Insight December 2019

INSIGHT DEC

2019

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

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WORLD CONGRESS BOUND FOR AUSTRALIA

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SPECSAVERS CLINICAL CONFERENCE 8 IMPRESSES Learn about the research, case studies and presentations at this year’s event.

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INSIGHT DEC

2019

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

AUSTRALIA WINS BID FOR WORLD CONGRESS OF OPTOMETRY, TO BE HELD ALONGSIDE O=MEGA21

In what has been heralded as a major coup for Australia’s ophthalmic sector, Melbourne has been awarded the rights to host the 4th World Congress of Optometry.

Key industry figures anticipate the event could generate as much as $12 million for Victoria, while also reinforcing Melbourne’s standing as Australia’s knowledge capital.

The international meeting, secured by Optometry Victoria South Australia (OV/SA) and the Optical Distributors & Manufacturers Association (ODMA), will run in conjunction with O=MEGA at the Melbourne Convention and Exhibition Centre (MCEC) between 2-4 September 2021.

It is expected to attract some 1,000 international visitors, as well

be a regional event for Asia-Pacific, and what better way to do that than through hosting a global congress in just O=MEGA’s second edition.”

as several thousand local and interstate delegates.

The meeting follows OV/SA and ODMA’s successful launch of the inaugural O=MEGA19 show in July. Replacing the former Southern Regional Congress (SRC) and ODMAFAIR this year, the joint venture was designed to bring the Southern Hemisphere’s largest optometry clinical conference together with Australia’s biggest trade show.

During the development of O=MEGA OV/SA and ODMA, with the support of the Melbourne Convention Bureau (MCB), were also working on a pitch to host the prestigious global congress in collaboration with O=MEGA21. The World Council of Optometry (WCO)

The Victorian State Government and Tourism Australia’s Business Events Bid Fund Program supported the Melbourne bid. confirmed the Australian team had secured hosting rights at its October event in Orlando, Florida.

“O=MEGA19 was an extremely ambitious project in and of itself, bringing together the biggest trade expo and clinical conference,” Mr Pete Haydon, CEO of OV/SA, said.

“It’s always been our ambition to turn this into more than the national event for Australia. We wanted it to

MCB CEO Ms Julia Swanson anticipated the congress’ economic impact could reach $12 million when accounting for accommodation, shopping, dining, entertainment and ancillary costs of around 2,000 international and interstate delegates during the event.

“Melbourne is recognised as Australia’s knowledge capital and innovation hub. The city is continued page 6

FUNDING FOR STANDALONE MIGS PROCEDURES CLOSER Government advisors have recommended minimally invasive glaucoma surgery (MIGS) should be publicly funded as a standalone procedure, following extensive campaigning from Australia’s ophthalmic community.

Almost a year since rejecting the proposal, the Medicare Services Advisory Committee (MSAC) now believes there is sufficient evidence for standalone trabecular microbypass glaucoma surgery (TB MBGS) – a form of MIGS – to have its own Medicare Benefits Schedule (MBS) item number.

It follows years of advocacy led by the Australian Society of Ophthalmologists (ASO) after a 2017 change in item number

regulations threatened funding for all MIGS procedures.

The issue was partially addressed in October last year when the Federal Government approved a new item number, but limited the procedure’s availability to patients who were simultaneously undergoing cataract surgery.

Although encouraged by the development, the ASO continued to campaign. It believed the move created two classes of glaucoma patients because those who did not need cataract surgery, or had already recieved the operation, would not be eligible.

According to MSAC, it originally did not support public funding of standalone MIGS due to

unclear eligibility criteria and high ‘leakage risk’ to other populations, poor comparative safety data, poor comparative efficacy, and unsatisfactory economic assessment.

However, at a meeting in August, MSAC agreed to support MIGS in isolation after considering the strength of available evidence for comparative safety, clinical effectiveness and cost-effectiveness presented by the ASO. Its application was supported by the Australian and New Zealand Glaucoma Society, treatment companies such as Glaukos, health economists Thema Consulting and Glaucoma Australia. continued page 6

GOING TOE-TOTOE WITH ONLINE RETAILERS Online retail has had a far-reaching impact on the eyecare sector, particularly in terms of contact lens sales.

MYLES HUME looks at how optometrists can differentiate their businesses to overcome new e-commerce operators. page 29

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UPFRONT Just as Insight went to print, SPECSAVERS released its latest report into Australian eye health. Titled the Specsavers Eye Health Report 2019-20, it builds on last year’s inaugural State of the Nation report. A highlight is the increased rate of glaucoma patients referred to ophthalmology following the chain’s completion of a nationwide rollout of OCT devices. In 2019, more than half of referrals to ophthalmology were new, a result that closely aligns with the findings of the

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WEIRD

Blue Mountains Eye Study. The increased utilisation and same-day performance of visual fields on at-risk patients, as well as the RANZCO Referral Pathways were also factors. IN OTHER NEWS, Optometry Australia (OA) has announced the organisation’s plans for 2020 are progressing well. “The Year 2020 presents a one-off chance to raise consumer awareness around the subject of eye health and we are taking this opportunity to amplify our eye health messages like never before over the next 12 months,” Ms Lyn Brodie, OA CEO, said. OA is currently working on a national survey of Australians about their approach to eye health that will

cover topics including glasses, disease, workplace and digital behaviour. FINALLY, Dr James Muecke has been named South Australian of the Year, placing him on the shortlist for the 2020 Australian of the Year.

Since starting his career in ophthalmology Muecke has fiercly campaigned to fight blindness. In 2000 he co-founded Vision Myanmar at the South Australian Institute of Ophthalmology, and more recently co-founded Sight For All. He is also a clinical senior lecturer in ophthalmology and visual sciences at the University of Adelaide. He was also recognised this year by the University of Adelaide with the ViceChancellor’s Alumni Award.

STAT

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WACKY

A legally blind golfer in Minnesota has defied the odds to sink a hole-in-one during a recent round of golf. Mr Terry Howard, who suffers from neovascular AMD and lost his sight one year ago, made the shot while playing a round of golf with his brother, kbjr6.com reports.

The two brothers have been golfing together for 25 years.

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WONDERFUL

Mattel has released a braille edition of the popular card game UNO for visually impaired players. The deck features braille markings on the corner of each card, telling players the colour, number or action. Instructions for the game can either be downloaded to a braille reader, or read aloud on a compatible home smart assistant.

Published by:

Publisher Christine Clancy

New research has found that the more doctors believe in a treatment, the better it works. Patients reported a greater decrease in pain from a soothing cream if it was provided by someone who was told it was a medicated substance, as opposed to someone who knew it was just Vaseline. Researchers believe this is due to subtle, interpersonal signals.

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COURIERED CONTACTS

Design Production Manager Michelle Weston

According to a recent survey conducted by Delta MV Market Research on behalf of CooperVision, only 21% of Australian contact lens wearers regularly purchase their lenses online.

Full report page 29.

Art Director Blake Storey Design Jo De Bono

WHAT’S ON THIS MONTH

2019 COSSOM MEETING

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Complete calendar page 49

NEXT MONTH

OPTI 2020

DEC 7, SYDNEY

JAN 10-12, MUNICH

Cossom is the annual scientific meeting of the UNSW Department of Ophthalmology’s Alumni Association.

Hanan.youssef@health.nsw.gov.au

Every year experts and creatives in the optics industry display their newest products in Fairground Munich at this International trade show for optics and design. visitor@opti.de

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INSIGHT December 2019 5

NEWS

ECONOMIC IMPACT COULD SURPASS $12 MILLION continued from page 3

a leader in sectors such as health, science, engineering and technology and it continues to attract great minds to collaborate, innovate and deliver real impact to the wider community,” she said.

“Our city is home to 10 world-class universities, 13 worlds-class research institutes, 10 major teaching hospitals and a wide net of thinkers, creators, innovators and producers.”

According to the MCB, in terms of delegate numbers the congress ranks 16th out of the 58 conferences secured at the MCEC during the past 2.5 years.

Federal Tourism Minister Mr Simon Birmingham also said the global congress was a major win for Melbourne and reinforced the city’s reputation.

“Business events are extremely valuable to our economy, with the average business events visitor spending at least twice as much as a leisure visitor,” he said.

BID PROMPTS O=MEGA REJIG The announcement coincided with the running of the 3rd World Congress of

addition of the global congress would require some changes, but organisers would adopt the same formula that made O=MEGA19 successful.

Optometry in Orlando, Florida, which featured a program offering continuing professional development (CPD) in a variety of formats.

The WCO, which comprises 83 member countries, partnered with the American Academy of Optometry (AAO) to run the global congress alongside the academy’s annual meeting.

Like the AAO, Haydon believed a crucial factor for the Melbourne submission’s win was OV/SA and ODMA’s track record in running marquee events for the national industry. He travelled to Orlando to attend a ceremony to officially recognise their successful bid, as well as examine how the congress integrated with AAO. For O=MEGA21’s clinical conference component, Haydon said organisers may consider running three simultaneous sessions, with the world congressaligned sessions likely to have a greater public health focus. CPD points would be available for all jurisdictions, and will factor in changes to Australian CPD requirements that will come into effect December 2020.

Ms Finola Carey, ODMA CEO, said the

"IT’S ALWAYS BEEN OUR AMBITION TO TURN THIS INTO MORE THAN THE NATIONAL EVENT FOR AUSTRALIA" PETE HAYDON, OV/SA CEO

“It will be designed to complement education and exhibition, so people can experience a complete growth opportunity over the three days from both a clinical and business perspective,” she said.

“O=MEGA19 was the coming together of our two events; it saw the Australian optical industry maturing in an event that was suitably representative of the entire industry. We had the world congress in mind when we first started talking about our partnership with OV/SA, so this has been part of our long-term plan.”

Mr Paul Folkesson, the incoming WCO president, added: “I’m delighted that the WCO is heading Down Under. We had a very strong international field of contenders wanting to host the 4th World Congress of Optometry, and the Melbourne bid was exceptional.

I have no doubt that the Australians have the experience, infrastructure and professionalism to deliver an outstanding event.” n

USE OF MIGS PROJECTED TO SAVE $500,000 PER ANNUM continued from page 3

after two years to see what effect it has on the number of trabeculectomies being done and make sure it is still costeffective,” the committee stated.

ASO vice-president and Sydney glaucoma surgeon Dr Ashish Agar, from the Prince of Wales Hospital, told Insight the organisation was encouraged by the recommendation, which would now go before Federal Health Minister Mr Greg Hunt.

“It’s a very positive development. We thank the minister for his support as this would not have been forthcoming for a long time without his intervention, and we can now reassure our patients that there is a solution in sight,” Agar said.

“This is about giving the patients much better access, and it’s an important step on the way to restoring that equity.”

In its decision, MSAC compared MIGS alongside trabeculectomy and concluded that although MIGS was slightly less effective, it was safer and may allow some patients to delay or avoid trabeculectomy.

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INSIGHT December 2019

MSAC also supported establishing a registry to record outcomes, believing it would be important to monitor use of MIGS and rates of trabeculectomy over time.

Other analysis shows that MIGS generally costs less than trabeculectomy, and is projected to save the MBS approximately $500,000 per annum by the fourth year of listing.

According to MSAC, this saving is driven by fewer initial and revision trabeculectomy services, however the true financial impact will depend on the efficacy of MIGS in reducing trabeculectomies, which is uncertain.

“MSAC will review the use of [MIGS]

A Federal Department of Health spokesperson told Insight that given the financial implications associated with new listings on the MBS, MSAC’s recommendations are subject to consideration by the government.

“This generally occurs through either the annual Budget or the Mid-Year Economic and Fiscal Outlook,” the spokesperson said.

“If the Government does agree to the listing, relevant stakeholders will be advised prior to listing to confirm the listing date and final item details.” n

NEWS

EYE INJECTIONS TOP OF AGENDA FOR ‘SCOPE OF PRACTICE’ GROUP Optometrists performing intravitreal injections is one of several key issues to be addressed by a newly formed Optometry Australia (OA) advisory committee established to identify future opportunities for the profession.

The association has formed its first Evolving Scope of Practice Advisory Group, comprised of 12 optometrists from across the country, with the goal of shaping the future of optometry and enhancing access to timely clinical care.

The committee, which will meet four times a year via teleconference, recently identified priority areas as part of its first meeting. These include facilitating a greater role for optometrists to administer intravitreal injections, as well as the more effective use of optometrists in public health eyecare pathways.

It follows the release of a controversial Medicare Benefits Schedule (MBS) ophthalmology review. Published in August, ophthalmologists opposed the proposed changes after it recommended optometrists and nurse practitioners could have a future role in administering eye injections.

“The Evolving Scope of Practice Advisory Group believes – as does Optometry Australia – that there are opportunities for optometrists, in collaboration with ophthalmologists, to play a role in providing this type of treatment,” OA general manager of policy Ms Skye Cappuccio said.

“Optometry Australia has been looking closely at this issue and sought to engage with RANZCO and the Australian Society of Ophthalmologists on how we may work collaboratively.”

Commenting on public health pathways, Cappuccio said there were various models internationally, as well as locally in Australia, demonstrating how optometry can be integrated with public health ophthalmology to support more timely access to care.

“Nationally public ophthalmology clinics have lengthy waiting lists and we believe there is scope to work together to establish models of care to maximise our highly skilled optometry workforce to help address some of this demand,” she said.

Queensland University of Technology School of Optometry and Vision Science head Professor Sharon Bentley has been

Skye Cappuccio, OA general manager of policy

appointed committee chair. According to OA, she will lead a group with strong cross representation.

The group has been convened following OA’s Optometry 2040 report, which asked members to help identify preferred and plausible futures for the profession. The role of the advisory group is to help OA “build the scaffolding to reach the Optometry 2040 goals”.

Cappuccio added: “We were delighted so many members demonstrated an interest in being part of it and by the calibre of their collective expertise – including academia, clinical research and service provision.

“The group has been convened in a way that ensures participants bring a diversity of experience and expertise to the discussion. This means we can capture a broad range of discussion and contexts from members who are at various stages of their careers including early career optometrists who are in the first 10 years of their profession.”

Future work of the advisory group could also include advocacy for regulatory or structural change and work to assist optometrists working in new areas.

Members of the Evolving Scope of Practice Advisory Group are all OA members: Professor Sharon Bentley (chair), Associate Professor Nicola Anstice, Dr Lauren Ayton, Mr Mark De Paola, Ms Jane Duffy, Mr Garry Fitzpatrick, Mr Jason Holland, Dr Christopher Law, Dr Jack Phu, Dr Amanda Sobbizadeh, Ms Robyn Weinberg, and Mr Michael Yapp. n

IN BRIEF “WE WERE DELIGHTED SO MANY MEMBERS DEMONSTRATED AN INTEREST IN BEING PART OF IT AND BY THE CALIBRE OF THEIR COLLECTIVE EXPERTISE – INCLUDING ACADEMIA, CLINICAL RESEARCH AND SERVICE PROVISION.

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CHANEL RENEWS

Luxottica and Chanel have re-signed their exclusive license agreement for the global development, production and worldwide distribution of sunglasses and prescription frames. The deal continues the partnership between the fashion house and frame maker that started in 1999. “We are convinced that Chanel’s eyewear will continue to be one of the most desirable fashion accessories thanks to Luxottica’s innovative knowhow which magnifies Chanel’s creation," Mr Bruno Pavlovsky, president of fashion at Chanel, said. The new deal comes into effect on 1 January 2020 and runs through to 31 December 2024.

n

RIDE FOR SIGHT

The Centre for Eye Research Australia (CERA) has been presented with a $60,000 donation from the Lions Ride for Sight. Held throughout Gippsland in April, the 2019 event saw 50 riders, along with 18 assistants, cycle more than 350 kilometres while supported by volunteers from Lions Clubs along the way. “We are incredibly appreciative of the great endurance and commitment shown by many riders who put themselves through their paces to raise money for our research,” Ms Leah Borsboom, CERA CEO, said. Through the event’s 26-year history, Lions Ride for Sight’s has seen 1,300 riders collectively raise over $1.2 million to support CERA’s work.

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NATIONAL RECOGNITION

Ms Katrina Fanning, a pioneer of women’s rugby and board member of The Fred Hollows Foundation, has been named the 2020 ACT Australian of the Year. The award recognises her varied career, many leadership positions and dedication to making the ACT a national leader for Aboriginal and Torres Strait Islander people’s outcomes. “We are delighted to see Katrina receive this tremendous honour,” Mr Ian Wishart, Fred Hollows Foundation CEO, said.

The award places Fanning on the list of candidates for Australian of the Year 2020. “It is fitting Ms Fanning will be considered for the Australian of the Year award 30 years after Fred Hollows was given the honour,” Wishart said.

INSIGHT December 2019 7

NEWS

AUSTRALIAN TEAR TEST COULD DIAGNOSE DIABETES COMPLICATION

BHVI DIVISIONS ANNOUNCE LEADERSHIP CHANGES The Brien Holden Vision Institute (BHVI) has announced new appointments in its public health and science divisions.

Optometrist and senior research fellow Mr Tim Fricke has been appointed acting executive director of the BHVI Foundation, which is the global non-profit public health arm of the BHVI. He temporarily replaces Ms Leigh Cleave who will take leave to travel for the next year.

According to BHVI, Fricke is “uniquely qualified for the complex role”, bringing experience in his role as a researcher and international development practitioner.

He comes to the position with extensive paediatrics clinical experience, as well as post-graduate research in paediatrics eyecare and health economics. His background also includes international research into the development of local systems and skills for eyecare in developing countries.

“I am a passionate advocate for sight being a fundamental right for everyone, regardless of where they live and BHVI is the world leader in ensuring this vision becomes a reality. It is an exciting time to be taking BHVI to the world,” he said.

Fricke’s appointment is the latest development involving the BHVI Foundation, which has undergone significant change since maladministration concerns emerged in February.

In another new appointment, wellrespected industry figure Dr Arthur Back will lead BHVI’s science arm, VisionCRC, as managing director.

Under the leadership of Back and Professor Padmaja Sankaridurg, BHVI hopes to continue building an innovative R&D organisation. Established in 1991, VisionCRC has co-developed ophthalmic devices, including the Focus Night & Day contact lens with Alcon/CIBA Vision, which has generated more than $300 million in royalty income.

Ms Yvette Waddell, CEO of BHVI, said: “We are excited to have Dr Arthur Back join us. Dr Back invented more than 60 patents and commercialised 18 products while he was chief technology officer at CooperVision. Combined with the expertise of Professor Sankaridurg, a pioneer in the field of myopia research, we are at the forefront of our industry.”

BHVI will also continue generating new revenue streams through its professional services business. n

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INSIGHT December 2019

“WHAT WE’RE PROPOSING WITH THIS METHOD IS SOMETHING THAT WILL BE DONE QUICKLY, NONINVASIVELY” MARIA MARKOULLI, UNSW

A potential biomarker located in the eye for a debilitating complication of diabetes could be the key to future development of a new point-of-care screening device.

Dr Maria Markoulli, an optometrist and senior lecturer at the University of New South Wales, was the senior investigator on the first study to demonstrate that signs of diabetic peripheral neuropathy can be traced in tear film.

The research, recently published in the journal The Ocular Surface, found people with type 1 diabetic peripheral neuropathy – a complication that can result in recurring foot ulcers and in extreme cases amputation – have reduced levels of a protein known as ‘substance P’ in the tear film.

Markoulli said the research could form the basis of a new point-of-care tear test, similar to devices used for the diagnosis of dry eye disease.

“What we’re proposing with this method is something that will be done quickly, non-invasively, and potentially could be done by an optometrist, chemist, GP or at the diabetes centre, who could

(From left to right) The study’s lead author PhD candidate Mr Shyam Tummanapalli with Arun Krishnan, Maria Markoulli, Aumy Yan and Tushar Issar.

then refer to the endocrinologist or neurologist,” she said.

