Insight November 2020

INSIGHT NOV

2020

Ophthalmology allegations most commonly relate to issues with surgery.

DEMYSTIFYING LENS COATING TECHNOLOGY Manufacturers and dispensers discuss market trends in this rapidly evolving field.

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NEW MEDICO-LEGAL COMPLAINTS DATA

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AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

PROFESSIONAL DEVELOPMENT OVERHAUL The groundwork has been laid for major changes to the optometry CPD standard.

AUSTRALIA 2020

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

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

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

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

INSIGHT NOV

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

SURGICAL ISSUES TOP LIST OF OPHTHALMOLOGY MEDICO-LEGAL COMPLAINTS IN AUSTRALIA

A snapshot of medico-legal matters against ophthalmologists insured by an Australian medical defence organisation has found claims for compensation and regulatory complaints most commonly relate to surgical issues involving cataracts, corneal operations and oculoplastic procedures.

demonstrating that ophthalmologists are more likely to be subject to a complaint than be sued.

other procedures on the cornea; and plastic procedures on soft tissue such as eyelids to treat blepharochalasis or ptosis.

Employment disputes accounted for 7% of matters, while 4% related to Medicare and 7% were classified as ‘other’.

The new ophthalmology-specific data collated by doctor-owned Avant, which provides medical indemnity insurance and medico-legal advice, also shows that one in nine ophthalmologists had a matter raised about their care in FY2018-19.

The organisation also conducted a retrospective review of routinely collected and coded data based on more than 120 matters involving its ophthalmologist members from across Australia. These were compensation claims and regulatory complaints indemnified and closed from July 2014 to June 2019.

Over a five-year period between July 2014 to June 2019, regulatory complaints (57%) and compensation claims (26%) were the most common legal matters received by the firm,

Within ophthamology claims and complaints, the most common type of issue was procedural or surgical.

A further breakdown of these cases showed 64% occurred at the intra-

Melissa Yee, Avant research and evaluation manager.

operative stage – such as allegations of poor surgical performance/skill/ competence – while 20% occurred at the pre-operative phase for issues like incorrect intraocular lens selection. The remaining 16% were post-operative issues.

Further, the most common types of procedures involving surgical allegations were; extraction and insertion of a lens; keratoplasty and

Ms Melissa Yee, research and evaluation manager at Avant, and Ms Eunice Ku, claims coding analytics manager, compiled and interpreted the data.

They said it was not surprising procedural/surgical issues were the main type of allegation, given the nature of ophthalmologists’ work.

“This is not dissimilar to other surgical specialties such as orthopaedic surgeons, general surgeons, and obstetricians and gynaecologists. Generally, we have found trends in medico-legal matters have some correspondence with the continued page 8

STAFF AND TAX INCENTIVES DOMINATE BUSINESS BUDGET Practices that employ and train new optical dispensers could receive up to $28,000 in annual wage subsidies, as part of Treasurer Josh Frydenberg’s Federal Budget plan that is set to generate jobs and investment across the ophthalmic sector.

In other measures, the government has created a new Pharmaceutical Benefits Scheme (PBS) listing for Eylea, streamlined the drug approvals process and committed research funding for a novel age-related macular degeneration (AMD) treatment.

Eligibility for adult children to remain as dependents on their parents’ private health insurance policies has also risen from 24 to 31 years.

Australasian College of Optical Dispensing director and senior trainer

Mr James Gibbins said practices could be eligible for a 50% trainee wage subsidy if they employ a new optical dispenser and enrol them in an accredited training college. The subsidy is only available for one year until September 30, 2021, to a maximum of $28,000 per employee.

“This will have a huge impact on our industry. Employers must respond quickly, or risk missing out,” he said.

For practices seeking equipment upgrades, Frydenberg announced until June 2022, businesses can deduct the full cost of newly purchased assets. The government is also allowing companies to offset losses against previous profits on which tax was paid, to generate a refund. A JobMaker

Hiring Credit up to $200 per week is now available for each job employers create over the next year for people aged 16 to 35.

Optometry Australia CEO Ms Lyn Brodie said: “In all, the Federal Budget is expected to benefit optometrists and optometry practices, primarily through tax cuts and investment incentives, and will support you in continuing to provide important community eyecare.”

She said it also funds a ‘continuous’ review of the Medicare Benefits Schedule (MBS), although the outcomes of the taskforce reviews into optometry and ophthalmology items are yet to be announced.

Australian Society of continued page 8

A ONE-STOP-SHOP Staff across Ocula’s independent optometry network grew tired of their intricate appointment booking system. It’s now been streamlined thanks to a new relationship with a health service platform that's also driving digital marketing to patients. page 33

www.sunglasscollective.com.au (03) 8202-4300 @sunglasscollective

IN THIS ISSUE NOVEMBER 2020

EDITORIAL

FEATURES

THERE’S CAUSE FOR OPTIMISM Maybe it’s tempting fate, but a topic worthy of discussion is the relatively good health of optometry businesses through COVID-19.

While I certainly can’t speak for all, many privately expect to breakeven or even turn a profit this year, despite Australia experiencing its first recession in almost three decades.

34

LENS TECH Lens coating technologies are creating opportunities for both patients and practitioners.

38

NICHE PRODUCTS A pharmaceutical firm explains why it has made preservativefree eye drops its mantra.

There’s no doubt April and May were dire, but the size of the rebound since then has surprised many, with practices and suppliers from June onwards reporting sales figures that have exceeded 2019 numbers.

It’s clear the government’s cash flow boosts, BAS refunds, JobKeeper and rent and loan deferrals have done their job to help avoid disaster, and new tax and staff incentives in the Federal Budget will be welcomed.

Which brings me to Victoria. By now it’s hoped metro Melbourne optometrists will be seeing early indicators of their own bounce back. Based on what was learned from the first lockdown, there is great cause for optimism, which means practices can hit the ground running with confidence around staffing, budgets and supplies.

For suppliers, the Victorian situation represents a second sales spike to make up on ground lost earlier this year. And the overall picture looks even better when you factor in the end-of-year health fund rush.

40

AN EVOLUTION A well-known lens brand details its transformation to appeal to a broader market.

42

CPD COUNTDOWN Find out how the sector has been preparing for an overhaul of the optometry CPD system.

Part of optometry’s resilience can be tied to the health aspect, supported by Medicare and health funds. But if there’s money left over, it’s unlikely to be spent on expensive holidays and luxury cars. Prudent practices will use this moment to futureproof their businesses.

Concerns remain about what will happen when the government support dries up and demand plateaus.

At least with what’s transpired, the sector appears to be in good shape to tackle the challenges of the year ahead.

EVERY ISSUE 07 UPFRONT

47 MANAGEMENT

09 NEWS THIS MONTH

48 CLASSIFIEDS

45 ORTHOPTICS AUSTRALIA

49 CALENDAR

46 DISPENSING

50 SOAPBOX

MYLES HUME Editor

INSIGHT November 2020 5

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

UPFRONT Just as Insight went to print, SPECSAVERS announced it’s ramping up its store opening program across Australia, with five initial new locations. The optical chain will add new stores in Seaford and Port Lincoln, South Australia, Warwick, Queensland, Newcastle and surrounds, NSW, and Belgrave, Victoria. “This is the first batch of new store locations we are announcing and we will publish more in the coming months. We also have an exciting program for expansion in existing

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WEIRD

stores too and these will see many more new ownership opportunities,” director of professional recruitment Mr Raj Sundarjee said. IN OTHER NEWS, a new University of Sydney study has found only half of all diabetics get recommended diabetes eye checks. The study, published in Clinical and Experimental Ophthalmology, linked data from the Sax Institute’s 45 and Up study with Medicare data to examine how frequently almost 25,000 diabetics in NSW had exams. Researchers found people with diabetes for 10 or more years were less likely to get regular checks, with almost 80% not having annual exams recommended for this

this group. FINALLY, Melbourne-based OCT manufacturer Cylite has won the Australian Engineering Excellence Award Victoria. It will represent Victoria this month for the Sir William Hudson award, the highest honour a project can receive from Engineers Australia. “This is a wonderful endorsement of the talented team delivering this exciting product. The combination of a unique approach to 3D ophthalmic imaging and diagnostics, with well-executed design and outstanding multi-disciplinary engineering, have delivered a product that we trust will prove worthy of this accolade over the years to come,” CEO Mr Steve Frisken said.

STAT

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WACKY

American singer-songwriter and television personality Kelly Clarkson revealed she has a serious dust allergy after appearing on her talk show wearing an eye patch. Although she didn’t detail her condition, dust got into her eye while filming for The Voice, on which she is a coach, causing irritation and infection, as well as a potential corneal abrasion.

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WONDERFUL

OrCam, a Jerusalem-based company developing handheld and wearable artificial vision devices for visually impaired people, has signed soccer star Lionel Messi as a global ambassador for three years. Messi posted the news on his social media accounts, saying he wants to bring awareness to technology that promotes equal opportunities.

Published by:

Publisher Christine Clancy

A fossilised embryo skull of a sauropod dinosaur has revealed it had forward facing eyes, unlike its adult counterparts. This suggests the dinosaur grew up in crowded forests where depth perception would help avoid predators. By adulthood, sauropods moved to open plains, where it’s more advantageous to have eyes on both sides of the head. n

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CPD CHANGES Therapeutically-endorsed optometrists – who account for 65% of all Australian optometrists – will need to complete 30 hours of professional development under new time-based CPD rules. Full report page 42.

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Retinal specialists have since confirmed it was an image of different phases of a fluorescein angiogram.

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INSIGHT November 2020 7

NEWS

COMMUNICATION AT ROOT OF COMPLAINTS continued from page 3

types of work involved,” Yee and Ku stated.

The review also identified other issues that can give rise to claims and complaints, such as communication with patients, billing, diagnosis and consent issues.

“In our experience, often when there are allegations of procedural or surgical issues, there can actually be shortcomings in the patient relationship/communication and/or the consent process. If a patient does not understand the treatment limitations, or the potential post-operative issues, it is not uncommon for them to be unhappy with the outcome and complain that the surgery was performed poorly,” Yee and Ku said.

An evaluation of expected standards found that, overall, doctors met the standard in 73% of cases, while 27% did not. However, it was noted that experiencing a medico-legal matter is often stressful, even if the care is appropriate, and can take years to resolve in some cases.

“Through our data, we can better understand the features, characteristics, or deficiencies in care that give rise to claims and complaints. By highlighting the common areas of risk which led to claims or complaints against ophthalmologists, we hope doctors are able to reflect on

their own practice and take steps to reduce their medico-legal risks," Yee and Ku added.

In other findings, the majority of diagnosis complaints were during the initial assessment stage, and included allegations of a missed or delayed diagnosis due to inadequate examination.

MANAGING EXPECTATIONS Recently, the Australian Society of Ophthalmologists joined other peak medical bodies in support of the new Informed Financial Consent: A Collaboration Between Doctors and Patients guide that aims to create greater medical fee transparency and prevent ‘bill shock’ for patients.

The organisation’s president and Sydney cataract and refractive surgeon Dr Peter Sumich said patients’ expectations can also give rise to complaints.

"MY STAFF HAVE BEEN TRAINED TO LISTEN TO THE VOICE IN THEIR HEAD IF THEY THINK A PATIENT MAY HAVE AN EXPECTATION MISMATCH" PETER SUMICH, CATARACT AND REFRACTIVE SURGEON

He said patients talk to friends who were spectacle independent after cataract surgery, but they don’t always realise every case has unpredictable individual variations and not all have the same visual requirements.

“And even more so with extra costs for enhancement with LASIK or supplementary piggyback lenses even when they were consented for prior. A recent patient mixed up the terms ‘supplementary’ and ‘complimentary’, which was interesting. In their minds their cataract procedure had become a refractive surgery. Whether it is a memory, language or a personality issue is irrelevant once the patient is in the chair going ‘full steam ahead’.”

He has adopted the mantra that five minutes’ extra chair time preparation can be worth an hour post-operation.

“We conduct staff discussions on any patient who has complained; in order to put procedures in place for future problems. My staff have been trained to listen to the voice in their head if they think a patient may have an expectation mismatch,” Sumich said.

RANZCO immediate past-president Associate Professor Heather Mack said complaints against doctors are a serious issue and understanding patterns is necessary to improve practice.

“RANZCO notes that the number of reported events would appear to be small for ophthalmology. RANZCO will continue to work with Fellows to improve outcomes and standards, including working with indemnity companies to explore complaints and events data,” she said. n

“I have occasionally had problems with standard cataract patients who become very hostile when faced with the need for glasses,” he said.

LESS RED TAPE TO BENEFIT EYE THERAPY PIPELINE continued from page 3

Ophthalmologists president Dr Peter Sumich said it would be interesting to see how insurers “juggle” the age extension for adult children on their parents’ policies.

“On the government’s figures, in 2019 around 500 patients accessed a comparable treatment. Without the PBS subsidy, patients may pay around $5,000 per year,” she said.

“Whilst it may increase the percentage of Australians covered it will also require increases to family health policy costs,” he said. “Minister Greg Hunt has [also] indicated that there is no appetite to damage existing service delivery models as part of the MBS review.”

“MDFA also welcomes the New Medicines Funding Guarantee and streamlining of TGA processes. This will enable new medicines to be listed faster and removes the requirement for cost offsets for new medicine listings on the PBS. This is potentially good news for new pipeline therapies for eye health.”

Macular Disease Foundation Australia (MDFA) CEO Ms Dee Hopkins said the budget included the PBS listing of Eylea from 1 October for subfoveal choroidal neovascularisation

RANZCO CEO Dr David Andrews said ophthalmologists would see support for their businesses through staff and tax incentives. “It is good to see additional funding for Aboriginal and Torres Strait

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INSIGHT November 2020

eyecare and regional hospitals and doctors, some of which is likely to be utilised by Fellows. RANZCO continues to advocate for measures to improve training and eye health in regional areas and we hope this may be further addressed in the next budget.”

due to pathologic myopia.

Dee Hopkins, MDFA.

ODMA CEO Ms Finola Carey welcomed the extension of the instant asset write off, which would include O=MEGA 21 purchases.

“It's a perfect time for practices to review their complete equipment suite and improve their customers' experience with the latest technology. Optical wholesalers can also take advantage of this to invest in new infrastructure to better serve practitioners and retailers,” she said. “Optical dispensing training subsidies should also help refill the qualified dispensing talent pool that has continued to drain since deregulation." n

NEWS

ALCON'S BREAKTHROUGH VIVITY IOL ARRIVES IN AUSTRALIA Alcon has officially ushered in what some Australian ophthalmologists are calling a new class in presbyopia-correcting intraocular lens (IOL) technology due to its ability to negate visual disturbances – the bane of many EDOF and multifocal IOL designs.

Australian surgeons got their first glimpse of the AcrySof IQ Vivity IOL at a virtual launch out of Sydney on 17 September hosted by media personality Ms Tracey Spicer. They were presented with findings of clinical trials and heard from leading ophthalmologists who have had early access to the lens, along with their patients.

The launch of Vivity, an extended range of vision IOL that uses non-diffractive design called X-Wave technology, has been highly anticipated after early adopters of the lens in Australia stated it could become their default lens for cataract surgery.

The virtual event featured presentations and a panel discussion with Associate Professor Chandra Bala, managing director at personalEYES, Associate Professor Michael Lawless from the Vision Eye Institute in Sydney, and Clinical Associate Professor Paul McCartney from Hobart Eye Surgeons.

Bala, who took part in a trial comparing Vivity with the Alcon Acrysof IQ monofocal, presented key findings from two US and global studies, which demonstrated how Vivity enables high-quality vision at far and intermediate ranges as well as functional up-close vision.

While patients may require spectacles for some near activities, a monofocal visual disturbance profile is said to be a key advantage for Vivity over other presbyopiacorrecting designs.

In his presentation, Bala showed that in bright light 94% of Vivity patients reported good or very good vision without spectacles for distance, which was comparable to Acrysof IQ patients (92%).

For intermediate, Vivity was superior with 92% reporting good vision compared with 63% for Acrysof IQ, and for up-close those numbers were 57% for Vivity and 25% for Acrysof IQ. In dim light, Vivity also performed better over all distances.

“So you are not only getting good distance vision, but the patient actually feels the quality of vision for intermediate is as good, and I think that’s an important

IN BRIEF "YOU ARE NOT ONLY GETTING GOOD DISTANCE VISION, BUT THE PATIENT ACTUALLY FEELS THE QUALITY OF VISION FOR INTERMEDIATE IS AS GOOD"

Associate Professor Chandra Bala, personalEYES.

take home message because the next question is what about visual disturbance, the one thing that plagues most presbyopia-correcting IOLs?” Bala said.

In another slide, Bala showed how Vivity offered a visual disturbance profile equivalent to a monofocal lens (Acrysof IQ). Overall, 74% of Vivity and 72% of Acrysof IQ patients were ‘not bothered’ by starbursts; 83% of Vivity and 89% of Acrysof IQ weren’t bothered by haloes; and for glare those numbers were 78% for Vivity and 70% for Acrysof IQ. Bala said Vivity had similar architecture to a monofocal, with a key difference being an added on component in the form of the X-Wave technology. It’s essentially a small shift in the lens in about one micron in thickness, affecting a 2.2mm-wide section in the centre of the lens.

Lawless, who has implanted 112 Vivity IOLs since December, labelled it “a new class of lens”.

“This is an evolution, if by evolution you mean that this does things that I can’t do with other lenses,” he said.

“The thing about the Vivity is its seamless quality, there is no hunting for the right focal lengths. It just seems normal to patients; they have described it to me as the vision they felt like they had when they were 35.”

He added: “It’s effectively taken the monofocal part of the practice, but it’s wrong to call it my default lens. The way I think about it is that I have to think of a reason why I would not use the Vivity lens in a particular patient, and it’s actually pretty hard to find a patient these days in my practice who I wouldn’t put a Vivity in.” n

CHANDRA BALA, CATARACT SURGEON

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ELECTIVE SURGERY

At the time of print, Victorian eye surgeons were on track to up their elective surgery capacity to 85% across public and private settings. For more than two months, surgeons were only permitted to perform urgent procedures, however a decrease in COVID-19 cases saw a return to 75% capacity on 28 September in metropolitan Melbourne. That was set to increase to 85% before the end of October, with plans to move to 100% of usual activity when the state moves to the last step to ‘COVID normal’, planned for 23 November. The Victorian Government is yet to unveil plans for an elective surgery ‘blitz’, which other states have already commenced.

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WHISTLEBLOWER RELIEF

Beijing’s city government has passed a new law to protect “non-malicious” medical whistleblowers, just months after Chinese ophthalmologist Dr Li Wenliang was punished for sounding the alarm on the pandemic. The Wuhan eye doctor became the most prominent medical whistleblower whom official accused of spreading rumours. He eventually died of the disease after contracting it from an asymptomatic glaucoma patient. The new law states that anyone whose tip-offs are later verified would be rewarded, and not penalised. However, the regulations do not cover people “fabricating or deliberately disseminating false information” about developing public health emergencies, according to a government notice.

