Insight December 2020

INSIGHT DEC

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

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Why patients thought they could no longer access care from their usual optometrist.

THE UNFORGETTABLE YEAR THAT WAS A look at the setbacks and breakthroughs that shaped the ophthalmic sector in 2020.

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HEALTH FUND LETTERS CAUSE CONFUSION

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KIDS, CONTACT LENSES AND COMPLIANCE Key considerations for optometrists when prescribing contact lenses for children.

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INSIGHT DEC

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

CONCERN OVER HEALTH FUND LETTERS THAT OPTOMETRISTS SAY LEFT PATIENTS CONFUSED

Independent optometry practices have been scrambling to contact thousands of patients in recent weeks after health funds sent letters to policy holders, with many wrongly interpreting them as notification they could no longer access care from their usual optometrist or use optical rebates.

Choice (Medibank) or Member Plus (HBF), which provide special optical deals. The letters go on to state patients could still claim benefits at the practice but may face increased out-of-pocket expenses. It also advises where patients can find practices still offering the programs in question.

The issue – which prompted Optometry Australia (OA) to intervene to help practices clarify the issue with patients – relates to letters private health insurers Medibank Private and HBF sent to patients of independent practices in recent months.

OA CEO Ms Lyn Brodie said this resulted in confused patients calling practices concerned they could no longer access care or use their optical rebate at the practice, which wasn’t the case.

The letters stated the name of the individual practice and informed patients it would no longer be part of programs such as Members’

However, health funds told Insight they were satisfied with the letters’ contents and were obliged to send them to policy holders under the Ombudsman's guidelines.

This was due to VSP Vision

such as the Members’ Choice and Member Plus.

Brodie said the subsequent letters informing people about this change prompted several optometrists to contact the organisation.

Medibank sent letters after VSP left its Members’ Choice network.

Care’s decision to withdraw from its role as a contracting entity between Australian health funds and independent optometrists earlier this year in response to COVID-19.

VSP’s contract ended with HBF on 31 August, all other health funds on 30 September and Medibank on 30 November. This meant independent practices subscribed to VSP were no longer part of arrangements

OA produced an open letter to help practices clarify the issue with their patients. It pointed out Medibank was limiting some deals on optical appliances to some practice groups only, but patients could continue to access care from their usual optometrist and still use their optical rebate at practices that are Medibank providers – which most are.

“We have spoken to Medibank Private, and worked with Optometry WA who were communicating continued page 8

SURGING DEMAND OUT OF VICTORIAN LOCKDOWN Melbourne optometrists are now almost two months into the mammoth task of recalling hundreds of thousands of patients, as new figures reveal the extent of pent up demand for eyecare services caused by Victoria’s second lockdown.

After a 10-week period of heavy operating restrictions that started in early August, Melbourne optometrists reopened their doors to routine appointments on 19 October.

Since resuming, patient bookings have reportedly surged to record heights, with predictions that the sector won’t catch up on missed routine consultations until well into 2021.

Mr Steven Johnston, CEO of the independent optometry network ProVision, said the organisation had measured Melbourne demand through appointments made via the MyHealth1st platform.

“The numbers are at record levels to the extent that our Melbourne practices are seeing appointments being made at the same volume as the rest of Australia combined a few short weeks ago,” he told Insight in late October.

“The resilience of our members and their teams during Stage 4 lockdown conditions has been truly remarkable. The majority of our Australian practice network has traded well beyond our expectations over the last

four months and this gives us confidence in the business to come for Melbourne practices in the lead up to Christmas and beyond.”

Specsavers Australia and New Zealand optometry director Dr Benjamin Ashby said the company’s Melbourne practices were prioritising care for those with the most immediate needs, including people with diabetes and glaucoma patients.

“Routine care is very important too and so we are open to all in line with allied health guidelines,” he said.

“We have kept track of the year-on-year impact of COVID-19 in Victoria and have started the continued page 8

PURCHASING IN A PANDEMIC Opening a new practice in Australia’s hardest-hit city has thrown up its challenges, especially when purchasing big ticket items. But Dr Jayson Stone found a way thanks to the efforts of a major supplier. page 36

NEW 1

Coming soon

ciclosporin 900 microgram/mL

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

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

PBS Information: This product is not PBS listed

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

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

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

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

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

IN THIS ISSUE DECEMBER 2020

EDITORIAL

FEATURES

ARE WE ON THE CUSP OF A DISPENSING RENAISSANCE? With the stroke of a pen, Prime Minister Scott Morrison and treasurer Mr Josh Frydenberg delivered a much-needed shot in the arm for optical dispensing that will raise the bar across our sector.

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SUMMER SHOWCASE Australia’s leading ophthalmic suppliers unveil their 2020/21 product releases.

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YEAR IN REVIEW The events that made headlines across optometry and ophthalmology in 2020.

For years, there has been concern about a leak in the pool of qualified dispensers, which has been punctured by deregulation and leadership issues. Although the situation has improved in recent years, training providers have battled to change the culture whereby practices employ optical assistants for years before eventually enrolling them for training. They miss out on subsidies only available early on, while stifling the employee’s progress.

Whether by design or accident, these obstacles were partially cleared on Federal Budget night via a new wage subsidy worth up to $28,000 per dispensing traineeship for the next year. It has led to a surge in enrolments with industry figures using words like ‘renaissance’, ‘revolution’ and ‘turbocharge’ to describe its potential impact.

After a frantic campaign led by ACOD, shrewd businesses realised they risked forfeiting thousands of dollars if they missed the vital window to upskill optical assistants they would have probably trained later.

Due to oversubscription, within weeks the government shifted the goal posts to exclude ‘existing employees’. Thankfully many enrolled before this cut off and new staff are still eligible.

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COST VS BENEFIT Important considerations for optometrists when prescribing contact lenses for kids.

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BUYING IN What opportunities await the next generation of independent practice owners?

EVERY ISSUE 07 UPFRONT

44 MANAGEMENT

09 NEWS THIS MONTH

45 CLASSIFIEDS

42 ORTHOPTICS AUSTRALIA

45 CALENDAR

43 DISPENSING

46 SOAPBOX

Either way, this scheme should create many more qualified optical dispensers within years.

This will lift standards, with more professionals having the lens theory for complex patients, while reducing lab remakes and non-adapts – the bane of optical practices.

Ultimately, there will be enhanced service and efficiency, and a greater pool of talent to hire from. And in the long term, there may be an attitude shift where employers are more motivated to use subsidies and upskill optical assistants much earlier in their career.

MYLES HUME Editor

INSIGHT December 2020 5

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UPFRONT Just as Insight went to print, THE OPTICAL COMPANY (TOC) revealed it had been acquired by major Australasian allied health group Healthia for $43 million. TOC is an Australian vertically integrated optical group specialising in optometry services, retail and eyewear distribution. It operates 41 optometry stores, including Kevin Paisley Optometrists, nib Eye Care, Optical Warehouse and Stacey & Stacey Optometrists. The acquisition was to be completed on 30 November, with CEO

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WEIRD

Mr Colin Kangisser to be appointed CEO of Healthia’s new Eyes & Ears division and as an executive director of Healthia. IN OTHER NEWS, RANZCO immediate past president Associate Professor Heather Mack announced a new scholarship in her namesake for young female ophthalmologists. The college’s first female president made the announcement at a recent council meeting where she handed over the presidency to Professor Nitin Verma. The $4,000 scholarship will fund one woman a year to undertake further governance and leadership education. “I hope this scholarship will encourage and enable more women to step into leadership roles

within the collage,” she said. FINALLY, Lions Eye Institute founder and patron Professor Ian Constable has been elected as a Fellow of the Australian Academy of Health and Medical Sciences. He now joins an elite group of Australia’s top medical and health researchers recognised for their achievements and commitment to their field. Constable, who founded LEI in 1983, was among 28 recipients. Through a career spanning five decades, he has sought to break new ground in ophthalmology. “It‘s a great honour to join leaders in Australian health and medical science as part of the great interdisciplinary team we have in this nation," he said.

