major part of that has been streamlining its supplier network to ensure its optometrists have the best chance of increasing their margins.

“With COVID we have managed to grow the business beyond anyone's expectations, but we have been purposefully slow in terms of bringing on new practices, so we could ensure our existing practices could get through unscathed and stronger out the other side,” he says.

“Now we know what COVID looks like, we are ready to scale up – the pipeline has expanded dramatically over the past year, so you’ll start to see a lot of that flow through very soon.”

successful to the next level with extra resources and expertise. That’s why we have a goal of growing practices in the first year; we want to demonstrate the value we can add early in the relationship which then builds trust, which is crucial in any partnership.”

G&M aims to provide value on numerous fronts. Buying and administrative power are the obvious advantages. But it has also invested heavily in technology and platforms that would otherwise be out of reach for standalone business. This includes the integration of artificial intelligence to send highly personalised patient recalls, as well as in-house data scientists who can analyse the trading performance of each practice to highlight opportunities, trends and inefficiencies. Practices can also benchmark their performance against others in the network.

“Other aspects include helping practices plan and manage their assortments, rationalising our suppliers to make sure we are getting not only a healthy product mix, but the best margin for all of our businesses.

Having people who can work through the data on that and come back with something that is considered and thought through for the partners to sign off on has been a really big help,” Algar says.

Staff training is an area optometrists often struggle with, so G&M also has modules on various topics – such as product, sales and mentorship – to help optometrists and dispensers provide better customer experience, ultimately translating into more conversions.

“One of the lovely things that happens organically outside of formalised training programs is that the optometrists call each other directly to talk through certain situations,” Algar notes.

theeyecarecompany by George & Matilda Eyecare in Liverpool, Sydney.

Luke Algar, head of partnerships at George & Matilda.

“As an independent you can feel like it’s you against the world, so many of our partners have found it great to suddenly have a bunch of like-minded people at the end of the phone with diverse skillsets and experience to draw on.”

THE G&M MODEL

DIFFERING MOTIVATIONS

G&M’s unique business model is one of the biggest drawcards for independents.

It provides significant back-office support and infrastructure so its partner optometrists can dedicate more time to their patients.

In the majority of cases, it purchases the assets of the business and cobrands, building on the existing brand equity. The optometrist becomes an employee, but still shares in the profits.

Whether it’s growth ambitions, succession planning or a desire to devote more attention to their craft, each practice has their reasons for joining G&M.

Algar says the company has always been built for scale, but is conscious of becoming too corporatised or top-heavy.

A feature of its model is the ability to mesh the G&M systems without interfering with the practice’s clinical individuality.

That means it is selective about who joins the network. There is a rigorous due diligence process, which involves aligning values and specific commercial requirements.

“Each practice that joins has different motivations and we try to understand that upfront and find out what success looks like. Once we have that level of detail and are clear-eyed on expectations, we are then able to develop a business plan for that specific practice in the first 30 days, 90 days and 12 months,” he says.

“Our whole model is based on taking practices that were already

Mr Ken Ingram, of Greg Bowyer Optical by G&M Eyecare near Brisbane, says one of the greatest benefits has been an ability to remain involved, while letting go of the many business aspects he has been handling for around three decades.

“When the opportunity to join G&M came up, I looked at the model and thought, this is the best of both worlds. There’s a corporate setting, there’s support in the professional sense, in the clinical sense, and there’s support with payroll and back-office functions, but I’ve got an element of independence in how I practise,” he says.

Since joining the group, store profit in the past year has risen 35-40%, without a big increase in its top line.

“We’re quite a mature practice that’s been in existence for 30 years, so having exponential sales growth is difficult, but G&M have helped us with controlling some of the costs and making things much more efficient. The end result has been a significant profit increase, which I’m really proud of my team for achieving.”

For Mr Dirk Den Dulk, from Partners in Vision by G&M Eyecare in Albion Park in New South Wales, maintaining his individuality as an optometrist has been vital.

“They allow me to practise the way I like to practise optometry and never interfere in that side of the business, so I’m fortunate enough now to be able to deal with my patients, the people around me, without having to take home the worries of business,” he says.

“I would urge anybody who was thinking of selling to do yourself a big favour and get out and do what you love doing.”