Markoulli said the tear test would be a viable alternative to current diagnostic methods that are either invasive, such as a skin biopsy, subjective or unreliable.

Markoulli and the study’s lead investigator, PhD candidate Mr Shyam Tummanapalli, collaborated with the Prince of Wales Hospital Diabetes Centre on the project.

Markoulli said the next phase could focus on why the difference is shown in type 2 diabetics, and not type 1. n

PORTRAIT UNVEILED FOR EX-HEAD OF UNSW SCHOOL OF OPTOMETRY The University of New South Wales’ School of Optometry and Vision Science (SOVS) has continued its long-standing tradition of the honouring former heads of school with an academic portrait.

A portrait of outgoing head of school Professor Fiona Stapleton was unveiled at an event in early October. She led SOVS from 2007 until the beginning of this year, and is currently the Associate Dean of Enterprise, Faculty of Science, at the school.

The unveiling was held in the Red Centre Built Environment’s Gallery Space adjacent to the old SOVS location, the Newton Building. The portrait has been hung alongside her predecessors in the hall that provides access to all the consulting rooms of SOVS’ General Optometry Clinic.

The audience included a broad selection of past and present graduate students and staff, including visiting

academics, Faculty of Science academics and representatives of the profession.

The gathering was addressed by the current Head of School Professor Lisa Keay, Head of the School of Psychology Professor Simon Killcross, and the Dean of the Faculty of Science Professor Emma Johnston. n

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Transforming eye health

NEWS

AUSTRALIAN COLLEGE OF OPTOMETRY EXTENDS CLINIC NETWORK TO SERVICE SOUTH AUSTRALIA “WE ARE ABOUT FILLING THE GAPS, AND WOULD LIKE TO SEE AN INCREASE IN THE NUMBER OF PEOPLE IN THE COMMUNITY WHO ARE ACCESSING EYE CARE”

The Australian College of Optometry (ACO) has established a public health optometry clinic in a new state responding to unmet eyecare needs in both the general population and disadvantaged communities.

Ms Amanda Vanstone, former Minister and Senator for South Australia, officially opened the clinic, located in the northern Adelaide suburb of Elizabeth, at a ribbon-cutting ceremony in October. The opening marks a significant milestone for public eyecare in the South Australia.

Elizabeth Eye Care will offer bulkbilling for all patients, with no out-ofpocket costs for diagnostic imaging services. The clinic will also provide comprehensive referral pathways and low-cost spectacles through the state government’s GlassesSA scheme.

ACO CEO Ms Maureen O’Keefe said the clinic was opened following a comprehensive review of Australian states that identified uptake of eyecare services in South Australia was below the national average across both the general population and in disadvantaged communities.

“The ACO has established a public health optometry clinic in Elizabeth towards helping provide accessible and affordable eyecare for South Australians,

and as a base for developing an outreach program for disadvantaged and vulnerable people and remote communities,” she said.

MAUREEN O’KEEFE, ACO

The ACO, a not-for-profit that has traditionally operated clinics across Metropolitan Melbourne alongside a comprehensive outreach program, has fitted out a former medical building in Elizabeth with four consulting rooms.

Optometrist Mr Tristan Glover and a dispenser are currently employed at the clinic, with plans to expand the service in the future.

experiencing or at risk of homelessness.

“We are about filling the gaps, and would like to see an increase in the number of people in the community who are accessing eye care. We are not looking to provide services where they are not needed,” O’Keefe said.

The clinic’s referral pathways will be linked with GPs and ophthalmologists.

It will also explore opportunities to co-manage patients with local public hospitals, building on collaborative care models that have been established with the Victorian public health system.

O’Keefe said the clinic would eventually offer outreach services that would have a particular focus on Aboriginal and Torres Strait Islander communities.

“The real public health value-add is through outreach because that’s a model that reaches the most disadvantaged and vulnerable.”

ACO director of clinical services Mr Neville Turner said: “Our aim is to work with other healthcare providers in South Australia to increase the number of people having their eyes checked so as to prevent the risk of avoidable blindness and vision loss, which is an increasing risk as the population ages and with the growing incidence of chronic disease including diabetes.” n

As part of its service, the ACO states it is committed to providing culturally appropriate services to Aboriginal and Torres Strait Islander people, as well as asylum seeker and refugee communities, people with disabilities and those

MDFA AWARDS $600,000 IN NEW GRANTS TO RESEARCH The Macular Disease Foundation Australia (MDFA) has awarded $600,000 in new research grants to advance research into Indigenous diabetic vision loss, sub-retinal fibrosis and novel disease detection methods.

Biomedical scientist Dr Audra Shadforth, optometrist and clinical researcher Mr Zhichao Wu and Aboriginal doctor and researcher Professor Alex Brown were the latest recipients of the MDFA’s Research Grants Program, announced on World Sight Day this year.

The trio were recognised at an event hosted by Governor-General Mr David Hurley and his wife at their Sydney residence, Admiralty House. The MDFA

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stratification in the early stages of AMD.

program has now contributed $4.2 million to research since its launch in 2011.

Shadforth, a lecturer in the School of Environment and Science at Griffith University and a visiting research fellow in the Ocular Cell Therapies Research Program at the Queensland Eye Institute, will use the funding to further her investigations into scar-less wound healing in age-related macular degeneration (AMD).

Wu, from the Centre for Eye Research Australia and Department of Ophthalmology at the University of Melbourne, will progress his study into novel prognostic imaging biomarkers for improved risk

Dee Hopkins, MDFA

His research aims to investigate better methods for detecting and monitoring AMD using optical coherence tomography and artificial intelligence.

The study will obtain imaging from 200 participants with intermediate AMD, which will inform clinical practice.

In a project called Defining the Risk and Epidemiology of Aboriginal Australian Macular Disease, Brown’s research will advance understanding of the underlying social, psychological, environmental, behavioural, clinical, biological and metabolomic risk factors of diabetic retinopathy and diabetic macular oedema among Aboriginal people. n

INSIGHT December 2019

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OPTOMETRIST – DARWIN CITY, NORTHERN TERRITORY

Australia’s only tropical capital city and gateway to the Top End, Darwin, on the traditional lands of the Larrakia, gazes out across the Timor Sea. It’s closer to Bali than Bondi and certainly feels removed from the rest of the country, which is just how the locals like it. Tables spill out of streetside restaurants and bars, innovative museums celebrate the city’s past, and galleries showcase the region’s rich Indigenous art. Darwin’s cosmopolitan mix − more than 50 nationalities are represented here − is typified by the wonderful markets held throughout the dry season.

As an Optometrist with us, you will get to work with world class technology including Retinal Camera, Visual Field Analyser, Non-contact tonometer, Corneal Topographer, Optos UWDRS and OCT. You will also understand the lives behind the eyes and identify how OPSM can help maximize customer’s lifestyle enjoyment factor with appropriate eyecare, while providing the highest level of tailored customer service. You can look to take on a fixed period role or even consider a more permanent move – who knows, you might fall in love with the place.

Attractive relocation packages are available for the right candidate. Start your journey with us today! Graduates or recent graduates are very welcome to apply.

EXPLORE OUR OPPORTUNITIES, CONTACT: BRENDAN PHILP Professional Services Manager, NT brendan.philp@luxottica.com.au or on 0418 845 197

OPSM.COM.AU/CAREERS JOIN OUR COMMUNITY ON LINKEDIN

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NEWS

GLAUCOMA AUSTRALIA ANNOUNCES GOVERNORGENERAL MR DAVID HURLEY AS NEW PATRON Glaucoma Australia (GA) is set to extend its reach and capacity to eliminate glaucoma-related blindness after announcing Governor-General Mr David Hurley will become patron of the charity.

GA subsequently widened its campaign this year to focus on other risk factors, including people over the age of 50, and higher susceptibility among African and Asian populations.

The high-profile appointment follows a successful invitation by GA CEO Ms Annie Gibbins and the organisation’s Ophthalmology Committee, with a view to raising the profile of GA and its campaign among the general population.

“Our risk campaigns are going well, and we are having exponential growth in referrals, which is exciting, but we want to get through to the average person in the community,” Gibbins said.

“At a time when multiple worthy causes are vying for His Excellency’s invaluable patronage, we sincerely thank the Governor-General for becoming patron of Glaucoma Australia,” Gibbins said.

“The biggest thing for us now is not just to have the Governor-General’s patronage, but to use his incredible support to extend the reach of our campaigns.”

Gibbins said GA’s early campaigns targeted people with a family history of the disease. While they have been effective in driving people with glaucoma to ‘tell their family to get tested’, this is not the only risk factor.

David Hurley, Governor-General

“The Governor-General, who has a national media following, is keen to have an active role, which is great.

He’s happy to put out videos and social media and to help us extend our reach. It’s early days, but it really does allow Glaucoma Australia to influence at a higher level to get our message out there.”

“The hard work of those involved, their supporters and the researchers they fund and collaborate with has directly helped hundreds of thousands of Australians. I look forward to being involved and working with them as patron.”

GA president Associate Professor Simon Skalicky said: “This is an exciting time for Glaucoma Australia. As we have moved digitally, we are connecting with more glaucoma patients and their families, as well as health professionals.

“Digitally integrating the support services of Glaucoma Australia through online referral pathways ensures greater support is provided to people with glaucoma at every step along the journey, in metropolitan, rural and regional Australia.”

The Governor-General said he was “delighted” to become patron of GA.

He added: “Ideally we aim to integrate our service better with health care providers to enhance the likelihood that patients access our resources and community support, which in turn motivates long-term adherence to medication and monitoring for glaucoma.” n

“Since being founded in 1988, Glaucoma Australia has increased community awareness of glaucoma, supported patients and their families and funded critical research. This is an important mission and their impact has been significant,” Hurley said.

VISION RESEARCHER TAKES OUT VICTORIAN SCIENCE AWARD Dr Lauren Ayton, senior research fellow within the Department of Optometry and Vision Sciences, Department of Surgery (Ophthalmology) at The University of Melbourne, has been announced as the Victorian Young Tall Poppy of the Year by the Australian Institute of Policy and Science (AIPS).

Ayton was recognised for her work on early disease biomarkers in retinal disease and vision restoration at a ceremony in October. She is currently examining genetic interventions for people with vision loss, as well as how this can improve mobility and quality of life among patients.

Ayton told Insight that receiving the award, considering the calibre of the nominees, is an honour.

She is also a University of Melbourne Driving Research Momentum Fellow and a NHMRC Medical Research Future Fund Next Generation Clinical Research Fellow.

“The really exciting thing with the award for me is that it recognises your academic work, as well as your community engagement and science communication. That's

12

(From left): AIPS board member Dr Sarah Meacham, Dr Lauren Ayton, and Burnet Institute senior principal research fellow Professor Mark Hogarth.

“THE REALLY EXCITING THING WITH THE AWARD FOR ME IS THAT IT RECOGNISES YOUR ACADEMIC WORK, AS WELL AS YOUR COMMUNITY ENGAGEMENT” LAUREN AYTON, UNIVERSITY OF MELBOURNE

something I'm really passionate about” Her outreach work includes co-hosting the radio shows Einstein A Go-Go on 3RRR and Conversation Hour on ABC Radio.

Ayton recently returned to Melbourne after working as director of clinical and regulatory affairs at the Bionic Eye Technologies program in New York, a continuation of her previous work in Melbourne on bionic eye technology.

Ayton is not the only ophthalmic professional recognised in this year’s awards. Australian National University researcher Dr Riccardo Natoli was announced as an ACT Young Tall Poppy for his work developing a blood test capable of detecting a patient’s risk of developing age-related macular degeneration. n

INSIGHT December 2019

NOB

DON’T LOSE SIGHT OF WHAT’S IMPORTANT

Age-related macular degeneration is the leading cause of legal blindness in Australia. Yet one in three Australians over 50 hasn’t had their macula checked in the last two years.2,3 That’s why Novartis and Macular Disease Foundation Australia are encouraging people to visit their optometrist for an eye exam.1 Find out more at:

seewhatsnext.com.au

1

The Macular Disease Foundation Australia (MDFA) and Novartis Pharmaceuticals Pty Ltd are working together on the common goal to raise awareness of age-related macular degeneration in the community. See What’s Next is an awareness campaign developed by Novartis. By supporting this campaign the MDFA is not endorsing any specific treatment or therapy. References: 1. Optometry Australia. 2019 Clinical Practice Guide for the diagnosis, treatment and management of Age-Related Macular Degeneration. 2. Macular Disease Foundation Australia. The Journey to See: A Model for Success. 3. Awareness of macular disease’ survey conducted by YouGov Galaxy, commissioned by Macular Disease Foundation Australia, 2018. Novartis Pharmaceuticals Australia Pty Limited ABN 18 004 244 160. 54 Waterloo Road, Macquarie Park NSW 2113. Ph (02) 9805 3555. August 2019. AU-9993. NOBR16939WIT. Ward6

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16/8/19 2:54 pm

NEWS

DFV SIGNS DISTRIBUTION DEAL FOR E-EYE IRPL DRY EYE DEVICE

RVEEH ESTABLISHES NEW ORTHOPTIST-LED CATARACT CLINIC

Designs For Vision (DFV) has become the new Australian distributor of the E-Eye intense regulated pulsed light (IRPL) device for dry eye disease and meibomian gland dysfunction.

A new clinic led by upskilled orthoptists is helping the Royal Victorian Eye and Ear Hospital (RVEEH) reduce wait times and streamline follow up appointments for cataract patients.

Six orthoptists are now handling suitable patients for the entirety of their appointments post cataract surgery.

Previously the process could involve multiple practitioners, including an ophthalmologist, medical photographer and orthoptist.

“Benefits have included shorter waiting times for patients seen in this clinic and it has enabled medical staff to review patients with more complex surgical outcomes or diseases,” Catherine Mancuso, the REEVH’s manager of diagnostic eye services, told Insight.

The orthoptists’ specialised training has included one-on-one sessions with the medical head of the surgical ophthalmology clinic, as well as observation time with ophthalmologists.

On completion of these sessions, they were assessed against a competency standard.

Now working independently, the orthoptists assess post-operative healing.

If there are no clinical concerns, they are responsible for discharging the patient and communicating with their GP about any follow-up care.

Planning for the clinic commenced in July 2017 as part of a number of initiatives aimed at improving patient access to care. Since its recent inception, there have been more than 300 eligible patients seen and treated in the clinic, with approximately 150 discharged by orthoptists.

“The aim of the clinic was to reduce the waiting time for patients to see medical staff and ensure we appropriately manage the high volume of post-surgery cataract patients,” Mancuso said.

“It is similar to other models that we have trialled in the past. The main difference is that this clinic empowers orthoptists to discharge patients when they have satisfied specific clinical criteria.”

Mancuso said the hospital now plans to expand the clinic further to cover more sessions during the week, while also providing an example for other units to explore non-medical models of care. n

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E-Eye IRPL device

The company, which has taken over the distribution rights from France Medical, will continue to support all existing customers. Manufactured by E-Swin in France, E-Eye was the first IRPL device specifically developed and certified for dry eye treatment in Australasia, with approximately 200 devices used by Australian optometrists and ophthalmologists today.

DFV product manager Mr Cameron Loveless welcomed E-Eye to the DFV product portfolio.

“We are really excited to have been appointed distributor,” he said. “It’s a new chapter for our business and although it is a significant investment for us, knowing that the E-Eye has been supported with numerous clinical studies by pre-eminent researchers including Associate Professor Jennifer Craig in New Zealand, and that we have a strong existing customer base, is reassuring.”

Loveless said existing E-Eye owners would now receive full and ongoing product support through DFV, with new stock “arriving almost immediately”.

“Designs For Vision is one of Australia’s most respected suppliers to the ophthalmic industry,” he said.

“We were established in 1978 and have strong clinical and service expertise right across the country. Partnering with a professional organisation in E-Swin is a natural fit, and customers will now have convenient and fast access to consumables and expert technical support.”

DFV showcased the device at the RANZCO Congress in Sydney. E-Swin president and managing director Ms Petra Bruckmüller was also in attendance to talk with practitioners interested in learning more about the technology.

“We will celebrate the re-launch with special introductory pricing until the end of 2019, so we encourage people to take advantage and stock up on consumables or purchase the unit itself,” Loveless said. n

UTS ORTHOPTICS OPENS NEW PURPOSE-BUILT FACILITY The University of Technology Sydney’s (UTS) orthoptics department celebrated the opening of its new purpose-built facilities with a clinician’s evening.

The department has moved to its new, location opposite UTS’ main campus, consolidating all of the university’s Graduate School of Health departments into a single building.

As well commemorating the move, the clinicians' evening was held to thank those who have supported the education of UTS’ orthoptics students.

The clinical and research endeavours of the department, which includes electrophysiology and virtual reality, are all housed within the new facility.

The evening was opened by Professor Kathryn Rose, UTS orthoptics’ head of discipline. She explained the move and thanked all those involved, including UTS staff and a relocation company.

Part of UTS' new orthoptics clinic

Orthoptics is now touted as a champion for the university, and total clinical placements for the course are expected to exceed 23,300 hours in 2019, including time offered at the Singapore Eye Centre. Time in New Zealand is expected to be made available for the 2020 academic year.

Pharmacy, clinical psychology, physiotherapy, speech pathology, genetic counselling, and indigenous health are located alongside. n

INSIGHT December 2019

NOB

Envisioning the future with Novartis N

ovartis is reimagining the treatment and prevention of visual impairment and blindness. By working to push the boundaries of medicine and technology, we aim to develop life-changing gene therapies, next-generation pharmaceuticals, and transformative technologies for diseases and conditions spanning every area of eye disease, from the front to the back of the eye.

In Australia, Novartis offers one of the industry’s largest and most diverse ophthalmology pharmaceuticals portfolios,2 and is the industry’s largest investor in clinical trials across Australia:3

This undertreatment is largely driven by: • 1 in 4 people with AMD undiagnosed9 • 1 in 3 people discontinuing anti-VEGF treatment in the first year8

At Novartis, we’re working to eliminate wet AMD-related vision impairment and blindness

14 ophthalmology trials sponsored in the last 3 years alone4

Novartis has partnered with Macular Disease Foundation Australia to launch See What’s Next, a public awareness campaign to support patients with wet AMD.1

100,000 blind or vision-impaired Australians’ lives touched by Novartis in 2017–184

Over the past few weeks, we’ve been running an awareness and education campaign to encourage people at risk of AMD to see their optometrist for an eye exam.

Proud hosts of the Australian annual Future Directions in Ophthalmology symposium since 2014

Together, we can help improve diagnosis of AMD and ensure patients receive the care they need to maintain their vision.

Envisioning improved diagnosis for people with wet AMD

If you’d like to order free materials to help increase awareness of wet AMD in your practice, scan the QR code or visit medhub.com.au/see-whats-next

Anti-VEGF injections have revolutionised the treatment of wet (neovascular) age-related macular degeneration (AMD).5 Australian wet AMD patients treated with anti-VEGF maintain their starting level of vision for an average of 6 years.6 However, there’s still more to do. More than 1 in 2 patients with wet AMD did not receive anti-VEGF treatment in 2017, putting them at serious risk of losing their vision.7,8

1

Macular Disease Foundation Australia (MDFA) and Novartis Pharmaceuticals Pty Ltd are working together on the common goal to raise awareness of age-related macular degeneration in the community. See What’s Next is an awareness campaign developed by Novartis. By supporting this campaign MDFA is not endorsing any specific treatment or therapy. Abbreviations: AMD: age-related macular degeneration; VEGF: vascular endothelial growth factor. References: 1. Optometry Australia. 2019 Clinical Practice Guide for the diagnosis, treatment and management of Age-Related Macular Degeneration. 2. Novartis data on file. IMS ophthalmology market sales, May 2019. 3. Austrade. Clinical Trials Capability Report 2018. 4. Novartis data on file. 5. Al-Zamil W, Yassin S. Recent developments in age-related macular degeneration: a review. Clin Interv Aging 2017;12:1313–30.