STAT

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Publisher Christine Clancy

Journalist Rhiannon Bowman rhiannon.bowman@primecreative.com.au

Business Development Manager Alex Mackelden alex.mackelden@primecreative.com.au

Client Success Manager Justine Nardone justine.nardone@primecreative.com.au

Design Production Manager Michelle Weston michelle.weston@primecreative.com.au

CONTACT LENS SAFETY A study across greater Sydney found 29% of domestic tap water supply samples collected during summer and winter were contaminated with free living Acanthamoeba. Full report page 32.

WHAT’S ON

Complete calendar page 45

WACKY

A University of Florida graduate student has found that eye size can help predict where birds breed and feed after fitting dozens of birds with photosensorcontaining backpacks. The study revealed the bigger the eye, the smaller the prey or the darker the environment.

It also suggested birds with big eyes are at risk because humans convert forests into farmland.

11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreativemedia.com.au

Editor Myles Hume myles.hume@primecreative.com.au

WONDERFUL

An 8-year-old Canadian boy with retinitis pigmentosa has seen the milkyway for the first time after receiving the Luxturna gene therapy. “Now he is able to function as a normal child,” his mother told CTV, adding that he can now dress himself. “This is a story of hope – a child told ‘it is what it is’, and now when he looks up at night, he can see stars.”

Published by:

christine.clancy@primecreative.com.au

A woman has discussed what it’s like to live with a bizarre neurological condition dubbed Alice in Wonderland Syndrome.

In an interview with Insider, she said her eyes would begin to feel ‘squeezed’ before her surroundings became dollhouse-sized. It’s been linked to migraines, epilepsy, strokes, head trauma, infections, drugs, and stress, but is not known to be dangerous. n

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The biennial European Glaucoma Society meeting will be in Brussels and marks the society's 40th anniversary.

The seventh Controversies in Ophthalmology: Asia-Australia will take place in Bangkok, featuring evidencebased debates and discussions.

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INSIGHT December 2020 7

NEWS

HEALTH FUNDS STAND BY THEIR APPROACH continued from page 3

with HBF, who are a Western Australiancentred fund. We believe the patient confusion reported by members may be from patients reading part of the letter only,” Brodie said.

Mr Dale Rolfe, director of Rolfe Optometrists (Eyecare Plus), was one of the affected practices. Across his 10-practice network in New South Wales, he’s had around 100 people come in-store querying whether they could still receive a rebate and has spent considerable time contacting 2,000 patients over the matter.

“Patients don’t understand the difference between me being a Medibank Private provider and a Members’ Choice provider,” he said.

“Three of my practices are isolated regionally and patients were distressed they would need to go more than 100km to another provider. Many even asked which health fund they should change to so they could continue to see me.”

In communications with Medibank, he expressed disappointment in being named in the letter, particularly with the statement that patients may face additional out-of-pocket costs.

“That word ‘may’ isn’t good enough.

It infers if the patient sees me then I’m

more expensive than another provider and that’s not the case. Medibank’s response was that it’s a generic letter and for some that could be true, but I said the problem is you put my name on it.”

Ms Nicky Kiparissis, who operates Kiddies Eye Care in Geelong, Victoria, was concerned for small practices like hers who did not have the resources to contact each patient.

“If I’ve lost patients, I don’t know about it,” she said.

HEALTH FUNDS RESPOND In response, a Medibank spokesperson said it reminded customers they could still attend their preferred optometrist and in most cases would still be able to get 100% back up to annual limits.

choice and claim their optical benefits.”

An HBF spokesperson said without an agreement in place with VSP-aligned practices, it could not guarantee the outof-pocket costs for members.

"MANY PATIENTS EVEN ASKED WHICH HEALTH FUND THEY SHOULD CHANGE TO SO THEY COULD CONTINUE TO SEE ME" DALE ROLFE, ROLFE OPTOMETRISTS

“Some optometrists have contacted us directly and we have advised that customers were told they could continue to claim benefits at their practice,” the spokesperson said.

“Accordingly, HBF determined this would likely result in a detrimental change to affected members’ ancillary benefits.

We were obligated to inform members of this likely detrimental change and we did so by letter,” the spokesperson said.

“We have received limited feedback/ inquiries from the optical industry and providers in response to our letter. We have taken all reasonable steps to ensure our communication with affected members was clear and the necessary matters were adequately addressed. In the circumstances, we have no concerns with our approach to this matter.”

With the withdrawal of VSP, in July EyeQ Optometrists established a new entity called Q Optical Network to ensure independent optometrists could continue to have agreements with health funds and prevent the loss of patients to other providers.

“We want to ensure our communications with our customers are clear, and we are required to advise of VSP’s withdrawal as per the Ombudsman’s guidelines. We have not had much feedback from customers on this issue, and trust they will continue to visit the optometrist of their

Chief business development officer Ms Lily Wegrzynowski said so far more than 100 practices have subscribed, along with 25 health funds. Medibank and HBF were not yet part of the network. n

RESILIENCE SHINES THROUGH TOUGH TRADING PERIOD continued from page 3

job of recalling the 200,000 Victorian patients who missed out on their routine eye test due to the lockdown. That work is well under way and the whole team is very focussed on it – because our own records show that we have a consequent backlog of more than 9,000 first-time referrals to specialist care across a range of conditions.”

Ashby said he was in awe of Specsavers optometrists, dispensers and store teams across Victoria who had been “knocked for six, came back once, and have now come back again”.

“The busiest time of the year is upon us and everyone is relishing the challenge. None of us are surprised by

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INSIGHT December 2020

care due to a slight easing of restrictions that allowed care for chronic conditions.

this but it’s important to call it out as it shows a resilience that might have been hard to predict but showed itself immediately when times got tough.”

Eyecare Plus national business development manager Mr Philip Rose said catching up on deferred recalls for patients is a priority now for Victorian practices, as well as maximising their total appointments per day.

“The time it will take to catch up on all the missed routine appointments is likely to stretch well into next year. [They’re] prioritising specs and emergencies for now,” he said.

Optometry Victoria South Australia CEO Mr Pete Haydon said most metrobased members were busy for a couple of weeks prior to the return to routine

Pete Haydon, OV/SA.

“I know a lot of members were anticipating the opening up, so their preparation for recalls was well in train.

Also, virtually all optometrists had really rigorous hygiene protocols established, and so they have been working hard to scale these for busier times,” he said.

“I was actually expecting some calls from members, in particular those who have quicker appointment times, saying they were having difficulty maintaining the hygiene protocols that are so vital for keeping us open. So far that hasn’t happened, so it seems that practitioners and front of house staff are coping pretty well.” n

NEWS

LOOMING OPHTHALMOLOGY SHORTAGE CONCERNS NSW REGION A regional New South Wales district that may have its ophthalmology services cut in half within months is blaming the shortage on what it describes as a flawed system controlling workforce distribution that “disadvantages” country communities.

The city of Tamworth, 400km north of Sydney, currently has four ophthalmologists. Two are approaching retirement, with one recently turning part time. The third is a part time locum returning to New Zealand early next year, and the fourth specialist works full time under one of the retiring doctors with a temporary Medicare Provider Number (MPN) expiring in January 2021.

While the fourth doctor wants to relocate to Tamworth, he is unable to secure a permanent MPN because the area is not considered a ‘District of Workforce Shortage (DWS)’ – a point the Tamworth Regional Council (TRC) says doesn’t match the reality.

Effectively, by the end of January, local authorities say Tamworth could be reduced from three full time equivalent (FTE) ophthalmologists to one and half to service up to 222,000 people.