Mr Kyriacos Mavrolefteros and his optometrist wife Katerina established

INSIGHT October 2021 59

OPTOMETRY

their practice in the Sydney beachside suburb of Maroubra in 1994. If he didn’t join G&M, Mavrolefteros would have struggled to continue practising and running the business beyond another five years.

“Whereas now, I’ve handed over the business things and I can be as good as an optometrist as I possibly can in the next decade. It has given me longevity as an optometrist and people tell me that I’m much more relaxed than I was before – and I feel it too,” he says.

After practising for 38 years, Mr Stephen Wakeling is also thinking about the next phase in his life. When it’s time to relinquish the reins of Prime Vision by G&M Eyecare, in the Melbourne suburb of Oakleigh, he wants to do so on his own terms.

“I’ve got the ability to take holidays when I want now. Previously, as the owner of the business, I’d feel guilty if I took much time off,” he says.

“But now as an employee it’s great that I can take my holiday and not have to worry about what’s happening with the busines in the meantime because G&M is organising all that for me. In the background they can organise locums and the rest of the staff are there, it works much better.”

UNSW senior lecturer Ms Margaret Lam is national president of the Cornea and Contact Lens Society of Australia (CCLSA). She’s also an optometrist partner at theeyecarecompany, a three-practice business that joined G&M seeking a step change.

She says it’s a true partnership that motivates optometrists to look after their practice, while considering innovative ways to improve the business in consultation with support office.

“Reflecting back, joining G&M Eyecare was the single best strategic decision we’ve made helping our optometry practices grow. Joining G&M gave us the background and structural support we knew we needed to NOVA EYE MEDICAL_INSIGHT-PRINT.pdf

2

27/7/21

Kyriacos Mavrolefteros (centre) and his optometrist wife Katerina (right) established their practice in Maroubra in 1994. Photographed with optometrist Antigone Kordas.

sharpen our business and then, in turn, improve our overall service to our patients,” Lam, who is also head of professional services at G&M, says.

“The team have been guiding us at every step with good expert advice.

If we have, for example, issues with leases and landlords, Chris Beer has amazing connections to support us with expertise in the leasing space. If we have issues with people and with HR, we have amazing in-house counsel to advise us on the best next steps. We now have a really strong marketing department to do clever strategic marketing and the best of IBM Watson algorithms to optimise and personalise recalls to our patients to hit new heights on recall success.” n

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CAREER

People

ON THE MOVE A wrap on the latest appointments and industry movements within the Australian ophthalmic sector.

EXPERIENCED OPTOS EMPLOYEE RETURNS Mr Tim Trede has returned to Optos as account manager for Queensland, South Australia and the Northern Territory. Over the past 10 years Tim has worked in various roles throughout the ophthalmic industry and after a short hiatus from Optos, he’s back. When asked about the return to Optos, Tim said “it’s great to be back home!”

NATIONAL OPTICAL CARE APPOINTS PRACTICE DEVELOPMENT MANAGER National Optical Care recently welcomed Mr George Nilas as its new practice development manager in Queensland. He has more than 10 years’ experience in the optometry sector. He spent four years as Queensland regional manager with Bailey Nelson and prior to this was store manager of its flagship Brisbane CBD store. He is a qualified dispenser and has also worked in a variety of roles with Specsavers, iLab Optics and OPSM.

MOVEMENTS WITHIN THE UNSW OPTOMETRY SCHOOL Dr Revathy Mani has joined as an EducationFocused Lecturer at School of Optometry and Vision Science, UNSW Sydney. She is involved in teaching Binocular Vision and her research interest is focused on studying eye movement deficits in people with traumatic brain injury.

NEW CEO FOR VISION 2020 AUSTRALIA AS JUDITH ABBOTT DEPARTS The peak body for the eye health and vision care has appointed former Aged and Community Services Australia (ACSA) head Ms Patricia Sparrow as its new CEO. Sparrow commenced in the role on 27 September, taking over from Ms Judith Abbott who is assuming the role of CEO at Carers Victoria.

Sparrow has also previously worked in consumer health advocacy, in departmental roles and as a senior adviser to federal government ministers.

LUXOTTICA ANNOUNCES INTERNAL APPOINTMENT Ms Elizabeth Kodari has taken on a new role as health fund and business partnerships sales manager for Luxottica, responsible for relationships and business development with corporate partners and health funds. Over the past six years, she has held numerous roles within Luxottica including managing optometrist to professional services manager for NSW and ACT. “I am incredibly fortunate and proud to work for a company that has nurtured my professional development as both an optometrist and a leader,” she said.