6. Gillies M et al. Long-term outcomes of treatment of neovascular age-related macular degeneration: data from an observational study. Ophthalmology 2015;122:1837–45. 7. Macular Disease Foundation Australia.

Macular degeneration research update. Dec 2017. 8. Drug Utilisation Sub-Committee (DUSC). Ranibizumab and aflibercept: analysis of use for AMD, DMO, BRVO and CRVO. May 2018. 9. Neely DC et al. Prevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care. JAMA Ophthalmol 2017;135:570–75. Novartis Pharmaceuticals Australia Pty Limited ABN 18 004 244 160.

54 Waterloo Road, Macquarie Park NSW 2113. Ph (02) 9805 3555. September 2019. AU-10075 NOBR17308WI. Ward6.

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NEWS

GEORGE & MATILDA RECOGNISED FOR OUTSTANDING GROWTH

BHVI MYOPIA EDUCATION PROGRAM AVAILABLE ANYTIME, ANYWHERE

For the second year in a row George & Matilda Eyecare has been recognised at the Australian Growth Company Awards.

The Brien Holden Vision Institute (BHVI) has made its internationally accredited Myopia Education Program more accessible, following the launch of a newlook format at a global optometry event.

The network of eyecare retailers won the Consumer Goods Growth Company of the Year award, a feat it also achieved last year, and was a finalist in the Health & Life Sciences Growth Company category.

The institute has unveiled a new ‘anytime, anywhere’ program model that will enable eyecare professionals to complete training in their own time.

Previously, participants had to log on at a set time and would miss sessions if they were unavailable.

“To grow rapidly is challenging but sustaining that growth over time is even more of an achievement,” Mr Chris Beer, George & Matilda Eyecare CEO, said.

“I’m incredibly grateful to all of our partners and practices who have trusted their businesses with us, and I’m proud of the results we have achieved together.”

BHVI released the new format at the 2019 American Academy of Optometry meeting in Orlando, Florida. The program’s education team, led by Ms Pamela Capaldi and optometrist Mr Michael Morton, were at the event showcasing the program and its benefits.

Beer also said that the George & Matilda Eyecare now has a thoroughly proven track record.

“We have refined our approach as we have learnt from our partners, and I believe that this flexible approach is key to us attracting so many of the industry’s best people.”

“We want to make our education program easily available to our community of professionals, so they have the flexibility to sign up and learn while still managing myopia in their busy practices,” Capaldi, BHVI director of professional services, said.

To be eligible for the awards, companies

Since its inception, BHVI reports 98% of participants have changed the way they treat myopia and there is a list of more than 350 people waiting to participate.

Course 1: Managing Myopia focusses on improving the profession’s understanding of myopia management with the latest research and clinical procedures.

Course 2: Complex Cases aims to give eyecare professionals tools and strategies to treat more challenging cases, while newly introduced course 3: The Business of Myopia teaches participants to maximise business results and expand their practice through managing myopia. n

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INSIGHT December 2019

need to be Australian, have been in business for more than two years and demonstrated a turnover or market share in the range of $15 million to $500 million.

Beer said the company expects further growth in the future.

“We have had a lot of interest in the past few months as we have built our reputation as an innovative and forwardlooking business. Looking ahead to 2020, it seems as though we can look forward to further growth, allowing us to realise our vision of uniting independent optometrists to build the best optometry community.” n

TOP ALUMNI AWARD PRESENTED TO FRED HOLLOWS FOUNDATION CEO

It has been developed in collaboration with the organisation’s own in-house and international experts. Features include interactive case studies, videos, polls and discussions that are professionally accredited in the US, UK, Australia and New Zealand, with more approvals currently in the pipeline.

Split into three courses, the program and has been designed to address myopia from both a clinical and business perspective. Participants must complete the program within a six-week timeframe.

(Left) George & Matilda Eyecare’s general manager of partnerships Luke Algar accepting the award.

The Fred Hollows Foundation’s CEO Mr Ian Wishart has been awarded the 2019 Chancellor’s Alumni Award from the University of Canberra in recognition of his contributions to the international humanitarian sector.

“WORKING IN A SECTOR THAT SEES THE ABSOLUTE BEST AND WORST OF HUMANITY HAS OPENED MY EYES ” IAN WISHART, THE FRED HOLLOWS FOUNDATION

The award, which recognises a former student’s outstanding achievements, was presented to Wishart at a gala dinner on 26 October 2019.

“I’m incredibly honoured and humbled to have been recognised alongside the likes of leading public sector professionals, health experts and politicians,” Wishart said.

“International humanitarian workers often go unrecognised as their work is overseas and out of sight. This is a huge encouragement to me as it is not just recognition for me but for all the colleagues in my sector.”

Wishart has a long career in the humanitarian sector that includes working across all levels of international

development, with roles ranging from grassroots response to global leader.

His career started with World Vision Australia as a graduate international emergency response officer. Prior to joining The Fred Hollows Foundation in 2018 he was CEO of children’s rights agency Plan International Australia.

“Working in a sector that sees the absolute best and worst of humanity has opened my eyes to the need for more people to follow in Fred’s footsteps,” Wishart said.

“Compassion strengthens humanity and the moral bonds that tie us together.

I’m proud to work for an organisation that’s compassionate and contributes to international fraternity.

“And of course, I’m extremely grateful for the generosity of thousands of everyday Australians giving to the foundation’s work. Without them, I would never have been able to do what I’ve done.” n

PERTH PARTNERSHIP TARGETS $1 BILLION MARKET FOR LEADING FORM OF CHILDHOOD BLINDNESS The Lions Eye Institute (LEI) has signed a commercial partnership that will combine its antisense gene therapy for a leading cause of childhood blindness with a new Australian-developed drug delivery platform.

LEI and ASX-listed PYC Therapeutics have entered into a commercial collaboration agreement that will initially develop drugs to treat retinitis pigmentosa. The partnership sees the formation of a new Perth-based special purpose organisation called Vision Pharma, to which LEI and PYC have contributed equal levels of intellectual property.

Vision Pharma will combine PYC’s cell penetrating peptide (CPP) drug delivery technology with a proprietary LEI drug known as an antisense oligonucleotide (ASO). The ASO has already shown preliminary evidence of successfully

reversing the effects of a genetic mutation in human cells associated with retinitis pigmentosa.

With no existing treatment options available for the disease, it is thought the therapy’s potential target market could top $1 billion per year.

The drug is currently in advanced preclinical development and is scheduled to enter investigational new drug-enabling studies during the first half of 2020.

“Professor Fred Chen (LEI) and Professor Sue Fletcher (formerly of Murdoch University) have been working on their genetic therapy and are partnering with PYC, using their transporter protein to deliver this novel therapy directly to the sick retinal cells,” LEI managing director Professor Bill Morgan said Chen, co-inventor of the lead drug candidate and head of LEI’s Ocular

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Fred Chen, LEI

Tissue Engineering Laboratory, said the agreement was the culmination of decades of splice therapy research.

Now, this work is being combined with PYC’s CPPs, data from the Australian Inherited Retinal Diseases Registry and LEI’s expertise in stem cell retinal disease modelling.

“The advantage of using ASO is that it’s personalised medicine; specific for the gene or the mutation. Its delivery into the cell does not require the introduction of a viral vector into the eye and into the retinal cell where the transferred gene is not under the normal regulation, resulting in the potential for over or under production of the protein coded by the gene."

Vision Pharma is also developing a pipeline of other ASO candidates for the treatment of different forms of inherited retinal disease. n

COMPANY

ESSILORLUXOTTICA ANNOUNCES STRONG Q3 FINANCIAL RESULTS

MARCOLIN SIGNS MULTIPLE NEW EYEWEAR DEALS The Marcolin Group has signed new deals with two fashion brands, one new and the other a renewal, to expand the company’s portfolio of licenced products.

Despite the Hong Kong protests and Japan’s long rainy season taking their toll on revenue growth, EssilorLuxottica has reported higher sales during the company’s third quarter as a merged entity.

As part of its third-quarter revenue results for 2019, the company reported sales across the group rose 5.2%, compared to the previous year at a constant exchange rate to €4.3 billion (AU$6.9 b).

New to Marcolin is contemporary women’s fashion house MAX&Co. The brand is part of the wider Max Mara fashion group, which includes Max Mara, Sportmax and Pennyblack.

According to the company, MAX&Co’s collections are designed to balance quality, originality and versatility. The company also debuted a new identity and direction at the Milan Fashion Week in September.

Now nine months after the merger of the French lens maker and Italian frame manufacturer, the conglomerate has reported total revenue has surpassed €13 billion (AU$21 b) for the period.

While Latin America and Europe led the company’s momentum, revenue falls in Asia, Oceania and Africa due to weather and political unrest resulted in a deceleration of growth.

“Our partnership with Marcolin Group marks an important step in the evolution of MAX&Co,” Mr Elia Maramotti, Brand Director of MAX&Co, said. “Together, we will develop design-driven eyewear, with the same attention to materials and details found in our ready-to-wear collections.”

Luxottica’s retail business posted growth of 7.8% over the previous year, with the company reporting solid business in Australia and New Zealand contributing to this result. There were both positive sales

Marcolin claims its eyewear designs for MAX&Co feature lightweight frames in a rich colour palette, alongside signature brand detailing.

“We are honoured to have entered into this agreement for MAX&Co, which enriches our offering in the women’s eyewear sector,” Mr Massimo Renon, Marcolin Group CEO, said.

“The opportunity to work on the design, production and distribution of this brand allows us to experiment with new ways of creativity and style, and to express the full potential of MAX&Co.’s contemporary image through their eyewear.”

Additionally, Marcolin has also announced a renewal of the company’s worldwide exclusive agreement with Emilio Pucci. The five-year extension will see Marcolin continue to produce and distribute Emilio Pucci sunglasses and eyeglasses through to the end of 2024.

According to the company, the Emilio Pucci designs focus on sophisticated craftmanship, refined structural elements and attention to detail. The licensing agreement Marcolin and Emilio Pucci originally dates back to 2015.

Marconlin’s other brands include Tom Ford, Bally, Moncler, Ermenegildo Zegna, Victoria’s Secret and Timberland, among many others. n

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INSIGHT December 2019

and comparable store sales in the region, with the overall retail optical business positive for the 13th quarter in a row.

The company’s annual report also singled out its purchase of a majority stake in Optimed Australia. According to EssilorLuxottica’s report, the Australian and New Zealand ophthalmic instrument distributor generates an annual revenue of about €10 million (AU$16 m).

“The continuous improvement in our performance validates our growth strategy as well as our investments in product innovation, digitalisation, fast-growing markets and talent. This acceleration further demonstrates our ability to execute the business plan and deliver sales and cost synergies”, Mr Francesco Milleri and Mr Laurent Vacherot, non-independent directors of EssilorLuxottica, said.

“On this basis we will confirm our efforts to transform the industry and eliminate poor vision throughout the world.”

In reach of this goal, Essilor published the Eliminating Poor Vision in a Generation report alongside a meeting of the United Nations General Assembly. n

OPTOMETRY GIVING SIGHT FINDS DIRECTION WITH NEW BOARD “WE LOOK FORWARD TO ENHANCING OUR EXISTING RELATIONSHIPS IN THE VISION CARE COMMUNITY” JUAN CARLOS ARAGÓN, OGS

International charity Optometry Giving Sight (OGS) has announced a new board of directors who will steer the organisation towards new priorities.

The announcement comes after a period of significant change at the charity, including the formal merger of its Australian division with the Brien Holden Vision Institute (BHVI) Foundation in July.

The new board will be led by Dr Juan Carlos Aragón, president of CooperVision’s Speciality Eye Care Division. In addition to serving on OGS’ global board for a number of years he was previously chair of the organisation’s US advisory committee.

Joining Aragón are Dr Howard Purcell, president and CEO of the New England College of Optometry, Ms Yvette Waddell, CEO of BHVI Foundation, Dr Susan Cooper, former president of the World Council of Optometry and Dr Earl Smith, former dean of the University of Houston

College of Optometry.

“We are very excited for Optometry Giving Sight’s future as we will be building on our strong history of supporting projects that bring accessible and sustainable eye care to those who are in need,” Aragón said.

“We look forward to enhancing our existing relationships in the vision care community and to establishing new partners throughout the industry.”

The charity is now focusing its fundraising activities on the US and Canada. n

Magazine Add 113mm x 297mm.pdf

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Your One Stop Shop for Dry Eye Products FDA CLEARS NOVARTIS’ NEW AMD TREATMENT

Novartis has secured US regulatory approval for Beovu, the company’s latest therapy for neovascular age-related macular degeneration (nAMD), following the drug’s comparable results in head-to-head trials with Eylea.

The US Food and Drug Administration (FDA) cleared the Beovu (brolucizumab) intravitreal injection for nAMD treatment on 8 October after the Swiss pharmaceutical company used a priority review voucher to fast-track its application.

The drug is now the third major player in the anti-VEGF market to treat nAMD. It will compete with Roche’s Lucentis, the pioneering anti-VEGF treatment that is also marketed by Novartis outside the US. It is also set to become the largest rival to Bayer/Regeneron’s Eylea (aflibercept), which has established itself as the marketleading therapy since its launch in 2011. Last year the drug generated US$6.75 billion (AU$9.83 b) in global revenue.

The recommended dose for Beovu is three initial monthly injections, followed by one treatment every 8-12 weeks. Novartis believes it has the potential to treat patients quarterly.

A Systematic Approach to Dry Eye Management.

Eylea’s recommended regimen is three monthly injections, followed by a treatment every eight weeks thereafter. A treat-andextend dosing regimen has also been approved, meaning some patients may be eligible for treatments every 12 weeks or more.

Beovu’s FDA approval was based on the results of the Hawk and Harrier clinical trials, in which it was compared with Eylea.

While Beovu demonstrated non-inferiority versus Eylea in mean change in best-corrected visual acuity at year one, it did show greater reduction in central subfield thickness, and fewer patients had intra-retinal and/or sub-retinal fluid.

According to Novartis, Beovu is now the first FDA-approved anti-VEGF to offer greater fluid resolution compared with Eylea, while maintaining eligible patients on a three-month dosing interval immediately after an initial three-month loading phase.

“The approval of Beovu delivers on the Novartis commitment to reimagining treatments for patients suffering from serious visual impairment,” Ms Marie-France Tschudin, Novartis Pharmaceuticals president, said.

“The product labels of existing treatments state that they are not as effective when dosed every 12 weeks. Beovu is the first to offer less frequent dosing in the first year of therapy while maintaining its effectiveness. This gives more time for wet AMD patients to focus on what’s important in their lives.” n

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INTERNATIONAL

AMERICAN ACADEMY OF OPTOMETRY PREPARES AHEAD OF CENTENARY MILESTONE The American Academy of Optometry (AAO) has unveiled a new strategic plan in order to drive the organisation towards new heights ahead of its 100-year anniversary in 2022.

The plan, which is designed to outline and address issues critical to the profession, was presented to members at the AAO’s annual meeting held in conjunction with 3rd World Congress of Optometry in Orlando, Florida.

“Our new vision, mission, and values will act as our compass as we implement our strategic plan and build a supportive culture of scholarship, collaboration, and respect,” the newly published report states.

Titled Inspiring Excellence in Eye Care, the organisation’s plan fixates on five pillars: education, research, membership, leadership and legacy, and partnerships.

For education and research, the AAO will work towards raising both the profile and reach of opportunities available to members. Additionally, the group will make sure more members are aware of all the education and research schemes available.

In terms of leadership and legacy, the AAO has set itself some concrete goals. It has committed to identifying, developing and nurturing 100 new leaders within the organisation as a celebration of its 100th anniversary.

The move is also designed to create a pipeline of strong leadership talent for the organisation's future.

ONE BILLION PEOPLE HAVE UNADDRESSED VISION LOSS “INCLUDING EYECARE IN NATIONAL HEALTH PLANS AND ESSENTIAL PACKAGES OF CARE IS AN IMPORTANT PART OF EVERY COUNTRY’S JOURNEY” TEDROS ADHANOM GHEBREYESUS, WHO

A report released by the World Health Organization (WHO) to coincide with World Sight Day has presented a detailed analysis of the world’s visual issues.

The WHO’s World Report on Vision, the first document of its kind created by the organisation, has identified ageing populations, changing lifestyles and limited access to eyecare as the main drivers behind the rising number of people living with vision impairments.

According to the report’s findings at least 2.2 billion people worldwide have a vision impairment of some kind, but at least one billion of them suffer a condition that either could have been prevented or is yet to be addressed.

Examples of the most common conditions include cataracts, glaucoma, trachoma and refractive errors.

The report also concluded that visual impairments are not evenly distributed worldwide, with the vast majority of those with preventable or addressable eye conditions located in South Asia, South East Asia, East Asia and Oceania.

Additionally, the burden of poor vision is often far greater in rural areas and

The WHO’s World Report on Vision.

among those with low incomes, women, older people, people with disabilities, and ethnic minorities.

The main causes of rising rates were attributed to increased time spent indoors leading to greater rates of myopia, type 2 diabetes increasing cases of diabetic retinopathy and poorly integrated eyecare services.

However, addressing these issues is not an insurmountable challenge.

The costs of the coverage gap for unaddressed refractive errors and cataract were estimated by the WHO as US$7.4 billion (AU$10.9 b) and US$6.9 billion (AU$10.2 b) respectively.” n

DEMAND CONTINUES TO OUTSTRIP SUPPLY OF OPHTHALMOLOGISTS A survey conducted by the International Council of Ophthalmology has found that while the global ophthalmologist numbers appear to be growing, improvements in workforce distribution and healthcare services are needed to meet the world’s increasing eyecare needs.

additional demand on placed on eyecare services by older people, the profession is expected to be placed under greater strain if trends continue.

To achieve this, the AOO is reassessing how new volunteers progress to senior leadership positions, as well as how this journey can be improved.

The team behind the research, which was recently published in the British Journal of Ophthalmology, surveyed both national ophthalmology societies and health ministries in 2015.

“We’ll provide micro-opportunities to have more volunteer support. We want people to be able to engage if they wish to be involved,” Scott said.

According to their results, in 2015 there were 232,866 ophthalmologists working across 194 countries, representing an increase of 14% over 2010 figures.

“Thus, ophthalmologist density alone is not a good indicator, because it does not inform on whether appropriate service and coverage are provided at a national level to meet population-based needs,” the report stated.

The organisation’s final priority, partnerships, centres on improving and strengthening relationships with groups such as the American Optometric Association and Association of Schools and Colleges of Optometry. n

Despite the growth, ophthalmologist numbers are still lagging behind the world’s ageing population. Compared to an annual global ageing population growth rate of 2.9%, ophthalmologist numbers increased by only 2.6%. With

“We’ll be 100 in 2022, and the AAO Foundation will be 75,” AAO executive director Mr Pete Scott told Healio. “We’ll be doing something big.”

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INSIGHT December 2019

A surprising finding noted by the researchers is the weak correlation between ophthalmologist density and prevalence of blindness.

The report’s authors also concluded the prevalence of blindness at a national level is also not directly related to patient density.

“Although training more ophthalmologists is important, our findings suggest that other regional factors may also play a significant role,” the authors state. n

TECHNOLOGY

AMAZON ENTERS THE RACE FOR SMARTGLASSES SUPREMACY Global technology and retail giant Amazon has launched the Echo Frames, marking the company’s entry into the emerging smartglasses market.