TRC councillor Ms Juanita Wilson said this wiould deteriorate the region’s capacity to perform much of its own sightsaving work. As a result, the remaining ophthalmologists will be stretched, with many patients required to travel to Sydney (400km) or Newcastle (280km) for care.

At the crux of the issue, according to the TRC, is the Federal Government’s “flawed” use of postcodes to assign MPNs and determine workforce distribution.

A Federal Department of Health spokesperson told Insight Tamworth is not considered to be a DWS because its ratio of ophthalmologists to population “is well above the national average”. The government’s numbers indicate there are 83,443 people included in the TamworthGunnedah region, but it doesn’t publish the specific FTE to population ratios.

In reality, Wilson said the ophthalmologists treat a population of 220,000 – more than 2.5x the size – with 60% of patients coming from outside of Tamworth.

“The use of postcodes may be appropriate to achieve a spread of specialists across metropolitan areas,

Tamworth is not classified as a District of Workforce Shortage.

but in regional areas it results in a small number of specialists being required to work unreasonably long hours in order to service large geographical areas,” Wilson said.

“The ridiculous situation for Tamworth is that a doctor could move to another postcode 10km away in another village, but they won’t have access to the hospital to perform surgery because it’s a different postcode.”

Wilson said having a ‘District of Workforce Shortage’ designation matters for Tamworth because the fourth ophthalmologist who has a temporary MPN is keen to establish himself there.

But because he is an international medical graduate under section 19AB of the Health Insurance Act 1973, he must work in a DWS for at least 10 years, which excludes Tamworth.

Alternatively, Tamworth has spent a lot of time and money trying to attract an eligible ophthalmologist to no avail. “[The Federal Government] is not prepared to factor in issues that impact and set regional and rural areas as significantly different from metropolitan areas. The main one being distance. This means a neighbouring health districts in a metropolitan situation may be 10 minutes away, while regionally that can mean five or six hours away. The situation needs to be responded to in real terms,” Wilson said.

At a recent meeting, the TRC agreed to submit a motion to raise the issue at the Local Government New South Wales (LGNSW) annual conference on 23 November.

The government has established a Distribution Advisory Group to review the methodology used for the DWS specialists layers and advise whether it is appropriate to continue using the current methodology. n

IN BRIEF “[THE FEDERAL GOVERNMENT] IS NOT PREPARED TO FACTOR IN ISSUES THAT IMPACT AND SET REGIONAL AND RURAL AREAS AS SIGNIFICANTLY DIFFERENT FROM METROPOLITAN AREAS" JUANITA WILSON, TAMWORTH REGIONAL COUNCIL

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TOP TRAINERS

Nine RANZCO Fellows have been recognised as Trainers of Excellence this year, as voted by trainees within the college’s Vocational Training Program. Each year, RANZCO asks its trainees to nominate the training supervisor in their network they believe deserves recognition for outstanding dedication to teaching. This year’s recipients were Dr Harry Bradshaw (New Zealand), Dr Leanne Cheung (Prince of Wales), Dr Nicholas Toalster (Queensland), Dr Weng Chan and Professor Bob Casson (South Australia), Dr Clayton Barnes (Sydney Eye Hospital), Associate Professor James Elder (Victoria), and Dr Vignesh Raja and Dr Fred Chen (Western Australia).

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DATA INSIGHTS

Specsavers has launched its new HealthHub website to share updates on detection, referral and treatment progress for key eye conditions, as well as the use of optometry services in New Zealand and Australia. The initiative is an evolution of Specsavers’s annual Eye Health Report, which were published in 2018 and 2019.

It aims to share information from eyecare initiatives and investments with the ophthalmic and healthcare community by publishing the measured outcomes of the programs, supported by anonymised Specsavers eye health data. It includes content written by Specsavers staff, as well as external contributors including health providers, specialists and patient support groups.

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HISTORIC FELLOWSHIP

An associate lecturer is the first Australian to receive an international research fellowship in its 95-year history, for his project on subtyping open angle glaucoma. Dr Jack Phu, from the Centre for Eye Health, School of Optometry and Vision Science at the University of New South Wales, is the 2020 recipient of the Beta Sigma Kappa Research Fellowship. The American Academy of Optometry Foundation (AAOF) announced the fellowship on 29 September in collaboration with the BSK International Optometric Honor Society. Phu, a fellow of the American Academy of Optometry, will use the award to fund his project on phenotyping open angle glaucoma subtypes to determine disease prognosis.

He previously received the AAOF’s 20162017 William C Ezell Fellowship when he was a PhD student.

INSIGHT December 2020 9

NEWS

GOVERNMENT UNEXPECTEDLY IMPOSES NEW RESTRICTION ON DISPENSING WAGE SUBSIDY After a major announcement in the Federal Budget, the government has made a crucial change to the Boosting Apprenticeship Commencements (BAC) scheme that is providing up to $28,000 in wage subsidies for optical dispensing traineeships.

"IF AN EMPLOYER DELAYS FOR A WEEK, THEN THEY LOSE A WEEK’S WORTH OF WAGES"

on 6 October, the $1.2 billion boost for employers to take on new apprentices and trainees was labelled one of the largest schemes to benefit the optical sector in recent memory.

However, it’s still hoped the program will address a dispensing shortage and lift standards across the sector.

JAMES GIBBINS, ACOD

“Certain other large industries moved quickly on this opportunity and enrolled thousands at a time. Unfortunately, the optical industry tends to be a little slow to respond and this was the case,” he said.

Australasian College of Optical Dispensing (ACOD) director and senior trainer Mr James Gibbins said the amendment now means ‘existing employees’ – such as optical assistants wanting to obtain a Certificate IV in Optical Dispensing – are no longer eligible for the program.

The government imposed the new measure effective immediately on 28 October – almost three weeks after the originally announced scheme included existing employees.

Before the change, it was thought to be the first time that such a program was available to existing staff who are either part or full time, prompting a wave of new enrolments from optometry practices across Australia. Importantly, the new measure was not applied retrospectively, so it did not affect those who had subscribed prior to 28 October. Gibbins

Australasian College of Optical Dispensing directors Chedy Kalach and James Gibbins.

said ‘existing workers’ – who are now ineligible – are a full time employee of more than three months and a part time employee of more than 12 months.

Gibbins said the government recently amended the criteria due to the program being oversubscribed.

“But in saying that, we have had a significant increase in enrolments and there was a very encouraging response from the independents in particular – and there are still some notable exceptions to qualify for the subsidy.”

However, they could become eligible if a casual employee is moved to part or full time status after October 28; or if a part time employee shifts to full time status.

He said ACOD is upscaling its capacity to meet the demand, particularly for workshops next year.

“If this is the case, then the employer may enrol any number of existing workers and gain the 50% wages subsidy, up to a maximum of 30 employees,” he said.

“We already have 14 teachers in place – causal, part time and full time around Australia and New Zealand – and we have four teachers ready to be added."

“Of course, any new or current full time employee of less than three months is still eligible, and any new or current part time employee of less than 12 months will qualify.”

He added: “The traineeship start date is backdated to the date the employee registers on the ACOD website. So if an employer delays for a week, then they lose a week’s worth of wages.” n

Announced in the Federal Budget

ASO ANNOUNCES MAJOR LEADERSHIP SHAKE UP The Australian Society of Ophthalmologists (ASO) has appointed Associate Professor Dr Ashish Agar as its new president, with his predecessor Dr Peter Sumich stepping into the role of vice-president.

Agar was asked to lead the country’s peak medico-political ophthalmic body at its AGM on Wednesday 21 October. He has been an active member of the ASO since 2009, including the last three years as vice-president.

He is a glaucoma consultant and surgeon at the Prince of Wales and Sydney Eye hospitals, and a partner at Marsden Eye Specialists. He conducted his fellowship at Oxford and was awarded a PhD in his field. At the AGM, attendees

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INSIGHT December 2020

acknowledged “the substantial leadership and support” of Sumich who has served as president for the past three years.

academic appointment at the University of New South Wales as a Conjoint Associate Professor in Ophthalmology.