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EYE TATOOS

Reports that a French kindergarten teacher lost his job after parents complained about his heavily tattooed appearance – including the sclera of his eyes – have prompted the American Academy of Ophthalmology (AAO) to warn against the unproven procedure. Dr John Hovanesian, clinical spokesperson for the AAO, told Ophthalmology Times that complications associated with eye tattoos could provide new challenges for ophthalmologists. “Our body’s skin is thick enough to absorb tattoo ink, but the eye is so thin, that even tiny tattoo needles will penetrate the surface causing permanent and painful blindness,” Hovanesian said. According to the AAO, scleral tattoos haven’t been studied medically or scientifically. The process also was not developed by a physician.

INSIGHT November 2020 9

NEWS

WHY FACE MASKS CAUSE DRY EYE, AND WHAT OPTOMETRISTS CAN DO TO HELP SUFFERERS Widespread use of face masks since the COVID-19 outbreak has giving rise to a new phenomenon in the ophthalmic world.

Mask-associated dry eye (MADE) is a new term that’s been coined in response to reports of ocular irritation and dryness among regular mask users and has been supported by a recent review published in the journal Ophthalmology and Therapy.

As a result, the Centre for Ocular Research & Education (CORE) at the University of Waterloo’s School of Optometry and Vision Science in Canada is advising eyecare professionals on how to recognise MADE and methods to mitigate the condition.

According to CORE, when a mask sits loosely against the face, exhaled air can move upwards, forcing a stream of air up and over the surface of the eye. This causes conditions that accelerate tear film evaporation, leading to dry spots on the ocular surface and discomfort.

“Face masks are crucial in the fight against COVID-19, and ECPs are wellpositioned to provide patients with advice on appropriate wear in order to maximise eye comfort,” CORE director Professor Lyndon Jones, a renowned contact lens and dry eye researcher, said.

“Asking patients about their mask-

Face masks are contributing to dry eye issues.

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

In addition to worsening symptoms in patients with pre-existing dry eye disease, MADE can also affect the elderly who typically have a poorer quality tear film, contact lens wearers, and masked people working extended hours in air-conditioned settings and/or while using digital screens.

"ASKING PATIENTS ABOUT THEIR MASK-WEARING EXPERIENCES AND PROVIDING A FEW HELPFUL TIPS TAKES LITTLE TIME AND CAN MAKE A SUBSTANTIAL DIFFERENCE" LYNDON JONES, CORE

•C onsider the role of the face mask if there are worsening symptoms in patients with confirmed dry eye, or if patients report dry, uncomfortable eyes or variable vision for the first time.

•R outinely ask all patients how their eyes feel while wearing a mask. Many may not think to volunteer their experiences or associate their symptoms with mask use.

•P rovide advice on alleviating symptoms, including using a new CORE-developed infographic to show how simple steps can provide relief and minimise reoccurrence.

TIPS FOR PATIENTS •E nsure masks are worn appropriately, particularly with spectacles or sunglasses. .

•A pply lubricating drops.

•L imit time in air-conditioned environments and take regular breaks from digital devices.

Jones said MADE may also encourage people to rub their eyes for temporary relief, increasing the likelihood of coronavirus infection through the mouth, nose, and to a lesser extent, the eye.

Jones said MADE should not be used to support anti-mask wearing sentiments.

“The good news is that we understand MADE and can address it. It's an opportunity for eyecare professionals to further communicate their knowledge and ongoing value to patients at a time when sound, scientific guidance is needed more than ever.” n

GUIDANCE FOR PRACTITIONERS Experts at CORE have suggested that eyecare professionals consider incorporating three MADE-related actions into their examination:

OPTOMETRY BOARD OF AUSTRALIA SETS FEE FOR 2020–21 The Optometry Board of Australia (OBA) registration fee has risen for a second year in a row to align with indexation and will now cost $317.

The authority announced the 3% increase for 2020-21, with optometrists paying $9 more for than last year when fees also rose 2.5% to $308.

$415 in 2012-13.

According to the OBA, its decision to increase the fee by indexation for the 2020–21 period ensures the it has sufficient income to carry out its duties and protect the public.

The annual renewal for practitioners whose principal place of practice is New South Wales, which is a co-regulatory jurisdiction, is also $317.

“The board is committed to keeping the fee as low as possible, while meeting its regulatory obligations to protect the public.

To achieve this in past years we have been able to reduce or hold fee increases,” OBA chair Mr Ian Bluntish said.

Until last year, optometrists enjoyed a consistent fee of $300, which was first imposed in 2016-17 and frozen for two years. Prior to that, the sector saw consecutive price drops from a high of

“The board recognises that this is a challenging time for health practitioners and sincerely thanks practitioners for their continuing commitment and professionalism.”

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INSIGHT November 2020

The fee is now $317.

Optometry was one of eight disciplines to experience a 3% fee hike, along with dental ($701), medical ($811), medical radiation practice ($197), nursing and midwifery ($180), occupational therapy ($116), pharmacy ($420) and physiotherapy ($148).

Australian Health Practitioner Regulation Agency (AHPRA) CEO Mr Martin Fletcher said registration fees cover the costs of the National Scheme and regulation of the 16 professions. AHPRA works with National Boards to ensure the fees set allow it to perform its duties to ensure the community has access to a safe care. The renewal fee applies from 18 September and for most covers the registration period of 1 December 2020 to 30 November 2021. n

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NEWS

EYE DOCTORS COMMIT TO BILL TRANSPARENCY The Australian Society of Ophthalmologists (ASO) has joined other peak medical bodies in support of a new guide that aims to create greater medical fee transparency and prevent ‘bill shock’ for patients.

The ASO is one of 29 medical groups that has subscribed to the Informed Financial Consent: A Collaboration Between Doctors and Patients guide, which has been spearheaded by the Australian Medical Association (AMA).

The guide is intended for practitioners to give to patients, so they have the confidence to discuss fees with their doctors before treatment, reducing the chance of unexpected bills.

ASO president Dr Peter Sumich said the catalyst for the guide was a series of news reports of urologists and orthopaedic surgeons whose charges were many multiples higher than their colleagues.

There were also occasional cases in which grossly overcharging surgeons have caused financial harm to patients.

“This does not occur in ophthalmology because the out-of-pocket expenses are relatively small. However, it does identify a problem for consumers that a fair fee may be hard to determine,” he said.

“The first requirement is for patients

Unexpected gaps are stressful for patients.

to understand their billing and out-ofpocket costs. The second is to be aware that getting a second quote is not an unreasonable option.”

Sumich said the most common grievance among patients was unexpected out-of-pocket expenses. When patients are informed pre-operatively, he said they are more accepting due to there being no surprise element.

"[IT] SENDS A VERY STRONG SIGNAL THAT THE WHOLE MEDICAL PROFESSION IS COMMITTED TO GREATER TRANSPARENCY ON FEES" OMAR KHORSHID, AUSTRALIAN MEDICAL ASSOCIATION

which is available through the ASO website. The submission outlines how insurance could be improved and made fairer. Unfortunately, despite the senate committee finding in favour of these recommendations, the PHI have not changed their current gap cover policies.”

Sumich said most ophthalmologists already have an informed financial consent document. The AMA guide provides a template for educating patients on their rights and the causes of out-of-pocket costs.

AMA president Dr Omar Khorshid said out-of-pocket medical bills are not the major cause of discontent for patients, but unexpected gaps were.

“The fact that all these groups have agreed to partner on this guide and promote it to their members and patients sends a very strong signal that the whole medical profession is committed to greater transparency on fees and the cost of quality medical care and treatment," he said.

However, he believed such complaints were worse than previously because private health insurers (PHI) were not adequately indexing their contributions.

“It is rare to see such a convergence of support for a single document, and demonstrates that the Informed Financial Consent guide is seen as a major step in building health financial literacy for patients." n

“The PHI gap policies have become exclusionary and punitive to patients who wish to choose their own doctor. I authored a full submission to a senate committee on out-of-pocket-costs

PROMINENT SPECSAVERS FIGURE RETURNS TO AUSTRALIA Mr Peter Larsen, who was instrumental in bringing Specsavers to Australia 13 years ago, has returned to Melbourne after moving to the company’s UK headquarters to serve as its first-ever group eye health strategy director.

UK to implement the eye health model pioneered in Australia and New Zealand in Specsavers’ other markets.

In his new role, Larsen will continue to work on eye health strategies across the Specsavers group, maintaining a special focus on glaucoma, diabetic eye disease and other sight threatening conditions.

Commenting on these developments, Specsavers co-founder Mr Doug Perkins said: “We are all excited for Peter and his new role where he continues to bring energy to eye health advancement at Specsavers while embarking on some exciting projects within the industry focusing on how optometry continues to evolve to meet the needs of patients and stakeholders in the future.”

He will also assume other roles with third party organisations. Initially, this will include forming a new Health Services Research Unit at the Centre for Eye Research Australia (CERA) and working with equipment suppliers to explore and test eyecare technology.

Last year, Larsen moved from Melbourne to take up the group eye health strategy director position. In that role, he was based in Guernsey in the

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INSIGHT November 2020

collaboration with RANZCO to develop a series of patient referral pathways.

He has returned to Australia – where much of his family is located – due to COVID-19.

Larsen was instrumental in bringing the company to Australia in 2007. In his time, he has implemented a systematic eyecare model across Australian and New Zealand markets encompassing use of OCT as part of the standard eye test, and

Peter Larsen, Specsavers.

Alongside this, he has developed professional benchmark reporting on customer centric commercial outcomes in parallel with all eye conditions, including detection and referral rates per condition down to each individual optometrist. This is said to have created an environment for self-directed training and professional development for optometrists to improve patient outcomes.

As a board member of CERA from 2012 to 2019, he worked on the ideation and seeding of the e-referral Oculo platform and other key health initiatives.

Larsen added: “I am excited to continue to help Specsavers evolve it’s groupwide eye health strategies whilst working with other industry bodies on developing sustainable care models and eye health outcomes for patients of the future.” n

DISRUPT INFLAMMATION IN DRY EYE DISEASE 1–3

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

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

PBS Information: This product is not PBS listed.

See approved Product Information before prescribing.

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

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

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

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

AU-13851. McCann Health NOXI19693M. September 2020.

NEWS

WORLD CONGRESS OF OPTOMETRY POSTPONED UNTIL 2023, BUT O=MEGA21 STILL GOING AHEAD The 4th World Congress of Optometry (WCO4), scheduled to be held in Melbourne alongside O=MEGA21 next year, has been postponed until 2023.

O=MEGA21, however, will continue as planned for an Australian and regional audience between 2-4 September 2021 at the Melbourne Convention and Exhibition Centre.

The World Council of Optometry (WCO), Optical Distributors and Manufacturers Association of Australia (ODMA) and Optometry Victoria South Australia (OV/SA) announced the postponement of WCO4 in a joint statement due to uncertainty and the economic impact of COVID-19.

Combined, the congress and O=MEGA21 were expected to generate as much as $12 million for the Victorian economy. WCO4 will now take place from 8-10 September 2023 in Melbourne with O=MEGA23, without needing to retender for hosting rights of the global event.

OV/SA president Ms Elise PockneeClem said it was a simple decision for all three boards to delay the WCO4 component of the 2021 program.

“Many private optometrists from overseas have experienced shutdowns, as we have in Australia, and the

The congress and O=MEGA21 were expected to generate $12 million for Victoria.

economic impact of closures may have a flow on effect limiting practitioners’ ability to travel abroad for CPD next year,” she said.

"BECAUSE OF THE STRENGTH OF OUR RELATIONSHIP WITH ODMA AND OV/SA WE REMAIN CERTAIN THAT MELBOURNE IS THE BEST PLACE TO HOLD WCO4" PAUL FOLKESSON, WORLD COUNCIL OF OPTOMETRY

“Also, significant periods of lockdown and inconsistent ‘opening up’ protocols could impact the capacity of attendees to commit to international travel in the short term. This, and the impact on the university and not-for-profit sectors, and the difficulty in predicting the timing for the ‘end’ of the pandemic meant that we needed to act decisively.”

there will be no need to retender for the congress,” he said.

OV/SA CEO Mr Pete Haydon said WCO4 was a hard-won piece of business for Australia, so he was happy it would return in 2023.

“It was a huge undertaking, so I’m pleased we didn’t have to retender. The Melbourne Convention Bureau, which is funding part of the event, is also continuing to support the bid in 2023,” he said.

ODMA chairman Mr Robert Sparkes said given O=MEGA21 is a year away, ODMA wanted to provide certainty about the event, with the welfare of attendees in mind.

The event is the largest eyecare and eyewear trade show and conference in the Southern Hemisphere.

WCO president Mr Paul Folkesson said the decision was in the best interests of stakeholders.

“We’re already working with the venue to ensure a really wonderful second iteration of O=MEGA. It has always been our intention to develop the O=MEGA product into a truly regional event for Australia and our near neighbours,” he said.

“Because of the strength of our relationship with ODMA and OV/SA we remain certain that Melbourne is the best place to hold WCO4, and as such

“Now we have one more opportunity to do that in September 2021 before we open up for the whole world to come and enjoy Australia in 2023.” n

GLAUCOMA TREATMENTS CHANGE HANDS UNDER MERGER A proposed merger between two pharmaceutical companies that compete in the glaucoma treatments market has been given the green light – with one stipulation.

The Australian Competition and Consumer Commission (ACCC) has accepted a proposed merger between Mylan and Pfizer-owned Upjohn – whose combined businesses will be renamed Viatris – on the condition that they sell three off-patent branded pharmaceuticals to appease competition concerns.

The off-patent products supplied to pharmacies and hospitals to be sold include two anti-glaucoma treatments with the active ingredients latanoprost and/or timolol, under the brand

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INSIGHT November 2020

Upjohn are currently the only suppliers of amlodipine/atorvastatin, meaning the proposed merger would make the combined new firm, Viatris, the only supplier in the Australian market.

names Xalatan and Xalacom, and a cardiovascular treatment containing amlodipine/atorvastatin.

The ACCC has approved Aspen as the buyer, ensuring competition that would have been lost as a result of the merger will be replaced by competition from Aspen.

The ACCC was concerned the merger would significantly reduce competition for the supply of pharmaceutical products based on the active ingredients.

“For medicines based on latanoprost and latanoprost/timolol, we were concerned that remaining competitors would not be a sufficient constraint on the merged entity,” ACCC commissioner Mr Stephen Ridgeway said. “Mylan and

Aspen is the approved buyer.

“Caduet, Xalatan and Xalacom are well established brands, and will provide the buyer with a strong opportunity to compete against the new combined firm."

The merger is part of a global transaction being considered in other jurisdictions. In Australia, Mylan supplies approximately 350 generic pharmaceuticals and more than 450 branded, biosimilar medicines and over-the-counter remedies, while Upjohn supplies 18 brands which are sold as off-patent products. n

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NEWS

OSCAR WYLEE PENALISED $3.5 MILLION OVER ‘BUY A PAIR, GIVE A PAIR’ CHARITY CLAIMS Eyewear retailer Oscar Wylee has responded following the conclusion of Federal Court proceedings in which it was penalised $3.5 million over misleading claims related to its charitable activities.

The ruling was handed down in the Federal Court on 18 September after the company, which has 60 stores, was found in breach of Australia Consumer Law (ACL) following prosecution by the Australian Competition and Consumer Commission (ACCC).

Oscar Wylee admitted that over a five-year period to December 2018 it made statements in its social media posts, emails, website, and promotional merchandise that for each pair of glasses a consumer purchased, it donated another pair of glasses to someone in need, when it did not do so.

Over that time, Oscar Wylee was found to have sold 328,010 pairs of glasses but donated only 3,181 frames to charity, without lenses.

“Oscar Wylee promoted its charitable activities as a core reason why consumers should buy Oscar Wylee glasses, but its claims were false and were made in circumstances where

The Federal Court approved a settlement agreed between the ACCC and Oscar Wylee.

consumers could not easily verify these claims for themselves,” ACCC deputy chair Ms Delia Rickard said.

“The misleading conduct also portrayed Oscar Wylee as a sociallyconscious company that made significant donations of glasses to people in need, which, because this was not true, unfairly differentiated it from other brands in the market.”

"THE MISLEADING CONDUCT ALSO PORTRAYED OSCAR WYLEE AS A SOCIALLYCONSCIOUS COMPANY THAT MADE SIGNIFICANT DONATIONS OF GLASSES TO PEOPLE IN NEED" DELIA RICKARD, ACCC

The company also admitted making false or misleading representations about an affiliation with Rose Charities.

Its association with the charity consisted of a single donation of $2,000 and 100 frames in 2014, despite claiming an affiliation until late 2018. It also published a promotional video, which claimed

support of eye tests, distribution of glasses, cataracts and eye doctor training. The video showed scenes of poverty in Cambodia, Rose Charities’ eye clinic in Cambodia, and stated “every Oscar Wylee glasses purchase will help restore vision in developing regions”.

Justice Katzmann said Oscar Wylee "built its reputation by engaging in the contravening conduct, appealing to socially-conscious consumers who wanted to support charitable causes through their purchasing behaviour. Its conduct was a betrayal of that promise".

In a statement, Oscar Wylee said it had taken corrective action in response to the court action and in line with its ongoing commitment to corporate social responsibility. “We have donated 336,585 pairs of glasses frames and $80,000 cash donations to charities supporting eyecare for the disadvantaged. We have also adopted a strict Trade Practices Compliance Policy, directed to the protection of consumers, and appointed a Compliance Officer responsible for its implementation. Oscar Wylee acknowledges the importance of the issues raised by the ACCC and sincerely regrets the contraventions of the ACL.” n

TGA APPROVES 'FIRST PHARMALOGICAL THERAPY' FOR PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY For 40 years laser therapy has been the standard treatment for proliferative diabetic retinopathy (PDR), but now Australian ophthalmologists have a new option following regulatory approval of an existing drug.

Novartis has announced the Therapeutic Goods Administration approval of Lucentis (ranibizumab) for treating PDR in adults. It is the first pharmacological therapy in Australia for the visionthreatening complication of diabetes – and the sixth indication for Lucentis.

Until now, panretinal laser photocoagulation (PRP) has been the standard treatment for PDR but can result in permanent side effects, and impact peripheral vision. Regulatory

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INSIGHT November 2020

approval of Lucentis was based on findings from a multicentre, randomised, active-controlled, parallel-assignment, non-inferiority Phase 3 study in which 305 patients with PDR, with or without diabetic macular oedema (DME) at baseline, were enrolled.

The study compared ranibizumab 0.5 mg intravitreal injections to standard treatment with PRP. Analysis of results at two years, with an additional follow-up with 66% of study participants at five years, favoured Lucentis over laser treatment and indicated a potential to prevent PDR disease progression.

Clinical Associate Professor of Sydney University and vitreoretinal ophthalmologist

and surgeon, Dr Andrew Chang, said ophthalmologists welcomed the approval.

Many with diabetic retinopathy progress to PDR.

“Study data shows that Lucentis is effective for improving the severity of retinopathy and treating complications due to proliferative retinopathy in addition to macular oedema,” he said.