The spectacles, which are designed to be worn all day and look like a regular pair of glasses, feature a microphone and speaker array to give the wearer hands-free access to Amazon’s digital assistant Alexa. Wearers can use Alexa to perform a number of simple tasks such as set reminders, make calls and issue instructions to other Alexa-equipped smart home devices.

The frames’ four speakers are designed to direct sound straight to a user’s ears, providing clear audio while also preventing other people from listening in. Additionally, the inbuilt microphone is designed to only respond to the owner’s voice, preventing anyone else from issuing commands. To maintain privacy, the microphone can be turned off at any time by pressing a button.

The frames can also be used to access other smart assistants, such as Google Assistant, and users are able to establish a ‘VIP’ list to only receive notifications

from selected apps and contacts.

In order to function the frames need to be paired with the Amazon Alexa app, and they are currently not compatible with iOS devices.

Unlike several other smartglasses that have recently launched, such as North’s Focals, the Echo Frames do not feature a heads-up display or augmented reality capabilities.

Amazon also claims the device has a battery life of three hours for audio playback and 14 hours on standby.

While the frames do not include prescription lenses, they can be fitted by a dispenser. The device’s built-in electronics prevent heat from being applied to the majority of the frame, however Amazon provides specific instructions for fitting lenses and the temple tips are adjustable. n

FIRST EVER 5G 4K TELEHEALTH EYE EXAMINATION PERFORMED IN UK The latest 5G mobile technology has been put to use in eyecare, with the recent completion of the first ever 4K tele-examination of an eye.

Dr Peter Thomas, consultant ophthalmologist and director of digital innovation at Moorfields Eye Hospital, and Dr Iain Livingstone, consultant ophthalmologist and the acute teleophthalmology system lead from NHS Forth Valley, performed the examination live in front of attendees at an Edinburgh conference.

Thomas was examined with a portable slit lamp connected to a 5G equipped smartphone outside of the Moorfields Eye Hospital in London, with a 4K resolution video of his eye streamed live to the conference. The stunt was designed to show that 5G technology is capable of streaming video at a resolution high enough to not impact the quality of an examination.

“This demonstration marked a significant turning point in teleophthalmology as we were able to deliver such detailed images in real time, using readily available equipment,” Thomas said.

“At Moorfields we have some very highly specialised doctors in rare diseases who could make their expertise available at a greater distance with this technology, which could have a significant positive impact on many patients.”

NEW AI SYSTEM DETECTS DIABETIC RETINOPATHY ACCURATELY IN SECONDS New research has found an automated, Artificial Intelligence (AI) powered screening system for diabetic retinopathy can provide a reading Srinivas Sadda, DEI with an accuracy of 99.5% in as little as 60 seconds.

The technology is expected to make real-time screening in diabetes centres possible in the near future.

The research, presented at the American Academy of Ophthalmology’s 123rd annual meeting, examined the effectiveness of the EyeArt system developed by US-based company Eyenuk.

EyeArt was used to screen 893 patients across 15 different medical location in the US, with results then reviewed by certified graders using the gold-standard ETDRS grading system.

Using undilated images, EyeArt’s sensitivity was 95.5% and specificity was 86%. Including the small number of eyes that did need to be dilated, sensitivity remained the same, specificity improved to 86.5 percent, and gradability improved to 97.4 percent.

Overall, more than 90 percent of the eyes identified as positive by the EyeArt system had diabetic retinopathy or another eye disease.

“Diabetic patients already outnumber practicing ophthalmologists in the United States, and unfortunately, that imbalance is only expected to grow,” Dr Srinivas Sadda, president and chief scientific officer of the Doheny Eye Institute (DEI) and author on the study, said.

Livingstone, who was at the far end of the consultation, said he was excited to see the resolution afforded by the technology.

“Accurate, real-time diagnosis holds great promise for the millions of patients living with diabetes. In addition to increased accessibility, a prompt diagnosis made possible with AI means identifying those at risk of blindness and getting them in front of an ophthalmologist for treatment before it is too late.”

“Keeping pace with these technological advancements means we can send and receive remarkably high definition video referrals which are particularly useful for relaying fine detail during a remote eye examination.” n

The EyeArt system has quickly developed as a leader in its field. Earlier this year the system was deployed

by Italy for the country’s first national prevention and diagnosis campaign for retinal and diabetic maculopathy. n

INSIGHT December 2019 25

RESEARCH

ANTI-VEGF DRUGS FOUND IN BREAST MILK

IMAGE OF TRABECULAR MESHWORK CAPTURED FOR THE FIRST TIME

Anti-vascular endothelial growth factor (anti-VEGF) drugs have been identified in breast milk, prompting warnings from researchers that the use of these medications during breastfeeding could affect developing infants.

Using the same technique that prevents starts from ‘twinkling’ in telescopic images, researchers have captured the first undistorted microscopic images of the trabecular meshwork.

According to a study recently published in the journal Ophthalmology, anti-VEGF drugs ranibizumab and aflibercept were detected in the breast milk of three lactating mothers after receiving injections.

The Indiana University (IU) team behind the project hope the imaging technique could make it easier to study glaucoma, in particular why certain glaucoma treatments that target the trabecular meshwork fail.

“The problem is the meshwork can only be seen poorly with the normal instruments in your doctor’s office, due to its location where the iris inserts into the wall of the eye, as well as the neartotal reflection that occurs when looking through the cornea,” Dr Brett King, associate clinical professor at the IU School of Optometry, said.

Of the study’s three participants, one continued to breastfeed throughout therapy, while the second discontinued breastfeeding and the third never started.

Drugs were found to have been excreted into breast milk in the days following an injection, with a corresponding reduction in VEGF levels detected.

The amount of medication found in the patient who continued to breastfeed was also significantly lower than the study’s other two participants, suggesting the medication was constantly excreted.

In order to overcome this challenge, the team modified an ophthalmic laser microscope with a mirror capable of changing shape in real time to correct for imperfections in the eye. A point of light is used as reference for the wider image, which informs the mirror’s shape.

Researchers behind the project warned that considering the important role VEGF plays in the development of an infant’s digestive system, the presence of anti-VEGF could lead to developmental issues.

Called ‘adaptive optics’, the device is accurate enough to visualise single

“As retina specialists, we often tell our pregnant or nursing patients that there’s a risk of a small amount of these drugs making its way into the breast milk, but we can’t be sure,” Dr Rajeev Muni, colead author of the study and vitreoretinal surgeon at St. Michael’s Hospital in Toronto, Canada, said.

“We don’t want these patients to lose their vision so we make a decision, despite limited information.”

Dr Verena Juncal, co-lead author on the study and retinal fellow at St. Michael’s Hospital, said the results confirm the drug reaches breast milk.

“We realise that some readers may question the small sample size, but if the drug reaches the breast milk in three patients, it’ll reach in 30 patients because it’s the same biological process.”

It is hoped that the findings might assist ophthalmologists and retina specialists when counselling pregnant and nursing patients. The team’s future plans include measuring the levels of the drugs in infant’s blood and the effects of long-term exposure. n

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INSIGHT December 2019

(From left) Kaitlyn Sapoznik, Thomas Gast, Brett King and Stephen Burns.

cells or measure blood flow within the retina. It is the same technology used by astronomers to overcome the atmospheric distortions that cause stars to appear to twinkle in the night sky.

While the technique has previously been used to image the retina, its latest application is a breakthrough. IU researchers reported they were able to successfully image the meshwork of nine study participants, including two with pigment dispersion syndrome.

“Thanks to this research, the ocular drainage area of the eye can now be seen with much-improved clarity, which will improve our understanding of how this essential drainage area is being altered or damaged,” King said. n

NEW EYE TISSUE COMPONENT FOUND

Soile Nymark, Academy of Finland

Researchers have found cellular components in the epithelial tissue of the eye that were previously only thought to be present in electrically active tissues. It is hoped the discovery could lead to new treatments for incurable diseases.

neural tissue, but whose prevalence or activity in epithelial tissue has not been previously reported. These proteins, voltage-gated sodium channels, are typically responsible for generating electrical signals in the nerve cells.”

A team from Tampere University, Finland, identified voltage-gated sodium (Nav) channels present in the eye’s epithelial tissue that play a role in the renewal of the retina’s sensory cells. Previously, this particular cellular component was only believed to be in electrically active tissues such as the heart or nerves.

The discovery reveals how the ion channel proteins responsible for the electrical signalling of neurons influence the phagocytosis process. Since this process is disrupted in many retinal degenerative diseases, such as agerelated macular degeneration, it is hoped this could lead to new treatments.

“The research project focused on the retinal pigment epithelium (RPE), a tissue that is critically important to the functioning of the retina,” Dr Soile Nymark, Academy of Finland research fellow, said.

“The project revealed proteins in the RPE whose function is essential for

The researchers made the discovery by applying techniques traditionally used on nerve cells.

“This perspective enabled our new observation and highlights that the major role of electrical phenomena and the underlying ion channels in the functioning of epithelial tissue may not yet be fully understood,” Nymark said.

n

POTENTIAL NEW PATHWAY FOR DIABETIC RETINOPATHY TREATMENT Researchers have identified a new link between diabetes and sight loss that has the potential to lead to new treatments for diabetic retinopathy (DR).

According to new research published in The American Journal of Pathology high levels of glucose increases the levels of an enzymatic precursor – lysyl oxidase propeptide (LOX-PP) – that promotes cell death.

“We found that hyperglycemic and diabetic conditions increased LOX-PP levels,” Dr Sayon Roy, professor of medicine and ophthalmology at Boston University School of Medicine and lead investigator on the study, said.

“LOX-PP may induce cell death by compromising a cell survival pathway, and in retinas of diabetic rats, increased LOX-PP contributed to retinal vascular cell death associated with DR. Administration of recombinant LOX-PP alone was sufficient to induce cell death.

This report shows novel functionality of LOX-PP in mediating cell death under

GENETIC MUTATION RESPONSIBLE FOR BARDET-BIEDL FOUND

high glucose condition in retinal endothelial cells as well as in diabetic animals.”

In a development that could lead to new treatments for the condition, a genetic mutation responsible for Bardet-Biedl Syndrome (BBS) Martha Neuringer, has been isolated in OHSU monkeys.

Researchers administered artificially synthesized LOX-PP in both normal and diabetic rats and examined the changes associated with DR such as swelling, blood vessel leakage, changes to vascular walls and histologic indicators.

In the retinas of diabetic rats, more acellular capillaries (AC) and greater pericyte loss (PL) was observed when compared to the control group. Among non-diabetic rats administered LOX-PP, increased AC and PL was also observed.

Researchers from Oregon Health and Science University (OHSU) have isolated a mutation of an individual gene (BBS7), one of at least 14 genes associated with the condition, in three affected rhesus macaques.

The team behind the project noted that there is a clear connection between high glucose and LOX-PP levels, which in turn promotes cell death.

In addition to vision loss, Bardet-Biedl Syndrome, a condition part of the broader family of retinitis pigmentosa diseases, can cause kidney dysfunction and the development of extra fingers or toes.

“Our findings suggest a novel mechanism for high glucose-induced cell death involving LOX-PP, which may be a therapeutic target in preventing retinal vascular cell loss associated with DR,” Roy said. n

“There is no cure for Bardet-Biedl Syndrome today, but having a naturally occurring animal model for the condition could help us find one in the future,” Dr Martha Neuringer, the paper’s author, said.

SECONDHAND SMOKE SHOWN TO DAMAGE CHILDREN’S EYES A study examining the eyes of 1,400 Hong Kong children has drawn a link between secondhand smoke and eye damage.

According to researchers from the Chinese University of Hong Kong, children exposed to secondhand smoke from family members have, on average, a thinner choroid than those from smokefree households.

Additionally, greater exposure to secondhand smoke was linked to even thinner tissue.

The team behind the project examined children between the ages of six and eight who presented at the Chinese University of Hong Kong Eye Centre between 2016 and 2017, with 459 reporting secondhand smoke exposure.

After adjustments for age, sex, body mass index, axial length and birth weight, the team found exposure to secondhand smoke was associated with a thinner choroid by 8.3 μm in the central subfield, 7.2 μm in the inner inferior, 6.4

The breakthrough was made when the genomes of two related monkeys lacking key vision cells had their genomes compared against one another. After a mutation of BBS7 was found in both, the result was compared against the genetic records of 2,000 rhesus macaques kept at OHSU’s nonhuman primate research centre.

μm in the outer inferior, 6.4 μm in the inner temporal, and 7.3 μm in the outer temporal. Thinning was slightly greater among children who were exposed to multiple smokers.

“In summary, we have shown an association of secondhand smoke to thinning of choroidal thickness by 6 μm to 8 μm among children exposed to secondhand smoking at home in Hong Kong,” the report stated.

“The thinning was associated with the number of smokers in the family and the quantity of smoking, suggesting a dose-dependent relationship. While it is unknown if there is a casual relationship from this association or if this is due to confounding factors, these findings add to the potential harmful effect of secondhand smoking on children’s ocular health and development.”

While the thinning identified in the study is low compared to that seen among long-term adult smokers, the potential for long term-exposure may cause visual problems later in life. n

“THE THINNING WAS ASSOCIATED WITH THE NUMBER OF SMOKERS IN THE FAMILY AND THE QUANTITY OF SMOKING” CHINESE UNIVERSITY OF HONG KONG

Based on this a third monkey with the condition was found, although its excellent adaption within its social group led to the impairment being overlooked.

The third monkey is now being observed in order to better understand how the disease progresses.

The team is hopeful their discovery could lead to the development of a treatment for the disorder, much like how studies in dogs have recently led to a gene therapy for Leber’s congenital amaurosis. The next step in the project involves breeding more animals with the naturally occurring BBS7 mutation to compare against.

Depending on the results it is hoped the research could lead to treatments for retinitis pigmentosa.

The findings have been published in the journal Experimental Eye Research. n

INSIGHT December 2019 27

RESEARCH

GENES FROM ARCHAEA USED TO PREVENT BLINDNESS

TREATMENT OPPORTUNITY FOR AMD AND ALZHEIMER’S A newly discovered mechanism has the potential to lead to the development of treatments for both agerelated macular degeneration (AMD) and Alzheimer’s Nicolas Bazan, LSU disease.

The accumulation of toxic proteins, which is caused by degrading cell function throughout the ageing process, results in inflammation and the subsequent brain and photoreceptor cell death that causes these neurodegenerative diseases.

Elovanoids, which are bioactive chemical messengers made from omega-3 very long-chain polyunsaturated fatty acids, have been found to counteract this process, according to research published in PNAS. “It is the first report that elovanoids are potential senolytic therapies because they target and dramatically arrest gene expression engaged in cell disturbances, including senescence gene programs and retina cell death in conditions that recapitulate retinal degenerative diseases,” Dr Nicolas Bazan, Boyd Professor and director of the Neuroscience Center of Excellence at Louisiana State University (LSU) Health New Orleans School of Medicine, said.

Elovanoids target the senescence genes, a key senescence protein, and the expression of senescence-related genes in the retinal pigment epithelial cells.

This ultimately fosters repair, remodelling and regeneration of the damaged photoreceptor cells.

“We demonstrate in the paper that the elovanoids block these events and foster the survival and function of these cells,” Bazan, who’s lab also discovered elovanoids, said.

While the results are promising, Bazan cautions that more work is needed. “Particularly by using these models to define the intimacy of the gene transcription of senescence and the epigenomic implications of these findings,” he said.

Bazan’s lab is now also looking for more unifying regulatory mechanisms that may impact neurodegenerative diseases and ageing. n

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INSIGHT December 2019

“WE’VE USED THE EYE AS THE MODEL, BUT I’LL BE INTERESTED TO LOOK MUCH, MUCH WIDER THAN THAT” MAXIM SOKOLOV, WVU

By combining archaea and mammal DNA, researchers are hoping to ‘bypass evolution’ and give people genes resistant to retinal degeneration.

A new project underway at West Virginia University (WVU) is looking at the proteins produced by singlecell organisms called archaea that help them survive in harsh conditions.

Particular proteins in archaea cells, called molecular chaperones, guide other proteins through the folding process which allows the organism to survive in harsh environments like hydrothermal pools and digestive systems. “[Molecular chaperones] embrace the baby proteins and help them to fold correctly,” associate professor Maxim Sokolov, WVU School of Medicine, said.

“And if the baby proteins fold incorrectly, the chaperones will unfold them and say, ‘fold again.’”

Giving human cells this capacity could lead to treatments for several incurable eye diseases, such as retinitis pigmentosa. By stopping the accumulation of misfolded proteins in the eye, photoreceptors would be saved.

“You bypass evolution,” Sokolov said.

Maxim Sokolov, associate professor, WVU School of Medicine, Departments of Ophthalmology and Visual Sciences, Biochemistry and Neuroscience CREDIT: West Virginia University.

“All of a sudden, this chaperone that’s not present in mammals – not just mice but mammals – is there. But you don’t know what will happen. This is where you start to do research.”

The method is being tested in mouse models. If successful the team believes the technique could be used to treat conditions such as Alzheimer’s and Parkinson’s diseases.

“There are diseases in the brain, and there is this disease called aging,” Sokolov said. “We’ve used the eye as the model, but I’ll be interested to look much, much wider than that.” n

LINK BETWEEN SLEEP APNOEA AND DIABETIC MACULAR OEDEMA FOUND New research has dawn a link between severe sleep apnoea and diabetic macular oedema, firming up a connection between the two conditions.

The effects of sleep apnoea are spread throughout the body due to the way the condition disrupts sleep patterns and causes blood oxygen levels to rapidly drop. This injures blood vessels and increases the risk of hypertension, heart attacks, stroke and type 2 diabetes.

It is also believed that sleep apnoea may contribute to diabetic retinopathy by increasing insulin resistance, elevating inflammation and raising blood pressure, which subsequently damages blood vessels in the eye.

According to the team from Taiwan’s Chang Gung Memorial Hospital, eight year data from patients diagnosed with diabetic retinopathy indicates severe sleep apnoea can lead to increased

rates of diabetic macular oedema.

The rate of severe sleep apnoea was found to be significantly higher in patients with diabetic macular oedema (80.6%), compared with those without diabetic macular oedema (45.5%).

Additionally, more severe sleep apnoea led to patients requiring greater management of their macular oedema.

“Based on these results, we hope that more medical professionals will approach sleep apnea as a risk factor for diabetic macular edema,” Dr Juifan Chiang, lead researcher on the project, said.

“This could allow for earlier medical intervention so patients can keep more of their vision and preserve their overall health as much as possible.”

The research was presented at this year’s annual meeting of the American Academy of Ophthalmology. n

FEATURE

e o t o t e o tWITH ONLINE RETAILERS

CONTACT LENSES: GOING

Online retail has had a far-reaching impact on the eyecare sector, particularly in terms of contact lens sales. MYLES HUME looks at how optometrists can differentiate their businesses to overcome the challenges presented by new e-commerce operators.

I

t is a scenario all too common for the modern-day optometrist: A patient visits the practice, obtains a prescription and is never heard from again, presumably venturing online to order their contact lenses.

Online retail has drastically altered business for traditional brick-andmortar retailers. The issue is particularly pertinent to the eyecare sector, where lean operating structures and the developing sophistication of e-commerce platforms has increasingly eroded the income of general optometry practices.

A brief analysis of Australia’s leading online contact lens retailers explains why patients shop online. Offers of up to 20% off first orders, free shipping and returns, 24/7 customer service and best price guarantees make it difficult for traditional businesses to attract price-sensitive consumers.

These convenient and competitive offers are driving revenues of up to $108 million for Australia’s online eyeglasses and contact lens sales industry, according to analysts at research firm IBISWorld. A 34% increase on 2013-14 figures, these statistics suggest eyecare professionals need to adapt if they are to retain and maximise the contact lens component of their business.