“Under Peter’s guidance the ASO has continued to become increasingly influential in the healthcare landscape.

He is an invaluable resource and I am delighted he has agreed to remain on the ASO Board in the role of vice-president,” Agar said.

Originally from regional NSW, he is director of ophthalmology at Broken Hill Hospital, a medical director of the Outback Eye Service based at Prince of Wales Hospital, co-chair and NSW lead of the Indigenous and Remote Eye Health Service (IRIS) program, member of the RANZCO NSW branch committee and chair of the RANZCO Indigenous committee.

In other areas, Agar teaches undergraduate medical students, registrar training and specialist education, including in overseas aid programs.

He is also conducts research in basic sciences, medical education, Indigenous health and new technologies, with an

Dr Ashish Agar, ASO.

As ASO president, Agar hopes to continue ensuring the independence of the profession. This includes countering moves to managed care and increasing awareness of ophthalmology’s essential role, especially in the public sector. n

DISRUPT INFLAMMATION IN DRY EYE DISEASE 1–3

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

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

PBS Information: This product is not PBS listed.

See approved Product Information before prescribing.

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

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

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

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

AU-13851. McCann Health NOXI19693M. September 2020.

NEWS

MAGPIE TORMETING LOCALS IN REGIONAL VICTORIAN TOWN FOR FOOD CAUSES SEVERE EYE INJURIES "WE GET ROUGHLY 60 INCIDENTS INVOLVING MAGPIES A YEAR, AND SOME YEARS WE HAVE HAD UP TO 120"

Victoria’s main eye hospital has asked authorities to remove a juvenile magpie from a regional shopping centre where it has left people with severe eye injuries, as part of an apparent scare tactic to steal food.

Retired businessman Mr James Glindemann, 68, was the latest victim in a string of attacks by the magpie that has targeted people near the Gippsland Centre in Sale, about 200km east of Melbourne.

James Glindemann suffered a penetrating corneal injury in the attack.

As he sat down to eat lunch on 13 October, Glindemann said the young magpie lunged at his left eye, causing a penetrating corneal injury, before launching again at his right eye and causing minor damage to the skin of his eye lid.

Mr Thomas Campbell helped repair Glindemann’s penetrating eye injury.

Just days earlier, it’s thought Ms Jennifer Dyer fell victim to the same magpie in similar circumstances at the same location. According to the ABC, she required three operations, including one to remove her lens after a cataract formed after the injury.

“It’s a bird that’s learned a response to try and get food from people. When people are sitting at this park bench with food it will jump at their face to try startle them so they will drop their food and eat it,” he said.

Royal Victorian Eye and Ear Hospital (RVEEH) ophthalmology registrar

He said several people had been attacked in the Sale area in September and October, which had caused eye injuries – some of those severe. The same culprit has been suspected in each case.

THOMAS CAMPBELL, ROYAL VICTORIAN EYE AND EAR HOSPITAL

attack, it’s quite distinct from that.”

Campbell, who has an interest in eye injuries caused by magpies and has collected data on RVEEH presentations since 2012, said the hospital had asked the local council to put up signs and remove the bird. He also advised people in the area wear has and eye protection, and avoid antagonising the bird.

“I’m from Queensland and when I first moved to Victoria, I was stunned at how many cases there were. That’s why I have collected this data, and presented it at some conferences,” he said.

“We get roughly 60 incidents involving magpies a year, and some years we have had up to 120, and it’s almost all during this season from July until October. At that time we can have several a week, and during the peak season we can have one a day – they seem to occur in clusters.

“We have had very severe injuries in the past, normally one per year, but most of the time the injuries are relatively minor with lacerations or scratches to the surface of the eye or the eye lid skin.”

“This is very unusual behaviour, I’ve never heard of it before with magpies – it wasn’t a territorial swoop

Glindemann said he hoped to make a full recovery. n

TOPCON HOLDS TOP SPOT IN COMPETITIVE OCT MARKET Topcon Healthcare has secured the number one position in the global optical coherence tomography (OCT) market, according to a major analysis of diagnostic ophthalmic devices.

The medical device and software company recently announced it now leads the OCT segment with 27.9% market share, based on the recently released 2020 Ophthalmic Diagnostic Equipment Market Report by independent market research firm Market Scope.

The report, compiled by in-house analysts with more than 100 years of collective ophthalmic market research, provides in-depth coverage of diagnostic equipment used during ophthalmic exams and procedures, and involved an analysis of 764 devices from 88 companies.

Mr Chris Mather, director of sales and

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INSIGHT December 2020

service for Topcon Healthcare Australia, said it was a major achievement. Topcon hardware is distributed by Device Technologies in Australia.

“These truly are difficult times for the medical diagnostic market globally, and it’s great to see that whilst the pressures of excellent competition continue to test us, Topcon are thriving in one of the most complex arenas for eyecare technology,” he said.

“Being named as the global number one provider of choice for OCT is both humbling and yet inspiring to all within Topcon. We strive to deliver perfection and reliability, everything that is needed in a modern, fast paced eye health clinic.”

Topcon’s line-up of OCT instruments features the Maestro2 Robotic OCT and the Triton Swept Source OCT. Both devices are said to combine

fundus and OCT functionality in an easyto-use platform.

Chris Mather, Topcon Healthcare Australia.

Device Technologies ophthalmic diagnostic business manager Mr Ryan Heggie added: “This is a milestone achievement for Topcon OCT imaging devices, a result of the companies continued innovation of diagnostic instrumentation.

“These statistics represent a shift in the OCT market we have observed in just the last few years and reflects what we see in the ANZ marketplace today. It’s exciting to think about what new technologies are on the horizon and how they will enhance eyecare and improve patient outcomes.” n

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NEWS

NEW GROUP FOCUSES ON ENHANCING EYECARE SERVICE DELIVERY AMID CORONAVIRUS BACKLOG "THIS RESEARCH WILL FOCUS ON HOW TO BEST DELIVER EYECARE SERVICES IN THE REAL WORLD RATHER THAN THE LAB"

The Centre for Eye Research Australia (CERA) has established a new research unit to improve current eyecare models and tackle the backlog of undiagnosed and untreated conditions due to missed appointments during COVID-19.

Headed by Specsavers former group eye health director Mr Peter Larsen in an honorary capacity, the Health Services Research unit will examine how innovative technologies, telemedicine and better coordination between different parts of the sector could increase access to screening services, early treatment and prevent avoidable blindness.

According to CERA, the research will target diseases where blindness can often be prevented with early treatment such as diabetic eye disease, glaucoma, age-related macular degeneration and cataracts.

“This research will focus on how to best deliver eyecare services in the real world rather than the lab,’’ Larsen said. “We will look at how we can better connect different parts of the system from optometrists to eye surgeons to increase access and improve the quality of care we provide for patients.’’

In Australia and around the world at the peak of the paandemic, governments suspended elective

Professor Keith Martin, CERA.

surgeries and imposed restrictions that only allowed optometrists to see urgent cases. Ophthalmologists and patient organisations have also voiced concerns about patients missing sightsaving appointments.

PETER LARSEN, CERA HEALTH SERVICES RESEARCH

– with demand for Medicare funded eye services rising about 5% annually. This is expected to be exacerbated postpandemic as people with undiagnosed and untreated conditions pour into the system.

But in the meantime, the pandemic has accelerated the greater use of telemedicine and remote services.

CERA managing director Professor Keith Martin said while the research would initially examine backlogs experienced in Australia – he believes its findings could have global significance.

“Peter Larsen brings great knowledge of delivering service to patients from his role at Specsavers, which include introducing new systems and approaches which have improved the detection and referral for disease such as glaucoma and diabetic eye disease,’’ Martin said.