Statistics show diabetic retinopathy is one of the top five causes of irreversible blindness among Australians and the leading cause of blindness in working age adults worldwide. It can worsen over time from the non-proliferative form (NPDR) to the vision-threatewning form, PDR. Without treatment, 50% with very severe NPDR progress to PDR within a year and 25% of people who have had diabetes for 15 years will have PDR. n

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NEWS

OPTOMETRIST’S SCHEME CONTINUES TO SUPPORT DEVASTATED BUSHFIRE TOWN A Queensland optometry couple who initiated a scheme to adopt a bushfire-affected community say the cause is now supporting more than two dozen people, with many still living in tents and temporary accommodation 10 months on.

Richard and Gwen Watt, who own and operate Richard Watt Optometrist in Hervey Bay, launched the Hervey Bay Adopt Fire Affected Families (HBAFAF) project in January. The initiative provides $100 monthly payments to 25 people across 14 families in the New South Wales South Coast community of Conjola, which lost 89 homes last summer.

The regular payments are designed to top up government handouts until mid2021 and provide relief to people whose lives were upended in the disaster.

Mrs Gwen Watt said many Conjola residents supported by the HBAFAF project were yet to get their lives back on track.

“They are very overwhelmed and appreciative – it makes a difference in their lives. Having money they don’t need to get approved and which they know is going to be there is a great help because they’re still jumping through hoops to get their homes rebuilt,” she said.

“It’s got to the state now where we need to help more people if we can. There are people who are still homeless and living in tents, while others who were lucky enough to get temporary accommodation at the time, now face losing that.”

The Watts kicked off the project earlier this year by pledging 1% of their business’ monthly gross income for 18 months. Since then, around 50 Hervey Bay residents have joined the cause with regular contributions.

CAMPAIGN TARGETS OVER-50 AUSSIES AT-RISK OF AMD "CHECK MY MACULA MAKES PERSONALISED RISK INFORMATION ABOUT AUSTRALIA’S LEADING CAUSES OF VISION LOSS QUICK AND EASY" DEE HOPKINS, MDFA

A new campaign aimed at motivating Australians in their 50s to visit optometrists for a macula check was launched last month after it was revealed most in this age group are unable to identify risk factors for macular disease.

Created by Macular Disease Foundation Australia (MDFA), the Check My Macula initiative includes an online risk assessment quiz for Australians over 50, which also allows people to book directly with an optometrist or schedule a reminder for an eye exam.

The MDFA is directing its efforts towards this age group after a recent survey found one in seven Australians over the age of 50 have early signs of age-related macular degeneration (AMD). However, many may not know it until it’s too late.

The MDFA campaign will feature social media tiles like this.

The organisation’s CEO Ms Dee Hopkins said the statistics also showed more than 80% of people in their 50s know they should have an eye exam every two years but almost 40% gamble with their sight by skipping it.

With a shared goal of preventing macular disease, MDFA has prepared a digital toolkit that contains material eye health professionals can share with their patients in support of the campaign.

Additionally, only one in 10 Australians in their 50s can properly identify the major risk factors for AMD; age, family history, smoking and lack of regular eye exams.

The MDFA’s Check My Macula campaign involves a one-minute, fivequestion quiz to help Australia’s over-50s quickly and easily identify their risk factors

Ophthalmic equipment company Zeiss has unveiled a new slit lamp imaging system for Australian eyecare professionals.

The Watts say they have been hearted by the Hervey Bay community’s response.

“We have a donation tin on our front counter and just [recently] someone put $600 in there anonymously,” Mrs Gwen Watt added. n

The software and hardware design mean that both the actual exam and documentation occur at the same time, so eyecare professional can

INSIGHT November 2020

Channel 7 Sunrise Showbiz Editor Mr Nelson Aspen, 57, and Australian radio presenter Mr Brendan Jones, 52, are ambassadors for the initiative, along with award-winning journalist Ms Melissa Doyle and rugby league commentator Mr Andrew Voss. It will also be supported by a television campaign voiced by MDFA ambassador Ms Jean Kittson and Aussie entertainer Mr Shane Jacobson. n

ZEISS HAS LAUNCHED A NEW SLIT LAMP IMAGING SYSTEM

The SL Imaging Solution works to improve slit lamp examinations by integrating high-quality 18-megapixel images and high definition video capture into exam reports. The technology allows the for documentation of cases for patient education, teaching or publishing.

18

for macular disease.“Check My Macula makes personalised risk information about Australia’s leading causes of vision loss quick and easy to access,” Hopkins said.

remain focussed on the patient.

“Compatible with the entire current range of slit lamps from Zeiss, including the brand-new SL 800 slit lamp models, this all-round imaging solution integrates with the Forum data management solution, giving you the option to seamlessly add slit lamp imaging into your workflow on a preferential basis,” a Zeiss Australia and New Zealand spokesperson said.

“One-click data export makes it convenient to add reports, images, and videos to the digital patient record, streamlining the daily workflow for all kinds of practice set-ups.” n

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From September 2020 Biotrue® ONEday for Astigmatism will be availablein 2,398 parameters, including -2.75 cylinder power.

For more information — contact your Bausch + Lomb Territory Manager or Customer Service 1800 251 150. *Among daily disposable contact lenses References 1. ACLM (2019) ACLM Contact Lens Year Book 2. Favata L.L. (2012) A Study to Evaluate the Product Performance of a Daily Disposable Soft Contact Lens. Final Study Report. #700. Bausch & Lomb Incorporated. 07. DEC. 3. Data on file. (2012) RE: ROC2-11-63.

19. Jan 4. Tomy Lo, Ph.D., Osbert Chan, Ph.D., Bill Reindel, O.D., M.Sc., Rob Steffen, O.D., M.Sc., (2020) Non-Invasive Tear Break-Up Time Evaluation of Six Unique Daily Disposable Lens Materials After 10 Hours of Wear. Presented at Global Specialty Lens Symposium at Las Vegas on 22- 25 Jan 2020 5. Data on file. (2011) Hypergel Surface Characterization Memo. 21.OCT. © 2020 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) BOD.0042.AU.20

NEWS

RACE TO IDENTIFY INHERITED RETINAL DISEASE PATIENTS FOR IMMINENT GENE THERAPIES Australian researchers are using genetic testing to identify as many people as possible with inherited retinal disease (IRD), in preparation for an influx of lifechanging gene and stem cell therapies expected over the next decade.

The IRD Natural History project is a new collaboration between the Centre for Eye Research Australia (CERA) and the University of Melbourne (UniMelb), which aims to create a clinical database of Australians suitable for an IRD treatment.

Dr Lauren Ayton, a senior research fellow at UniMelb, is leading the study with CERA’s Dr Thomas Edwards.

She said historically there were limited treatment options for people with IRD. To some extent, this led to them “falling off the radar” because they were often not reviewed regularly by eyecare practitioners.

However, recent advances, including approval of the first ever direct-to-human gene therapy Luxturna, and emerging technologies such as stem cells, gene editing (CRISPR) and pharmaceuticals, meant it was important to identify patients who may benefit once they’re available.

At the same time, Ayton says it is vital to learn more about the natural history of IRDs to determine whether the new treatments are effective.

The IRD Natural History project is a collaboration between CERA and the University of Melbourne.

“Luxturna has very recently been approved for use in Australia by the Therapeutic Goods Administration, after an outstanding advocacy campaign by clinicians, researchers and the IRD community,” she said.

"THERE ARE OVER 300 KNOWN IRD GENES, AND IT IS ESSENTIAL THAT AN INDIVIDUAL’S GENETIC MUTATION IS KNOWN FOR MANY OF THE NEW TREATMENTS" LAUREN AYTON, UNIVERSITY OF MELBOURNE

“We really do see this as ‘opening the floodgates’. The success of Luxturna has encouraged other academic and industry projects, and there are over 20 international clinical trials of IRD gene therapy under way at present. It is very likely that we will see a number of gene therapy treatments approved in the next 10 years, for different types of IRDs.”

challenging aspects of diagnosis is that many IRD subtypes look similar clinically.

For example, she said ‘retinitis pigmentosa’ is often referred to, but is really an umbrella term for many different types of disease.

“There are over 300 known IRD genes, and it is essential that an individual’s genetic mutation is known for many of the new treatments, as well as for family planning and clinical care. The race is now on to perform genetic testing on as many people with IRD as possible, in preparation for the rollout of new therapies,” she said.

The study is seeking people with any known IRD. As part of the study, participants will receive a comprehensive eye examination and access to research-grade genetic testing. The study is funded by several government and philanthropic grants, including an NHMRC Investigator Grant to Ayton and support from the CASS Foundation and the Angior Family Foundation.

The IRD Natural History project will also work with colleagues at other ophthalmology research centres, including the Lions Eye Institute in Perth and Save Sight Institute in Sydney, and the Australian Inherited Retinal Disease Register DNA bank. n

There are an estimated 16,500 Australians currently living with an IRD. According to Ayton, one of the most

WA GOVERNMENT SUPPORTS NEW BROOME EYE CLINIC A $4.7 million Western Australian Government investment will help employ an eye health workforce at the underconstruction Northwest Hub – the first permanent eye clinic in the sparse Kimberley region.

Lions Outback Vision (LOV) is transforming the former backpacker accommodation into a new eyecare facility in Broome, featuring at least two resident ophthalmologists available for 24-hour emergency support.

WA Premier Mr Mark McGowan recently visited the Broome facility to announce the funding as part of a $110.9 million Kimberley Recovery Plan. Along with ophthalmologists, the Northwest Hub will employ optometrists, Aboriginal health workers, nurses and offer training in rural medicine for junior doctors and optometrists. They will treat cataracts, trachoma, diabetic retinopathy and glaucoma, while also supporting people with low vision and permanent blindness.

Through a hub-and-spoke model, the centre will also service six towns through outreach services, while providing access to ophthalmology and telehealth clinics, seminar rooms and open space for community diabetic health education.

“We are very grateful that the WA government is supporting the people in the team to make the Lions Outback Vision Northwest Hub a reality,” Dr Angus Turner, McCusker Director of LOV, part of the Lions Eye Institute (LEI), said.

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INSIGHT November 2020

Dr Angus Turner, Lions Outback Vision.

“Construction of the facility in Broome is on track with Federal Government funding. And the extraordinary equipment donations from Zeiss, Topcon, Novartis and Alcon will enable retinal surgery and other state-of-the-art ocular diagnostics and treatment.”

Traditionally, patients in the region were treated through a fly-in fly-out service model. There was also no resident ophthalmologist north of Geraldton, 1,900km south of Broome.

Turner said the area had major eye health challenges with many also treated through a Vision Van and regional clinics.

Some of the LOV team are already based in Broome in a temporary clinic while the hub undergoes refurbishment. n

NEW 1

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ciclosporin 900 microgram/mL

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

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

PBS Information: This product is not PBS listed

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

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

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

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

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

NEWS

NEW BOOK PUTS A POSITIVE SPIN ON LIVING WITH LOW VISION

SAFILO INTRODUCES NEW MISSONI COLLECTION Safilo has unveiled the latest female collection from Italian luxury fashion brand Missoni to the Australian optical market.

At two recent virtual launch events out of Sydney, Safilo Australia launched the range comprising 30% sunglasses and 70% optical, which are available in 33 styles and 161 colours.

The collection is said to feature premium quality materials in the distinctive colour combinations and modern reinterpretation of Missoni’s iconic textures. The optical price point ranges from $260 to $420, while sunglasses are $310 to $420.

Missoni has split the range into a heritage and seasonal collections, featuring cat-eye wraparound sunglass, squared sunglasses, butterfly sunglasses, pilot sunglasses and squared optical frames designs.

“The contemporary yet timeless elegance of the new eyewear collection, echoing a seventies-inspired feeling, is mirrored in the oversize squared or rounded shapes, proposed as modern reinterpretations of the frames from the Maison’s archives,” Safilo stated.

“Innovative technologies and graphic designs define the utmost lightness of the architectures, highlighted by unique colour combinations, in a balanced mix of transparencies in the materials and refined coloured textures.”

According to Safilo, Missoni’s signature knitted graphic patterns – such as the distinctive zig-zag – are a distinguishing feature of the new collection.

These have been enhanced thanks to innovative manufacturing techniques: either with the authentic Missoni fabrics incorporated into the frames or stylised into graphic textures on the lenses. They also feature on the acetate temple-tips.

"AFTER RETIRING, I FELT THAT MY EXPERIENCE MIGHT HELP A LOT OF PEOPLE LIVING WITH LOW VISION" KEN BRANDT, AUTHOR

An American-born IT consultantturned-author credits two Australian ophthalmologists with restoring limited vision in his right eye, allowing him to write a book on living with low vision.

First-time author Mr Ken Brandt’s new book Positive Vision: enjoying the adventures and advantages of poor eyesight, launched on 18 September, and is an upbeat exploration of how he manages life with poor vision.

“I was born premature and had poor vision as a result. I have slightly crossed eyes and have been on a roller coaster with my vision my whole life,” Brandt said.

He has had six eye operations, including a detached retina and cataract operation in each eye, and spent parts of his life legally blind. Brandt credits Melbourne cataract surgeon Dr Mark Troski and retinal specialist Dr Daniel Chiu with helping restore his vision.

“Both had been watching the cataract in my right eye get slowly worse over the years. During a check-up with Dr Chiu he recommended that I see Dr Troski and that now would be a good time to have the cataract operation on my right eye.

Based on his recommendation I saw

Prior to retiring and becoming an author, Brandt held senior management and management consulting positions in information technology and information security. He initially showed his manuscript to his friends before reworking it and handing it to a freelance editor for The New York Times.

“I never wanted to discuss my vision or what it was like to live with low vision, until now,” Brandt said. “I could see much worse than most people realised – worse than everyone else I knew. I didn’t want to discuss it, but after retiring, I felt that my experience might help a lot of people living with low vision. n

Patients of Australian optometry practices that are linked with the MyHealth1st appointment booking platform now have access to a buy now, pay later (BNPL) payment option.

BNPL company OpenPay recently formed a three-year strategic partnership with 1st Group Limited, which owns MyHealth1st. The agreement sees Openpay’s BNPL service available to patients of health practices that offer the MyHealth1st digital portal.

Under the partnership, Openpay will market the MyHealth1st platform to existing healthcare practices within its merchant network.

The agreement will involve a phased rollout of OpenPay’s service across the MyHealth1st network.

The collection is now available to Australian optical professionals. n

This would begin with around 60 sites in the first half of FY21 and is

INSIGHT November 2020

Dr Troski, he agreed and performed the successful operation,” Brandt said.

MYHEALTH1ST FORMS ALLIANCE WITH BUY NOW, PAY LATER FIRM

The collection features colours from the Missoni colour palette, such as rusty orange, as in the shades of the lenses or in the exclusive Havana colours of the acetates, as well as the natural shades of pink, green and blue.

22

Ken Brandt's new book on living with low vision.

MyHealth1st and OpenPay have joined forces.

likely to expand further, subject to the performance of the initial phase.

“The benefit to practices participating is expected to be increase basket size – that is, value of the services and products provided by practices – and increased patient bookings which together will drive revenue growth,” 1st Group stated.

Openpay will also market the MyHealth1st platform to existing healthcare practices within its merchant network. n

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1. Lemp, M.A., Crews, L.A., Bron, A.J., Foulks, G.N. and Sullivan, B.D., 2012. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea, 31(5), pp.472-478.

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NEWS

UNSW CEMENTS PARTNERSHIP TO DEVELOP NOVEL THERAPEUTIC CONTACT LENSES Sydney researchers are collaborating with Uka Tarsadia University in India to investigate using contact lenses as drug delivery systems for common ocular diseases like glaucoma, dry eye and myopia.

Professor Mark Willcox from UNSW’s School of Optometry and Vision Science was instrumental in establishing the partnership.

“Ocular diseases are usually treated using eye drops, but unfortunately these often do not deliver enough drug or have the drug resident on the eye for long enough,” Willcox said.

Using contact lenses to deliver the drugs can overcome these problems and may be able to treat diseases such as glaucoma, dry eyes, conjunctivitis, myopia development and macular degeneration, he said.

Uka Tarsadia is a private university established in 2011; the affiliated Maliba Pharmacy College is the centre of collaboration with UNSW. Dr Furqan Maulvi, who is from Maliba Pharmacy College and has published several key papers on contact lenses and drug delivery, said he was looking forward to working with UNSW to develop novel therapeutic contact lenses to treat anterior and posterior eye diseases.

The partnership involves staff and students from both universities going on exchange to work on the collaborative project.

Academics will participate in research, co-supervise postgraduate students, and give lectures and tutorials in the research area.

Students will also work alongside clinical scientists in emerging areas of research in contact lenses, drug delivery and the ocular surface.

Dr Alex Hui from UNSW’s School of Optometry and Vision said the partnership would allow for complementary collaborations between engineers, pharmacists, optometrists and chemists.

“It comes at a critical time where research interest in managing diseases such as dry eye and myopia development is increasing both from clinicians and patients,” he said. n

24

INSIGHT November 2020

AUSSIE-ENGINEERED CORNEA AIMS TO SUCCEED WHERE OTHERS FAILED "THEY WILL BE ABLE TO ORDER ONE OF THE READY-MADE PRODUCTS OFF THE SHELF, OR EVEN ONE THAT IS CUSTOMISED SPECIFICALLY FOR THEIR EYE" GERARD SUTTON, UNIVERSITY OF SYDNEY

Electromaterials experts are working with Sydney ophthalmologist Professor Gerard Sutton to develop a bioengineered cornea and supporting collagen fibres to overcome two major issues with corneal transplantation.

The ARC Centre of Excellence for Electromaterials Science (ACES) at the University of Wollongong is collaborating with Sutton to develop the cornea, which centres on an electro-compaction technique. There are hopes it may overcome supply and rejection issues associated with corneal transplantation.

ACES director Professor Gordon Wallace said collagen had been identified as a critical factor in the success of the technique.

The bioengineered cornea is strengthened through electro-compaction. Image: ACES.

compaction to achieve the combination of properties, which has resulted in “beautifully aligned collagen fibres, and bringing us one step closer to bioengineered corneas”.

“Collagen can provide a cell-friendly, antiinflammatory environment that can promote cell proliferation in the eye,” he said.

Sutton, from the University of Sydney and Lions NSW Eye Bank, said while there have been attempts to bioengineer a cornea, they have failed because of a lack of durability and strength.

“While the base composition and molecular structure of collagen provide the biological attributes, it is the highly organised structure that retains these properties and contributes to the transparency and mechanical strength of the cornea – quite a demanding set of properties in one material.” Wallace said the ACES team had used electro-

“Our bioengineered cornea ... maintains excellent and critical optical properties. If successful, it will mean the many people suffering corneal blindness will not have to wait for someone to die to receive a sight-restoring cornea. They will be able to order one of the ready-made products off the shelf, or even one that is customised specifically for their eye.” n

GUIDE DOGS VICTORIA CHIEF APPOINTED TO INTERNATIONAL POSITION Guide Dogs Victoria CEO Ms Karen Hayes has been appointed as a board member of the world’s most significant peak body for guide dog associations.