NEW CEO FOR AUSTRALIAN COLLEGE OF OPTOMETRY The Australian College of Optometry (ACO) has announced Mr Pete Haydon has been appointed CEO, resigning from his position at the helm of Optometry Victoria South Australia after seven years. Haydon said he was eager to get started in his new role, which he’ll commence on 22 November, with Professor Michael Ibbotson continuing as interim CEO until then. “I genuinely believe in the work the ACO does and there is a strong fit with my own personal philosophy and professional goals,” Haydon said.

Do you have career news to share?

Email editor Myles Hume at myles.hume@primecreative.com.au to be featured.

INSIGHT October 2021 61

AN ORTHOPTIC-LED GLAUCOMA CLINIC AN ORTHOPTIC-LED CLINIC AT THE SYDNEY EYE HOSPITAL THAT IS MANAGING LOW RISK AND STABLE GLAUCOMA PATIENTS IS HELPING TO DRIVE MAJOR EFFICIENCIES, WRITES CHRISTINA PETERSON AND MELANIE LAI.

T

he Sydney Eye Hospital (SEH) glaucoma service has experienced 33% growth during the past 10 years.

MELANIE LAI

To manage this increased demand on the service and a rise in referral of complex cases, the hospital’s glaucoma unit has worked collaboratively with the orthoptic department to ensure patients receive the right care, at the right time with the right people.

A prospective audit conducted in 2016 of case complexity of patients attending glaucoma consultant clinics demonstrated that 11% of patients met the criteria of low-risk glaucoma, based on a glaucoma risk stratification tool. (Shah, Peter (2018).

Guidance on Glaucoma - Medical Defence Union Journal - Summer 2018)

CHRISTINA PETERSON

At SEH, we adopted a model of care for low risk and stable glaucoma patients called the Stable Monitoring Service (SMS), which is similar to models of care delivered in the UK’s National Health Service.

The SMS clinic adheres to clear inclusion and exclusion criteria governing which patients are appropriate to use this service. All patients must have had a face-to-face assessment with a glaucoma specialist prior to being transferred to the SMS clinic.

A standardised clinical assessment form was developed for the clinic, indicating the minimum assessment requirements.

Orthoptists perform a comprehensive assessment for patients in the SMS clinic, analyse patient outcomes and recommend a care plan including timeframe for review and whether follow up is appropriate in the SMS clinic or if a consultant review is required.

Orthoptic care plans are reviewed by a glaucoma specialist and recommendations endorsed or adjusted accordingly.

To support orthoptists to work at an advanced scope-of-practice, an orthoptic education package was developed to ensure consistency in the standard of care. The package details a standardised method for analysing patient outcomes and recommended care plans as per ophthalmology recommendations

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INSIGHT October 2021

Members of the Sydney Eye Hospital orthoptic team (from left) Thy Maria Tran, Kirsty Somerville McAlester, Alicia Yap, Danielle Morgan and Quantelle Benjamin.

in the SMS clinic. It also ensures ongoing feedback and education to maintain this skill set.

monitoring service delivers value-based care through a collaborative approach that aims to:

Transferring low risk and stable glaucoma patients from speciality clinics to the SMS clinic has increased capacity in glaucoma speciality clinics for patients referred with complex and progressive glaucoma.

• Improve health outcomes.

In total, orthoptists assessed 479 patients in the SMS clinic between 2018 and 2021. Data from 418 of these patients were retrospectively reviewed. There was a 79% agreement rate between care plans recommended by orthoptists and ophthalmologists. Of the remaining 21%, orthoptists were over conservative in their care plan for 18% of cases.

The SMS model of care has reduced the total time patients spend at their appointment and number of face-to-face appointments they attend. It has also increased accessibility to the glaucoma consultant service for patients with more complex and acute disease.

Since its inception in 2018, there has been a 216% growth in demand for the SMS service.

SEH is now seeking to pilot the SMS clinic in a hub-and-spoke model, by providing the SMS clinic at Kogarah Eye Clinic, a satellite clinic of SEH located about 20km south.

In summary, the orthoptic-led stable

• Improve the experience of those receiving care and those providing care.

• Use available resources optimally to enable best outcomes and at a reduced cost to the service.

The service highlights the benefits of orthoptists working at their full scope-ofpractice can have in delivery of eyecare.