Other data from Optometry Australia has shown there were one million fewer general optometry services during the peak COVID period.

“His research, working with private and public providers across the eye health system, will complement the work under way at CERA to develop new ways of diagnosing and monitoring patients with eye disease."

And data from Specsavers at the start of the pandemic in March and April showed 600,000 fewer Medicare funded optometry services compared to the previous year. In April and May, 25,208 Specsavers patients that likely had eye conditions requiring specialist attention did not attend appointments.

He said COVID-19 had added impetus to the need for new technologies which enable remote screening and diagnosis and reduce the need for patients to attend a clinic in person. n

Larsen said eyecare services were struggling to keep up before COVID-19

ONLY HALF OF DIABETICS GETTING RECOMMENDED TESTS As the KeepSight program hit 100,000 enrolments, a new University of Sydney study has found only half of diabetics are getting the recommended diabetes eye checks, putting them at risk of significant vision loss and blindness.

The University of Sydney paper, recently published in RANZCO journal Clinical and Experimental Ophthalmology, linked data from the Sax Institute’s 45 and Up study with Medicare benefits data to examine how frequently almost 25,000 people in New South Wales with diabetes had eye examinations.

The researchers found people with diabetes for 10 or more years were even less likely to get regular eye checks, with almost 80% not having the annual

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INSIGHT December 2020

recommended check.

changes in the eye related to diabetes.”

Study co-author and ophthalmologist Professor Mark Gillies, from the University of Sydney Faculty of Medicine and Health and Save Sight Institute, said the findings reinforced the need for more education.

“Ninety-eight per cent of serious vision loss from diabetes can be prevented with regular eye examinations and early treatment,” he said.

“I encourage people to use services like KeepSight to keep on top of their appointments. It’s also important they understand the kind of eye check required, as only eye checks that include dilation of the pupil with eye drops (fundus dilation) is appropriate to detect

The study findings were revealed in conjunction with Diabetes Australia (DA) announcing the KeepSight program had reached 100,000 enrolments.

Prof Mark Gillies, University of Sydney.

DA CEO Professor Greg Johnson said the organisation is confident KeepSight will lead to an increase in people with diabetes accessing eye checks in coming years. Ultimately, he hopes every person with diabetes will attend appointments. “[It] is an important milestone for the program, but there are currently over 1.36 million Australians living with diabetes so we are encouraging every person with diabetes, and all health professionals, to register,” Johnson said. n

NEWS

CONTACT LENS AND ATROPINE LICENSING DEALS BOLSTER BAUSCH + LOMB’S MYOPIA PORTFOLIO Bausch + Lomb has acquired an exclusive license for a novel myopia control contact lens developed by a Sydney ophthalmic research institute, immediately after it signed another deal to commercialise an investigational microdose formulation of atropine.

The company, which is the global eye health subsidiary Bausch Health Companies, announced the new licensing agreement with the Brien Holden Vision Institute (BHVI) on 16 October.

As part of the deal, BHVI’s novel contact lens design will be paired with Bausch + Lomb’s contact lens technologies to develop treatments that slow myopia progression in children.

In simple terms, BHVI says its patented designs combine different amounts of different types of aberrations to achieve extended depth of focus (EDOF), which enables good vision at a

range of distances from far to near.

EDOF technology for myopia has been the focus of another deal BHVI signed in 2017 with Spanish contact lens manufacturer mark’ennovy, which led to the Mylo contact lens.

Just a week before the BHVI deal, Bausch + Lomb also announced an exclusive license with Eyenovia in the US and Canada for the development and commercialisation of an investigational microdose formulation of atropine ophthalmic solution.

Joseph Papa, Bausch Health.

The therapy is being investigated for the reduction of paediatric myopia progression in children aged between three and 12-years-old.

“We are excited to leverage cuttingedge contact lens design technology from renowned ophthalmic research organisation BHVI with our leading lens technologies so that we can research

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potential new treatment options for myopia, which continues to become more prevalent around the world,” Mr Joseph Papa, chairman and CEO of Bausch Health, said. “As evidenced by both of our new exclusive licenses for different potential treatments for myopia, Bausch + Lomb remains committed to finding new approaches to treating this condition for as long as there is a need.”

BHVI chairman Mr Frank Back said for decades the organisation had sought solutions to unmet ophthalmic needs by innovating commercially relevant technologies, including for myopia control.

“Bausch + Lomb’s long-standing position as a leader and innovator in eye health makes it the ideal choice for a partner, and we look forward to helping improve the vision of people with myopia around the world through their use of this contact lens design,” he said. n

NEWS

EXORBITANT PRICES IN REMOTE COMMUNITIES ARE HINDERING INDIGENOUS TRACHOMA EFFORTS "WE RECOGNISE THE OPERATIONAL COST OF RUNNING THESE REMOTE STORES SUCH AS POWER AND WATER AND STAFF WAGES IS A LOT HIGHER"

Access to basic cleaning and hygiene products are essential in Australia’s efforts to eliminate trachoma in remote Indigenous communities, however residents in those areas can pay up to three times more for items such as towels and soap, an inquiry has heard.

The University of Melbourne’s Indigenous Eye Health Unit (IEH) says 120 remote communities are still at risk of trachoma in Australia, the last developed nation with the disease. It is most often found in small children, and after many reinfections (150 - 200) it leads to scarring and in-turned eye lashes in adults.

Trachoma is preventable and persists in areas with poor personal and community hygiene. Further, in the first year of life in an Indigenous community, the average clinic attendance was 21 presentations per child. Almost two thirds of visits were for infections, including upper respiratory, diarrhoea, ear disease, lower respiratory tract infection and skin sores.

Senior engagement officer Mr Karl Hampton outlined the IEH’s concerns in a submission to the House of Representatives Standing Committee on Indigenous Affairs’ Inquiry into food pricing and food security in remote Indigenous communities. Established by

Stores in remote communities are charging more for hygiene and cleaning products.

KARL HAMPTON, INDIGENOUS EYE HEALTH UNIT

Minister for Indigenous Australians Mr Ken Wyatt, many submissions have focused on exorbitant prices and price-gouging.

a store in Alice Springs. The cheapest towel in the remote store was $29.99 while in Alice Springs it was $10.98. For soap, those figures were $3.49 versus $1.90; x6 toilet paper was $9.50 versus $5; and the cheapest cleaning products were $3.90 versus $3.

“IEH are aware of the efforts of some store chains operating in remote Aboriginal communities to reduce the costs of health and hygiene products and increase the access to these products to residents, however despite these efforts these stores still require subsidised funding to offset any loss of income for the store,” Hampton said.

“We recognise the operational cost of running these remote stores such as power and water and staff wages is a lot higher than those in regional centres and therefore having a significant impact of the cost of products sold by the store.”

Hampton stated that local stores play a role in providing affordable hygiene and cleaning products to improve health in remote communities.

However, on remote community visits over several years, the IEH has found products are far more expensive than what they may be in regional centres and capital cities. Exacerbating the issue is the fact many people in these areas have low incomes, making some essential products out of reach.

He also said it appears much product pricing is dependent on what the stores and suppliers set, meaning community stores are restricted to shop around and negotiate with suppliers.

“More affordable hygiene and cleaning products remote stores will increase use of these products to improve health,” Hampton added. n

Hampton provided several examples comparing remote community stores to

LATEST GOVERNMENT REPORT REVEALS ‘SUBSTANTIAL’ INDIGENOUS EYE HEALTH IMPROVEMENTS A new government report has shown that more Indigenous Australians are accessing eye health services than ever before, with significant strides reported in cataract surgery rates and the suppression of trachoma.

“The Indigenous eye health measures were developed to monitor changes in Indigenous eye health, and their use of eye health services,” AIHW spokesperson Dr Fadwa Al-Yaman said.