Following a competitive submission process, she has joined the International Guide Dogs Federation (IGDF) Board where she will represent Australia’s low vision and blindness community at a global level.

“Being a part of the IGDF Board will ensure Guide Dogs Victoria and the broader Guide Dogs Australia network continues to stay at the forefront, providing world-class services that will improve outcomes for our clients, our dogs, our employees and supporters,” Hayes said.

Hayes is a recognised figure within the Australian not-for-profit sector. She

Karen Hayes, Guide Dogs Victoria.

is a board member of Multiple Sclerosis Limited, The Melbourne International Comedy Festival and a past board member of Vision 2020 Australia.

She is also the president of the VU Western Spurs AFLW Football Club and is one the founders of Breast Cancer Network Australia, and was a cofounder of the Australian chapter of the International Women’s Forum (IWF). n

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COMPANY

BAUSCH + LOMB HAS FIRST DRY AMD TREATMENT IN ITS CROSSHAIRS Bausch + Lomb and its parent company have struck a deal to acquire an option to purchase the ophthalmology assets of private biopharmaceutical company Allergo Ophthalmics, which is working to develop the first treatment for dry agerelated macular degeneration (AMD).

Bausch Health Companies and Bausch + Lomb, its global eye health business, and Allegro announced the agreement, which includes global rights for risuteganib (Luminate), Allegro’s lead investigational compound in retina.

It is believed to simultaneously act on the angiogenic, inflammatory and mitochondrial metabolic pathways in diseases such as intermediate dry AMD. “As part of the ongoing transformation of Bausch Health, we continue to seek strategic opportunities to build-up our pipeline in core businesses, including Bausch + Lomb, our global eye health business,” Mr Joseph Papa, chairman and CEO of Bausch Health, said.

“The addition of the ophthalmic assets of Allegro would significantly enhance our comprehensive portfolio of products for AMD. If approved, risuteganib may be the first treatment indicated to help reverse vision loss due to dry AMD and would address a significant unmet medical need affecting millions of people globally.”

Allergo CEO Dr Vicken Karageozian added: “[Bausch Health is] an established global player in ophthalmology that values the potential of risuteganib and our integrin-regulating platform as much as we do.”

Allergo is planning two Phase 3 studies evaluating the use of intravitreal risuteganib to treat intermediate dry AMD, which are expected to begin within the next 12 months. Its other ophthalmology assets include ALG-1007, a topical integrin regulator under investigation for dry eye. It is in Phase 2 development outside the US. Bausch Health’s option payment would be made in two tranches, with the first payment of $10 million (AU$14 m) upon signing. Allegro intends to raise additional funding, following which, Bausch Health will make a second payment of $40 million (AU$56 m), which is expected to be made in 2021. If Bausch Health then elects to exercise the option, additional payments will be payable. n

26

INSIGHT November 2020

ESSILORLUXOTTICA AND FACEBOOK TO DEVELOP SMARTGLASSES "WE ARE PAVING THE WAY FOR A NEW GENERATION OF PRODUCTS DESTINED TO CHANGE THE WAY WE LOOK AT THE WORLD" ROCCO BASILICO, ESSILORLUXOTTICA

Social media giant Facebook is joining forces with EssilorLuxottica to develop smartglasses under its Ray-Ban brand.

Facebook CEO Mr Mark Zuckerberg announced the multiyear collaboration with the Franco-Italian eyewear company in mid-September during Facebook Connect, an annual conference held virtually from California.

According to EssilorLuxottica, the partnership will combine Facebook apps and technologies with Luxottica’s well-known frames brands and Essilor’s advanced lens technology with the aim of improving connectivity between people.

The first product will be branded under Ray-Ban, one of the world’s most recognisable eyewear brands, and is scheduled to launch in 2021.

With bulky designs being a common drawback in current smartglasses designs, the companies claim they will combine innovative technology and fashion-forward style to create a product that consumers like wearing.

“We’re passionate about exploring devices that can give people better ways to connect with those closest to them,” Mr Andrew Bosworth, vice president of

Facebook Reality Labs, said.

“Wearables have the potential to do that. With EssilorLuxottica we have an equally ambitious partner who’ll lend their expertise and world-class brand catalogue to the first truly fashionable smart glasses.”

Mr Rocco Basilico is the chief wearables officer at Luxottica. He is proud of the collaboration, which he said will project an iconic brand like Ray-Ban into an increasingly digital and social future.

“Combining a brand that is loved and worn by millions of consumers around the globe with technology that has brought the world closer together, we can reset expectations around wearables. We are paving the way for a new generation of products destined to change the way we look at the world,” he said.

Commentators say the move is further evidence of Facebook’s ambition to extend beyond social networking and into hardware development.

The name of the smartglasses, specifications, software capabilities, pricing, and other details will be shared closer to launch in 2021. n

ESSILOR REPORTS POSITIVE RESULTS WITH ‘GAME CHANGING’ MYOPIA LENS Global ophthalmic lens manufacturer Essilor has unveiled interim findings of an ongoing clinical trial of its new Stellest myopia control lens.

The trial, which involves 167 myopic children, started in 2018 in Essilor’s joint Research and Development Centre with its key partner, the Wenzhou Medical University, in China.

The one-year results were announced at the World Society of Paediatric Ophthalmology and Strabismus virtual congress in September.

According to the company, after one-year, children wearing Stellest lenses saved more than half a diopter of myopia degree on average. This was a more than 60% slow-down in progression when compared to a control group wearing single vision lenses. Eye elongation was prevented in

Essilor has developed a myopia control lens.

28% of children wearing Stellest lenses while it occurred in all single vision lens wearers. All Stellest wearers reportedly had clear vision, adapted to their new lenses within a week, and were as satisfied with their quality of vision as those wearing single vision lenses. n

AMERICA'S LARGEST CONTACT LENS RETAILER SNAPPED UP IN MULTI-BILLION-DOLLAR DEAL A global investment firm has acquired the US’s largest contact lens retailer 1-800 Contacts for a reported $AU4.2 billion.

The disruptive online retailer, which was launched out of a dorm room in 1995, announced the deal on 23 September with the investment company KKR. The sale follows many years of strong growth and technology innovation for the vision brand, which was purchased by AEA Investors in 2016. Financial terms of the transaction were not disclosed, but Bloomberg valued the sale at US$3 billion (AU$4.2 b).

1-800 Contacts imposed itself on the US vision market, claiming to offer the first online platform for purchasing contact lenses. It’s also been involved in passing a federal law to give people the right to their own prescription and has battled with contact lens manufacturers over what it claims were anti-consumer pricing models.

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Most notably, the company has expanded into technology that allows orders and eye tests to be conducted with smartphones. It acquired vision technology startup 6over6 in late 2019 and launched new app-based offerings including ExpressExam, which enables consumers to renew contact lens prescriptions online in minutes.

The company’s sister brand Liingo Eyewear also introduced Rx Reader, an app that extracts optical parameters directly from a pair of prescription glasses.

According to the company, as many Americans dealt with stay-at-home orders and business closures in response to COVID-19 earlier this year, many contact lens wearers visited the online store in place of traditional brickand-mortar sellers.

During the peak of the shutdown, the company experienced a 100% year-

over-year increase in new and returning customers. In that period, usage of the ExpressExam app also increased 200% and the Rx Reader app experienced a 700% increase in monthly active users.

1-800 Contacts has been acquired.

“1-800 Contacts was founded 25 years ago to offer consumers a better way to buy contact lenses. Since the very beginning, we’ve kept the customer at the centre of everything we do,” Mr John Graham, CEO of 1-800 Contacts, said.

“It’s gratifying that KKR sees such incredible value in our brand and that they will continue to support us in doing what we do best – delivering the best vision care to consumers with the highest quality customer service.”

Mr Nate Taylor, KKR partner and cohead of Americas Private Equity, said 1-800 Contacts is a customer-centric, technology-enabled business that brings convenience to the optical space. n

RESEARCH

QUARTER OF COVID-19INFECTED CHILDREN DEVELOPED OCULAR MANIFESTATIONS Almost one in four children who were hospitalised at a children’s hospital in Wuhan – ground zero of the COVID-19 pandemic – had ocular manifestations, including conjunctival discharge, eye rubbing and conjunctival congestion.

The study, recently published in JAMA Ophthalmology, set out to gain a better understanding of ocular symptoms in children with confirmed coronavirus infection, and how they may differ to adults.

The researchers noted respiratory droplets are considered the main transmission route, with aerosol and conjunctival also suggested as possible forms of transmission, however these remain controversial.

They stated that nearly all reported cases involving ocular symptoms were adults, and little is known about ocular manifestations in children.

The cross-sectional study of 216 children hospitalised at Wuhan Children’s Hospital with COVID-19 found 49 (22.7%) had ocular manifestations, of which nine had ocular complaints being the initial manifestations of the disease.

The common ocular problems were conjunctival discharge (27 or 55.1%), eye rubbing (19 or 38.8%), and conjunctival congestion (5 or 10.2%).

Overall, the most common symptoms among symptomatic children were fever (37.5%) and cough (36.6%). Of the 216 children, 93 (43.1%) had no systemic or respiratory symptoms.

“There have been reports of COVID-19 infections among medical staff, including ophthalmologists, presumably acquired during close contact with infected patients,” the researchers stated.

“Better understanding of the ocular manifestations of COVID-19 can help develop more effective prevention and mitigation strategies.”

Children with systemic symptoms or cough were also more likely to develop ocular symptoms, which were mild, and recovered or improved with minimal eye drops or self-healing.

COVID-19 in children was typically not severe, and all ocular symptoms were mild and could recover or improve eventually. n

28

INSIGHT November 2020

MONOVISION STUDY REVEALS MYSTERIOUS MOTION ILLUSION "A COMMON MONOVISION CORRECTION STRENGTH WILL CAUSE THE DISTANCE OF A TARGET MOVING AT 15 MILES PER HOUR TO BE OVERESTIMATED BY 2.8 METRES" STUDY AUTHORS

Monovision contact lens wearers could be misjudging the distance of moving objects, potentially increasing the likelihood of traffic accidents, new research has found.

“A common monovision correction strength will cause the distance of a target moving at 15 miles per hour to be overestimated by 2.8 metres. This, remarkably, is the width of a narrow street lane,” the authors revealed. “If the prescription is reversed, target distance will be underestimated by 1.3 metres."

In their report published in Current Biology, the authors noted monovision contact lenses correct each eye for a different distance, causing one image to be blurrier than the other.

They said that little is known about how interocular blur differences affect motion perception.Their investigation found that blur differences cause a previously unknown motion illusion “that makes people dramatically misperceive the distance and three-dimensional direction of moving objects”. The effect occurs because the blurry and sharp images are processed at different speeds, they said, and for moving objects, the

Drivers wearing monovision contacts may misperceive cyclists by almost three metres.

mismatch in processing speed causes a neural disparity, which results in the misperceptions.

Their study demonstrated that novel combinations of non-invasive ophthalmic interventions such as tinting the blurring lens can nullify monovision-induced motion illusions.

“We have reported a new version of a 100-year-old illusion: the reverse Pulfrich effect. We found that interocular differences in image blur, like those caused by monovision corrections, cause millisecond interocular differences in processing speed. For moving targets, these differences cause dramatic illusions of motion in depth,” the authors concluded. n

ATROPINE MYOPIA CONTROL DOSE COMPARISON SHOWS CLEAR WINNER A concentration of 0.05% atropine was superior in slowing the rate of myopia progression in pre-teen children compared with two other concentrations of the drug, according to findings published in Ophthalmology.

Researchers at the Chinese University of Hong Kong studied the efficacy and safety of 0.05%, 0.025% and 0.01% atropine over two years to determine the most useful concentration for long-term myopia control.

Using data from the Phase 2 study, the researchers identified 383 children aged 4 to 12 diagnosed with myopia of -1.0 D or greater. Participants received one of the three atropine concentrations or placebo once daily in both eyes.

Study lead Associate Professor Jason Yam and colleagues concluded “all concentrations of atropine were well

The study assessed three atropine strengths.

tolerated without apparent adverse effects on the quality of life”.

However, the efficacy of 0.05% atropine was double that observed with 0.01% atropine in spherical equivalent progression over two years.

In the second year, the researchers observed a similar efficacy between the 0.05% and 0.025% atropine groups compared with the first year and a mild improvement in the group that received 0.01% atropine. n

STUDY REVEALS MACULAR DEGENERATION PATIENTS AT HIGHER RISK OF DEATH FROM CORONAVIRUS A new study has found people with age-related macular degeneration (AMD) are at greater risk of developing severe complications and dying from COVID-19.

The association between the eye disorder and COVID mortality was established after a study in the journal Nature Medicine found one of the immune system’s oldest branches – called complement – may be influencing the severity of the disease.

According to the study, conducted by researchers at the Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center, macular degeneration is a proxy for complementactivation disorders.

Study lead Professor Sagi Shapira said if complement and coagulation influence severity of COVID-19, then people with pre-existing hyperactive complement or coagulation disorders – such as AMD –

should be more susceptible to the virus.

Among 11,116 COVID-19 patients who came to Columbia University Irving Medical Center with suspected virus infection, the researchers found more than 25% of those with AMD died, compared with the average mortality rate of 8.5%.

Roughly 20% required intubation.

Shapira said the investigation of coagulation and complement in COVID-19 began with a sweeping survey of viral mimicry across more than 7,000 viruses.

Prof Sagi Shapira, Columbia University.

“The greater mortality and intubation rates could not be explained by differences in the age or sex of the patients,” Shapira said.

“Complement is also more active in obesity and diabetes and may help explain, at least in part, why people with those conditions also have a greater mortality risk from COVID.” The researchers say their findings suggest existing drugs that inhibit the complement system could help treat patients with severe COVID-19.

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He said viruses have proteins that can mimic certain host proteins to trick the host’s cells into aiding the virus with completing its life cycle.

Coronaviruses, the survey found, are masters of mimicry, particularly with proteins involved in coagulation and proteins that make up complement.

Complement proteins are said to work like antibodies and help eliminate pathogens by sticking to viruses and bacteria and marking them for destruction.

“Unchecked, these systems can also be quite detrimental,” Shapria added.

“The new coronavirus – by mimicking complement or coagulation proteins – might drive both systems into a hyperactive state.” n

TECHNOLOGY

ACCURATE DOSING DEVICE RECEIVES FDA CLEARANCE

Khurem Farooq, Gyroscope.

A system that delivers a microinjection into the back of the eye has received regulatory clearance in the US, paving the way for less invasive therapeutic treatment for inherited eye disease.

Gyroscope Therapeutics Limited, a clinical-stage retinal gene therapy company, has announced that the US Food and Drug Administration (FDA) has approved its Orbit Subretinal Delivery System (Orbit SDS).

The global organisation, with teams based in London and Stevenage in the UK, and Philadelphia and San Francisco, said the Orbit SDS microinjection procedure is designed to avoid damaging the structure of the eye by preventing the need for a vitrectomy, a procedure that involves removing the vitreous.

The technology, which involves injecting a Balanced Salt Solution (BSS), also eliminates the need to create a hole in the retina in order to access the subretinal space.

Gyroscope Therapeutics chief executive officer Mr Khurem Farooq said the Orbit SDS is designed to target the subretinal space, with the aim of providing precise and consistent dosing.

“Our mission is to develop gene therapies and delivery systems to help preserve sight and fight the devastating impact of blindness. The FDA clearance of the Orbit SDS is an important component in advancing towards this goal,” Farooq said.

In a statement announcing the regulatory clearance, the company said the device is capable of delivering a controlled volume to a targeted subretinal delivery site.

“The Orbit SDS accesses the subretinal space via a suprachoroidal approach.

This specially-designed system enables cannulation of the suprachoroidal space with a flexible cannula. A microneedle inside the cannula is advanced into the subretinal space to enable targeted dose delivery,” the company stated.

The company is planning to enter into licensing and collaboration arrangements involving the Orbit SDS with other companies who are developing gene and cell therapies to treat eye disease. n

30

INSIGHT November 2020

WEARABLE MYOPIA CONTROL DEVICE TO BE MARKET-READY BY 2021 Clinical stage Japanese ophthalmology company Kubota Vision has completed a proof-of-concept clinical study for its wearable myopia control device.

The instrument is based on the company’s Kubota Glasses technology, which works to reduce increases in axial length by projecting myopically-defocused virtual images.

These are generated using microLEDS on the peripheral visual field to stimulate the retina.

It’s latest study confirmed that the changes in axial length from baseline in the test eye versus the control eye – previously seen when utilising a bench top device that projected defocused images on the peripheral retina – can be replicated with a wearable device.

The study monitored effects of projected peripheral defocus on ocular biometrics, including axial length, using a wearable device in 25 people aged 18 to 35 years at the Manhattan Vision Associates/Institute for Vision Research (MVA), New York. A wearable prototype is expected to be available by the end of 2020 and anticipated to launch as a market-ready device in 2021. According to the company, passive stimulation

Half of the world's population are expected to have myopia by 2050.

using myopic defocus is already in use in a US Food and Drug Administrationapproved contact lens.

Dr Ryo Kubota, chairman and president of Kubota Vision stated: “It is another great achievement that this proof-ofconcept study using a wearable device demonstrated the same efficacy as a bench top device.

“We will continue our effort to produce more scientific evidence on Kubota Glasses technology through further clinical studies so that our wearable myopia device will soon become available to people in need.”

Myopia affects 40% of people over the age of 12 in the US. It's more prevalent in East Asia; 96.5% of 19-year-old males are myopic in Seoul. n

SMART CONTACT LENS WIRELESSLY MONITORS STRESS HORMONE Korean researchers have developed a smart contact lens that could monitor cortisol in real time, helping overcome accuracy issues often associated with conventional testing methods.

High levels of cortisol, the stress hormone, are correlated with Cushing’s disease, autoimmune disease, cardiovascular complications and type 2 diabetes, as well as depression and anxiety. Low cortisol levels can lead to Addison’s disease, which results in hypercholesterolemia, weight loss, and chronic fatigue In their human pilot trial published in Science Advances, a team comprising engineering and nanomedicine academics produced a soft contact lens with a cortisol sensor formed using a graphene field-effect transistor that can measure cortisol concentration with a

The lens can detect cortisol levels.

detection limit of 10 pg/ml.

With transparent antennas and wireless communication circuits, it connects with a smartphone to operate the lens remotely without obstructing the wearer’s view.

In-vivo tests using live rabbits and the human pilot experiment also confirmed its biocompatibility and reliability as a noninvasive, mobile healthcare solution. n

INTERNATIONAL

PLANNED MEDICARE CUTS DEAL HEAVY BLOW TO UNDER PRESSURE AMERICAN OPHTHALMOLOGISTS US Ophthalmologists may back out of performing Medicare services for older Americans if a proposed 6% pay cut is given the green light, the American Academy of Ophthalmology (AAO) has warned.

The Centres for Medicare & Medicaid Services (CMS) has signalled the pay cut for 2021, with ophthalmology being one of the worst-affected specialities. Other heavily impacted disciplines include cardiac surgery (9%) and thoracic surgery (8%).