While online retailers can continue to expect healthy returns from disposable contact lenses, industry experts say the advent of specialised

INSIGHT December 2019 29

FEATURE

products, alongside services for myopia and presbyopia, present a new opportunity for private practitioners.

Meanwhile, other industry statistics show that despite increasing revenues, the percentage of people buying contact lenses online is now in decline since peaking six years ago, partly thanks to superior the customer service offered in the practice and technological advances supporting smaller operators. Faced with an increasingly competitive market, optometrists who are staving off the challenge by differentiating their business.

the retention of patients at the re-ordering phase.

Jones says that while contact lenses sellers have had an online presence for some time, in recent years their profile has increased exponentially.

"THE GOAL IS TO OVERRIDE THESE DRIVERS BY ESTABLISHING ENOUGH TANGIBLE VALUE"

‘PATIENT RETENTION IS CRITICAL’ The emergence of e-commerce, in combination with optical chains, has had a transformative impact on Australia’s eyecare sector over the past decade. According to ProVision, Australia’s largest network of independent optometrists, these changes have demanded a more tactful approach from smaller eyecare businesses.

“It’s important that practices recognise the key drivers for patients wanting to shop online, such as convenience and price, but the goal is to override these drivers by establishing enough tangible value in the practice experience that patients want to return,” ProVision merchandise manager Mr Tony Jones says.

ProVision represents 465 independent practices and supplies members with comprehensive business support. Helping optometrists navigate the competitive contact lens dispensing market is one of its services, particularly

TONY JONES

“This increased awareness coupled with highly competitive retail pricing has seen many patients sourcing their repeat orders via an online site instead of returning to their practice of choice.

“Not only does the optometrist lose the repeat business, they are at risk of compromising the patient relationship, which has far greater implications in terms of future business growth.

“In an ever-increasing competitive market, patient retention is as critical

THE CONVENIENCE FACTOR Mr Richard Lindsay, optometrist and director of East Melbourne practice Richard Lindsay & Associates, says convenience is a major reason why at least 80% of his patients continue to order through his practice and its website.

Established in 1998, his practice provides specialist contact lens care for patients who require custom contact lenses, while also caring for many patients with regular soft disposable lenses.

“We can’t really compete with online distributors on price. Our attitude is not so much to compete, but to focus on service, in other words, convenience, and online is just as much about convenience as it is about cost.”

Lindsay says optometrists should embrace the fact some patients will only visit to obtain a prescription. For those patients he focuses on providing a quality service and charging accordingly, knowing that dispensing income is only part of the contact lens business.

“If someone chooses to get their contacts online, that’s their prerogative, we just want to make sure we see them on a regular basis for their care, and then we charge appropriately for that,” he says.

“Contact lenses can be profitable, but you have got to charge for your services and accept the fact that some will go online and, if they do, you should make every effort to make that patient feel welcome to come back for their regular follow up.

“If you make them feel uncomfortable or unwanted because you’re upset about them going online, of course they will go elsewhere,

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and you’ll lose that patient and potentially others they may have recommended.”

While overcoming the price challenge could be difficult for some practices, Ms Soojin Nam, an optometrist for independent optometry group Eyecare Plus, says there are now options for practices to price match internet retailers, as well as offer free home delivery.

“There are also many patients who would prefer to support their local optometrist,” Nam says.

“Online retailers will continue to provide the convenience that some people need but as the need for customised eyecare rises, there will be a greater awareness of the different options available that would be best suited for their specific situation. The better the differentiation, the better educated the patient will be.”

At the other end of the scale, optical chains

are focussing on ensuring patients can access contact lenses in a way that best suits them.

Specsavers, a leader in the Australian contact lens market, is one such example. Its model is based on a strong over-the-counter and online offering, supported by its optometrists and dispensing professionals in-store.

“This in-store and online approach has been the mainstay of our approach to contact lenses since 2012,” Mr Steve O’Leary, the company’s director of product and contact lenses, says.

“We have seen our market share grow to market leadership by volume in both categories as a consequence, at around the 40% mark in each. A model that allows our patients to buy online and manage any issues with no-cost aftercare in the Specsavers practice of their choice has facilitated our success and lifted patient satisfaction to new heights.”

SPECIALISED PRODUCTS GO MAINSTREAM Manufacturers are also playing a part in the patient-practitioner relationship as more specialised products, that can’t be provided online, are pushed further into general optometry practices.

Optometry Australia (OA) chief clinical officer Mr Luke Arundel highlights soft multifocal contact lenses for myopia control and presbyopia as an example.

“With an aging population, multifocal contact lens fitting will become more important in providing a full range of visual solutions for patients.

Likewise, with myopia set to affect half the world’s population by 2050, the demand for myopia control lenses will continue to rise,” he says.

as attracting new patients, so any erosion to online players is sure to have a serious impact.”

Jones says practice-patient continuity is especially important for contact lens wearers. Optometrists have a duty-of-care to ensure the product is suitable, particularly for first-time wearers. This hands them a key advantage over online retailers.

“The patient needs to be reassured that any questions or concerns they have can be answered satisfactorily. It’s also important that regular eye exams are part of any patient’s care plan, both to detect changes and ensure that the best solution is being prescribed.

“The patient benefits from an in-practice visit by: increasing their awareness around latest technological developments, receiving fitting guidance from trained staff, and trouble-shooting to improve the overall contact lens experience – none of which are available through online providers.”

With convenience being a key motivator for online shoppers, five years ago ProVision built a business-to-consumer online portal to help its practices compete. Called ProShop, it is a ProVision-managed online store skinned as if it were part of an individual practice’s website.

“This provides an avenue for patients to purchase products online, particularly contact lens replenishment orders, to avoid them straying to other online players that they have no relationship with,” Jones says.

“Whilst a number of ProVision members utilise this service well as a patient retention strategy, ProShop uptake has plateaued in recent years in line with overall market trends.”

"BEST PRACTICE FOR ONLINE RETAIL WOULD BE TO CONFIRM VALIDITY OF THE PRESCRIPTION" LUKE ARUNDEL

MULTI-MILLION DOLLAR INDUSTRY In its report titled Online Eyeglasses and Contact Lens Sales - Australia Market Research Report, market research firm IBISWorld found online eyewear and contact lens revenue reached $108 million this year. In Australia alone there are now 47 businesses operating in this space, and from 2015-20 the segment has grown at an annual rate of 5.1%.

According to Inside Retail, based on a 2014 IBISWorld report, revenue

“The advent of soft myopia control contact lenses has very much taken this facet from contact lens practices involved in speciality contact lens fitting and orthokeratology into mainstream practice.”

These burgeoning markets, at opposite ends of the human lifecycle, have seen the arrival of products by Visioneering Technologies (VTI), mark’ennovy and CooperVision.

Mark’ennovy’s Asia Pacific managing director Mr Chris Harous says the release of the company’s MYLO myopia control contact lens is a “a game-changer” for practitioners.

“This process of contact lens fitting, prescribing, dispensing and aftercare has the ability of taking contact lenses from just another retail commodity product back to a prescribed medical device that starts and stays with the eyecare professional, from the first consultation to ongoing treatment of their patient,” he says.

VTI’s senior vice-president of sales and marketing Mr Tony Sommer also believes specialised products, such as his company’s NaturalVue multifocal for presbyopia and myopia, present a new opportunity for independent optometrists.

“Our company is one of few that focuses on the independent practice. We don’t offer NaturalVue to retail chains such as Specsavers or OPSM, but may make exceptions on a case-by-case basis for independent franchise owners,” he says.

“Our products require the practice to spend time educating the patient on their use, and are only available to independent optometrists. Myopia progression control cannot be purchased from a website.”

Sommer says VTI has made it relatively straightforward for optometrists to prescribe NaturalVue. This involves an online accreditation process with a questionnaire and videos, which takes about 40 minutes to complete. This allows the practitioner to secure a firm grasp of the fundamentals and allows the company to qualify the account. The final step is a visit by a sales representative for fit set installation and in-person training.

“The fundamental issue is that a contact lens is a medical device, not a razor blade or toothbrush. As such, its fit and efficacy must be evaluated by a trained professional. Websites are built for convenience of commodity purchases – not fit and evaluation of a medical device,” he says.

“I think online retailers will be as successful as they are in other industries, particularly for spherical lenses. However, lenses that are more specialised in nature, such as those for myopia progression control, will be a key pillar in a successful private practice.

“Remember, many practice management consultants counsel that the way to beat a ‘big box’ or an online retailer is to offer products and services that they cannot – such as specialised lenses and outstanding patient experience.”

INSIGHT December 2019 31

FEATURE

was previously $71 million, equating to a $37 million increase during the past five years alone.

Arundel predicts the convenience and economy of online retail will continue to be an attractive option in increasingly time-poor societies.

Analysts said online retailers continued to reap the rewards of having low operating cost structures. This enables them to aggressively discount products, while brick-and-mortar counterparts are faced with high labour and utility costs.

While there is little doubt e-commerce retailers are here to stay, what is less certain is how regulators will respond to a market that has become vulnerable to counterfeit and unapproved products.

Today, IBISWorld reports the online eyewear and contact lens industry in Australia may only just be getting started, but warns more disruption is on the horizon.

“The online eyeglasses and contact lens sales industry displays low market share concentration, with only one player commanding a market share in excess of 5%.

"MYOPIA PROGRESSION CONTROL CANNOT BE PURCHASED FROM A WEBSITE" TONY SOMMER

The US and Europe have adopted quite different approaches to the regulation of contact lens sales. In the US, tightened Federal Trade Commission legislation means sellers can only supply contact lenses if they are presented with a valid prescription. Europe has gone down the path of deregulation, with some countries even allowing contact lens sales through vending machines.

In Australia, the rise of unapproved contact lenses from overseas providers has been a cause for concern for OA, which has begun advocating for stricter regulations.

“Best practice for online retail would be to confirm validity of the prescription from the patient’s prescriber, or require an upload of a valid prescription, as is common in the US,” Arundel says.

OA is aware of patients accessing websites to swap their prescribed contact lens for an alternative product without undergoing an appropriate review to determine if it fits and provides optimal performance.

Patients can access these products by ‘self-validating’ that they have a prescription.

“The existing large networks and strong reputations of incumbent operators increases the entry barriers for prospective industry participants.

However, as the Australian industry is still in its infancy, new companies still have the opportunity to gain first mover advantages.”

Despite analysts predicting a profitable short-term for e-commerce operators, other figures suggest it may have already peaked.

Jones points to a survey conducted by Delta MV Market Research for contact lens manufacturer CooperVision ANZ in November 2017 as evidence patients did not believe an online purchase was a better overall value option.

“When asked where they most often buy their contact lenses, in 2017 only 21% regularly purchased online. This has dropped from 26% in 2013 with a steady decline seen over the intervening years,” he says.

“When patients were asked why they don’t buy online, the key reasons given were: better customer service was provided in practice, they could mostly order via a practice website 24/7, and the interaction from buying in a practice enhanced their contact lens experience.”

CLOSING A LEGAL LOOPHOLE Looking ahead, Optometry Australia (OA) chief clinical officer Mr Luke

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INSIGHT December 2019

Arudnel says purchasing unapproved and counterfeit lenses from overseas presents a risk. A 2017 Journal of Forensic Sciences study testing 300 pairs of these types of lenses found 48% of the non-prescription cosmetic lenses and 60% of the counterfeit tested positive for microbial contamination.

Research published in the journal Ophthalmology by Australian researchers has also identified the purchase of contact lenses over the internet as a risk factor for microbial keratitis.

Subsequently, OA recently lodged a formal submission with the Australian Therapeutic Goods Administration to close down the legal loophole surrounding plano contact lenses not being regarded as a medical device.

“We are also working with state governments to explore opportunities to pursue online retailers supplying contact lenses without a valid prescription, as in some states this carries a $30,000 per offence fine,” Arundel says.

While the issue of industry regulation will remain up for debate, optometrists can be certain that online retailers will continue to assert themselves in the market, particularly in the disposable lens category. For practices, particularly independents, trying to maintain customer loyalty, offering expert knowledge, care and service that cannot be matched online is the best option for both the business and patients. ■

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REPORT

SPECSAVERS CLINICAL CONFERENCE 8

CONTINUES THE TRADITION Back for its eighth year, the Specsavers Clinical Conference delivered two days of presentations to optometrists, locums and optometry students.

In the first of a two-part series, LEWIS WILLIAMS reports on the event.

A

s has become the norm, the eighth Specsavers Clinical Conference (SCC8) was held at Melbourne’s Convention & Exhibition Centre on the 7th and 8th of September 2019.

Around 750 delegates attended both days alongside a total of 25 exhibitors, which included schools of optometry, eye health organisations, and industry suppliers.

The opening address was delivered by Dr Ben Ashby, Specsavers director of optometry, who acknowledged that delegates were a mix of both Specsavers and non-Specsavers optometrists, as well as students.

He noted that all Specsavers stores have commissioned OCTs, marking the end of the national rollout that commenced in 2018. The project has been accompanied by ophthalmologist-led training programmes for relevant staff. Glaucoma referrals and detection rates have approximately doubled in stores equipped with OCT, and a diabetic screening programme has also been instigated.

With the number of people attending a Specsavers store annually now in the millions, the potential influence of efficacious screening programmes is obvious.

endured a dog bite. Vision was normal in both eyes, but a decreased sensation over the left brow was reported.

Excyclotorsion was observed during a fundus examination. The problem developed after the facial injury, which resulted in a significant laceration. A left superior oblique (LSO) muscle palsy was diagnosed and the condition was described as an uncommon cause of a superior oblique palsy. That is, trauma to the supra-nasal orbit. Surgical management was required.

The second case was that of a seven year old female who reported three months of difficulty reading and seeing the blackboard at school. Reading glasses produced no improvement. She also reported a virus-induced wheeze requiring an occasional dose of Ventolin.

Visual Acuity (VA) was found to be about 6/15 OU. Importantly, a pinhole did not improve the VA, suggesting a non-refractive aetiology of the vision problem. Stereopsis was good and only a small exophoria was found.

Retinoscopy under cycloplegia was normal for the patient’s age (+1.25 and +1.50 DSph).

Catt stated that several terms were used to describe non-organic vision loss, but the firming favourite is Vision Conversion Disorders (VCDs) – disorders that are subconscious and certainly not voluntary.

The first step is counselling the parents and the patient, usually separately, about the condition and offering a likely timeframe for any expected improvements.

The characteristics of VCDs were given as: • Symptoms do not fit any known ophthalmic disease • There are not explained by organic disease • Usually, diagnosis by exclusion is required

OPTOMETRIC MANAGEMENT OF PAEDIATRIC CONDITIONS

• Assign the condition to ‘unknown cause’ if necessary

Sydney-based paediatric ophthalmologist Dr Caroline Catt used a casebased approach to cover several eye conditions that might present.

• Age range is generally six to 16 years

Her first case was a 13-year-old female with a left hypertropia that was exacerbated by a left head tilt and could be compensated for by a right head tilt. The girl was also autistic, suffered from ADHD, and had recently

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INSIGHT December 2019

• If the patient is more than ten years old, they are 3x more likely to be female • Most patients seem neither concerned nor inconvenienced by an apparently severe vision loss.

Catt cautioned the audience about the possibility that a VCD could be superimposed on an organic disease. Presentations can include: blurred vision, visual field defects, and distorted colour vision. The defects are usually bilateral.

since the age of two and the development of a strabismus at three. The steroid therapy resulted in posterior, sub-capsular cataracts bilaterally. She reported a large, bilateral esotropia that lasted 11 hours following a bump to the head.

Possible stressors include: family disharmony, school-sourced stress, change of ‘habitat’, bullying (increasingly common in the social-media era), a recent vision test, sibling rivalry, and friends/classmates getting glasses recently. Often coaxing the patient can result in vision improvements but equally, differences can be found from day-to-day.

A week later, the condition returned and lasted 24 hours. Later, an MRI revealed a lesion in her cerebellum. Vision returned to normal but a miosis and an esophoria were found at near. Furthermore, a slight pupil enlargement was noted when the eyes resumed straight-ahead fixation. A spasm of accommodation/convergence was diagnosed and 1% atropine twice a day was prescribed for three days, as was a pair of bifocals (+2.00 DSph OU, Add +3.00).

Sometimes, ‘tricky’ retinoscopic or tricky fixation findings will also be noted. When reading, the tone can be monotonous and the delivery/recital slow, often with the sound tapering off at the end. Alternatively, a sing-song style of recitation can be adopted.

Catt advised that the parents be spoken to first and together with the patient later. A clear aim is to identify the stressors and referral to a psychologist might be required in refractory cases.

In the same vein, case three was of a 14-year-old female with several years of reduced vision (6/24) but only –0.50 DSph to explain the decrease. A cycloplegic refraction, electrophysiology, and OCT revealed nothing further.

Tellingly, visual fields were unreliable (VFs are significantly more difficult to be ‘consistent’ with) but were suggestive of a bi-nasal hemianopia. Further investigation revealed that the onset coincided with bullying at a new school.

Fortuitously, the patient shared her parent’s enthusiasm for motorcycles, and her desire for a motorcycle licence was used to resolve the issue.

Case four was a little more serious and featured an 8-year-old female patient who had indistinct optic disc margins, intermittent headaches, and behavioural and schooling difficulties.

VA and a lumbar puncture proved to be normal. Idiopathic intracranial hypertension was diagnosed. Papilloedema and intermittent headaches are known to accompany the condition. The condition is rare (0.6 cases per 100,000 children) and is more likely to affect females and the obese.

Interestingly, the patient did not respond to the use or discontinuation of acetazolamide therapy, and the disc appearance did not change over a three year period. Treatment was stopped as a result. It was also noted that intracranial pressure can be normal and the disc still be elevated.

Another case was that of a nine year old female with acute leukaemia

Ben Ashby, Specsavers director of optometry.

Surprisingly, three weeks later she returned with an alternating esotropia that eventually subsided, leaving her with a small amount of esophoria.

Further investigation identified a misunderstanding on the part of the patient whereby she understood, erroneously, that her childhood cancer had returned and triggered the whole episode.

The final case was that of a five year-old female who was playing at being cross-eyed with a friend. A large comitant, left esotropia and 6/9 VA OU resulted. Retinoscopy was normal for the age (+1.50 DSph OU). Trial glasses and an MRI were ordered. Sudden onset comitant esotropias can be a result of an artificial interruption to fusion and be of the Bielschowskytype in ametropes of up to 5 D myopia, or a Franchetti-type that has no apparent cause but often follows a bout of illness.

GLAUCOMA: DIAGNOSIS AND MANAGEMENT Western Australian ophthalmologist Dr Dru Daniels undertook the welltrodden topic of glaucoma. It never fails to engage audiences since the more that is learned, the more it is realised just how mysterious certain aspects of the condition can be.

Glaucoma affects about 1.3% (range 1 - 1.5%) of the population, but far too many remain unaware until symptoms become too significant to ignore.

Unfortunately, by that stage much irreparable damage has already been sustained, leading to less than ideal outcomes.

Of a cohort that exhibit glaucoma-related signs and/or symptoms, 18% are likely to be considered glaucoma suspects, 53% will be placed on a review path, and 29% will be entered into a collaborative care regimen. While intraocular pressure (IOP) is still important, the three main steps in glaucoma

Caroline Catt, paediatric ophthalmologist.

INSIGHT December 2019 35

REPORT investigation remain an examination of the optic nerve head (ONH), a dilated fundus examination (DFE), and a visual field (VF) assessment.

IOP is highest when the body is supine and asleep. Daniels recommended that delegates not be afraid to dilate eyes for fear of precipitating an angle-closure event because in his experience it has never happened in over 100,000 dilations. Although the risk of angle-closure is not zero, dilation is essential if a good view of the fundus and the ONH is to be had. Generally, a VF assessment simply confirms the function aspects that are a sequel to the anatomical posterior pole findings.