The new data – published last month – features in the Australian Institute of Health and Welfare (AIHW)’s fourth annual report entitled Indigenous eye health measures 2020.

“Since the first report, published in 2017, there have been substantial improvements in the rate of Indigenous Australians accessing cataract surgery, diabetic retinopathy screening and eye health exams.”

Launched virtually by Federal Health Minister Mr Greg Hunt, it shows Indigenous Australians 40 years and over had three times the rate of vision loss of non-Indigenous Australians, after adjusting for age and sex.

The figures show between 2010–11 and 2018–19 the proportion of Indigenous Australians who had an eye health check as part of a health assessment increased from 11% to 30% (based on age-standardised rates).

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INSIGHT December 2020

The rate of diabetic retinopathy screening increased from 31% to 37% between 2008–09 and 2018–19.

Eye check rates improved 19%.

The report examined other causes of vision loss among Aboriginal and Torres Strait Islander people and showed the rate of cataract surgery increased by 42% since 2008–10, from around 5,200 procedures to 7,400 per 1,000,000 in 2016–18.

The prevalence of trachoma – a highly infectious eye disease that can cause blindness if left untreated – has fallen significantly among Indigenous children aged 5–9, from 15% in 2009 to 4.5% in 2019. n

NEWS

BLUE SKY POSTPONED TO ACCOUNT FOR TRAVEL AND SUIT NEW OPTOMETRY CPD REQUIREMENTS Adelaide’s Blue Sky optometry conference has been postponed until February. It’s hoped the new date will coincide with fewer interstate travel restrictions and allow the program to better align with new CPD requirements.

Optometry Victoria South Australia (OV/SA)’s biennial boutique event – planned to take place at the Adelaide Convention Centre 20-21 November – was rescheduled to 26-27 February.

With more people expected to attend the new date, fees for face-to-face attendees have been reduced by $100 to $499 (full conference), while those who stream the full event remotely will have access for $150.

OV/SA CEO Mr Pete Haydon said the organisation had listened to delegates who were hesitant about interstate travel and keen to focus on the new CPD registration standard that comes into

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effect on 1 December. If OV/SA went through with the original November conference, the new time-based standard would have been introduced just nine days later.

“From a CPD perspective, many members have mentally put the 2019/20 OBA-registration year behind them and are more concerned about the new system,” he said.

“Moving Blue Sky to February means members can start with the new system, with expert help at hand, to ensure you’re CPD compliant by the end of 2021. We can also really easily adapt our program to the new requirements.”

Haydon said approximately 60 people had registered for the in-person November event. That would have increased closer to the date, but they now hope to attract more than 100 physical attendees in February.

“We hope that by the end of February more borders will be open and members from across Victoria, SA and wider Australia are more likely to have increased confidence to enjoy a weekend away,” he said.

The Adelaide Convention Centre is hosting the event.

“The extra couple of months will also give certainty to businesses and exhibitors to commit. By moving Blue Sky to the end of February, they can anticipate a greater number of face-to-face delegates and have confidence that participation will be worth their while. If borders are open, this delay will also enable interstate exhibitors to be able to attend.”

OV/SA will provide a free crèche on both days, with fees applicable for nonmembers. Face-to-face registrants have a choice of rescheduling, a full refund or a credit note. Virtual attendees can expect a transfer of their registration to the new date, full refund or credit note. n

NEWS

NEW SUPPORT FOR PATIENTS FACING ENUCLEATION SURGERY A health professional’s firsthand experience of having an eye removed has led to an international collaboration to educate patients about the anxietyinducing procedure.

Mitchell Wilson, Royal Victorian Eye and Ear.

Mr Mitchell Wilson, a nurse unit manager at Melbourne’s Royal Victorian Eye and Ear Hospital (RVEEH), had his eye surgically removed as a child and has often been asked to talk about his experience with patients at the hospital.

The procedure – enucleation surgery – involves removal of the eye, leaving the eye muscles intact to support the insertion of an artificial eye.

“Patients who needed to have an eye removed were often traumatised by the prospect, and there was little information available to them that could support their understanding of the process,” Wilson said.

He felt more resources would fulfil a broader need, both locally and internationally. Wilson’s experience led him to champion an international collaboration project of eye hospitals to develop an education package that support patients facing the procedure.

On World Sight Day on 8 October, the RVEEH announced a partnership with the World Association of Eye Hospitals (WAEH) and other leading member institutions, including Moorfields Eye Hospital in the UK and Kellogg Eye Centre in the US to create more patient focused resources for enucleation.

A project team, including Wilson, have created videos, a fact sheet and FAQ resource that answer common questions for patients.

The RVEEH said the objective was to develop a sustainable education package for patients and healthcare professionals that can provide reliable and complete information on the surgery and living with an artificial eye.

The hospital treats approximately 60 penetrating eye injuries every year that require surgery, mainly men aged between 20 and 59. The specialist hospital said most are a result of accidents that could have been avoided with good eye protection. n

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INSIGHT December 2020

LOW UPTAKE SPELLS END OF OPTOMETRY ADVANTAGE PROGRAM "IT HAS BECOME DIFFICULT FOR US TO CONTINUE TO PROVIDE THE HIGH LEVELS OF SUPPORT NECESSARY TO ENSURE WE ARE GETTING [MEMBERS] THE BEST DEALS" OPTOMETRY AUSTRALIA

Fewer optometrists taking up businessrelated offers and deals provided through Optometry Australia (OA)’s Advantage Program has prompted the organisation to end the scheme after more than 20 years.

In a decision announced in October, OA said that while the program had once provided the member-based organisation with an “excellent revenue stream from external companies”, this was no longer the case.

“It has become difficult for us to continue to provide the high levels of support necessary to ensure we are getting [members] the best deals possible,” OA stated.

In the 22 years OA has provided the Advantage Program, its offers have covered business, travel, and home and contents insurance; finance, legal and human resources support; and deals on lifestyle products and services.

Through the program, OA optometrists have saved thousands of dollars on international money transfers using OFX Global Money Transfers. As of 2019, 77 members made 1,559 deals using the service since 2013, transferring nearly $18.4 million from Australia to overseas or vice versa. Likewise, many members have used the program’s business insurance partner,

The program helped Li Chen slash her practice electricity bill. Image: Make It Cheaper.

Guild Insurance, to support their businesses through unexpected disruptions.

Despite the savings and support, OA said it has become “very challenging to maintain a program that should offer exclusive deals for members, but in reality, offers similar deals readily available elsewhere at the click of a mouse and often at a more competitive price”.

OA will retain a streamlined business directory service on its website for all members to access and will also consider adding new businesses to the directory depending on demand.

OA members can access current services provided by all Advantage Program partners and participate in any deals advertised until its closing date of 18 December 2020. n

NEW ONLINE TRAINING TO HELP PATIENTS QUIT SMOKING Eye health professionals are being offered access to new resources to help them talk to patients about smoking and offer practical quitting advice.

Smoking cessation organisation Quit, in partnership with the Vision Initiative – a program managed by Vision 2020 Australia – has created the online training course for the eye health sector based on Quit’s three-step model; ask, advise, help.

It follows a joint survey they conducted in June which showed the majority of eye health professionals, including optometrists and orthoptists, are not aware that most patients who smoke would like help to quit. Moreover, most don’t feel confident to provide support.

Vision 2020 Australia CEO Ms Judith Abbott said the new training and resources

The material offers an effective way to have a conversation about quitting smoking.

have been specially developed to help optometrists and orthoptists talk to patients and offer practical assistance.

“It’s a fast, simple and effective way to have a conversation about quitting smoking with patients and is easily integrated into a normal consultation,” she said. n

NEWS

MORE THAN HALF OF AUSSIES ARE UNAWARE THE SUN CAN CAUSE PERMANENT EYE DAMAGE New research commissioned by a major optometry provider has found 60% of Australians aren’t aware the sun can cause permanent eye damage through conditions such as cataracts, cancer or macular degeneration.