Medicare in the US is a national health insurance program that primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disabilities.

According to the AAO, ophthalmology lost more patient volume due to the COVID-19 pandemic than any other medical specialty.

Ophthalmologists have since returned to work rehiring staff, managing a backlog of delayed care and implementing costly safety procedures to protect their patients and staff from the virus.

“It’s as if the last five months didn’t happen,” Dr David Glasser, AAO secretary for federal affairs, said. “CMS is asking

" WE NEED TO REIMAGINE A HEALTH CARE SYSTEM THAT PROVIDES MORE PATIENT ACCESS, NOT LESS"

Funding cuts could have ramifications for US ophthalmic care.

DAVID GLASSER, AAO

the specialty that took the economic brunt of the pandemic and took massive code decreases this year to also take the brunt of planned pay cuts in 2021.

There is no way that these pay cuts won’t affect Medicare patients’ access to timely surgical care.”

highest overhead in medicine, to back out of Medicare participation entirely,” the organisation stated.

“Coronavirus upended the professional world of ophthalmologists and that of our patients. As we exit the acute phase of the pandemic, we need to reimagine a healthcare system that provides more patient access, not less. A pandemic is no time to reduce healthcare funding and force ophthalmology small businesses to face the choice of restricting access to Medicare patients, selling their practices or retiring.”

The payment cuts were triggered by CMS’ decision to change its policy on evaluation and management (E/M) coding and to selectively apply it to certain specialties.

The AAO said Congress could fix the problem by waiving Medicare’s budget neutrality requirements to allow CMS to implement increases in payment for E/M visits, but avoid drastic payment cuts to other physician services to offset it.

AAO is working with the Surgical Care Coalition, a group of 12 medical associations representing more than 150,000 surgeons across the country, to urge Congress to rectify the issue.

“The proposed rule will likely force ophthalmologists to take fewer Medicare patients leading to longer wait times and reduced access to care for older Americans. It may also force more ophthalmologists, who already have the

It also proposed the CMS apply the increased E/M payment to 10- and 90-day global surgical post-operative visits as done in the past. Without these changes, the AAO fears patient care will be compromised. n

ONLINE PRESCRIPTION RENEWAL PILOT IN EUROPE The world’s first CE-certified online eye test that allows customers to renew glasses and contact lens prescriptions online instead of in-store is being trialled in Finland and Poland.

“As the eyewear market is moving online, the need for adequate and fast online eye testing grows, especially considering COVID-19’s impact on retailers and the eyecare sector,” he said.

Global optical retail group GrandVision, which operates in more than 40 countries with more than 7,000 brick-and-mortar stores, has partnered with online eye exam platform easee, giving its customers access to the technology.

“Using easee’s platform, our customers in Finland and Poland can now choose to visit a store to receive validated renewal prescriptions, or simply take eye tests online.”

The platform is being piloted with the GrandVision’s Finnish and Polish retailers, Instru Optiikka and Vision Express, respectively.

Announcing the partnership, Mr Andreas Jacobsen, GrandVision’s vice president of operations, said more customers are choosing to shop online.

Developed with the University Medical Center Utrecht in the Netherlands and in line with the requirements of the European Commission, easee’s online refraction test is as accurate as an inperson eye exam, according to research published last year in the Journal of Medical Internet Research.

In that study, which was led by Dr Robert

Wisse from the University Medical Center Utrecht in the Netherlands, the results indicate the web-based eye test is a valid and safe method for measuring visual acuity and refractive error in healthy eyes, particularly for mild myopia.

Andreas Jacobsen, GrandVision.

The researchers also found the tool could be used for screening purposes.

Mr Yves Prevoo, easee CEO, said the company’s aim is to make clear vision accessible to everyone and the partnership with GrandVision “proves we are on the right path.”

The company is continuing to develop its software and is looking into applying the technology to other areas, providing the world with a comprehensive digital platform for online eye tests. n

INSIGHT November 2020 31

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PRACTICE MANAGEMENT

A ONE-STOP-SHOP

FOR PATIENT ATTRACTION AND RETENTION Staff across Ocula’s independent optometry network grew tired of their intricate appointment booking system. It’s now been streamlined thanks to a new relationship with a health service platform that's also driving the business's digital marketing to patients.

I

ndependent optometry business Ocula has never made the mistake of underestimating the value online booking systems bring to the practice.

In fact, the business – which operates three locations across New Zealand’s South Island in Christchurch and the resort towns of Queenstown and Wanaka – went to great lengths to develop its own ‘quasi-online booking system’ using third party software, which sat alongside its practice management system Optomate.

But the process was arduous and much maligned among staff.

“Obviously that didn’t link automatically into Optomate,” Ms Danielle Winstone, director and optometrist at Ocula, recalls.

“It was an incredibly manual process. We realised the huge importance of online booking, and how important it is to consumers these days to be able to make appointments online after hours. But there was nothing available at the time from Optomate, we were having to do our own kind of band-aid approach to make it work. Our customers really appreciated being able to book online, but it was a nightmare from the back-end side of things.”

For Winstone, the frustrations involved with this intricate system are now in the past, after Ocula joined MyHealth1st (owned by ASX-listed 1st Group) in 2018. It now counts itself among the 70% of independent optometry practices across Australia and New Zealand that use the health digital portal.

The alliance means its three practices now have a simple online booking process, but the company has also expanded on the range of services to include patient recall system EasyRecall, after-appointment feedback system EasyEngage and, most recently, MyHealth1st’s managed digital advertising services.

MyHealth1st’s OnlineAppointments is a fully integrated online booking platform that allows instant booking and real time availability. If patients cancel an appointment, that spot becomes instantly available in the practice schedule, with no manual input required.

Since enlisting MyHealth1st, Ocula has seen close to 2,000 online bookings, including 884 new patients, across its three practices.

“Before we came to MyHealth1st, we were actually doing everything that they do for us. It was just taking us 10 times as long, and our staff hated us, but the ability for a patient to make an appointment online, or to be able to give instant feedback about their experience with an optometrist, is incredibly important,” Winstone says.

Joining MyHealth1st has saved the business both time and money, she says. Whereas the practice previously had staff dedicated to IT issues with online bookings and feedback, the number of new bookings has more than paid for itself.

Ocula considers itself a proactive optometry practice, so implementing online bookings is only part of the plan. The Christchurch practice recently contracted MyHealth1st for digital marketing to drive more patients through the door.

Winstone says Ocula previously spent large sums of money with digital agencies, but it’s been difficult to get them to understand what the business is trying to sell. It’s measure of success comes down to patient bookings, as opposed to click rates and impressions.

Danielle Winstone's optometry business has generated close to 900 new patients since enlisting the services of MyHealth1st.

With MyHealth1st managing Ocula’s digital advertising campaigns, Winstone said there was an immediate difference, with new bookings increasing at the Christchurch practice.

Mr Klaus Bartosch, CEO and co-founder of 1st Group, says while digital agencies may understand how to sell a t-shirt online, many don’t understand how to sell an appointment.

“One major advantage MyHealth1st has over digital agencies when it comes to healthcare advertising is that we understand independent healthcare. Our team understands that in most cases you’re not trying to sell a product, and there is no impulse buy when it comes to healthcare.

Increased traffic is all well and good, but without conversions to bookings, that traffic is all but pointless,” he says.

Bartosch says the MyHealth1st team can deliver results for optometry practices like Ocula by identifying keywords and targets that are most likely to convert into a patient, and then integrating these campaigns seamlessly within the booking platform.

“We don’t believe in a ‘one size fits all’ approach to advertising, so each campaign, and each ad in that campaign is individually crafted and optimised to ensure the best, most cost-effective outcomes,” he adds.

During a two-month period up until September, Ocula’s digital marketing with MyHealth1st resulted in 83 new patients booking appointments, for an overall cost per booking of $19.46 per new patient.

Winstone says when considering the return on investment “the numbers speak for themselves”.

She now plans to roll out the advertising services to Ocula Queenstown. Due to COVID-19, the economy of the tourist town has suffered, leaving the practice with fewer bookings.

“But I’d like to at least give it a shot and know that we’re trying our hardest to get patients in the door, and I believe our relationship with MyHealth1st will help that,” she says. n

INSIGHT November 2020 33

FEATURE

LENS COATINGS AND TREATMENTS The breadth of choice in lens coatings and treatments plays to the patient’s advantage, whether they are motivated by function, fashion – or both. Insight talks shop with lens manufacturers and dispensers about market trends and retail dynamics.

L

ens coatings can undeniably enhance the durability, performance and appearance of sunglass or spectacle lenses, with patients spoilt for choice in an ultra-competitive market.

Anti-reflective, scratch-resistant, and anti-fog coatings, ultraviolet (UV) treatment, blue-light filters, polarisation and photochromic lenses are mainstays of the market, but with a continuous evolution of lens technology, there’s no telling what developments are on the horizon.

With Australia’s harsh summers and well-established evidence of the damage caused by long-term UV overexposure, lens companies report that UV protection is in hot demand. So too are photochromic lenses, with more players entering this category, and focusing their efforts towards elusive younger markets.

New challenges associated with COVID-19 such as fogging glasses and digital eye strain are also presenting new opportunities for optometrists and dispensers to deliver the best outcomes for their patients while realising additional sales.

Investment driving R&D in the lens coating market

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isn’t showing signs of letting up either, as manufacturers continue with the roll out of new and existing products.

ANTI-FOG SHOOTS INTO RELEVANCE In recent times and in response to new consumer demands, Zeiss and Essilor have unveiled new products in the anti-fog market; Zeiss launched an anti-fog spray in October, and Essilor relaunched its Optifog lens to offer a new solution to prevent mask-associated lens fogging.

Essilor professional services director Mr Tim Thurn says anti-fog lens surface treatments are a “big thing” in the lens market at present, with demand soaring in line with maskwearing protocols.

“Essilor’s original Optifog lens product needed a spray.

With the re-launch of this product, Essilor has introduced a cloth to wipe the lens to activate its anti-fog properties – the activation cloth is the key difference from the original product launched in 2011,” Thurn says.

Essilor has filed two international patent applications for its Optifog system. According to the company, specific molecules in the Optifog Smart Textile microfiber dry cloth activate fog repellent properties in the Optifog

XX

lens hydrophilic top layers, providing immediate fog-free vision.

Hoya too has reported a surge in demand for anti-fog lens products. Mr Ulli Hentschel, national training and development manager, says fogging is typically an issue in European countries, where the outdoor temperatures can be more extreme than indoor temperatures in homes, workplaces or retail spaces.

“Lenses fogging up has not been such a big deal in Australia, because we don’t experience the extreme variations in temperature. But because of COVID-19, we are seeing a resurgence of popularity in anti-fog lens properties. We have organised supplies of anti-fog cloths for the local Australian market because demand is increasing,” Hentschel says.

POLARISING OPINIONS Blue-light, photochromic and polarising lens treatments are also proving to be hot spots in the current market.

Marketing manager at Zeiss Vision Care, Ms Renay Lotz, says blue-light filtering products are still an expanding category.

“The impact the COVID-19 pandemic has had on our lives – more time spent indoors, more home schooling with LED lights and screenwork – seems to fuel this category even more,” Lotz explains.

She says Zeiss’s DuraVision BlueProtect serves this market segment and is well perceived by eyecare practitioners and consumers around the globe.

“There are new products coming in this segment soon,” she adds.

Essilor and Hoya also offer blue-light lens filters, but both Thurn and Hentschel agree there is still a lot of speculation about the evidence to support blue-light products.

“We are currently running a campaign with independent practitioners to promote Hoya’s BlueControl – which is offered in combination with our flagship Diamond Finish anti-reflection coating. Blue-light filtering has been a hot topic in the industry, and there’s been a lot of conjecture about the evidence. Our key message with BlueControl is based on the sleep/ wake cycle, and there is evidence to support that,” Hentschel says.

Thurn says clinical studies on blue-light blocking will never be able to control for all variables for a definitive outcome on the question of retinal damage, but points to several that are investigating the other effects of blue light, from UNSW academics Dr Maitreyee Roy and Emeritus Professor Stephen Dain, to Emeritus Professor Arnold Wilkins from University of Essex who looked at colour, contrast and flicker.

Ultimately, Thurn says, there is ongoing research investigating the link between blue-light and digital eye strain as well as its role in oxidative stress in the retina.

Polarisation, however, is another segment of the market that is ripe for growth.

“The need for prescription sunglasses is enormous. According to our data, one in four customers get prescription sunglasses. Polarisation is growing but it has the potential to grow more,” he says.

Thurn says scratches, dust, reflection, smudges and UV light are the bane of lenses, and Essilor is continually trying to improve its coatings to eliminate these elements from detracting from clear vision.

Essilor was the first lens manufacturer to introduce double-layer coating in Australia combining hard coating and multicoat. It is the only lens company that has Cancer Council endorsement for its UV multicoat that offers an Eye-Sun Protection Factor (ESPF) of up to 50+.

Thurn says protecting eyes from UV damage while also designing a lens that can withstand harsh temperatures is part of Essilor’s current problemsolving agenda.

“We often hear of patients leaving their multicoat lenses on their car dashboard on a 40-degree day, which affects the lens. We did an experiment at our Sydney lab on a 35-degree day – and it was 80-degrees

Essilor has re-launched its Optifog lens coating in response to mask-associated lens fogging.

Celsius on the dashboard of the car; a coating will have a hard time at that intensity of heat,” Thurn says.

In another industry ‘first’, Lotz says Zeiss lead the way in offering full UV protection for all its clear plastic lenses with Zeiss UVProtect.

“This set the tone to improve protection for all spectacle lens wearers as more and more companies start to close their protective gaps, but most other companies still did not make it their default across all plastic lens materials,” she says.

Zeiss’s UV coatings range also includes Zeiss AdaptiveSun, sunglasses that adapt to changing light conditions, which change from dark to darker, and DuraVision Sun UV, an anti-reflective coating for sunglasses to reduce reflection on the back surface of the lens.

NEW FACES FOR PHOTOCHROMIC LENSES According to Lotz, variety and choice in photochromic lenses is catering to consumer needs and preferences with extra-dark varieties now being introduced. But the classic grey and brown varieties continue to represent more than 90% of the volume.

She adds: “There is an overall trend in photochromics that adapt to changes of light faster – a trend set by Zeiss PhotoFusion – for improved all-day use, such as when frequently changing from indoors to outdoors.

Wearers prefer lenses where that change happens more quickly.”

Hentschel, at Hoya, agrees with this assessment. He says the number one feedback from Hoya’s market research about its photochromic lenses was based on reaction time.

“It’s a common thread in the market; consumers want Hoya Sensity photochromic lenses to go clearer quicker, and darker a bit faster too,” he says.

The company has listened to the market, launching Sensity 2 in October. Hentschel says the main driver of the new lens is it reacts faster when people come indoors.

Other variations available in the range include Sensity Dark – which delivers extra darkness as a reaction to UV and visible light, even behind a car window – and Sensity Shine, a mirror coating that is more intense in the light yet subtle when indoors.

“These novel approaches to photochromic lenses are a talking point for eyecare practitioners, they are designed to appeal to

INSIGHT November 2020 35

FEATURE

fashion-focused patients,” Hentschel says.

Mr Stuart Cannon, general manager Asia Pacific at Transitions Optical, has been with the company for 18 years and has seen a lot of changes in lens coatings in that time.

He says Transitions was the first manufacturer to successfully commercialise plastic photochromic lenses.

“It’s a complex, innovative industry. There are more players in photochromic lens manufacturing now; it is an area of opportunity, companies are investing into research and development, and there’s more knowledge in this field. We know one product doesn’t fit all, and wearers have different needs,” Cannon says.

In April this year, the company launched Transitions Signature GEN 8, a photochromic lens that features faster fade back and is available in seven colours, allowing patients greater choice to suit their personal style.

Cannon says photochromic lenses have been successful among the presbyopia demographic, but the market has struggled to net younger, single-vision wearers.

The problem, he says, has been two-fold; a limited colour choice, and cost – younger people haven’t necessarily seen the value in photochromic lenses.

But this is gradually changing.

“When you start to focus on younger wearers, you need to focus on health and wellbeing. They lead a digitally-connected lifestyle, and they want bluelight protection. Younger wearers have lifestyles that are now more aligned to photochromic lenses. The technology is much improved, and like Transitions Signature GEN 8 available in a range of colours, they can find a product to meet their lifestyle, and they start seeing value,” Cannon says.

Competition in the market drives performance, he says, and the photochromic market needs to grow with new, younger wearers.

“Transitions lenses has a 95% re-purchase rate but there is still a long way to go in netting new wearers. Based on a consumer survey, only about 15% wear photochromic lenses but one in two say they are interested.

There’s a massive opportunity for photochromic lenses, but we need to raise consumer awareness,” Cannon says.

At Essilor (Transitions is part of the Essilor group), Thurn agrees that the youth market is untapped. He says about 30-35% of patients wore glass photochromics, but in the plastic era, it’s between half to two-thirds of that figure.

One of the first players in the photochromic market was Rodenstock. In

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INSIGHT November 2020

1986, they launched their first generation of photochromic plastic lenses, Perfalit ColorMatic, led by Dr Herbert Zinner, who is now Rodenstock’s director of research and development for polymers and photochromics.

Last year Rodenstock introduced ColorMatic X-tra Fast in a 1.54 index which brought the 1.54 into line with the speed of the 1.6 and 1.67 indexes.

A portfolio of ColorMatic IQ Sun 2 photochromic self-tinting lenses is also available in six colours that change from a 40 to 90% tint in fashion and contrast colours.

Ms Nicola Peaper, Rodenstock Australia’s national sales and professional services manager, says from an optometrists’ point of view, photochromic technology is a great addition.

“Traditional ‘clear to dark’ photochromic lenses are not always a replacement for sunglasses as these do not necessarily give glare protection in bright sunlight and will not give the degree of protection when driving that is achieved with a polarising lens.”

Peaper says manufacturers are committing money and research to improving photochromics as they all want to be the fastest, darkest and most effective in climates with high temperatures, like Australia. She believes additions of photochromics in sun lenses is no less an exciting and underdeveloped area of research.

“Rodenstock have developed a superb consistency of colour regardless of the percentage of colour change. The contrast colours are a great substitute for reducing glare and give a lot more flexibility to traditional sunglasses with more comfort in a wider range of light conditions,” she says.

Rodenstock has also released a new coating, X-tra Clean, made up of extremely flexible molecular chains that boast streak-free cleaning, which has proven popular among patients in rural areas, Peaper adds.

A THREE-WAY CONVERSATION Ms Virgilia Readett is a part-time dispenser at Specsavers Charlestown, near Newcastle, and part-time teacher at the Australasian College of Optical Dispensing (ACOD).

With more than eight years’ experience in dispensing, and qualifications in both dispensing and training and assessment, Readett is well-versed in the language of optical retail.

In her experience, a three-way discussion between optometrist, dispenser and patient is crucial to setting up a successful lens sale.

“If the optometrist introduces the concept of lens treatments, the dispenser can explain how treatments differ, and how they would benefit the patient.