Maximising the use of the existing orthoptic workforce within the public health setting is now being used to improve access to eyecare for patients with other chronic eye conditions (including diabetic retinopathy). n

ABOUT THE AUTHORS: MELANIE LAI is the Orthoptic Discipline Advisor for the South Eastern Sydney Local Health District SESLHD and Head Orthoptist at Sydney Hospital/Sydney Eye Hospital (SSEH). CHRISTINA PETERSON is the Acting Discipline Advisor Orthoptics (SESLHD), as well as Acting Department Head – Orthoptics at SSEH. 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

MANAGEMENT

KEEPING IT PROFESSIONAL ON SOCIAL MEDIA DURING LOCKDOWNS, SOCIAL MEDIA HAS BECOME A USEFUL WAY FOR HEALTHCARE PROFESSIONALS TO KEEP IN TOUCH WITH PATIENTS. AVANT’S RUANNE BRELL EXAMINES HOW TO BE BOTH EFFECTIVE AND PROFESSIONAL ONLINE.

W

hen the NSW Chief Health Officer took to TikTok for a Q&A, she was one of many health practitioners using social media to share information during the COVID pandemic.

RUANNE BRELL

"YOUR SOCIAL MEDIA PRESENCE, INCLUDING YOUR PERSONAL ONE, DOES REFLECT ON YOUR PROFESSIONAL REPUTATION"

Sharing accurate professional information via social media can be an important way to counter misinformation online. It can also be a way to engage with patients.

Recent months have seen practitioners posting updates on practice availability, contactless delivery options, advice on eye health in lockdown, and the latest tips on how to avoid mask-fog.

Whether you are a long-time social media user, or a recent convert, it is important to be deliberate in the way you use it. Understand that your social media presence, including your personal one, does reflect on your professional reputation.

Social media guidelines issued by the Australian Health Practitioner Regulation Agency (Ahpra) and the National Boards outline the standards expected of all regulated health practitioners when engaging on social media. Of course, it is essential to maintain professional boundaries and ensure posts do not breach advertising requirements. It is also important to understand where general guidance on how to engage with social media using images, humour, and personal opinions may conflict with professional responsibilities.

PATIENT PRIVACY AND CONFIDENTIALITY Social media marketing tips often recommend adding images to make a post more engaging. Images and graphics can also make complex information easier to understand, and can be valuable communication tools for health practitioners, once patient privacy and confidentiality have been addressed.

Always make sure you have permission from the patient to use an image – even if you think it’s not

identifiable. A common pitfall is posting an image about a clinical issue or successful treatment, but neglecting to seek permission in the belief the image cannot be identified. The internet has a wide reach and people notice all kinds of things – a rare condition, identifying mark, unique piece of jewellery, or combination of time and place could make the image identifiable.

If you are posting images of children, be particularly careful to seek permission from their parent or guardian, or from the child themselves if they have decision-making capacity.

Always check what else can be seen in your photo. Social media users have found themselves inadvertently posting patient information in the margins or background of a photo.

PERSONAL OPINIONS AND JOKES Ahpra has made it clear that “where relevant, National Boards may consider social media use in your private life (even where there is no identifiable link to you as a registered health practitioner) if it raises concerns about your fitness to hold registration”.

For doctors, the Medical Board’s Code of Conduct reinforces that they need to consider how public online comments and behaviours might reflect on their role as doctors and the reputation of the profession.

Practitioners can engage in legitimate public debate about clinical and social issues, including discussion of emerging evidence or competing theories. Concern arises, however, where those views contradict public health messaging or conflict with accepted guidelines and standards within the profession.

Be aware also of your employment conditions and workplace policies that cover acceptable use of social media.

Using humour can be effective but remember the impact it may have on others. Even if intended as a joke, comments about particular groups may be considered derogatory and will be taken seriously by the Boards.

Social media can be a powerful medium for health professionals to engage with their community.

Comments that could lead a patient to feel intimidated or discouraged to seek healthcare are likely to be considered damaging to the profession and a risk to patient safety.

PLAN TO ENGAGE Be clear about how you would respond if someone asked for advice via a post. One option is to refer them to their own treating practitioner. If they wish to consult you professionally and it is appropriate they do so, make sure you establish a formal clinical relationship first.

Social media can be a powerful and effective medium for engaging with your community. Being intentional in your use and treating it as a professional communication are important guiding principles.