Glaucoma remains the number two cause of preventable blindness worldwide. In the very old, a decision to treat or not comes down to the question: Will glaucoma outlast the patient? Australian data suggests there are about 400,000 glaucoma sufferers and a further 400,000 suspects with elevated IOP. Early detection is important because late presenters generally do badly even when treatment is commenced. Optic disc features, such as cupping and disc rims, that are not the normal salmon pink should always trigger suspicion.

Importantly, does the VF match the ONH appearance? VF assessment is more appropriate to confirm progression of the disease, rather than diagnosis, because up to 50% of optic nerve loss can occur before VF defects become apparent.

Usefully, modern VF devices offer data that gives an idea of how reliable findings are. Generally, OCT has overtaken the role previously occupied by the Heidelberg HRT. The more recent OCT-A technology allows the perfusion of the ONH and optic disc capillaries to be assessed. That is significant because glaucoma generally decreases ONH perfusion.

There are some conditions that can masquerade as glaucoma, such as a neuropathy resulting from compression of the optic nerve.

While MRI can disclose such a situation, its yield rate is generally low.

Pituitary tumours can result in VF defects.

Other possible masquerades include ischaemic optic neuropathy,

hereditary issues, and nutritional deficiencies. Even if it is not glaucoma there is the possibility that lowering IOP might still be useful. In one US National Institutes of Health study, a glaucoma misdiagnosis rate of 25% was reported.

Ocular hypertension was reported to be common, and greater care was required when there is a family history, the patient is myopic, has thin corneas, or is of advanced age.

If IOP is >30 mm Hg, a good first line treatment is selective laser trabeculoplasty (SLT), especially if the patient is young. However, SLT is not regarded as primary glaucoma therapy. Rather, it is a temporary step.

Daniels gave the standard glaucoma treatment options as: • Xalatan (latanoprost - a prostaglandin analogue) as a first line of defence • Timolol (a beta-blocker) - especially useful if dry eye or blepharitis is present as it is better tolerated. However, it is unsuited to those suffering from asthma or heart disease and is known to have the potential to cause depression, respiratory difficulties, and asthma.

While compliance is an evergreen problem, it has been shown that once more than one medication is prescribed compliance plummets.

Alphagan (brimonidine tartrate) eye drops can result in up to 40% of users experiencing red, dry eyes. When eye drops prove to be unsuitable, the alternatives include minimally invasive glaucoma surgery (MIGS), a trabeculectomy, or some other surgical approach.

Glaucoma severity varies widely. Up to 52% of case are classified as mild, 25% as moderate, 13% advanced or severe, and 10% refractory. Once control was well established, Daniels’ recommendation was for the patient to be seen ophthalmologically every two years and optometrically in the odd years. He emphasised that glaucoma was a lifelong condition that involved an accelerated loss of optic nerve function.

Cataract surgery is useful in glaucoma management as it is known to lower IOP for at least two years. This can be longer in hyperopes, especially if greater than 2 DSph, but is less beneficial in myopes. The insertion of a MIGS device is also possible in conjunction with cataract surgery. A gonioscopic examination is critical in all patients. He also advised against the use of multifocal (MF) IOLs in any case, except those that are mild and non-progressive.

MIGS devices allowed earlier intervention with the potential to reduce the disease’s morbidity and the burden of medications. Although the Cypass Micro-Stent has been withdrawn from the market due to detectable corneal endothelial cell loss, Daniels expressed that it was probably not a real issue.

As a comment on the cost of MIGS devices he estimated that 1 kg of I-Stents was worth $1 trillion. Overall, he estimated that MIGS lowered IOP by 23-43% after settling, and medication usage was reduced by 46-67%.

He also called out the industry for having the tendency to overstate the performance of MIGS devices.

Other treatments touched on in his presentation include Ellex’s iTrack laser re-establishment of the trabecular meshwork for 360 °, trabeculectomy, and Baerveldt or Ahmed tubes/valves. He also noted that pigmented races do not do as well with conjunctiva-based surgical solutions.

He summarised his take on glaucoma as a case of giving the correct diagnosis and stratifying the risk guided by the following factors: •A ge •O NH condition •N TG vs. high IOP (NTG remains a difficult issue) •C ompliance •P igmented race?

•T ailor the management strategy •C o-management with an optometrist Despite advances made in our understanding of the disease, glaucoma

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INSIGHT December 2019

Dru Daniels, ophthalmologist

therapy remains IOP-lowering centric and fading levels of compliance remain a problem. Despite advances in instrumentation, the Goldmann applanation tonometer (1950) remains the gold standard.

HELPING PATIENTS AVOID LASER EYE SURGEONS Sydney ophthalmologist and refractive, corneal, and cataract surgeon Associate Professor Colin Chan undertook this seemingly contrary topic to assist the audience to refer only the most necessary for laser eye surgery.

He estimated that annually there are about 250,000 CL fits undertaken in Australia and about 25% of all microbial keratitis (MK) were CL-related.

He estimated further that about 47.5% of contact lens-induced papillary conjunctivitis (CLPC) cases were also CL-related, as was up to 50% of dry eye (DE) cases. Other noteworthy conditions included: Acanthamoeba keratitis (AK) - about 4-8 people affected annually, 40,000 MK annually, CLPC/GPC 58,000 annually, and DE 125,000 annually.

He finds that refractive surgery candidates are motivated by dissatisfaction or unhappiness with either their spectacles or CLs, and sometimes both.

Those unsuited to refractive surgery include: •F orme fruste keratoconus (FFKC) •D E cases •C hronic blepharitis sufferers •E pithelial basement membrane dystrophy (EBMD) •C L-related infiltrative keratitis/CLPC(GPC) •T hose with certain personality characteristics He reported that 66% of refractive surgery candidates suffered from DE, a figure that probably goes a long way to explaining the incidence of DE immediately after refractive surgery. Quoting the literature, he reported that 10-50% of CL wearers had discontinued wear within three years of commencing. Discomfort is the main issue.

In the general population, 12% of those over 50 years of age report DE. About 75% of LASIK candidates have tried CLs, with discomfort and DE the major barrier to wearer success.

The DEWSII report tends to confirm Chan’s claim that managing DE is something of an art and the division of the disease into four stages was a welcome development.

Initial treatment mainstays are still dietary modification, ocular lubricants, and lid hygiene. However, compliance remains a significant problem and drops off fairly rapidly after commencement of a treatment regimen.

Colin Chan, ophthalmologist

He also noted that a PRN regimen was not useful, and the prescribed treatments should be applied routinely regardless of the patient’s subjective impressions.

Special care is required when DE and possible laser treatments were contemplated, especially if the patient is female, of Asian descent, has MGD, has a connective tissue disorder, Sjögren’s Syndrome, Fuch’s Dystrophy (especially if Caucasian female) or an androgen deficiency (menopause). Laser surgery or CL wear can only be considered if, and when, the magnitude of any DE problem is lessened by suitable treatment.

Should blepharitis be a cause of CL intolerance, it must be treated successfully before continuation of CL wear is contemplated. He estimated that about 70% of old people had DE and figures in the general population could be as high as 37-47%. The adverse effects of blepharokeratitis are worse than blepharitis.

Compliance with instructions to use lid scrubs has been shown to fall to 50% after just one month. If CL-related infiltrative keratitis (CLIK) is detected, it too must be treated before continuing with CL wear or progressing to laser surgery. If CLPC/GPC is present, an anti-histamine and a mast-cell stabiliser are required. If a particular mast-cell stabiliser does not work, Chan suggested trying an alternative before discontinuing.

In cases of unhappy MF CL wearers, he suggested that signs of map dot dystrophy be sought using sodium fluorescein. About 43% of older patients exhibit the problem.

Chan noted that high myopes tend to get cataracts earlier (as early as 35 years of age). Vitrectomies for macular holes, for example, can also bring forward cataractous changes. When corneal conditions are present, have been present, or are under treatment currently, he suggested that monofocal IOLs be used rather than more complex options in the interest of better vision in the longer-term.

If monovision is considered an IOL option, he suggested strongly that an analogous CL monovision trial precede any final decision.

For particularly pedantic patients, especially those with high vision demands, he warned the audience to steer clear of MF spectacles, CLs, or IOLs. He gave the following as characteristics to be on the lookout for: •C ompulsive checking of vision and differences between eyes • Orderliness •O bviously competent and confident individuals • Dutifulness •T hose striving for achievement constantly

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INSIGHT December 2019 37

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REPORT

ICCLC TURNS UP THE MUSIC ON CONTACT LENSES

In addition to cutting-edge clinical lectures, the CCLSA embraced all things Pink Floyd for the 17th International Cornea & Contact Lens Congress. In part one of his report, LEWIS WILLIAMS details several lectures and awards presented during the event.

T

he Cornea and Contact Lens Society of Australia (CCLSA) held its 17th International Cornea & Contact Lens Congress (ICCLC) in the Macquarie Conference Centre, part of the Peppers Noosa conference complex, at Noosa Heads, Queensland from 11-13 October.

This year’s ICCLC was unlike any previous event because of its thematic approach and celebration of all things Pink Floyd, particularly the rare 1970 album Picnic - A Breath of Fresh Air. The novelty was the result of efforts by Ms Margaret Lam, the CCLSA National President, Mr Alan Saks, CCLSA’s CEO, and the conference organiser Corporate Communiqué. Given many of the delegates’ age, CL-related education would not have been all they learned about over the three-day programme.

SCLERAL CONTACT LENSES Sugar Land, Texas, optometrist and scleral CL specialist Dr Tom Arnold opened the scientific part of the programme. He is a Fellow of the Scleral Lens Education Society (FSLS).

He gave the dominant reasons for using scleral CLs as irregular astigmatism, keratoconus (KC), pellucid marginal degeneration (PMD), post-penetrating keratoplasty, and other post-surgical indications. He acknowledged that scleral CLs were not always the best option, such as when the origin of an optical problem was the posterior cornea and not the anterior cornea that a scleral lens can address effectively.

Where KC is the problem, solutions include GP, hybrid or scleral CLs and, more recently, SCLs designed especially for KC. He described the latter as becoming increasingly popular in the US. Despite what some claim, Arnold does not believe that an OCT is essential to scleral CL

practice, but he admitted that it was “useful”.

In his experience, the surface profile of the scleras he has assessed are spherical in only about 6% of cases, toric in 29%, and asymmetrical in 41%. Importantly, the scleral profile is dynamic and changes according to eye movement because of the influence of the EOM’s activities and their points of insertion. KC and PMD were nominated as being the most difficult to deal with and fortunately, PMD is relatively rare.

The uses of topographical data recommended by Arnold were axial maps to reveal surface power differences and elevation maps for information on lengths/distances/radii. On the subject of the clearance or vaulting height of scleral CLs, he noted that the ‘settling’ (decrease in ocular surface clearance) was often more than 70 microns by 8 hours of CL wear, 75% of which occurred in just the first 2 hours and 50% of which occurred within 45 minutes of CL insertion.

He also noted that apart from possible formation of bubbles (dimple veiling), excessive clearance is a barrier to oxygen transmission given that the Dk of water is finite.

ANTERIOR SEGMENT PEARLS This segment, subtitled A Saucerful of Secrets (the title of Pink Floyd’s 2nd studio album) was delivered by the experienced ophthalmologist duo Professor Charles McGhee and Dr Sue Ormonde from Auckland, New Zealand.

McGhee occupies the M Paykel Chair of Ophthalmology and is head of department at the University of Auckland. Ormonde is currently the only female laser refractive surgeon in NZ and a senior lecturer in McGhee’s department with dual roles in clinical and teaching.

INSIGHT December 2019 39

REPORT

MCGHEE ACKNOWLEDGED THAT DESPITE BEING A WELL-ESTABLISHED PROCEDURE, PENETRATING KERATOPLASTY HAS NOW BEEN SURPASSED BY THE ALTERNATIVE LAMELLAR PROCEDURES. CHARLES MCGHEE

ORMONDE ADVISED THAT CL WEAR MUST CEASE PRIOR TO ANY ANTERIOR SEGMENT SURGERY BECAUSE UNTIL STABILITY OF THE SEGMENT HAD BEEN ACHIEVED THE OUTCOME CAN BE UNPREDICTABLE SUE ORMONDE

McGhee cemented his status as the world’s best ophthalmic entertainer bar none by opening the presentation with an extensive video production that he and Ormonde starred in. McGhee is an accomplished rock guitarist (appropriately, his guitar was decorated with false colour maps taken from a corneal topographer) who seriously considered a career in the music industry. Ormonde, who played a real guitar as an air guitar in the clip, is a budding video producer and editor.

Triggers of recurrent HSV keratitis include injury, corneal surgery, and previous episodes of stromal keratitis, as well as any event leading to the patient becoming immunocompromised. Menstruation, heat, stress, and sunlight have also been postulated as possible triggers. Antiviral therapy at the time of corneal surgery has been suggested. Ormonde advised the audience to think of HSV infection whenever an abnormal looking cornea was encountered.

The final product was a result of the combination of their two skills that is rumoured to have consumed between 80 to 100 hours of their ‘spare’ time. The audience owes them; it was an outstanding entertainment piece and will be a hard act to follow should anyone decide to rise to the challenge.

After showing their excellent video, the duo got back to the more serious topic of anterior segment surgery. McGhee acknowledged that despite being a well-established procedure, penetrating keratoplasty (PKP) has now been surpassed by the alternative lamellar procedures.

These include DSAEK (Descemet Stripping Automated Endothelial Keratoplasty) and DMEK (Descemet’s Membrane Endothelial Keratoplasty), which only started gaining traction circa 2011.

Fuch’s Endothelial Dystrophy accounts for 49% of lamellar procedures and about 9% of PKPs are actually repeat PKPs. The life expectancy of a PKP can vary between about 10 and 30 years, with 15 years being an average. Other endothelial dysfunctions account for a further 9% of lamellar surgeries. Problems with lamellar procedures, such as DSEK, include the graft simply falling off or early graft mislocation.

Data suggests that the 12-month survival rate is 94%. DSEK and DMEK survival rates were stated to be about the same. However, detachment is more common in DMEK, whereas DSEK patients experience higher complication rates. Future developments include the use of Rho-kinase (ROCK) inhibitors for Fuch’s and the use of in vitro endothelial cell culturing, which are seeded subsequently onto the posterior cornea.

Ormonde discussed herpes simplex keratitis, noting that there were no benefits from the consumption of oral acyclovir or interferon antiviral therapy. However, topical steroids did slow progression of the condition and sped-up recovery, all without any adverse effects on vision.

Interestingly, there is some evidence that oral acyclovir might decrease recurrence rates and can act as a prophylactic in PKP, as well as reduce the risk of graft failure.

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THE KENNETH W BELL MEDAL A highlight was the awarding of the well-established Kenneth W Bell Medal for 2019 to optometrist, CL pioneer, GP scleral innovator, and one-time CL manufacturer Mr Don Ezekiel from Perth. Ironically, Ezekiel and the late Kenneth Bell knew each other in the early 1960s when both practised optometry in Singapore. The inaugural recipient of the medal was none other than Professor Brien Holden himself, who received the award at the 1993 ICLC.

She then turned her attention to iris and pupil defects and related problems, specifically repairing or ‘replacing’ irides either partially or fully. Tumours remain a major reason for iris removal and simple ideas to hide the altered appearance include tinted spectacles or sunglasses, cosmetic CLs, and bespoke custom tinted/artificial iris print CLs. Surgical solutions include repair, excision, or replacement of excised tissue with artificial iris segments or a whole iris. Where possible, surgeons will attempt to conserve or reposition as much natural iris tissue as is prudent under the circumstances.

The artificial iris manufactured by HumanOptics of Germany is a siloxane elastomer alternative, but its use is predicated on extraction of the crystalline lens. Artificial iris segments, sometimes multiple segments in the same eye, are useful in partial tissue removal cases.

Switching topic to one directly relevant to the audience was preparation of current, especially long-term, CL wearers for IOL implantation.

Ormonde advised that CL wear must cease prior to any anterior segment surgery because until stability of the segment had been achieved the outcome can be unpredictable. That time of cessation depends on the CL-wearing history and CL type. Examples include: DW SCLs need days to settle, toric SCLs take longer (poorer physiology, more corneal changes to be reversed or stabilised), corneal GP CLs, weeks or even months, EW GP even longer.

Importantly, she advised practitioners use the same topographer throughout the monitoring process because results between devices, models, and brands are not directly comparable. In cases of KC, she advised that managing patient expectations help all involved and they had to be realistic. Importantly, VA post-surgically was probably going to be inferior to the vision achieved with their best CLs before surgery. An ongoing problem is the difficulty of biometry in KC eyes.

Sometimes, a toric IOL can be useful. She also finds that a CL can be useful in ascertaining a refractive target before surgery. In the case of myopes, it is often a case of ascertaining what the patient wants as a refractive goal because it is not always emmetropia. If monovision IOLs are contemplated, she advised a monovision CL trial first. Similarly, if MF IOLs are contemplated, a MF CL trial before surgery is prudent as it is a reasonable first-order approximation of the likely result.

THE DOROTHY CARLBORG CCLSA RESEARCH AWARDS In a change for 2019, the research awards presented by the CCLSA (and CLSA earlier) to postgraduate students are now to be known as the Dorothy Carlborg CCLSA Research Awards.

The naming is in honour of the service provided

by Ms Dorothy Carlborg (earlier McDiarmid, or Boyer) to the contact lens industry and later the CLSA and CCLSA as their CEO. The 2019 recipients are: Ms Azadeh Tavakoli, Mr Hari Kumar Peguda, and Dr Ngozi C Chidi-Egboka, all from the School of Optometry and Vision Science, University of New South Wales.

Tavakoli is a MSc candidate researching the impact of preand probiotics on dry eye disease. Peguda is a PhD candidate endeavouring to develop fluorescein nanoparticles that can identify Acanthamoeba spp. in vivo faster. Chidi-Egboka’s very topical work is investigating the possible impact of smartphone usage on the ocular surface with a focus on visual comfort and eye health.

If history is any indication, the recipients will go on to make significant contributions to our knowledge in the short and longterms, and could even create research entities to match those already existing.

NEW AWARD RECOGNISES CAREER ACHIEVEMENTS Wratten G (15) deep yellow filter, and the pair of Holden’s place nametags from his address to the National Press Club of Australia in 2005.

The year's ICCLE also saw the presentation of a new lifetime achievement award.

The Brien Holden Memorial Award has been created to honour the contributions to CL knowledge made by the late Professor Brien Holden, who died in 2015.

The section of the congress allocated to the presentation of the award was subtitled Wish You Were Here, named after one of Pink Floyd’s greatest, and possibly saddest, hits.

The inaugural award was presented jointly to Holden’s first and third PhD candidates, respectively Dr Steve Zantos and the writer of this report. The writer also constructed the perpetual trophy, based on design input from Ms Yvonne Holden, Mr Alan Saks, and Dr Zantos, using archival items.

The objects are mounted on a hexagonal plinth. Research into the endothelium was a major ‘brick’ in the foundation of Holden’s research career, Zantos’ academic career,

and the writer’s PhD. All continued the line of research initiated by Zantos’ discovery of endothelial blebs in the mid-1970s.

Items included are: the original Holden-Zantos adaptor for high magnification and endothelial photography mounted on an original Olympus OM-1 camera with an original 50 mm macro lens, an original Holden-type, glass-faced, SCL wet-cell, a Haag-Streit optical pachometer, two rolls of unexposed Kodachrome 64 slide film, a 20th anniversary CCLRU celebration badge, a

Inside the base is a somewhat more fragile Sharp programmable desktop calculator magnetic programme card (circa 1973) inside its paper sleeve, bearing Holden’s distinctive handwriting declaring it is for calculating the BVP of CLs. It is accompanied by a program listing printed on the special metalised paper roll used by the calculator’s integral printer – it is still as legible as the day it was created.