Virgilia Readett, Specsavers & ACOD.

Ulli Hentschel, Hoya.

April Petrusma, The Eye Piece & ACOD.

Stuart Cannon, Transitions Optical.

Renay Lotz, Zeiss Vision Care.

Tim Thurn, Essilor.

Launched this year, Transitions Signature GEN 8 is a photochromic lens featuring faster fade back.

The AntiFOG Kit from Zeiss ensures lenses stay fog-free for up to 72 hours.

Hoya unveiled its Sensity 2 photochromic lens in October.

The patient trusts recommendations, and it sounds less like a sales pitch,” she says.

Petrusma says The Eye Piece’s tailored approach to each individual starts with their hand-over system.

“The best way to get the patient to understand the benefit of a particular lens treatment is if the optometrist starts the conversation, and then the dispenser can offer a tailored approach, by trying to ‘read’ the patient and letting them know all the options available.”

“We’re involved in the whole process from the start. I have an idea of what the patient needs before they see the optometrist. The hand-over following the eye examination is then an open discussion with the three of us about the patient’s history and their current needs, and I tailor my follow-up questions accordingly,” she says.

Readett uses a multi-pronged approach to explain and demonstrate lens enhancements. Her methods range from verbally explaining a lens enhancements qualities and benefits, showing patients an information brochure highlighting different in-store deals, using an iPad to demonstrate different lens enhancements with virtual simulated examples, or presenting physical lens samples, half with coating, half without.

Readett says different methods appeal to different personality types; some prefer tactile displays, others prefer to see simulation of different scenarios such as driving, yet others base their decision on price.

“It’s a matter of reading the customer you’re with, being across the full range of products, and staying up-to-date with industry developments,” she says.

THE ANTITHESIS OF A SALES PITCH Ms April Petrusma is also a part-time teacher at ACOD and dispenser at The Eye Piece, an independent practice with two locations in Sydney.

Qualified in dispensing and training and assessment, Petrusma has seven years’ industry experience, a mix of corporate and independent practice.

“As a dispenser in an independent practice, we have access to a range of suppliers lenses to sell to patients, but the key is not to sell – not to make it sound like a sales pitch,” Petrusma says.

She says an important factor in successfully selling – or upselling – lens coatings and treatments is to keep the patient informed and give the best optical result possible.

“It’s about making sure the customer knows the benefit of what they’d be getting. Ask the patient questions about their lifestyle, and based on that, make an informed decision about what lens coatings or treatments would benefit them most, and explain why,” Petrusma says.

“In an independent practice when you are dealing with patients in a one-onone environment, they are looking for expert advice and recommendations.

We build trust through a combination of rapport building, asking questions and offering product knowledge, which in turn leads to the patient trusting us and accepting our recommendations.”

Petrusma says the most effective method to explain and demonstrate lens coating and treatments differs for every patient.

“Every patient is different, regardless of the environment you work in and you should never take a one size fits all approach. You need to know your patient and adapt your method for each individual based on their needs , whether it’s a lens sample they can touch, feel, see, or whether a diagram or simple verbal explanation will suffice,” she says.

“The key is always recommend and don’t make it sound like a sales pitch.

That’s why they’ve come to see us, for our expertise and our knowledge. If we provide that, their trust is ten-fold.”

As national training and development manager at Hoya, Hentschel says they do a lot of work with practice and sales teams, to educate practice staff about coatings and their benefit to patients.

“Some lenses can cost $1,000 retail – naturally, customers want them to last. How those lenses perform makes a huge difference in how customers view lenses when the time comes to get their next pair of glasses,” he says.

In Hentschel’s experience, when it comes to lenses, and the benefits of better quality or coating, a lot of people will spend more on lenses, and less on frames.

Thurn, from Essilor, says educating practitioners and practice staff is paramount.

He says individual participation in Essilor’s online lens education programs has grown by 34% since the start of the year and the number of practices participating has risen 24%.

“We’re increasing the amount of available training material dramatically, recently adding two videos on blue-light filtering lenses, and guides for dispensers, including conversation starters to help guide discussion towards consumer benefit,” Thurn says.

“We’re teaching eyecare practitioners to treat the patient as a whole. The patient is looking for information and advice; it’s a conversation, let that guide the patient.” n

INSIGHT November 2020 37

Dr Hartley Atkinson and his wife Marree founded AFT Pharmaceuticals.

EYECARE

WITH PRESERVATIVE FREE EYE PRODUCTS In the space of 23 years AFT Pharmaceuticals has gone from a home-based business to a multinational company. It’s eyecare business is also experiencing remarkable growth, and more therapies are in the pipeline, including one for glaucoma.

A

t the age of 37 and with a $50,000 redundancy cheque, Dr Hartley Atkinson started AFT Pharmaceuticals out of the garage of his home in the Auckland suburb of Takapuna.

People told him it was a ludicrous proposition, but in 1997 – armed with a doctorate in pharmacology and experience as a medical director at Swiss drug company Roche – Atkinson began mapping out a plan for a multinational pharmaceutical firm that now counts itself among the major players across Australia and New Zealand.

Fast-forward from its humble beginnings more than two decades ago, the company today has around 90 staff across its offices in Auckland, Sydney, Kuala Lumpur and Singapore and turns over more than $100 million annually.

AFT, which is listed on the ASX and NZX, supplies more than 130 licensed and proprietary products in Australasia in multiple healthcare categories, and began carving out a niche for its eyecare business eight years ago.

Its seven eyecare products – some of which are top sellers in the lucrative eye lubricants category – are distributed to Australian eyecare professionals via Melbourne-based Good Optical Services. And AFT is working to add three more products to its portfolio with therapies for eye infections, glaucoma and a prescription dry eye treatment.

Atkinson says AFT’s eyecare range is a strong and fast-growing contributor to the overall business, generating approximately $18 million in revenue and accounting for approximately 15% of total sales.

“It’s an area we like, we are the number three supplier in Australia after a couple of big specialist eyecare companies (Alcon and Allergan) so it makes a lot of sense to carry on and grow our eyecare portfolio,” he says.

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Atkinson says AFT’s differentiator in eyecare is its portfolio consisting only of preservative-free products. It’s a trend the company identified in European markets and believed would catch on in Australasia once the products became available.

An added benefit of AFT's products is their multi-dose containers, which he says are more precise, user friendly and produce less plastic waste compared with single-use eye drop dispensers.

Dr Hartley Atkinson, AFT Pharmaceuticals.

“In 2012, we started with the HyloForte and Fresh range from a German family-owned company,” Atkinson says, adding that they are both listed on the Pharmaceutical Benefits Scheme (PBS).

“We then knew we wanted to extend it, and we saw other angles. There was the whole heat, clean and hydrate message that come out of the DEWS II work, so we were able to license a good quality heat mask in Opti-Soothe, then we looked at the Opti-Soothe preservative-free wipes to clean the eye lids and then preservative-free eye drops to use afterwards, so we are a looking at the holistic approach to treatment of patients with dry eye.”

AFT extended its portfolio further 18 months ago with the addition of NovaTears from another German firm, Novaliq, based out of the university town of Heidelberg. The PBS-listed treatment is preservative-free, nonaqueous and intended for the evaporative form of dry eye. It is now AFT’s fastest-growing eyecare product.

The portfolio is rounded out with another PBS-listed therapy called VitaPOS, a preservative-free night time ointment for dry eye, and preservative and phosphate-free Cromo-Fresh for eye allergies. In Australia, an eyedrop dispensing aid called Compleye is also available.

Atkinson says AFT will continue forging ahead with plans to consolidate its position as dominant player in the preservative-free eyecare market.

The increasing prevalence of dry eye, particularly in the warmer Australian climate, also warrants further investment.

“The market is only going to grow; the population is aging, but also too we have a younger population that’s spending more time in front of screens and that only tends to exacerbate the problem. You can call it a market, but at the end of the day, they are patients who need solutions and want to come to places like optometrists or ophthalmologists to find those solutions,” Atkinson says.

As such, the company’s marketing efforts are mainly focused at healthcare professionals like optometrists who can then stock and sell to patients.

“Optometrists, as a health professional, their time is valuable, so if they are going to spend any time recommending a product, they need to be making a reasonable dollar on it, while also doing the right thing by their patients by giving them a high-quality product. Our products maybe aren’t the cheapest on the market due to the cost of the related technology but that’s part of the point.”

OPTING FOR PRESERVATIVE-FREE When deciding which products to licence in an increasingly saturated eye therapeutics market, Atkinson says there is strong scientific evidence to support AFT’s preservative-free direction.

Before establishing its eyecare portfolio, the company looked to Europe for trends that were yet to take hold in Australia.

“Over there, there has been a real trend for the past 10 years with preservative-free and multi-dose containers. It was quite an eye opener for us and that’s what motivated us to make it our mantra,” he says.

“There is good data that shows that preservatives – which tend to be benzalkonium chloride which is a bit like a very weak soapy dishwater – tend to irritate the eye, so it just doesn’t make good sense to have something like that to treat issues like dry eye.”

Atkinson believes the latest IRi pharmacy sales data demonstrates Australian patients are increasingly seeing the value in preservative-free eye solutions as well.

In the eye lubricants category across all brands and products, including prescription, AFT’s Hylo-Forte was ranked first in terms of sales dollars.

It generated $13 million for the company, representing a 36% annual increase in the year to August.

Hylo-Fresh ranked seventh with sales of $3.6 million, an increase of 30%, while sales for relative market newcomer NovaTears topped $1.7 million – a remarkable 105% increase year-on-year.

“If we look at when NovaTears launched on the PBS, it’s actually further ahead of Hylo-Forte at that point, so that’s going very well,” Atkinson says, adding that NovaTears +O-Mega3 was also launched last month.

The overall eye lubricants category grew 8% in Australia during the past year, which AFT believes it played a major role in driving with $20 million in sales, a 39% increase on the same time last year.

Further, while all of AFT’s products showed significant growth, there was only one other preservative-free product from another company that grew, which itself saw its sales increase 37%.

In the coming year, Atkinson expects even greater purchase from its eyecare business with the introduction of three new licenced products, with the most notable of these being Vizo-PF Bimatoprost, AFT’s first foray into glaucoma.

The Pharmaceutical Benefits Advisory Committee recommended the therapy for listing on the PBS at its July meeting. It comes in a preservative-free multi-dose bottle and is indicated for the reduction of elevated intraocular pressure, or open angle glaucoma, as first-line therapy or monotherapy or as adjunctive therapy to topical beta-blockers.

Atkinson says another product on the horizon is Chloramphenicol, which is a staple treatment for bacterial eye infections.

It too will be preservative-free.

The other is a prescription dry eye treatment which is still under development, however regulatory filing in Australia is planned soon.

PRECISION DROP TECHNOLOGY Good Optical Services owner, Mr Rick Good, says when AFT first introduced its products to Australia it represented a breakthrough in the eye lubricants market.

Aside from the preservative-free benefits, he says the multidose pump containers are engineered to deliver 0.03ml to the eye, which is the exact amount the eye can hold. This is opposed to unit does products which can dispense anywhere up to 0.4ml.

“A lot of people say ‘wow $34 for a bottle of tears’, except you get 300 drops out of a 10ml bottle, and there’s no wastage. We’ve tested it and it’s not 298 or 301, its exactly 300, we’re rewarded with German engineering and exactness here,” he says.

“It actually leads to savings of about 50% to the average person. If you look at the millilitres, one bottle of Hylo is equal to about four boxes of the unit dose products because there’s just so much wastage. Most people are putting more of the tear on a tissue because it’s falling out of their eye due to the drops being so big.”

He says these economic savings were also viewed favourably by the PBAC around six years ago, which led to a swift introduction of AFT products on the PBS. Good Optical Services distributes AFT’s eye drop range Australia-wide to optometrists (corporate and independent), opticians, ophthalmologists and the universities. Good says the product range has had exponential sales growth, largely due to their efficiency and efficacy.

“And the unique thing from an optometry point of view is the synergy between Hylo-Forte and NovaTears. Hylo is an aqueous base so if you’re having trouble making tears it builds up your tear base, and then NovaTears, because it acts like a lipid layer substitute, it creates a seal so there is no leakage,” he says.

Overall, he believes AFT’s 'preservative-free' position on ophthalmic products was a positive and clever marketing idea.

“We are very happy to partner with AFT to supply efficient, economical, and effective products to the Australian optical industry,” Good adds. n

INSIGHT November 2020 39

OPTICAL

FROM FUNCTION TO LIFESTYLE AND FASHION Transitions Optical was one of the world’s first lens brands marketed directly to consumers. Insight details its transformation from a company with a niche product aimed at functional and clinical needs, to a lens portfolio that fulfils the protection and fashion requirements of a broader market.

O

ne of optometry’s most distinguishing features is its blend of medical and retail practice.

As a result, most products optical businesses offer can be classified as clinical or fashion-oriented. In the lens category particularly, few can bridge the gap between these two almost opposing spheres.

But those rare products that manage to unite eye health and style provide unique opportunities to fulfil the clinical demands of patients, as well as their personal requirements.

Typically, these products can offer easy opportunities to enhance profitability for a business, while creating greater satisfaction among patients.

For nearly three decades, one such company has focussed its efforts on addressing this challenge. It has evolved a functional and convenient lens positioned towards the medical aspect of optometry, into a lens whose fashion appeal and protection properties now attract a much larger market.

NICHE BEGINNINGS When Transitions Optical introduced its lenses to the market in 1991, it was the first time wearers could purchase a lightweight photochromic lens rather than its heavy glass predecessors.

While the company heralded this as a breakthrough, first incantations of Transitions lenses were a far cry from today’s designs.

The lens tended to have a ‘pleasing blush tint’ indoors, and was not overly dark outdoors, with slower reaction times compared with the company’s current offerings.

As such, the traditional market for Transitions lenses was niche and appealed to wearers who were predominantly older, seeking convenience and who may have had a clinical need to reduce light sensitivity.

With innovation at the core of Transitions Optical from its inception, the company’s second generation of lenses was quickly launched with improvements to the technology.

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INSIGHT November 2020

That innovation soon extended into its marketing campaigns, leading to the first inklings of a consumer lens brand. In fact, Transitions says it was the first lens – and remains to this day only one of a few – to market directly to consumers.

According to the company, as new generations of technology were introduced and consumer awareness increased with large investments in marketing, so did the appeal of Transitions lenses. Although it was no longer considered a niche brand, at this point it was still mostly worn by presbyopic patients not overly concerned with style.

HEALTHY SIGHT In the early 2000s, Transitions Optical identified a demand for providing long-term healthy sight to glasses wearers.

Technological innovation was fuelled by the need to provide maximum protection for wearers, while marketing efforts and budgets included extensive public health campaigns.

Ranging from young children to the elderly, the focus was on the long-term effects of UV to eye health, and how people can protect their eyes.

As a result, ‘Healthy Sight in Every Light’ was the mantra for Transitions Optical and became synonymous with its lenses.

However, during the 2000s health concerns remained a

Melbourne businessman Beni Doolan wearing Transitions lenses.

concern for predominantly older people – particularly long-term health.

Fast forward to today, however, and it’s clear patients live drastically different lives with different concerns.

Now, the company views health – once a concern among older people – as a key focus for all ages. The change has been particularly evident in younger people where wellness and health are now held in the same regard as fashion.

According to Transitions Optical, the increase in screen time and digital device use has altered today’s light environment, disrupting the amount of natural and artificial light people were traditionally exposed to.

Additionally, artificial light exposure has changed with a rapid conversion to LED lights with increased blue light and brightness – all of which can negatively affect health.

Countless studies show people now spend more time than ever before in front of screens and devices. With this significant change in the way people live their lives comes the potential health impacts of blue light – both in the short and long term.

Importantly, the company says the blue light risk is not limited to digital devices. In addition to damaging UV rays, the sun emits large amounts of blue light; at a rate at least 100 times more than digital devices.

Acknowledging these risks, Transitions Optical geared its R&D efforts towards evolving its lenses to incorporate filtering to protect not only from UV but also blue light from artificial sources.

Then, with the knowledge the sun is the highest emitter of blue light, its R&D team increased the blue light filtering outdoors to provide more protection where needed. With the increased time spent on devices and indoors, Transitions also points out that the natural circadian cycle can be disrupted, while the eyes face more demands from artificial and constantly changing light sources. Along with less exposure to natural day light of high spectral quality, this results in light sensitivity.

In fact, Transitions data shows nine out of 10 people declare they experience sensitivity to light and seven out of 10 want their eyecare professional to provide advice.

To help eyecare professionals in their diagnosis and treatment of light sensitivity, Transitions Optical applied a holistic approach by creating its Light Sensitivity Quiz – located on the Transitions website – so patients can assess their light sensitivity.

“By answering a few simple questions, the quiz determines how light sensitive a person is and how it impacts their life, this then begins the process of considering different solutions to address the issue,” Mr Stuart Cannon, Transitions Optical’s general manager of Asia Pacific, says.

“Transitions light intelligent lenses are obviously an ideal solution to conveniently address light sensitivity and safeguard eye health.”

Since its first product in 1991, Cannon says Transitions Optical now offers a choice of technologies to better address light sensitivity requirements.

“All of our technologies block UV and filter blue light, but wearers can choose the level of protection suited to their lifestyle,” Cannon continues.

“Transitions Signature GEN 8 is our fastest technology which indoors provides twice the blue light protection of a standard clear lens. Transitions XTRActive and Transitions Vantage both provide three times more blue light protection than a clear lens.

“Transitions XTRActive is our darkest lens outdoors which also activates behind a windscreen. Transitions Vantage features variable polarisation – as it darkens outdoors it also increasingly polarises. All of these everyday lenses increase the blue light filtering outdoors whereby the sun is the highest emitter.

Finally, there is Transitions Drivewear which is a variable tint polarised sun lens; it activates to three different colours and is optimised for outdoor use.”

This transformation, however, was by design, rather than by accident.

Once again, the company asked its R&D team to create new technology that was faster and expanded its lens colour range, which resulted in the Transitions style colours range.

This was followed by the breakthrough speed of Transitions Signature GEN 8 which is the company’s latest offering available in seven colours so wearers can create personalised frame and lens colour combinations for a personalised look.

The new technology has been coupled with new campaigns that are said to speak with relevance to younger and styledriven audiences, and features talent the company believes is identifiable, relatable and aspirational.

Campaigns have been supported by digital tools that are readily accessible to engage consumers. An example is the Virtual Try On tool on the Transitions website, which allows users to virtually try different frame styles and lens colours in any location, to create unique combinations that suit both their face and style.

By combining eye health with style, the Transitions brand is positioned to also appeal to younger markets.

According to the company, this has resulted in patients having a higher purchase intent before visiting an optical practice.

Cannon attributes Transitions’s appeal to younger and fashion-conscious wearers to faster technology, lens colour options and the hassle-free protection for eye health.

“Transitions GEN 8 testing revealed that seven out of 10 younger clear lens wearers are interested in purchasing Transitions,” Cannon says.

“The appeal of Transitions is now wide, but particularly with younger wearers.