While 92% of the population is concerned about long term damage to their body, the YouGov study – conducted on behalf of Specsavers – also revealed the eyes tend to be forgotten, with only 35% worried about long-term eye damage from the sun.

With Australia having one of the highest levels of UV light and rates of skin cancer in the world, optometrists around the country are now calling on Aussies to be more sun smart and have their eyes checked if they suspect an issue.

“The reality is that living in Australia means that we can be exposed to

dangerous levels of UV radiation when we’re outside, even when it’s not bright and sunny,” Specsavers optometrist Ms Greeshma Patel said, in light of the survey that comprised a nationally representative sample of 1,000 Australians aged 18 years and older.

In other findings, the data showed two fifths of Aussies admit they don’t wear sunglasses most of the time when they’re outside. Most also don’t have lenses that provide the right level of protection with less than half (47%) owning sunglasses with any kind of UV protection, and 39% unsure of the protection of their sunglasses.

“Most patients I’ve seen don’t know what to look for in sunglasses when it comes to sun protection. The same way you put on sunscreen and a hat to protect your body, you should ensure

you are wearing sunglasses that block out UV,” Patel said.

Greeshma Patel, Specsavers.

“I would recommend sunglasses that have polarised lenses because they not only offer 100% UV protection for your eyes but they also eliminate 99.9% of glare caused by reflected light.”

Around half of Aussies think they only need to wear sunglasses when it’s sunny and during the middle of the day.

“Many people believe that sunglasses only need to be worn on a hot sunny day at the beach for example, but regardless of whether it’s clear skies and high temperatures or not, as a preventative measure you should be wearing them every time you’re outside. Even if it is an overcast day, UV rays are still present so we also want to encourage good sun safe habits for years to come,” Patel said. n

INTERNATIONAL

MYOPIA INNOVATIONS SNAP UP COVETED SILMO D’OR AWARDS

SINGAPORE ADOPTS AI TO SCREEN FOR DIABETIC EYE DISEASE An artificial intelligence (AI)system that cuts the time needed to spot signs of diabetic eye diseases will be rolled out in Singapore as Lai Teik Kin, novaHEALTH. part of a worldfirst adoption of the technology in a national screening program.

Expected to go live last month, the AI product, SELENA+, will initially be deployed to screen 120,000 patients annually for signs of diabetic eye diseases, namely diabetic retinopathy, glaucoma, and age-related macular degeneration.

Singaporean healthcare IT company Integrated Health Information Systems (IHiS) has awarded a five-year contract to EyRIS, a company that develops AI deep learning technology in the healthcare industry, to deploy SELENA+.

EyRIS is 42% owned by novaHEALTH, which in turn is wholly-owned by Nova MSC, a software company headquartered in Malaysia.

Mr Lai Teik Kin, CEO at novaHEALTH and EyRIS, said there are more than 415 million diabetics in the world today who require annual eye check-ups to prevent vision impairment.

“With this intelligent deep learning system

by SELENA+, it can perform automated image analysis of retinal images with results in mere seconds, much faster than the best trained human graders. Moreover, there is always a chance of human error, which can be prevented with SELENA+,” he said.

Kin said the five-year contract is not only a milestone for Singapore but is also the world’s first real world adoption of an AI-based medical device in a national screening program.

“It is our mission to introduce practical and proven technology to chronic care management and work with relevant authorities and organisations to develop screening programs and protocols,” he said.

“Such initiatives will address the need for ever increasing manpower to tackle retinal complications from diabetes, the world’s fastest growing chronic disease.” n

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INSIGHT December 2020

"IT IS AN HONOUR TO BE RECOGNISED

BY OUR PEERS RECEIVING THE SILMO D’OR AWARD FOR OUR GROUNDBREAKING MIYOSMART LENS" ALEXANDRE MONTAGUE, HOYA

Hoya’s new myopia control lens and a Topcon’s Myah instrument for myopia and dry eye management have taken out their respective categories in the regarded Silmo d’Or Awards.

Both products were recently introduced to the Australian ophthalmic market and were nominated for the awards, which took place despite the cancellation of Silmo Paris this year.

Out of the 10 categories, Hoya’s MiyoSmart lens won the vision category, while Topcon’s Myah – which is distributed locally by Device Technologies – claimed the material/equipment prize.

The Miyosmart spectacle lens uses Defocus Incorporated Multiple Segments (DIMS) technology to provide sharp vision and a treatment effect for myopic children.

According to Hoya, it has been shown to slow myopia progress by 60%, on average, based on results from a two-year clinical trial published in the British Journal of Ophthalmology.

“It is an honour to be recognised by our peers receiving the Silmo d’Or Award for our ground-breaking MiyoSmart lens which is successfully managing and controlling myopia in children,” Mr Alexandre Montague, CEO of Hoya Vision

Topcon Myah (left) and Hoya's MiyoSmart lens.

Care, said. Commenting on the Myah award, Device Technologies ophthalmic diagnostic business manager Mr Ryan Heggie said: “The Silmo d’Or equipment award is recognition of the benefits that the Topcon Myah offers eyecare professionals who are looking to build, manage and grow their practice through myopia and dry eye services.”

According to Topcon, the instrument’s myopia features include optical biometry, corneal topography, pupillometry, comparison and differential map, contact lens fitting simulation and keratoconus screening. In dry eye, practitioners can conduct non-invasive break-up time, meibomian gland analysis, blink analysis, tear meniscus height analysis and fluorescein imaging. n

CONTENTIOUS CONTACT LENS RULE COMES INTO EFFECT IN AMERICA The Federal Trade Commission (FTC)’s controversial Contact Lens Rule has come into effect which now requires US optometrists to provide a copy of the contact lens prescription to the patient following the consultation – unprompted.

The new measure has been enforced since mid-October and put the onus on the practitioner to comply with the law.

Optometrists are now required to obtain a signed receipt from the patient for the prescription, and they must retain it for three years.

Optometrists also cannot require patients to buy contact lenses, pay additional fees, or sign a waiver or release in exchange for their contact lens prescription.

The move has been welcomed by online retailers, but condemned by the American Optometric Association (AOA).

The FTC has been accused of dismissing the concerns of eye health practitioners.

It stated the FTC dismissed the concerns of doctors of optometry, ophthalmologists, patient health and consumer advocates, and a bipartisan group of more than 100 US House and Senate leaders. The AOA also believes the new mandate will cost the industry tens of millions annually and at least US$18,000 (AU$25,000) per doctor annually. n

COMPANY

Glam Collection

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NOVARTIS EXPANDS GENE THERAPY FOOTPRINT Just months after securing approval for Luxturna in Australia, Novartis has acquired two more gene therapy programs and delivery technology for inherited retinal dystrophies and geographic atrophy.

In a deal worth up to US$280 million (AU$390 m), the Swiss pharmaceutical giant announced last month it would takeover Vedere Bio, a venture capital-backed gene therapy developer in the US. The acquisition includes light-sensing proteins that can be delivered to cells in the retina and adeno-associated virus (AAV) delivery vectors that enable treatment via intravitreal injection.

Together, the company stated these assets have the potential to expand the number of patients who could be treated for vision loss due to photoreceptor death, including all inherited retinal dystrophies (IRDs).

“We believe that gene therapy technologies have transformative potential for treating blinding diseases,” Ms Cynthia Grosskreutz, global head of ophthalmology at the Novartis Institutes for BioMedical Research, said.

“With the new tools that this acquisition brings to the table, we will no longer be limited to replacing single genetic mutations that are causing eye diseases. This introduces the potential to treat any patient with retinal degeneration leading to photoreceptor death.”