• Seek and document patient consent to use any patient information, even if apparently de-identified.

• Be aware of your professional, legal and employment obligations when using social media.

• Always consider before you post. n RUANNE BRELL is a senior legal advisor in the Advocacy, Education and Research team at Avant with over 15 years’ experience in health and medical law. She also provides advice to Avant’s members via its Medico-legal Advisory Service.

INSIGHT October 2021 63

DISPENSING

PRACTICAL FRAME ADJUSTMENT GUIDE – PART 2 IN THE SECOND PART OF HIS SERIES ON FRAME ADJUSTMENT, MURRAY O’BRIEN COVERS THE MOST SALIENT PRACTICAL POINTS THAT DIFFER FOR VARIOUS FRAME TYPES AND MATERIALS.

I

n the practice of frame adjustment, the frame material type will ultimately determine the methods and limitations.

MURRAY O’BRIEN

"THERE’S AN ONUS ON FRAME PRODUCERS TO ENSURE PRODUCTS CAN BE ADJUSTED ADEQUATELY FOR GOOD ANATOMICAL FITTING. THIS OFTEN ISN'T THE CASE"

Frames are generally divided into: Metals – stainless steel, monel, nickel silver, pure titanium, beta titanium, aluminium. Plastics – cellulose acetate, TR90, cellulose propionate, Optyl, SPX (Silhouette).

The following are some basic instructions to solve the most common issues.

1. Distance between temple tips too wide – There are two choices to resolve this: bend at the bridge, or where the temples attach to the rim.

For acetate frames, warm the bridge with an air heater ensuring it only targets the bridge. There’s a risk of damaging multicoats if lenses near the bridge get too hot; potentially an expensive mistake. Once softened enough, hold the frame with the back facing you and thumbs each side of the bridge on the back of the lenses. Bend the frame to increase the facial curvature bringing the temple tips closer.

To bring in the angle of the temples on plastic frames, the frame front near the temples can be gently heated to soften the plastic and then, by pushing the heated area on a bench top, the angle can be brought in a little. Don’t apply too much heat as this can loosen concealed joints.

For metal frames, the most common method is to use one or two pairs of inclination pliers. Slip the metal conical part of the pliers between the rim and in front of the temple joint with the plastic part on the outside of the frame. Hold the frame front near the joint and bend in. Metal frames can also be adjusted at the bridge to increase the frame front curvature. Place your thumbs on the back nasal top corner of the frame and apply little pressure to bend the bridge in the middle.

2. Distance between temple tips too narrow – For acetate frames there’s the choice of either bending the frame

64

INSIGHT October 2021

Metal frames can be widened or narrowed by bending gently at the bridge.

After heating the front near the temple, push down on the bench to bring in the temple width.

at the bridge or filing the temple ends where they intersect the frame front.

Use a rubber bench block to rest the frame while carefully removing material from the temple end whilst trying to maintain the original angle. Be careful to only take off a small amount and constantly check until the desired temple angle is achieved.

joints they cannot be effectively adjusted, so the only option may be to twist at the bridge to achieve the desired difference in tip height.

Although not ideal because the lens tilt will be different, it’s better than glasses that aren’t straight laterally.

If the frame has a lot of facial wrap due to high plus lenses, the first option may be to heat the bridge and flatten the frame. If this doesn’t widen enough, the next step must be to file the temple ends.

For metal frames, inclination pliers can be used as above, but to bend the temples out. Observe the facial wrap of the frame. If there’s more than necessary, flatten by a gentle bending at the bridge first.

3. Adjusting for straightness on the face – if the frame doesn’t align with the eyes laterally, then one temple will need to be bent up a little and the other down. The technique to achieve this will depend on the frame construction.

Metal frames that are fine enough to bend in front of the temple attachment should be adjusted using parallel pliers.

Plastic frames that have a single charnier joint can be bent at the joint by applying pressure up or down on the temple itself by hand.

When frames have multiple charnier

There’s an onus on frame producers to ensure products can be adjusted adequately for good anatomical fitting. Unfortunately, this often isn't the case, so beware.

4. Temple tips behind ears – whether metal or acetate, heat with either an air heater or hot box (heated beads). Warm the plastic just enough so it is pliable. Straighten the tip if the bend needs to start in a different place.

Only use your fingers to bend tips, it would be rare for tools to be required.

Using two hands, support with the thumbs and use the index finger to bend the tip around.