Following an introduction to the award

by Saks and Ms Dorothy Carlborg, Zantos and the writer each gave brief presentations illustrated with numerous historical images of people, situations, publication banner pages, instruments created along the way, and buildings occupied by Holden entities. That was followed by a brief presentation by Ms Yvonne Holden and awarding the Brien Holden Award medals to the recipients. n

INSIGHT December 2019 41

REPORT

OPHTHALMOLOGY UPDATES! PART 2 Associate Professor Adrian Fung’s Ophthalmology Updates! Conference series reached new heights in its fourth year.

In the second and final part of his report, LEWIS WILLIAMS provides a recap of the event’s presentations.

T

he ongoing success of the Ophthalmology Updates! series has confirmed its role in the Australian conference marketplace, and tentative dates for the next event next have been set for August 29 and 30, 2020.

Once again, each presenter at the 2019 conference followed a set format of detailing a common condition, frontier cases’ that proved challenging or required a novel approach, and illustrative case reports.

UVEITIS - ACUTE RETINAL NECROSIS Professor Peter McCluskey is director of the Save Sight Institute at Sydney Eye Hospital and professor of ophthalmology at the University of Sydney. He also holds a position at Sydney’s St Vincent’s Hospital. His sub-specialties are inflammatory eye disease and cataract surgery; two conditions that sometimes collide and result in significant challenges.

Acute retinal necrosis (ARN) is a rare (0.63 cases per million), destructive infectious retinitis with rapid onset that was first described in the late 1970s.

Since the 1980s the most common cause is HSVI or HSVII, although the varicella-zoster virus (VZV) is also a possibility. Up to 20% of cases are associated with a CNS encephalitis attributable to HSVI or HSVII. Interestingly, the age of onset also depends on the causative organism, with VZV occurring in older populations and HSVII in younger groups. However, the prevalence data spread is quite broad, and age alone is not indicative of the virus involved.

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Despite the virus connection, up to 50% of cases are classified as idiopathic. Only 20% are infective (mostly herpetic) and 30% are inflammatory in origin. The idiopathic classification also embraces those cases associated with Fuch’s corneal endothelial dystrophy and white dot syndromes (WDS) that affect the outer retina, the RPE, choriocapillaris, and choroid, or some combination of those.

An inflammatory classification can include HLA B27/systemic B27, sarcoid, Behçet disease, TB, toxoplasmosis, and the great mimic - syphilis. In patients that are very immunosuppressed, the retina is destroyed rapidly.

Generally, ARN can happen in those who are normal or immunosuppressed, and the sudden onset and rapid progression means the window for treatment can be small.

Furthermore, the severity can be variable. Additionally, the risk of a RD and the possibility of the fellow eye becoming involved are both high. The possibility of a pan-uveitis (multifocal and spreading) developing must also be considered with a triad of signs - peripheral retinitis, vasculitis, and optic neuropathy all possible. A differential diagnosis of ARN from cytomegalovirus retinitis (CMV retinitis) might also be required.

Generally, ARN occurs in a normal patient with a sudden onset and results in an inflamed eye/infective endophthalmitis or occurs in those with a known history of Behçet disease, TB, toxoplasmosis, or syphilis. CMV retinitis has an insidious onset and is usually asymptomatic; the eye is quiet, the ocular media clear, and the patient is likely to be immunosuppressed or suffering from HIV (15-40% of cases).

Characteristically, the retinal signs are described as ‘pizza fundus’.

Differentiation requires multi-modal imaging, careful monitoring of the fellow eye, a careful history, and a thorough, comprehensive eye examination with targeted investigations. Syphilis should always be considered as a cause and eliminated early. An OCT can help differentiate viral and toxoplasmosis cases because the latter causes choroidal shadowing and disruption.

ARN treatment must cover the possibility of acute blinding, and a ‘tap & inject’ might be needed. Intravitreal antivirals, antibiotics, and antifungals separately, or in some combination, might be required. Systemic valtrex/ acyclovir, ciproxin, or voriconazole and high-dose oral steroids also could be necessary.

The literature suggests that there are few differences between the oral and intravitreal approaches to medication. Laser demarcation might be useful to contain the condition and reduce the risk of rhegmatogenous RD, but the evidence is not strong. About 10% of cases became bilateral, about half end up with reduced vision, and about 63% experience a RD. PCR remains the standard for a definitive diagnosis. Severe vision loss is still common.

NEURO-OPHTHALMOLOGY: NEUROLOGICAL PTOSIS Associate Professor Clare Fraser from the University of Sydney delivered a solid, informative, and engaging lecture on neurological ptosis.

Adrian Fung, Ophthalmology Updates!

Clare Fraser, University of Sydney

When presented with a ptosis case, her first piece of advice was to seek old photographs of the patient and quiz family members regarding their observations of the patient’s eyes, head posture, physical activity, general appearance, and so on.

If the ptosis is unilateral, first thoughts should turn to Horner’s syndrome, 3rd Nerve palsy, or a tumour. If the condition is bilateral, especially if symmetrical, chronic progressive external ophthalmoplegia is the most likely issue. Other causes, such as aponeurotic, congenital, neurogenic, myogenic, or neuromuscular/mechanical (floppy eyelids), are possible. Myasthenia gravis (MG), a chronic, autoimmune, neuromuscular junction problem, is also a possibility.

The demographics of MG are interesting. Females are likely to present in their 3-4th decade, whereas males are more likely to present in their 6-7th decade.

Importantly, ocular symptoms are the first presenting sign in about 70% of cases. Furthermore, 50% of ocular MG (OMG) patients progress to the systemic version of the disease, although the data varies widely depending on the source (12%-65%).

Clinical signs are muscle weakness and fatigability due to antibodies working against post-synaptic nicotinic ACh receptors at neuro-muscular junctions. That reduction in ACh receptors is the root cause of the signs and symptoms.

A patient history might reveal a fatigable ptosis and/or diplopia immediately upon awakening. Crucial to the management of the condition is information relating to the speed of onset and any difficulty with speech, swallowing, or breathing.

Medications can include lithium compounds, beta-blockers, statins, and botox. The practitioner also needs to be alert to the possibility of thyroid and other autoimmune symptoms.

Unfortunately, MG can be mimicked by other conditions, such as MillerFisher and Eaton-Lambert syndromes, or too much cosmetic botox.

Other ocular features that might be noted include: variable performance of the EOMs, weak orbicularis oculi muscles, fatigability more generally, Cogan’s lid twitch (the patient looks down for 20 seconds then back to eye level - one or both lid overshoots upwards and then drifts [droops/ twitches] downwards [fatigue] while eye-level fixation is maintained), and altered saccades.

Signs and symptoms never involved are pupil behaviour, pain, and numbness. Fatigability can be disclosed by worsening ptosis and/or a downward drift of the eye position, or a gradual reduction in movement amplitude during repeated horizontal eye excursions.

General aspects that warrant investigation include: neck strength (flexion and extension), arm strength and fatigability, hip flexion, and the simple act of getting out of a chair.

Paul Healey, University of Sydney

Peter McCluskey, Save Sight Institute

INSIGHT December 2019 43

REPORT

A simple test to apply is the ice test, in which ice cubes, contained in a disposable glove or a cool pack, are applied to the closed lids for 2 min. A 2 mm improvement in ptosis is indicative, as is an improvement in ocular motility. The improvement is due to a low-temperature-induced reduction in acetylcholinesterase (AChE) activity at the neuro-muscular junctions leaving more ACh still active.

Other tests include various blood tests, CT/MRI of the chest (looking for thymoma), and what is widely regarded as the gold standard: single-fibre electromyography (EMG).

Medications include the anti-AChE pyridostigmine and steroids that can precipitate a crisis, which might require a neurology consult. A thymectomy is possible if a thymoma is detected.

Other treatments include ptosis surgery in severe and unresponsive cases, but only after stability of the condition has been demonstrated for at least 6 months. However, ptosis surgery can result in corneal exposure.

There is only weak evidence supporting the suspicion that the use of statins can induce MG, however several drugs other than botox can affect MG. They include: aminoglycosides, lithium compounds, phenytoin, Cachannel blockers, beta-blockers, chloroquine, and gabapentin.

Differential diagnoses are required for other cranial nerve or brainstem diseases, Miller-Fisher syndrome, CPEO, Kearns-Sayer syndrome, myotonic dystrophy, oculopharyngeal dystrophy, Eaton-Lambert syndrome, and botulism (not of the injected type).

Fraser summarised her presentation as: involve a neurologist, the risk of systemic involvement is greatest in the first 2 years after diagnosis of OMG, there are systemic associations with the thyroid, and treatment options include pyridostigmine, steroids, immunosuppressants, and a thymectomy.

Symptom management using patching for diplopia and a ptosis prop enable postponing surgery until the condition is stable.

OCULAR HYPERTENSION important than IOP. Many POHT cases actually already have glaucoma, and even a 20% IOP reduction is inadequate to prevent a conversion from POHT to POAG.

Clinical Associate Professor Paul Healey holds positions with the University of Sydney (Sydney Eye Hospital, Westmead Hospital) as well as in various private practices. He is also the glaucoma specialist investigator for the Blue Mountains Eye Study.

The % reduction in IOP that should be aimed for depends largely on what the starting point is.

If IOP is 16 mm Hg, for example, aiming for a 1 SD reduction is reasonable.

He opened his presentation by defining what ocular hypertension (OHT) is not. That is, it is not glaucoma, angle-closure glaucoma, a steroid response, nor is it secondary to pseudoexfoliation syndrome (PXF), the most common cause of secondary glaucoma.

He made it clear that when he spoke of ocular hypertension he was referring to primary ocular hypertension (POHT), which he defined as an eye with an IOP more than 2 standard deviations (SDs) above the population mean.

Unlike secondary OHT, POHT has no known cause and the patient has no history of IOP rising substantially.

NSW data suggests that the mean IOP is 16 mm Hg and 2 SDs. That data takes the POHT threshold to 22 mm Hg. He estimated that 3-4% of the population has POHT, but ethnicity is relevant. Japanese estimates for their population put the prevalence of POHT at just 0.8% using a different definition based on a mean IOP of 14 mm Hg. Based on an Indian study (The Chennai Eye Study), Healey noted that if OHT is detected at the first eye examination, OHT is usually found subsequently. Glaucoma and POHT have similar risk factors including age, higher IOPs, larger cup-disc ratios, higher pattern SDs, and thinner central corneal thicknesses.

In the US-based Ocular Hypertension Treatment Study (OHTS), the IOP of the control (observation only) group decreased at the five-

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Healey also stated that if a ‘POHT’ case exhibits disc haemorrhages, it is reasonable to change the diagnosis to glaucoma.

However, he also noted that it was easy for disc haemorrhages to be missed, especially if subtle. year mark, but the decrease due to medications used in the treatment group resulted in greater IOP reductions and bigger differences. At year five, 9.5% of the control group had developed glaucoma and 4.4% of the treatment group had converted to glaucoma. At the study’s end (year 13), 22% of the controls and 16% of the treatment group had glaucoma. Most of those with POAG had manifest optic disc differences, but not differences in vision.

Ethnic differences are known. For example, African Americans have a higher incidence of glaucoma than white Americans (6.9% and 3.6% respectively). Central corneal thickness (CCT) is a key feature and generally, Caucasians have thicker corneas. Thinner corneas have an increased hazard ratio.

Surprisingly, alterations to the visual fields responded poorly to medication, even when large IOP reductions were achieved.

It has been suggested that CCT is much more

The presence of a disc haemorrhage suggests a much higher risk of glaucoma, although in normal tension glaucoma (NTG) the situation is less clear cut. He described disc haemorrhages as a result of ripped optic disc capillaries due to glaucomatous disc changes that occur throughout glaucoma.

It was also noted that taking prostaglandins thins corneas. Patients whose CCTs lie outside the range 500 to 580 microns should be investigated more thoroughly, although the normal diurnal variation in CCT is a confounding factor.

To the glaucoma specialist, Healey referred to the use of non-Goldmann tonometers as a ‘complication’, stating that ophthalmologists use a Goldmann applanation tonometer for consistency when assessing risk. It seems that, despite the significant numbers of NTG cases in the population and other better correlated tests for glaucoma, the predicted demise of tonometry is somewhat premature. n

CELEBRATING OUR DIAMOND JUBILEE AFTER 75 YEARS OF PROFESSIONAL REPRESENTATION, NOW IS A GOOD TIME TO REFLECT ON ORTHOPTICS AUSTRALIA’S ACHIEVEMENTS. OUTGOING PRESIDENT MARION RIVERS LOOKS AT ORTHOPTICS’ PAST, PRESENT AND FUTURE.

L MARION RIVERS

THESE EARLY PIONEERS MANAGED TO HOLD CONFERENCES EVERY YEAR ACROSS AUSTRALIA

ast month orthoptists celebrated 75 years of having a professional association in Australia.

From humble beginnings in 1944, while the Second World War was raging, six orthoptists from across the country sent letters to each other and formed a national association. They believed this new organisation would provide each other mutual support, as well as grow the body of scientific work presented at conferences.

These early pioneers managed to hold conferences every year across Australia, publish transactions, produce local education meetings and were even able to establish a refereed scientific journal.

It was an interesting time for the profession. The synoptophore, a now iconic investigative tool, was first introduced here in 1931. Although the shape has changed considerably, it still has a place in the investigation of binocular anomalies.

In 1944, at the height of the war, orthoptists were recruited into the armed forces. Many were tasked with testing air force pilots for small changes in levels of ocular motility balance that could affect the way they landed their planes.

Following the war and a return to civilian life, many orthoptists moved into private practices and public hospitals.

Orthoptists were still very much involved in traditional orthoptic investigation and therapy, but by the mid 60s they were performing many more investigative roles in ophthalmology clinics. This included visual field tests, tonography and investigating the new phenomenon of pleoptics.

By 1973 New South Wales and Victoria began to consider a move away from private training and into governmentled learning institutions. We withstood challenges to this move, as well as challenges to the existence of the profession by other groups through changes to legislature.

In the years since the number of orthoptists in Australia grew. Formal training courses, always based in Sydney and Melbourne, began, and

eventually moved out of privately-run courses established by ophthalmologists to university-based courses run at a post-graduate level. We now have numerous orthoptists with PhDs, and many more on the path to achieve this distinction.

There have been bumps along the way. Smaller courses are always at risk in a university, but orthoptics has moved from strength to strength. The University of Technology Sydney and its fabulous new School of Health Building at 100 Broadway is a particular highlight.

Alongside the advent of vison research, orthoptists’ scope of practice has evolved and become more sophisticated.

As ophthalmology investigations became more sophisticated, orthoptists moved with the times to support in this intensive and time-consuming area while never forgetting the roots of ocular motility, neuro-ophthalmology and the investigation of functional vision.

With this came the move into supporting the rehabilitation of people with low vision or vision loss from any cause, including acquired brain injury or ocular misadventures.

Orthoptics Australia now looks to a new era of management and growth after a successful vote to become a company limited by guarantee at this year’s conference.

We now have a worldwide International Association, of which Australia was a founding member in 1964 alongside six other countries. We now have an organisation of 25 nations, with many more seeking to join.

Orthoptists are now employed in many managerial and health policy roles, both locally and internationally.

Many retain expert clinical focus in the diverse areas of rehabilitation, low vision and blindness, surgical assisting, managing hospital clinics and traditional paediatric and adult strabismus and binocular vision.

We celebrated this growth and diversity at our conference in Sydney, attended by more than 350 orthoptists. We have also

Emmie Russell, Optometry Australia’s first President.

launched a book written by orthoptists Shayne Brown and Jill Gordon, titled: Rear Vision: Celebrating the Lives of Early Orthoptists.

Some of our oldest orthoptists, aged in their 90s, joined us to celebrate our history and share their memories of the early days.

We now look forward with renewed enthusiasm for the next several years as we prepare to showcase orthoptics in Australia at the 2024 International Orthoptics Association conference in Brisbane. ■

ABOUT THE AUTHOR: Marion Rivers has represented orthoptists for many years as part of the Orthoptic Board of Australia, the Federal Orthoptic Council has the distinct honour of being President of orthoptic association branches in three states. She was re-elected president of Orthoptics Australia in November 2017 and now sits on committees for Vision 2020 and Allied Health Professions Association.

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 December 2019 45

DISPENSING

COMPETING WITH MILLENNIAL OUTLETS: PART 1 CHANGING TASTES AND NEW RETAILERS ARE SENDING YOUNGER CUSTOMERS ONLINE. LEIGH ROBINSON EXPLAINS HOW DEVELOPING A 'VALUE FASHION' STORY CAN GET MILLENNIALS EXCITED AND ENGAGED WITH YOUR PRACTICE.

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e are nearly two decades into the 21st century and the ophthalmic industry is facing increased competition, shrinking margins and changing consumer behaviours.

LEIGH ROBINSON

TODAY’S MILLENNIAL CUSTOMERS WANT EXPERIENCEBASED SHOPPING, BOTH AT THE TIME OF PURCHASE AND AS THEY USE THEIR PRODUCT

Our challenge as optometrists and optical dispensers is to build trust so our customers accept that we, and the products we recommend, are reliable.

You see, we are comfortable when we surround ourselves with people who believe what we believe. This creates trust and makes us feel good about ourselves and our decisions.

Trust is the acceptance of the truth without evidence. In the dispensing of optical appliances, our customers need to have a lot of trust in us. They find evidence difficult to obtain and when they do, they don’t understand it.

When we are able to build trust, we become more comfortable taking risks, exploring other possibilities and recommending better lens solutions to our customers. We can recommend products because they believe what we believe.

Our customers can, and will, look things up and purchase optical products online, but that cannot form trust. The internet cannot replace a human bond, how we relate to each other and the response we have when we see another person smile.

FASHION FORWARD Many ophthalmic practices believe the eye test powers their businesses, but if it did there would be a far greater response to recall letters. I believe that, indisputably, we are in the fashion industry. It’s why we have mirrors in our practices.

If we want to compete with millennialfocused outlets, that’s the arena we must be in.

The whole idea of fashion is to create social pressure so you believe your current item is old, even though it is working perfectly fine. The idea of fashion is social pressure to keep up with trends.

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But fashion is not just the latest style, trends, craze, rage, fad or fancy.

According to the Oxford dictionary, fashion is also defined as, convention, custom, practice and usage.

If you want to compete with millennial focused outlets you need to accept that you are in the fashion industry first, and the ophthalmic industry second.

Both complement each other magnificently, but you must acknowledge that it’s not the thorough eye test or the technologically advanced lenses that attract customers. It is the story we tell through the means of fashion. I call it: Value Fashion.

Value Fashion is for life. Today’s millennial customers want experiencebased shopping, both at the time of purchase and as they use their product.

They want these experiences to affect how they feel about themselves.

To separate yourself from the big box and millennial-focused stores, you need to develop a ‘shop within a shop’ concept and create an optical practice that is a ‘Value Fashion’ shopping destination.

Millennial shoppers want value, but value is not just the price of goods.

The meaning of value is also, utility, practicality, advantage, desirability, efficacy and benefit. Value Fashion is very much about telling a story of the benefits of available lens technologies, plus the fashion concepts of convention, custom, practice and usage.

WHAT DO MILLENNIALS WANT? A millennial is a person who reached maturity around the turn of the century and are now considered to be aged between 32 and 45 years old. They are the children of the baby-boomers and are developing or early presbyopes.

Millennials are incredibly sophisticated technology-wise and immune to most traditional marketing and sales pitches. These are the people that will research a product before buying it instore or online.