Some fantastic content has been created by younger fashion-conscious wearers which we have given Transitions lenses to; their enthusiasm and love for Transitions lenses is phenomenal, particularly considering our beginnings.

There’s passion for how Transitions lens colours allow for self-expression and individuality that defines fashion today.”

The hassle-free protection and fashion appeal of Transitions lenses means the product now uniquely bridges the gap between medical and retail.

“It is a premium product, which patients desire and need. For patients it represents exceptional value for money and for practices it enhances profitability,” Cannon says.

EVOLUTION INTO FASHION

Overall, through advances in technology, marketing and consumer demands, Transitions’s near 30-year journey has taken the company from an innovative yet niche brand, to a fashion, lifestyle and protection product that appeals to the masses.

From its humble beginnings, Transitions lenses have evolved to become a product that the company believes younger and more style conscious wearers desire.

Take the Light Sensitivity Quiz at Transitions.com/quizVirtual. The Virtual Try On Tool is also available at Transitions.com/VTO. n

INSIGHT November 2020 41

EDUCATION

THE NEW CPD STANDARD FOR OPTOMETRISTS On 1 December, the registration standard for optometrists’ CPD will change from a pointsbased two-year cycle to a time-based annual cycle. Insight examines the challenges this presents, how optometrists are responding and whether COVID-19 has helped or hindered the impending change-over.

A

nnounced 18 months ago, the Optometry Board of Australia (OBA) is officially ushering in its new registration standard for continuing professional development (CPD) next month, bringing an end to the existing system that’s been in place for the past seven years.

The optometry CPD standard was revised after being scrutinised in a joint scheduled review that involved extensive consultation with the profession before being approved in June 2019.

The updated standard, applicable to all registered optometrists except those with student or non-practising registration, has been introduced to implement adult learning principles that contribute to better practice outcomes for the benefit of the public, according to the OBA. The shift will align the optometry standard with other health professions that have already made this transition, including occupational therapists, chiropractors, Chinese medicine and Aboriginal and Torres Strait Islander Health practitioners.

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INSIGHT November 2020

At ground-level, the change-over has been a significant undertaking for the sector, which has overhauled the CPD framework while contending with the COVID-19 pandemic. At the same time, CPD providers say they are moving to safeguard the integrity of the system, due to the removal of an accreditation requirement.

For optometrists, there’s anxiety about what the changes will mean in real terms. And it’s important to understand the new obligations; failure to meet the new standard can result in OBA-imposed conditions on an optometrist’s registration or – at worst – a registration, or registration renewal, application being refused.

attracting 10,000 page views per month,” he says.

OA continues to expand its range of education programs delivered through its Institute of Excellence.

“This now includes a portfolio of regular live and on-demand webcasts, publications and Optometry Virtually Connected – our annual conference and product showcase,” Hanna says.

He says one specific challenge the new system presents is for therapeutically endorsed practitioners to complete 30 CPD hours (including 10 therapeutic hours) per year.

The OBA’s current registration standard for CPD, which has been in place since January 2013 and will expire at the end of November, is based on a rolling twoyear cycle in which optometrists need to achieve a minimum 80 CPD points.

“In order to assist our members obtain these hours, Optometry Australia has been populating its Institute of Excellence’s online learning platform with relevant high quality course content from a host of reputable CPD providers. It is also in the process of developing, for each member, a unique CPD Learning Plan to help practitioners meet their CPD requirements.”

Under the new standard, which takes effect on 1 December, optometrists have one year to achieve a minimum of 30 hours’ professional development if they are therapeutically-endorsed, or 20 hours if they are not.

Corporations and not-for-profits such as Specsavers and the Australian College of Optometry are also navigating the new system and the challenges they may face to provide CPD.

According to OBA statistics, there are 3,801 therapeutically-endorsed optometrists, equating to 65% of all registered optometrists. For this group, 10 of their 30 hours’ professional development, or one third, must be therapeutic units.

Specsavers CPD manager Dr Joseph Paul says the first major challenge is ensuring all Specsavers optometrists are aware of and understand the new standard.

NEW STANDARD PROMOTES GREATER FLEXIBILITY

Optometrists will now be required to log five hours' minimum interactive units, and five hours' maximum non-scientific units, and will need to log a minimum 25 hours of clinical activities if they are therapeutically-endorsed, or 15 hours if they are not.

“We are confident that we are on track for this. Recent documents from the Optometry Board of Australia have been helpful in clarifying some of the greyer areas of the new standard,” he says.

Unchanged from the previous system, optometrists will be required to document and submit a learning plan, and update their CPR training every three years.

The OBA says the review presented an opportunity to consider ongoing professional development-based contemporary understanding, research, feedback from practitioners and experience from other health profession boards both nationally and internationally.

According to the OBA, a key benefit for optometrists of the new standard is much greater flexibility in understanding what contributes to professional development, implementing personal learning plans and broadening the ways that this can be achieved.

In comments he shared in Insight’s July Soapbox column, OBA chair Mr Ian Bluntish said the new standard emphasises a need for practitioners to reflect on their personal professional development needs and seek out opportunities to undertake CPD. “[Optometrists] will need to reflect on how these activities have influenced [their] practice and, ultimately, how they benefit patients and the wider community seeking optometric care,” he said.

CHALLENGES AND OPPORTUNITIES Optometry Australia (OA) – which provides CPD, approves content from external providers, and keeps a record of its members’ CPD – has been preparing for the changeover.

Professional development and clinical policy manager Mr Simon Hanna says OA has created the relevant framework to support its members’ transition to a new time-based CPD standard and understand their educational obligations to meet new registration requirements.

“Our move into education aligns to our strategic goal to be the preeminent provider of CPD and our forward thinking has placed us in a strong position to not only provide members with the planning tools that they will need to meet their time-based CPD registration requirements, but to also offer them a portfolio of quality time-based CPD programs,” Hanna says.

“One of the first initiatives that we implemented was to launch Optometry Australia’s Institute of Excellence in August 2019. This is now members’ primary digital destination for professional education

SIMON HANNA

JOSEPH PAUL

OPTOMETRY AUSTRALIA

SPECSAVERS

Paul says an important change optometrists will need to adapt to is setting up and maintaining a CPD portfolio, that covers learnings needs, CPD training plans and a reflective CPD journal.

“To support this, we have developed a simple and accessible way for our optometrists to manage their personal records within the Specsavers MyCPD portal that we launched earlier this year,” he says.

“The portal houses online courses, live events and webinars, as well as providing a place for each individual optometrist to keep the records they will need to meet the new standard, including training plans and reflections on how each CPD event met their learning needs.”

The opportunities the new standard presents are as equally important as the challenges, Paul says.

“The focus on self-directed learning and meaningful interaction with peers and presenters allows us to look at new ways to deliver CPD that will meet our optometrists’ educational needs. The Ophthalmology Local Education and Engagement Program that we ran last year was in many ways designed with this new standard in mind. Having small group CPD sessions facilitated by a local ophthalmologist really encouraged interaction and engagement for the optometrists who attended and allowed the CPD content to be tailored quite specifically for the local area,” he says.

INSIGHT November 2020 43

EDUCATION

CEO of Australian College of Optometry (ACO) Ms Maureen O’Keefe says her organisation is committing time and resources into preparing for the new system, as will all CPD providers.

“like all changes, with some nervousness”, but as they get to comprehend what is expected most understand the benefits.

“We’re investing in reorganising or reformatting our education programs and our systems to meet the new requirements and to ensure the program remains relevant,” O’Keefe says.

“This has been greatly assisted by the work undertaken by Optometry Australia in disseminating the details and working with their members to provide support, increasing the range of CPD activities and tools to assist in developing plans and recording activities,” the OBA says.

“It seems that in 2020 change is the only certain. Making some of these changes in the current COVID climate may also be challenging.”

Paul says Specsavers optometrists are getting to grips with the new system, but questions remain.

ACO is considered a major national provider of best practice clinical learning pathways for optometrists. Its flagship programs include certificate courses in ocular therapeutics, public health and leadership in eyecare, children’s vision, glaucoma, and contact lenses.

“We’ve had numerous questions from our optometrists over the past few months about the forthcoming changes, which I think shows that they are engaging with the change and looking to get on top of it so they can hit the ground running when the standard changes over,” he says.

“The ACO also offers a broad range of face-to-face and online professional development opportunities including clinical workshops, an annual conference, therapeutics updates, lectures and webinars,” O’Keefe says.

“We’ve seen on our MyCPD portal that a lot of our optometrists are already writing reflections on their CPD events and are completing courses that are relevant to their learning needs."

She credits the new CPD system with bringing optometry into line with other health professions but cautions it can’t be at the expense of quality.

“There is a continued focus on interactive learning and the need for optometrists to develop a learning plan based on their own needs and interest.

The focus on improving patient outcomes and evidence-based knowledge is very pleasing,” she says.

“However, given that the Optometry Board of Australia no longer requires activities to be accredited there is a risk that there may be a drop in the quality of CPD available.”

She adds: “The ACO will continue to invest in developing high quality education to help optometrists provide the best possible care for their patients.”

OA shares O’Keefe’s concerns about a potential decline in the quality of CPD and has put safeguards in place to protect this from happening.

“Optometry Australia has launched a quality assurance program designed to ensure that members can access the best education on offer. Our new Institute of Excellence Quality Assurance Program will identify those CPD activities that are considered a suitable quality to meet members’ learning needs,” Hanna says.

“We expect that the majority of Optometry Australia’s members in particular will rely on this indicator of quality when determining what CPD to undertake.

We have contacted all providers to let them know of our new quality assurance program and we will work closely with them to ensure that their courses meet our quality expectations.”

OPTOMETRISTS’ RESPONSE With nearly 6,000 registered optometrists directly affected by the change to CPD requirements – and all subject to a random annual registration audit under OBA including CPD compliance – it stands to reason there is some nervousness about the change.

Hanna says OA is actively supporting its members to prepare for the change.

IAN BLUNTISH

MAUREEN O'KEEFE

OPTOMETRY BOARD OF

AUSTRALIAN COLLEGE OF

AUSTRALIA

OPTOMETRY

RE-THINKING CPD IN COVID ERA When the OBA announced the new CPD standard in August 2019 with a start date of 1 December 2020, no one could have predicted a global pandemic would strike in the ensuing year, or what impact it may have on CPD. As Hanna explains, COVID-19 presented OA with the challenge of ensuring it could support members meet their current CPD commitments while preparing for the new system.

“It provided us with the opportunity to expand our range of CPD offerings via an enhanced program of live and on-demand webcasts and to launch Optometry Virtually Connected [conference],” he says.

“In addition to delivering these programs, we continued to prepare our systems and processes to meet the CPD transition on 1 December.”

“Optometry Australia has an extensive communications program under way aimed at informing members of the changes and how it will impact them. This includes a comprehensive guide that was distributed to all members in the September issue of Pharma, and a Q&A session with the chair of OBA, Ian Bluntish, during Optometry Virtually Connected [conference],” Hanna says.

The OBA concurs that the COVID-19 environment has already highlighted how the new requirements can be facilitated using online webinars and interactive apps to provide greater flexibility.

He says the organisation is also fielding several questions and providing one-on-one advice to members.

“Webinars, like we have been running through Specsavers Clinical Conference Online, are a fantastic way to reach a lot of people at once and to make CPD accessible, but the downside of a large webinar is that it is a little harder to get interactivity between presenter and attendees,” he says.

“We are proactively communicating with our members about the changes and this will not abate for several months. For instance, we have a video planned to walk members through the new Learning Plan and we recently published a comprehensive guide highlighting the different types of education that they will require, such as interactive and independent learning,” Hanna explains.

The OBA says optometrists have responded to the change in CPD standard

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Paul, Specsavers’s CPD manager, says the emphasis on interaction at CPD events may present a challenge if in-person events can’t be held.

“I think the spirit of CPD entrepreneurship, for want of a better word, that has sprung up over the past few months will carry us through the changeover. I’d say there’s never been a better time for having all sorts of CPD available at an optometrist’s fingertips.” n

DISPELLING MYTHS AROUND REGIONAL PRACTICE ORTHOPTIST ALINA SAYER SAYS MANY COLLEAGUES ARE RELUCTANT TO RELOCATE TO REGIONAL COMMUNITIES FEARING A LACK OF SUPPORT OR JOB SATISFACTION. HER EXPERIENCE IN CENTRAL QUEENSLAND HAS BEEN TO THE CONTRARY.

D

on’t be misled by the misconception that working outside the comfort and convenience of populous cities can limit the occupational scope or lifestyles of those willing to follow the less chosen path.

ALINA SAYER

"THERE IS AN OVERWHELMING SHORTAGE OF SKILLED ORTHOPTISTS WORKING IN REGIONAL AREAS, DESPITE THE CLEAR AND OBVIOUS DEMAND FOR OUR CLINICAL COMPETENCIES"

The roles and responsibilities available in regional practices are as varied as the communities they serve. From general clinical duties to outreach clinics, surgical assisting and everything in between, the possibilities for development and continuing education in many areas of interest is vast and often encouraged.

My position as a valued member within a diverse and multiskilled team of clinical assistants in a regional private ophthalmology practice has been immensely rewarding as an orthoptist.

After transitioning from working in Melbourne for close to a decade, the move to Rockhampton in Central Queensland has provided many opportunities to increase my professional skillset and deeply explore the multitude of diagnoses under the guidance of an ophthalmologist.

Working regionally has its own unique challenges for servicing the local population which is not experienced on the same scale by our urban counterparts. Not only is patient age and demographic broad and widespread, but the conditions are likely to be more severe and subsequently less likely to have been managed.

This, in many circumstances, is directly related to the burden of accessing appropriate and timely healthcare. It's not unusual for a patient to travel upwards of 400km one way to attend routine care at the clinic every four weeks for intravitreal therapy, or postpone treatment because they were unable to find suitable transport for the 10-hour round trip to attend the clinic.

In a regional location, patient care encompasses much more than the immediate ophthalmic status or the documentation of what’s visible diagnostically on the slit lamp or OCT. A comprehensive and holistic approach is often required, with acknowledgement of the many aspects of the patient’s health and wellbeing forming an integral part of maintaining care, promoting an effective and open dialogue, and thereby improving

As an orthoptist in Rockhampton, Alina Sayer says she is exposed to a wide variety of conditions, and has high levels of clinical autonomy.

compliance with management and treatment plans.

It is also an inherent and ever-present necessity to consider the patients’ peripheral circumstances such as locality, ability to obtain transport, family and peer support, and ease of access to health facilities.

Tertiary eyecare resources are often taken for granted in densely populated areas like Melbourne or Sydney, with access to public health facilities and dedicated eye hospitals so readily available. In contrast, this is often a complex and difficult undertaking for many of those living regionally.

When an urgent ophthalmic issue arises demanding immediate attention, it is not as straightforward as heading to the city for care at the Eye and Ear Hospital.

The process of accessing care can be a significant logistical challenge that involves juggling the burden of cost and travel, navigating the local public hospital system, care flights and trips to the nearest capital city for vital and often sight-saving inpatient care. This was not something I appreciated prior to my role in Central Queensland.

While having an orthoptist as part of the eye health team is standard practice in metropolitan clinics, there is an overwhelming shortage of skilled orthoptists working in regional areas, despite the clear and obvious demand for our clinical competencies. Many orthoptists are reluctant to relocate fearing they may

not receive adequate support, training and direction in an isolated environment. My experience has been to the contrary.

The spectrum of professional orthoptic practice and clinical autonomy intrinsically afforded by many regional orthoptic positions present an ideal opportunity for orthoptists willing to take up the challenge of regional or remote eyecare. The ability to engage with the local community in an effective and meaningful way through patient education, counselling and highquality care plays an important role in job satisfaction and for ultimately providing a sense of work-related accomplishment.

I would encourage other orthoptists and eye health professionals to explore the multitude of diverse paths and rewarding positions beyond our major capital cities and extend your much-needed expertise within more regional communities. n

ABOUT THE AUTHOR: ALINA SAYER is an orthoptist working in a regional private ophthalmology practice in Central Queensland.

She graduated from La Trobe University with a Bachelor of Orthoptic and Ophthalmic Sciences in 2010.

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

INSIGHT November 2020 45

DISPENSING

GETTING TO KNOW YOUR PRODUCT RANGE CHOOSING THE FRAME PRODUCT RANGE CAN BE BOTH AN EXCITING AND STRESSFUL PROSPECT FOR ANY INDEPENDENT PRACTICE. IT ALSO SAYS A LOT ABOUT A BUSINESS, SO IT’S IMPORTANT TO GET RIGHT, WRITES EMMA ROBERTS.

2

020 is sure proving to be a tough year, especially for small businesses. The optical industry has taken quite a hit, and made us all realise that to survive times like this we need to be adaptable, and open to looking at new ways to conduct business.

EMMA ROBERTS

"HAVING THE RIGHT FRAME AND SUNGLASS SELECTION IS WHAT KEEPS THE CUSTOMER IN THE PRACTICE"

But before that, we need to understand what we already have. One area that gets overlooked is frame product ranging, and how to get it right.

Product can be the most exciting, and the most stressful part of an independent eyewear practice. Eyecare is undoubtedly the main priority, but having the right frame and sunglass selection is what keeps the customer in the practice. Knowing and understanding our demographic is key to getting the stock formula right, but many practices are unsure of how to manage their stock ranges effectively.

By conducting a regular range review, optical dispensers can identify their bestselling brands, the most profitable price points, slow moving stock and areas that are worth investing in – or not.

I’ve developed a list of tips to help dispensers organise their product range.

GETTING STARTED An Excel spreadsheet that’s updated monthly is an ideal place to conduct a range review. Other people are happy to write one up fresh each time they need it.

There’s no right or wrong way, as long as the plan makes sense.

Next, separate RX frames and sunglasses and review for each independently. These two categories are quite different from each other.

Just because a brand performs well in sunglasses, doesn’t necessarily mean it will be the same for frames.

Dispensers should make a list of how many pairs they want to stock. This will become the target range. For example, the number of display spaces plus six weeks’ back up. Put as much detail into this as possible. Try splitting the range into men’s/women’s/children’s, fashion, sport, budget etc.

Run a stock listing report per brand

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INSIGHT November 2020

Emma Roberts helping to range frames at Glenn Howell Optometrist in Victoria.

Practices should stick to one brand per row if their frames are displayed this way.

and see where these numbers fit into the above plan. This can be time consuming but gives an understanding of the stock performance. Manually going through this stage is the best way to understand what is working. And there are sure to be a few surprises.

performing brands, and see if they are willing to swap out the models and start afresh, or swap out for another one of their brands.

Enter the numbers into the spreadsheet as goal quantity, current quantity and over/under quantity per brand.

After this, run a report showing sales for the category. I look at this every three months. Ensure the report run is listed by brand so it’s possible to see which are best performing.

At this point, the dispenser should have an idea of where changes need to be made. It makes no sense to have 30 frames on the shelf of one brand if only two are being sold per month. Ensure to look at prices too, checking GP, repetitive product faults, quality of after sales service from suppliers etc.

Once deciding which frames will stay, ensure these brands are topped up. If the eyewear display is in rows, I strongly suggest sticking to one brand for the entire row as splitting them makes the ranges look messy.