For the mastoid process, use fingers and thumbs again as there really aren’t tools specifically designed for the job.

Sometimes it’s hard and frame benders (meniscus pliers) can be used. 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.

2021 CALENDAR OCTOBER 2021 ORTHOKERATOLOGY SOCIETY OF OCEANIA 2021 CONFERENCE Gold Coast, Australia 1 – 3 October oso.net.au

39TH CONGRESS OF ESCRS Amsterdam, The Netherlands 8 – 11 October escrs.org

PEACE 2021 - FUTURE OF OPHTHALMOLOGY Sydney, Australia 31 October personaleyes.com.au/events

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

AUSCRS 2021

ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE

Australia (online) 23 October auscrs.org.au

Brisbane, Australia 20 – 22 November orthoptics.org.au

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

FEBRUARY 2022

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

JANUARY 2022

MIDO EYEWEAR SHOW DIGITAL EDITION Milan, Italy 12 – 14 February mido.com

APRIL 2022

OPTI 2021

AUSTRALIAN VISION CONVENTION (AVC)

Munich, Germany 14 – 16 January opti.de/en

Queensland, Australia 9 – 10 April optometryqldnt.org.au/avc

100% OPTICAL London, UK 22 – 24 January 100percentoptical.com

SPECSAVERS – YOUR CAREER, NO LIMITS All

Graduate Opportunities – NSW Specsa ve stores rs The Specsavers Graduate Recruitment Team are currently looking for new graduates to join our now w ith OC teams Burnie, Devonport & Launceston in Tasmania.

T Benefit from our ‘Go with a friend’ bonus, as well as a generous regional salary and relocation package.

Specsavers have continued to develop our comprehensive two-year Graduate Program, which provides newly qualified optometrists with a dedicated mentor, support network and structured program to assist you in your development.

Brand-new Specsavers store – Rockhampton, QLD Opportunity for an experienced optometrist to join our brand-new store in Rockhampton, QLD. Operating as a Joint Venture with our existing Specsavers store, we offer a highly trained and supportive retail team along with market leading equipment – including OCT and excellent ongoing professional development. We have opportunities for both Partnership or Full and Part-time Optometrists to join a well-established and highly successful business.

Interested in relocating to NZ? Specsavers has a range of opportunities for NZ optometrists looking to return home. From North to South, we have fantastic opportunities for optometrists at all levels. And as a Specsavers optometrist, you’ll have the chance to advance your skills and become part of a business that is focused on transforming eye health outcomes in New Zealand. Be equipped with the latest ophthalmic equipment (including OCT in every store) and develop your clinical experience across a range of interesting conditions and an ever-growing patient base. You’ll also have the support of an experienced dispensing and pre-testing team, the mentorship of store partners and access to an exemplary professional development program.

Vision of Optometry Webinar Are you looking to understand how Specsavers can help ‘Advance your Optometry Career’? This webinar is an excellent opportunity to learn more about Specsavers’ Pathway partnership development course and opportunities available across ANZ for JVP, permanent and locum. You will have the chance to hear from our Optometry Development Team, on how we’re continuing to transform eye health by eliminating preventable vision loss and blindness. Our Professional Recruitment team will discuss how Specsavers can best equip you with the fundamental development opportunities to excel your optometry career.

Please register your interest here!

Locum opportunities Have you considered Locum Optometry? Offering variety, travel and the opportunity to expand your network, we have a number of vacancies across WA and seeking optometrists who have a real passion to provide the best service to the WA people. With work available across the state, why not reach out today for a confidential conversation on how we work.

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: QLD, NT, VIC & TAS Optometrist enquiries: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134 WA, SA, NSW & ACT Optometrist enquiries: Madeleine Curran – Recruitment Consultant

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader

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

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

SOAPBOX

DUTY OF CARE AND URGENCY OF REFERRAL

A

medical practitioner's duty of care to a patient is well entrenched in law. The classical statement of a medical practitioner’s duty of care was eloquently conveyed in the landmark decision Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479 at 483: “The law imposes on a medical practitioner a duty to exercise reasonable care and skill in the provision of professional advice and treatment. That duty is a ‘single comprehensive duty covering all the ways in which a doctor is called upon to exercise his skill and judgment’ ... it extends to the examination, diagnosis and treatment of the patient and the provision of information in an appropriate case... (citations omitted).