Get over it! Buying online is the way it is nowadays, but they still need

Millennial shopping habits are driven by value.

you to provide expertise in lenses.

Today’s customers have high levels of marketing scepticism and want clear explanations of product benefits. They are willing to spend on brands they know and trust. And don’t forget, that brand can be you and the practice you represent.

Today’s patient will not respond favourably to you telling them they need new glasses; they need their interest kindled somehow.

Today’s customers are time-poor, know more and expect more. And they know the difference between what is quality and what isn’t.

Use your story, or your ‘shop within a shop’ concept, and Value Fashion to change people’s lives and how they shop with you. Sure, the millennial customer will want to look fashionable, but they also want solutions for their lifestyle.

In part 2 we will look how you can use lens technology and your store’s image to engage customers and present them with a lifestyle solution. ■

LEIGH ROBINSON is optical dispensing champion, consultant and training facilitator at Spectrum Optical and a teacher of Cert IV in Optical dispensing at RMIT University Melbourne.

He conducts optical dispensing short courses, workshops and in-house training options to suit individual practice needs across Australia. Visit: spectrumoptical.com.au

MANAGEMENT

MID-TERM REVIEWS - ARE YOU ON TRACK? AS 2019 DRAWS TO A CLOSE, NOW IS THE IDEAL TIME TO ANALYSE YOUR PRACTICE'S GOALS AND PERFORMANCE. KAREN CROUCH EXPLAINS WHAT NEEDS TO BE DONE TO GUARANTEE A SUCCESSFUL START TO 2020.

I

t’s once again the time of year when we wish all readers a joyful and safe Christmas holiday season to be followed by a happy New Year.

KAREN CROUCH

IT IS NECESSARY TO APPRECIATE THE FINE DIFFERENCES BETWEEN THE PRACTICE’S BUSINESS PLAN AND STRATEGIC PLAN

It's also an ideal time to dwell on the past six months’ performance against set targets by conducting a mid-term review of your goals. This is to determine whether any aspect deserves adjustment, upward or downward, in order to meet targets for the end of the financial year.

Large companies go a step further by undertaking QBRs – Quarterly Business Reviews – to track progress on targets and objectives, whether financial, operational or client related.

Reviews should address both key elements of the annual business plan: • Tactical: ‘business as usual’, day-today management framework by which the practice continues to build on identified strengths and avoid negative performances, and • Strategic: growth aspirations aimed at optimising new opportunities so that short- and long-term goals are aligned and achievable.

As a valuable starting point, it is necessary to appreciate the fine differences between the practice’s business plan and strategic plan.

The business plan is an annual compilation of goals and key performance indicators (KPIs) that includes achievable results, but also ‘stretch’ targets to encourage optimum performance. It is usually created just prior to each financial year after consultation with key staff and in recognition of the prevailing business environment.

By contrast, the strategic plan is a longer-term projection, say 3 – 5 years, of realistically ‘where you want to be’, not ‘where you would like to be’. Many practices do not have or maintain a strategic plan and instead rely on a best efforts business plan.

For those that do maintain a strategic plan, regular tracking of the business plan against longer-term aspirations is essential to ensure future developments,

opportunities and competitive advantages are grasped. For practices that do not maintain a strategic plan, monitoring and reviewing the business plan becomes even more important.

PLAN WELL Business plan review activities should typically include: Expenses: budgets on a line-by-line basis (such as wages, insurance). Are they progressing to forecast trends, allowing for cyclical peaks? If the run rates (monthly averages) are higher than set targets, should adjustments to spending practices be considered?

Income: revenues projected for the year, based on practitioner numbers, working hours, charging rates and estimated number of consultations. Are they progressing to set targets? Any shortfall or excess should be carefully analysed as this particular element is vital to achieving a viable practice. Are there new or emerging community or patient demands that should be accommodated? Are there opportunities to differentiate the practice from others by the introduction of a new service?

Non financial: a vital aspect for practices to excel in is patient care. Are service levels (patient satisfaction surveys, wait times) being consistently met? It may be necessary to adjust, or introduce new day-to-day procedures, clinical or administrative, to ensure compliance with changing business imperatives, competition, or external factors like regulatory changes.

Human Resources: this vital element of any business should cover plans to develop staff and practitioners, as well as achieve ‘employer of choice’ status.

Is it time to undertake appraisals of staff so they have timely feedback on their performance, encourage good work and address any less-than-satisfactory behaviour?

Marketing/Advertising: are selected advertising channels delivering value for money? How is the success rate of campaigns or individual advertisements being measured? Is it time to review your marketing activity, create greater

A strategic plan helps you reach your targets.

exposure opportunities or consider a new drive?

Monitoring and Measuring: thoroughness of the overall budgeting system is paramount to tracking progress. Are the employed mechanisms accurate and consistently applied? Are KPIs (such as patient satisfaction and patient numbers) being consistently met, or were they too ambitious and require adjustment?

Obvious conclusions are that a ‘betterthan-budget’ performance is a practical way to identify the practice’s strengths and continue doing more of it. While a ‘poorer-than-budget’ outcome is certainly an alert message, it should also present an opportunity to remedy problems.

Finally, as part of the measurement and monitoring process, it is advisable to review business plans at least each quarter to ensure end-of-year tactical and strategic goals, including profit targets, will be met. Additionally, practice owners and business planners should remain abreast of developments in the political, regulatory, cultural, social or economic environment which may have potential impacts on practice operations.

From the team at HPC, we wish you a merry Christmas and a happy 2020. ■

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

INSIGHT December 2019 47

SPECSAVERS – YOUR CAREER, NO LIMITS Full-time Optometrists – multiple locations *$225,000 package available*

All Specsa ve stores rs no with O w CT

Specsavers has three highly remunerated full-time opportunities available across regional Australia in Taree (NSW), Berri (SA) and Emerald (QLD). The roles are offering a $225,000 package and the opportunity to work in a central hub for a wide catchment area with a varied client portfolio. At Specsavers, we offer competitive rewards and benefits as well as ongoing development and training. We are on a clear mission to transform eye health in Australia and we would like you to join us on that mission.

Optometrist and Dispenser Partners, brand new store – Singleton, NSW We are looking for an experienced optometrist and retailer / dispenser to join as joint venture partners in the brand-new Specsavers Singleton store, due to open early next year. A riverside town in the Hunter Valley wine region, Singleton is just an hour’s drive northwest of Newcastle. Singleton boasts rolling vineyards, colonial heritage, outdoor adventure opportunities and more. To be successful, you will understand what it takes to lead and motivate a team and have a passion for delivering high-quality clinical care and customer service.

Full-time Optometrist – Toombul, QLD Specsavers Toombul has a rare opportunity for a customer-focused optometrist to join their team. Located in the Toombul Shopping Centre, the store has three test rooms and an audiology offering along with an experienced and welcoming retail team. The position offers a Tuesday to Saturday roster with some flexibility if needed, an attractive salary and includes PI insurance, AHPRA and CPD allowance. The successful candidate will work with market-leading technology and will receive excellent opportunities for further career development and progression. Specsavers Toombul offers many benefits including birthday and volunteer leave, two free pairs of glasses each year and discounts for family and friends.

Graduate Optometrist – Griffith, NSW If you’re a graduate optometrist looking to find your feet in optometry, consider this exciting opportunity with the Specsavers Griffith team. The successful candidate will gain access to Specsavers’ structured, two-year graduate program, work with world-class equipment and be part of a team that makes a difference in their community. The patient demographic is vast and with strong working relationships with local health professionals, you will have the opportunity to work collaboratively to best support patient outcomes.

Full-time / Part-time Optometrist – Lower Hutt, NZ

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

SO LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership (JVP) enquiries: Maria Savva – Partner Recruitment Manager maria.savva@specsavers.com or 0401 353 587 For NSW/ACT, SA & WA enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134 For QLD/NT & VIC/TAS 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

Join a team of professionals dedicated to delivering the highest level of eye care at Specsavers’ Lower Hutt store. Located in the heart of Lower Hutt, the practice boasts four consulting rooms equipped with state-of-the-art technology including an OCT. If successful, you will be become part of their highly professional and friendly team, supported by three experienced partners. You will also be rewarded with an attractive salary, flexible roster to suit your needs and have registration and PI Insurance covered each year. This is an opportunity not to be missed!

OPTOMETRIST – TAREE, NSW The town of Esperance faces a scattering of gently sloping islands known as the Recherche Archipelago, and it’s this view that makes the town so beguiling. Stop in at Taylors St Quarters for lunch and gaze out to sea, then drive the 38-kilometre (24-mile) Great Ocean Drive as it loops past a dozen blindingly white, fine sand beaches, motionless bays and fragrant native scrub. Keep an eye out for dolphins frolicking in the glassy ocean and stop at local favourite, Twilight Beach. For something a bit different, head to the full size Stonehenge replica and finish with dinner at the delicious Loose Goose restaurant. Joining OPSM Esperance means combining a rewarding career with an amazing lifestyle balance!

OPTOMETRIST – KATHERINE, NT

OPTOMETRIST – WHANGAREI, NZ Why only visit the winterless north when you can live here?

We have an exciting opportunity for one to two optometrists to join our evolving Whangarei store. The clientele are amazing, with a retail team to match. Whangarei is a thriving city with a vibrant arts community. A fantastic outdoor lifestyle awaits with sandy beaches, amazing hikes and bountiful water sports.

Enjoy those long warm summer nights in subtropical Whangarei.

OPTOMETRIST – BENDIGO, VIC A city of insta-worthy shops, locally-made drops, pottery, pictures and fun times for the family. Are we ticking off your list here?

In other words, in this lovely city you can partake in your fair share of holiday dining, sampling local wines, craft beer and market goodies. You can look to take on a fixed period role or even consider a more permanent move – who knows, you might fall in love with the place. Attractive relocation packages are available for the right candidate. Start your journey with us today!

Graduates or recent graduates are very welcome to apply.

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We have a fantastic opportunity for an optometrist to join our team in picturesque Katherine in February 2020. Katherine has a young population and a friendly environment. It is the kind of place where everyone takes the time to say hello. There is plenty to do in and around Katherine. The stunning Nitmiluk (Katherine) Gorge has ancient rock art and is a great place to spend a day relaxing or getting active with bush walks and canoeing. The Katherine Hot Springs and Mataranka Thermal Springs are both popular locations for taking a relaxing soak and Edith Falls, part of Nitmiluk National Park. This park is also a great place for picnics, barbecues, swimming and hiking.

OPTOMETRIST – WAGGA WAGGA, NSW We have two full-time graduate or experienced optometrists positions available at our OPSM Taree Practice. We are looking for passionate and motivated individuals to join the team.

You will be part of our industry leading team and will have the opportunity to work alongside likeminded optometrists to ensure the highest possible standard of patient care. You will also play a pivotal role in building loyal and trusting relationships with the community to grow the practice. High salary package is on offer for the right candidate. On your days off enjoy the Manning regional art gallery, entertainment centre or explore ‘the big oyster’.

JOIN OUR TEAM In these roles you will work closely with vibrant and supportive store teams and have many opportunities to make a difference through our OneSight outreach program. We offer world class technology including leading edge technology Optos UWDRS. We provide opportunities for continuing professional development through financially supported industry training, peer learning communities and product training, and reward with a competitive salary and bonus scheme to recognise your contribution.

We have full-time, part-time, casual and fixed-term opportunities available. Attractive relocation packages are available for the right candidate.

Contact the relevant Professional Services Manager for the region to discuss these opportunities and more: NSW/ACT: Elizabeth Kodari elizabeth.kodari@au.luxottica.com QLD/NT: Brendan Philp brendan.philp@luxottica.com.au VIC/TAS: Melissa Downing melissa.downing@luxottica.com.au SA: Sophie Pym sophie.pym@luxottica.com.au WA: Mario Basso mario.basso@luxottica.com.au NZ: Jonathan Payne jonathan.payne@opsm.co.nz

OPSM.COM.AU/CAREERS

4/11/19 3:42 pm

MARKETPLACE OPTOMETRIST (FULL TIME OR PART TIME) QUEENSTOWN, NZ An opportunity is available for an optometrist to join our team in Queenstown.

Very flexible position. Choose 3 to 5 days testing a week, so you can make the most of living in one of the most exciting places in the southern hemisphere.

30 minute testing with all pre-screening (OCT, visual fields, auto-refraction and tonometry) performed on all patients by an experienced and motivated team of support staff. Career progression, with the possibility of partnership. APC, CPD and PI insurance.

Queenstown sits on the shores of the South Island’s Lake Wakatipu, set against the dramatic Southern Alps. Renowned for adventure sports, it’s also a base for exploring the region’s vineyards and historic mining towns. With an international airport, Queenstown’s stunning scenery, huge range of activities and renowned warm welcome cement its reputation as New Zealand’s favourite visitor destination.

Applications are welcome from both experienced optometrists and graduates.

This opportunity is not to be missed.

For more information, contact: Aaron Irvine, on +64 (021) 0374 800 or email dir.queenstown.nz@specsavers.com

To place a classified advertisement email: julia.austin@primecreative.com.au

OPTOMETRIST JOINT VENTURE PARTNER OPPORTUNITY – QUEENSTOWN, NZ We are currently on the lookout for an experienced optometrist to join us as a joint venture partner in our Specsavers store, Queenstown. The practice opened in 2010 and has shown exceptional growth and profitability. A second testing room will be ready early 2020 to take advantage of further opportunities in one of New Zealand's fastest growing regions.

In partnership with the Retail Joint Venture Partner, you will be responsible for the daily operations of the Specsavers store, whilst leading your team to provide customers with the highest standards of service and eye care.

As a Specsavers joint venture partner, you will have the backing of a successful international brand that focuses on your long term profitability. This gives you the freedom to run your business in the way you want with lower levels of risk and access to the following benefits: • Back-office administrative support from our Port Melbourne Support Office team, including payroll, accounts payable and quarterly BAS • The power of Specsavers’ market-leading brand driving customers to your store • An annual combined marketing fund of more than $60 million • A guaranteed market-rate salary and superannuation in addition to your share of store profits For more information, contact: Aaron Irvine, on +64 (021) 0374 800 or email dir.queenstown.nz@specsavers.com

19/20 CALENDAR DECEMBER 2019 WORLD EYE AND VISION CONGRESS

OPTI 2020 Munich, Germany 10 – 12 January opti.de/en

Abu Dhabi, UAE 5 – 6 December

SKI CONFERENCES FOR EYE CARE PROFESSIONALS

2019 COSSOM SCIENTIFIC MEETING

Selva di Val Gardena, Italy 11– 18 January skiconf.com

Sydney, Australia 7 December ranzco.edu/events/the-2019cossom-scientific-meeting/

JANUARY 2020 ANNUAL REGISTRARS’ CONFERENCE & TEACHING COURSE Sydney, Australia 7 – 11 January sydney.edu.au

APOIS SYMPOSIUM Singapore 17 – 19 January ssophth.org/sso-apois2020

EYECARE 2020 Glasgow, Scotland 19 – 20 January cetpoints.com/event/eyecare-2020

To list an event in our calendar email: callum.glennen@primecreative.com.au

FEBRUARY 2020 SHANGHAI INTERNATIONAL OPTICS FAIR Shanghai, China 11 – 13 February siof.cn/eng/fairinfo.php

6TH ANNUAL CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: ASIAAUSTRALIA Bangkok, Thailand 14 – 15 February cophyaa.comtecmed.com

ANZGS SCIENTIFIC MEETING Adelaide, Australia 21 – 22 February ranzco.edu/events

INTERNATIONAL CONGRESS ON WAVEFRONT & PRESBYOPIC REFRACTIVE CORRECTION Napa, USA 21 – 22 February wavefrontcongress.org

MIDO EYEWEAR SHOW Milan, Italy 29 February – 2 March mido.com/en

SKI CONFERENCES FOR EYE CARE PROFESSIONALS Nozawaonsen, Japan 29 February – 7 March skiconf.com

100% OPTICAL London, UK 25 – 27 January 100percentoptical.com INSIGHT December 2019 49

SOAPBOX

TAKING DISPENSING OUT OF THE TWILIGHT ZONE Therefore, we believe the Certificate IV should be regarded as a minimum.

The principle of lifelong learning and the Kaizen approach to continuous improvement needs to sit at the core of everything we do.

We have tried to do our bit through the Specsavers Dispensing Conferences by bringing the very best researchers and industry experts to present the latest information to all Australian dispensers.

Turnout over the first three years has steadily increased, proving the core of our profession has a real desire to learn.

I

s it me or does it feel like ophthalmic dispensing in Australia has been in a ‘Twilight Zone’ for the last decade? This once great and respected profession seems to have allowed itself to become increasingly marginalised.

Successive state deregulations were certainly a blow, but the measure of any profession is how it responds to adversity.

However, just like the aforementioned TV show, nothing is as it first appears.

Beneath the apparent apathy one often encounters a highly skilled, knowledgeable and passionate cohort committed to ensuring patients get the very best visual comfort and clarity from their corrective eyewear.

Even more encouragingly, the younger and newer entrants to our profession demonstrate a real thirst for knowledge and a desire to build a career in this wonderful industry.

All of this is taking place at a time of rapid change. After a 35-year career I can honestly not recall a time as dynamic as the one we find ourselves in right now.

People’s eyes have never had to work as hard as they do today. We see digital screens on our commute to work, in our offices, shopping centres and, of course, in our homes.

Coupled with an increasing and ageing population, our services have never been more in demand.

Our optometrist colleagues spend

50

INSIGHT December 2019

Our proactive support of our UK colleagues from the Association of British Dispensing Opticians is helping to deliver the beginnings of an FBDO OS qualification for dispensers who really want to stretch themselves. years honing the skills needed to craft the exact prescriptions necessary to deliver the optimal visual outcomes. But, as every good dispenser knows, the resulting prescription is not worth the paper it’s written on if it is not translated into high quality spectacles that fit well and have correctly aligned lenses.

Recently we have seen a rejuvenation of Certificate IV training through the many excellent providers who constantly challenge themselves to deliver better outcomes for their students.

One of our core beliefs at Specsavers is that we have a responsibility to deliver the best outcomes for our customers.

Equally, we believe that we can only achieve this if we enable each and every one of our team members to “be the best they can be” every day.

Our commitments to learning and development runs deep, having been built on the seeds planted by our founders 35 years ago. We are proud to have enabled over 1,200 individuals across our Australian and New Zealand store network since 2012 to start their optical career journey through the acquisition of their Certificate IV in Optical Dispensing.

We also believe that the changing nature of our industry requires optical dispensers to stay absolutely up to date with new technology, products and services to continue to be able to deliver the most optimal solutions for customers.

Personally, I believe – as do many of my colleagues – that there are plenty of things to be positive about. The real question is how can we, as qualified optical dispensers and dispensing opticians, embrace the changes and ensure we continue to play a relevant role in the delivery of primary eyecare services?

It was really encouraging to attend the open forum held at O=MEGA19 in July and hear the sheer amount of goodwill that exists from all quarters of the industry. It is equally encouraging to see a reformed and rejuvenated Australian Dispensing Opticians Association stepping up and facing the need to become a truly national representative organisation with a strong voice.

The real challenge for all of us, as passionate and caring optical professionals, is to step out of the twilight zone and into the spotlight. To challenge ourselves to be the best we can be. To do the best we can do, for each and every one of our customers, every day. We must strive for excellence in everything we do to deliver the very best outcomes for our customers. ■

Name: Steve O’Leary Workplace: Specsavers Australia and New Zealand Position: Director of Product and Dispensing Advancement Years in profession: 35

WE ALSO BELIEVE THAT THE CHANGING NATURE OF OUR INDUSTRY REQUIRES OPTICAL DISPENSERS TO STAY ABSOLUTELY UP TO DATE

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