Following this, dispensers can contact the frames wholesaler about slow or poor

By following these steps, there should be a clear understanding of what is missing from the range. Next, contact the practice reps and explain the gap to see if they have any brands that may fit.

Alternatively, look around to investigate any new potential suppliers.

Overall, a good product range says a lot about a business. If it is neat, organised and tells a story, this is how our overall business will be viewed.

Knowing our product and having a solid goal in place will alleviate some of the stress of purchasing and managing product in uncertain times.

With the knowledge that the practice is investing only in brands and product that works for its business, frame ranges become less of a risk and more of a benefit to invest in. n

EMMA ROBERTS has 17 years’ industry experience and is a qualified optical mechanic and dispenser. She founded The Eyewear Girl, a platform that informs consumers about quality eyewear. For more information visit www. eyeweargirl.com, Instagram @theeyeweargirl or email theeyeweargirl@gmail.com.

MANAGEMENT

THE PERILS OF TREATING FRIENDS AND FAMILY THE MEDICAL BOARD OF AUSTRALIA HAS UPDATED ITS GUIDANCE ABOUT TREATING PEOPLE WHOM A PRACTITIONER IS IN A PERSONAL RELATIONSHIP WITH. AVANT’S JAMESON ABADAM AND DR USHMA NARSAI DETAIL THE RISKS INVOLVED.

A

s a practitioner, a family member or a close friend may ask for your medical opinion or a prescription.

Sometimes it is difficult to refuse.

However, writing that one-off prescription or referral may do more harm than good.

JAMESON ABADAM

To demonstrate this, let’s use the case of Patient P who started to develop severe debilitating headaches. Dr S was a general practitioner and was in a de facto relationship with Patient P. Dr S became his primary medical provider. She prescribed medication, wrote referrals and accompanied Patient P to appointments. During this period, two ophthalmologists raised their concerns with Dr S in relation to her being P’s treating practitioner and partner.

USHMA NARSAI

Dr S’s treatment of P led to an appearance before the Tribunal and a finding that Dr S’s knowledge, skill and judgement was significantly below the standard reasonably expected of a medical practitioner. The Tribunal also found that Dr S’s conduct constituted professional misconduct.

TREATING PERSONAL CONTACTS The Medical Board of Australia’s (MBA) new Code of Conduct came into effect on 1 October 2020 and has revised guidance about treating anyone who the doctor is in a close personal relationship with.

The Code states “whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate”.

It now also states that doctors must not prescribe certain medication and perform elective surgery for anyone with whom they have a close personal relationship.

The code recognises that it may sometimes be unavoidable to provide care, such as in an emergency.

LACK OF OBJECTIVITY You may find it difficult to maintain your professional objectivity when treating family, friends and staff or colleagues.

The problem is that there is an inherent conflict of interest between a therapeutic

relationship and your personal relationship.

As practitioners, your treatment plan usually involves taking a complete history from and conducting a full physical examination of the patient. If you have a personal relationship with the patient, both parties may find this uncomfortable especially when asking sensitive questions or conducting a physical examination. In addition, the nature of your relationship and what you know of the patient outside of the consultation may influence both what you ask/do and what the patient tells you.

There is also a potential risk of missing vital information, which may impact on the overall management of the patient.

This could include failing to arrange the appropriate investigations or referrals.

It could also lead to a diagnosis being overlooked or delayed.

DISCONTINUITY OF CARE Ensuring continuity of care is the cornerstone of holistic patient management.

Unfortunately, it may be affected where practitioners have not kept appropriate records in cases where there has been an informal discussion, a one-off prescription or a referral has been written. This means that other practitioners may not have the complete picture, which could compromise patient care.

In the above case, Dr S failed to maintain adequate records regarding consultations with P. Furthermore, she arranged referrals to seven different specialists, all of whom did not have accurate and sufficient information to enable them to conduct a comprehensive assessment.

Personal relationships with patients can cause discomfort when discussing sensitive issues.

• Documenting your consultation and any treatment accurately.

• Arranging and following up appropriate investigations.

• Keeping all treating practitioners informed with the treatment provided; and • Handing over care to their usual practitioner as soon as practicable.

For doctors, it is in your nature to want to care for people. However, in the case of family, friend, staff or colleagues, it is best to let someone else care for them.

While it might be especially difficult to not treat those close, it is in the patient’s best interests and your own.

More information can be found via the Medical Board of Australia’s Good medical practice: a code of conduct for doctors in Australia (from 1 October 2020). n

So, what to do if you’re providing care to family, friends or staff?

The MBA does recognise that there may be situations where practitioners may need to treat someone close to them, for example in emergency situations. If it is unavoidable to provide care, you should consider: • Setting boundaries and expectations with the patient about your care.

JAMESON ABADAM is a Senior Claims Manager at Avant. He also provides advice and support to doctors, medical practices and other health professionals through Avant’s Medico-legal Advisory Service.

DR USHMA NARSAI is a Senior Medical Adviser and Claims Manager at Avant and a general practitioner.

INSIGHT November 2020 47

SPECSAVERS – YOUR CAREER, NO LIMITS A

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

Optometrist opportunities, regional QLD We are currently seeking Australia’s most dedicated and driven optometrists to join our Specsavers family in regional Queensland. We will give you access to the latest technology and equipment (including OCT), assist you with your career progression, provide you with a host of professional development opportunities – from our annual clinical conference to ophthalmology-led education programs and offer a competitive salary – including PII, AHPRA, CPD allowance and bonuses and incentives. Full time, part time and contract roles are available across the state.

Graduate Optometrists –Northern Territory & Regional QLD Are you looking for the right opportunity to kick start your career as an optometrist? Specsavers is offering its highest ever graduate salary package for Specsavers Emerald (QLD) and Specsavers Darwin (NT). If you’re looking to make a genuine impact, deliver patient-centric, evidence-based preventative eye care and work collaboratively to manage health outcomes, then we urge you to talk to us about how you can join our mission to transform eye health. At Specsavers you will have access to cutting edge technology and be part of the driving force bringing optometry into the forefront of the healthcare industry.

Joint Venture Partnership Opportunities– Specsavers Tasmania Specsavers is on the lookout for experienced optometrists to join us as Joint Venture Partners in Tasmania. We have various opportunities available – with high growth potential and affordable buy in – these are opportunities not to be missed! As a Specsavers JVP, you will have access to back-office administrative support from our support office, the power of Specsavers market-leading brand driving customers to your store, and an annual combined marketing fund of more than $60 million.

Receive a guaranteed market-rate salary in addition to your share of store profits, along with guaranteed annual leave and access to exclusive wellbeing workshops.

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

SO LET’S TALK! Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership (JVP) enquiries: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134 Australian employment 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

Specsavers Recruitment Services – Locums across Australia and New Zealand: Locum optometrists: ever feel like you didn’t have enough time during the week to complete all your tasks? Weekday work commitments getting in the way? It’s time to REDEFINE your working week with Specsavers – we have vacancies available each weekend in all regions. Join us and help transform the eye health of our loyal Australian customers. Enjoy working with the country’s leading optometry brand and our first-class technology.

*

Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

OPTICAL DISPENSER - MT ANNAN AND CARNES HILL, SYDNEY

Eyecare Plus provides business support and marketing services to over 150 clinically focused independent full scope optometry practices throughout Australia.

Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment. Eyecare Plus offers three membership options; branded, co-branded and unbranded. Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training.

Our practice, that prides itself on excellence in family eye care through the provision of services in children’s vision, behavioural vision care, complex contact lenses and state of the art equipment for early detection of eye diseases, is looking for a full-time Optical Dispenser. The successful applicant will have great customer service in a bright and friendly manner. Possess good communication skills, both in person and over the phone. Be either qualified in Optical dispensing or have experience in working as an optical assistant in a retail practice for a minimum of 1 year. Further, the ability to work constructively within a team and an eye for fashion, while enjoying assisting patients to choose frames and sunglasses will be valued. Attendance at training courses and team meetings is required as will some occasional overtime. Only successful applicants will be contacted.

We also actively assist Optometrists and Dispensers who are looking to establish their own practice. If you are looking to buy, or sell, an optometry practice, please contact us.

For more information call Philip Rose: Philip.rose@eyecareplus.com.au.

All Current Positions Vacant and more details: www.eyecareplus.com.au/careers/

OPTOMETRIST - WARWICK, QLD Full time Optometrist required for our practice in Warwick (Chas Sankey FraserWarwick). We have a new exam room stand/chair equipment as well as new Huvitz OCT with retinal camera combination, new VF’s tester plus Nidek Tonoref III, Autolensometer and progressive lens identifier. Our practice has well trained staff with plenty of experience who perform pre-testing and are delegated to do VF testing.

Graduate and foreign trained Optometrists are encouraged to apply. Warwick is a friendly city with a mix of agriculture, tourism and industrial business within 2 hours of Brisbane. SALARY: Base Salary of $110,000 plus super with an accommodation allowance of $20,000 and a $20,000 salary increase for 20 minute testing. Also, includes payment of OAA membership, AHPRA and annual AVC Trade Fair.

To apply: sylvia@eyesense.com.au

OPTOMETRIST – GOLD COAST The practice is located in the Miami One Centre, a short distance from the beach, and has a very good level of equipment and excellent support staff. A broad base of patients makes for an interesting clinical profile, and a high level of autonomy, with patient care being the primary focus. There is a full range of clinical optometry services offered to patients, including Orthokeratology and other forms of contact lenses.This is a very effective small team and a great opportunity to make your mark in a friendly and professional practice.

To apply: Please apply with your CV and cover letter to Mark Overton, Ideology Consulting. mark@ideologyconsulting.com.au

To apply: Please send through your CV and cover letter via email to csfoptical@bigpond.com

CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/

OPTOMETRIST – GAWLER, SA

OPTOMETRIST: Warwick & Miami, QLD. Gawler, SA.

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

To apply please contact Chris via phone on (08) 8522 7611 or via email; gawler@eyecareplus.com.au

OPTICAL DISPENSER / SALES ASSISTANT: Mt Annan and Carnes Hill, Sydney

20/21 CALENDAR NOVEMBER 2020 OPTOMETRY NSW/ACT CANBERRA CONFERENCE Canberra, Australia 8 November optometry.org.au

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

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

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

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

EUROPEAN MEETING OF YOUNG OPHTHALMOLOGISTS

Milan, Italy 6 – 8 February mido.com silmobangkok.com

MARCH 2021

Furano, Japan 6 March skiconf.com

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

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

Kuala Lumpur, Malaysia 13 – 15 August

RANZCO NSW BRANCH ANNUAL SCIENTIFIC MEETING Newcastle, Australia 18 – 20 March cophy.comtecmed.com

ANNUAL CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: EUROPE Lisbon, Portugal 27 March orthoptics.org.au

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

apgc2020.org

silmobangkok.com

APRIL 2021

BARCELONA SPECS

MAY 2021

Bangkok, Thailand 25 – 27 November silmobangkok.com

Brussels, Belgium 13 – 15 December egs2020.org

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

FEBRUARY 2021

SILMO BANGKOK

14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS

5TH ASIA-PACIFIC GLAUCOMA CONGRESS

Barcelona, Spain 10 – 11 April barcelonaspecs.com

SKI CONFERENCES FOR EYE CARE PROFESSIONALS

DECEMBER 2020

AUSTRALIAN VISION CONVENTION 2021

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

MIDO EYEWEAR SHOW

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

100% OPTICAL London, UK 8 – 10 May 100percentoptical.com

VISION EXPO EAST New York, USA 25 – 28 May east.visionexpo.com

JUNE 2021 ASIA OPTOMETRIC CONGRESS & AEGEAN OPTOMETRIC CONFERENCE Kuala Lumpur, Malaysia 9 – 10 June

SEPTEMBER 2021 O=MEGA21 Melbourne, Australia 2 – 4 September omega21.com.au

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

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

OCTOBER 2021 AUSCRS 2021 Noosa, Australia 20 – 23 October www.auscrs.org.au

asiaoptometriccongress.com

JULY 2021

NOVEMBER 2021

APOTS MEETING

RANZCO ANNUAL SCIENTIFIC CONGRESS

Bali, Indonesia 1 – 4 July apots2020.com

VISION 2021 Dublin, Ireland 11 – 15 July vision2020dublin.com apots2020.com

AUGUST 2021 OPHTHALMOLOGY UPDATES! Sydney, Australia 28 – 29 August ophthalmologyupdates.com

Brisbane, Australia 19 – 23 November ranzco.edu

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

INSIGHT November 2020 49

SOAPBOX

THE ROLE WE ALL HAVE TO PLAY IN KERATOCONUS up. The new optometry module of the registry led by Associate Professor Laura Downie now allows seamless outcomes data collection between optometry and ophthalmology. Patient data can be shared and outcomes tracked, benchmarked and displayed to patients.

A team of optometric experts will guide the registry via its steering committee.

This will allow the profession to work together to use everyday practice data to benefit the care of patients.

K

eratoconus is common. In fact, it’s so prevalent that I see it most days I’m in the clinic.

The typically young patient will be struggling with their vision at a time when they are facing major life hurdles.

COVID-19 has exacerbated these difficulties whilst they work towards finishing school or university or start their career. The move to spending more time online, face masks which fog glasses and obscure lip movements and facial expressions, have all had an impact.

“Will my keratoconus get worse?

What will happen if I have cross-linking?

And what will I be able to do?” These are common questions for people with keratoconus or their carers. They are seeking answers that are relevant to them and want to understand the ongoing impact of keratoconus and the benefit of any treatments.

Searching through the literature we tried to find the answers.

Looking at 11,594 eyes – the largest systematic review and meta-analysis of keratoconus progression ever conducted, our results, published in the journal Ophthalmology, showed younger patients and those with a Kmax steeper than 55 D have a significantly greater risk of progression. We recommended closer follow-up and a lower threshold for cross-linking in patients younger than 17 years and steeper than 55 D Kmax. But this data included studies prior to modern topography. Everyday people with keratoconus consult eyecare professionals. The Save Sight

50

INSIGHT November 2020

Keratoconus Registry (SSKR) was established more than six years ago to use the information from everyday practice to understand and improve outcomes in keratoconus. Global data on over 6,000 eyes and close to 30,000 visits, with modern topography, are providing answers to inform practice.

The KORQ – Keratoconus Outcomes Research Questionnaire developed by Professor Konrad Pesudovs – is used by SSKR to collect patients’ views on their functioning and treatment. Improving the vision in the better seeing eye helps with their day-to-day activities. But clinicians should be aware vision in their worst eye is strongly related to emotional wellbeing; so they should consider what they can also do for that eye.

Our registry data has identified clinically significant haze after cross-linking is more common in patients who are younger and have steeper keratometry. They should be monitored more closely post-operatively.

Most patients though can be reassured as, in the long term, our data shows few late adverse events from cross-linking and for most there are small improvements in vision and a stable corneal shape.

These improvements are similar in both conventional (long) or accelerated crosslinking techniques. Long-term follow up is still needed as some fail to stabilise.

Optometrists have a life-long role in managing patients with keratoconus; spectacles and contact lenses remain the mainstay of visual rehabilitation.

Following procedures like cross-linking, many return to their optometrist for follow

As ophthalmologists and optometrists track outcomes they can benchmark their practice and this has been shown to improve outcomes. But patients want to know more and have concerns they wish to share. Now in its fifth year, the Keraclub, a support group for patients and their carers with keratoconus, provides the opportunity for patients to learn and share from ophthalmology and optometry. The event is supported by Keratoconus Australia, led by President Mr Larry Kornhauser.

This year at the Keraclub, Ms Michelle Pritchard, violist and violinist, moderated presentations from optometrist Ms Jessica Chi on COVID-19 and contact lenses, Mr Allan Ared on eye rubbing, with Dr Himal Kandel and myself providing updates on the SSKR. The session was a success. One attendee commented “I learnt more about keratoconus in that one hour than I have in almost 30 years with the condition.”

During COVID, it is more important than ever to work together to track outcomes.

The SSKR has found fewer patients with keratoconus attending care. With quality of life impacted, we need to know who is receiving care and its outcomes; this will benefit patients and the profession. n

Name: Professor Stephanie Watson Qualifications: Bsc(Med), MBBS, PhD, FRANZCO Business: Corneal specialist and academic Position: Professor, Head of Corneal Research Group, Head of Corneal Unit and Chair, ORIA Location: The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School and Sydney Eye Hospital, Prince of Wales Hospital, and Sydney Children’s Hospital Years in the profession: 20

"OUR REGISTRY DATA HAS IDENTIFIED CLINICALLY SIGNIFICANT HAZE AFTER CROSS-LINKING IS MORE COMMON IN PATIENTS WHO ARE YOUNGER AND HAVE STEEPER KERATOMETRY"

INTRODUCING

EVOLVING DESIGN. ADVANCING PREDICTABILITY. Featuring a wide flange at its base, the new precision-engineered iStent inject ® W Trabecular Micro-Bypass System is designed to optimise stent visualisation and placement, enhance procedural predictability, and increase confidence.

FOR MORE INFORMATION CONTACT YOUR GLAUKOS REPRESENTATIVE

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INDICATION FOR USE. The iStent inject ® W Trabecular Micro-Bypass System (Model G2-W) is intended to reduce intraocular pressure in adult patients diagnosed with mild to moderate primary open-angle glaucoma (POAG) currently treated with ocular hypotensive medication. The device can be implanted with or without cataract surgery. CONTRAINDICATIONS. The device is contraindicated for use in eyes with primary angle closure glaucoma, or secondary angle-closure glaucoma, including neovascular glaucoma, because the device would not be expected to work in such situations, and in patients with retrobulbar tumor, thyroid eye disease, Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS. This device has not been studied in patients with uveitic glaucoma.

Patients should be informed that placement of the stents, without concomitant cataract surgery in phakic patients, can enhance the formation or progression of cataract. The surgeon should monitor the patient postoperatively for proper maintenance of intraocular pressure. iStent inject ® is MR-Conditional, meaning that the device is safe for use in a specified MRI environment under specified conditions; please see labelling for details. Physician training is required prior to use and consists of 3 parts: webinar, Didactic session with Glaukos surgical representative and observation of surgical cases by Glaukos representative until implantation proficiency is demonstrated. Do not reuse the stent(s) or inject or. ADVERSE EVENTS. Postoperative adverse events include but are not limited to: corneal complications including edema, opacification and decompensation, cataract formation (in phakic patients), posterior capsule opacification, stent obstruction, intraocular inflammation (non-preexisting), BCVA loss and IOP increase requiring management with oral or intravenous medications or surgical intervention. Please refer to Directions for Use for additional adverse event information. CAUTION: Please reference the Directions For Use labelling for a complete list of contraindications, warnings and adverse events. © 2020 Glaukos Corporation. Glaukos and iStent inject ® are registered trademarks of Glaukos Corporation.

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Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408. Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) New Zealand Distributor: Toomac Ophthalmic. 32D Poland Road, Glenfield 0627 Auckland New Zealand (Ph 0508 443 5347) FIV.0017.AU.20