In relation to diagnosis and treatment, section 5O of the Civil Liability Act 2002 (NSW) provides a defence and precludes a finding of negligence if a medical practitioner has “acted in a manner that... was widely accepted in Australia by peer professional opinion as competent professional practice”1.

Section 5P of the Act provides that section 5O does not apply to liability in connection with the giving of advice or information.

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INSIGHT October 2021

A recent case in the NSW Court of Appeal: Makaroff v Nepean Blue Mountains Local Health District [2021] NSWCA 107 (Makaroff), explored the scope of the duty of care surrounding the referral of a patient.

For present purposes, the facts of Makaroff can be briefly stated. A patient attended a hospital for treatment of a shoulder injury following an incident with a horse. She was given some treatment and told to see an orthopaedic surgeon.

The patient attended for orthopaedic review several months later and by that time the injury could not be repaired.

The patient commenced proceedings in the NSW Supreme Court against the hospital alleging negligent care. The trial judge found that the hospital had not breached its duty of care, however, the majority of the NSW Court of Appeal allowed the patient's appeal on the basis that the hospital had breached its duty of care by not advising the patient of the "urgency" of the need for orthopaedic consultation2.

The majority of the court found that had the urgency of the referral been conveyed, the patient would have attended in a timely manner for orthopaedic review and the injury could have been repaired resulting

in a better outcome. Accordingly, causation was established.

Optometrists refer a range of diseases, including those that are sight and life-threatening such as tumours and retinal detachments.

Makaroff is significant and instructive, as it establishes that for an optometrist to discharge their duty of care, the optometrist is not only required to use their professional and clinical judgment to appropriately refer a patient, but the urgency or timeliness of the referral should be communicated to the patient and the same should be well documented.

The immediacy of the referral will be influenced by a number of factors, but the potential medical and ocular consequences of delayed treatment (or further investigation) such as irreversible vision loss (or death if a life-threatening condition such as a brain lesion is suspected) should be at the forefront of an optometrists consideration when they are referring a patient.

Legal Disclaimer: The article is intended to provide general information but is not intended to constitute legal advice and should not be relied upon as such. Formal legal advice should be sought for particular matters and circumstances. Liability limited by a scheme approved under Professional Standards Legislation. n REFERENCES 1. See Dobler v Halverson [2007] NSWCA 335 at [60]-[61]. This article focuses on the NSW position.

Different legislation and case law will apply in other states and territories.

2. It should be noted that simultaneous proceedings brought against the patient’s general practitioner were dismissed as it was held that he had not breached his duty of care.

Name: Mr Bachier Mawassi Qualifications: LLB (Hons 1) B.Optom (Hons) Business: Seven Wentworth Selborne Position: Barrister and optometrist Location: 7th Floor, 180 Phillip Street, Sydney NSW 2000 Years in profession: Optometry – 17; Legal – 10.

THE URGENCY OR TIMELINESS OF THE REFERRAL SHOULD BE COMMUNICATED TO THE PATIENT AND THE SAME SHOULD BE WELL DOCUMENTED.

SEE YOURSELF DOING WHAT YOU LOVE

WORKING AT OPSM MEANS YOU’RE PART OF SOMETHING BIGGER. At OPSM, we are obsessed with eye care and offering our customers the confidence in how they see the world. Our advanced technology enables us to look deeper to ensure we give the best care to every customer. When you join OPSM, you work with world class technology including the Optos Daytona ultra wide field scanner.

You have many opportunities for continuing professional development through financially supported industry training, mentoring, graduate induction, peer learning communities and product training. You are rewarded with a competitive salary and bonus scheme to recognise your contribution. You have career flexibility through our extensive store network. Most importantly, you can make a real difference in the way people see the world not only from your consulting room but also by participating in our OneSight outreach program. #DoWhatYouLove

CONTACT OUR PROFESSIONAL SERVICES MANAGERS TO EXPLORE YOUR NEXT OPPORTUNITY: NSW/ACT – Amy Pillay Amy.Pillay@opsm.com.au QLD/NT – Brendan Philp brendan.philp@luxottica.com.au VIC/TAS – Melissa Downing melissa.downing@luxottica.com.au SA – Sophie Pym Sophie.Pym@luxottica.com.au WA – Mario Basso mario.basso@luxottica.com.au

Kahla Optometrist

NZ – Jonathan Payne jonathan.payne@opsm.co.nz

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