According to the company, the optogenetics approach acquired from Vedere Bio acts directly on surviving cells in the retina, altering their behaviour and making it possible for those with vision loss due to photoreceptor cell death to benefit. This approach also holds promise for treating other conditions that involve photoreceptor loss, including geographic atrophy, which affects more than five million people globally.

It comes as Novartis broadens its footprint in the gene therapy space, with a focus on three platforms – AAVs, chimeric antigen receptor T-cells (CAR-Ts) and clustered regularly interspaced short palindromic repeats (CRISPR).

Novartis also supplies the gene therapy Luxturna in Australia and other markets. The Therapeutic Goods Administration approved the therapy in Australia in August for a small group of patients with IRD caused by pathogenic biallelic RPE65 mutations, who also have sufficient viable retinal cells.

As part of the deal, Novartis will pay Vedere Bio shareholders US$150 million (AU$208 m) upfront. They will also be eligible for up to US$130 million (AU$180 m) in milestone payments. n

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RESEARCH

CALLS FOR COMBINED OCULAR AND CARDIOVASCULAR DISEASE SCREENING A Texas Tech University Health Sciences Center study has found that ideal cardiovascular health is associated with lower odds of ocular diseases, especially diabetic retinopathy.

Published in the American Journal of Medicine, the findings suggest that interventions to prevent cardiovascular diseases may also hold promise in preventing eye diseases.

Lead investigator Dr Duke Appiah said that prior to his team’s research, no other studies have comprehensively evaluated the association of all the metrics of ideal cardiovascular health – such as smoking, obesity, or hypertension – with ocular diseases.

Investigators evaluated data from 6,118 adults aged over 40 who took part in the 2005-2008 US National Health and Nutrition Examination Survey. The average age of participants was 57 and 53% were women.

Using the American Heart Association’s prescription for health metric based on the status of seven cardiovascular disease risk factors – not smoking, regular physical activity, healthy diet, maintaining normal weight, and controlling cholesterol, blood pressure, and blood glucose levels – the research showed that good cardiovascular health was associated with lower odds for agerelated macular degeneration, diabetic retinopathy, cataract and glaucoma.

Individuals with optimal cardiovascular health had 97% lower odds for diabetic retinopathy compared to individuals with inadequate cardiovascular health.

The investigators hoped their study findings would lead to increased collaboration between cardiologists, optometrists, and ophthalmologists in order to better prevent cardiovascular and ocular diseases.

They recommended that screening for ocular diseases be incorporated into existing clinical and populationbased screenings for cardiovascular diseases, given the significant overlap of the risk factors for ocular diseases and cardiovascular disease. n

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INSIGHT December 2020

PARKINSON’S DISEASE DRUG MAY HOLD KEY FOR ADVANCED AMD "A 29% DECREASE IN RETINAL FLUID WAS SUSTAINED AND MEAN VISUAL ACUITY IMPROVED" THE AMERICAN JOURNAL OF MEDICINE

A safe and readily available drug commonly used to treat Parkinson’s disease has proven effective in stabilising and improving vision in patients with advanced age-related macular degeneration (AMD).

Levodopa, well-tolerated by patients with Parkinson’s, reduced the number of treatments for patients with neovascular AMD (nAMD) to maintain vision, according to results published in The American Journal of Medicine.

With the standard treatment for nAMD being frequent anti-VEGF injections – which, while effective, are both expensive and painful – the success of the trial suggests levodopa can potentially reduce the burden of treating the disease.

Based on earlier research that patients being treated with levodopa for movement disorders such as Parkinson’s disease were significantly less likely to develop any type of AMD, investigators developed two proofof-concept studies to test whether levodopa improves visual acuity and the anatomical changes caused by nAMD. They also evaluated the safety and tolerability of the drug in treating nAMD and whether treatment reduced or delayed the need for anti-VEGF therapy.

AMD patients required fewer than the standard monthly treatments.

According to a press release from the journal’s publisher, Elsevier, the first study, involving 20 patients, and the second study, involving the original 20 and a second group of 14 patients, demonstrated that after six months a 29% decrease in retinal fluid was sustained and mean visual acuity improved, enabling patients in the first and second group to read an additional line on the eye chart.

The investigators noted that levodopa may be unlikely as a standalone treatment in patients with newly diagnosed nAMD since 11 of the patients required anti-VEGF injections.

However, they required fewer than the standard monthly treatments, and in the second group, monthly injections of anti-VEGF decreased by 52%. n

PRESBYOPIA EYE DROP MOVES TO PHASE 3 CLINICAL TRIAL Israeli ophthalmic pharmaceutical company Orasis Pharmaceuticals has commenced two Phase 3 clinical studies to evaluate its eye drop candidate to improve presbyopia.

Approximately 600 participants with presbyopia have enrolled in Orasis’ NEAR-1 and NEAR-2 multi-centre, double-masked, parallel-group clinical trials in the US to investigate the efficacy and safety of the drop, currently identified as CSF-1.

Participants will receive one drop bilaterally twice daily for approximately two weeks, either CSF-1 or a placebo.

Researchers will be measuring the percentage of participants with a greater than or equal to three-line gain in best distance-corrected visual acuity

The company is now preparing for precommercialisation.

at 40cm and no loss in best distancecorrected visual acuity greater than or equal to five letters at four metres on days one, eight and 15.

CEO Mr Elad Kedar said the company was preparing for precommercialisation of the corrective eye drop as they moved into the final stage of clinical development. n

THE

For Australia’s ophthalmic manufacturers and suppliers, the challenges of 2020 prompted a major rethink about how they can get their new products and services to eyecare professionals. The COVID-19 pandemic wiped several key events off the trade fair calendar, while travel and border restrictions limited face-to-face interactions between practices and reps.

As the sector rapidly recovers from the downturn, Insight brings together a host of suppliers to showcase their 2020/21 releases so that ophthalmologists, optometrists, dispensers and other staff can continue to deliver world-class eyecare to patients.

INSIGHT December 2020 23

SUN PHARMA INTRODUCES AUSTRALIA’S LATEST DRY EYE TREATMENT Cequa is a newly-approved novel aqueous, nanomicellar ophthalmic ciclosporin solution for treatment of moderate-to-severe dry eye, where prior use of artificial tears has not been sufficient.

Manufactured and distributed

by Sun Pharma and cleared by the Therapeutic Goods Administration in January, Cequa’s novel delivery system utilises nanomicellar technology to improve the formulation’s bioavailability. It also allows for a more than 10-fold increase in the aqueous solubility of ciclosporin. The solution works by inhibiting T-cell activation and reduces inflammation associated with dry eye disease. In two clinical studies, OTX-101-2014001 and OTX-101-2016-001, the therapy demonstrated clinically and statistically significant improvements in tear production and ocular surface integrity over 84 days. Significant improvements were also observed for corneal staining and conjunctival staining from day 28 and 56, respectively, in the OTX-101-2016-001 trial.

According to the company, the most common adverse event reported was mildly transient instillation site pain, which was resolved within five minutes.

Email: nic.kurstjens@sunpharma.com

REACH MORE PATIENTS THROUGH MANAGED ADVERTISING MyHealth1st has developed a managed advertising service that can help independent optometry practices achieve greater cutthrough via Google Ads and social media campaigns.

According to the company, an effectively managed Google advertising plan can help practices climb to the top of search engine rankings to reach more patients at every stage of the booking funnel.

Meanwhile, well conceived and delivered social media campaigns across platforms like Facebook, Instagram and LinkedIn can help optometry businesses connect with people in the right areas to grow their practice.

“It’s all too easy to throw money at advertising but it’s far more difficult to find a return on investment,” the company stated. “We understand the challenges that come with running an independent optometry practice, because we work with thousands of practices.”

According to MyHealth1st, its team have extensive experience planning, implementing and managing successful and costeffective Google Ads and social media campaigns. Through tailored managed advertising services, messaging is designed to be unique to the practice, speak directly to its market, and accelerate the recovery amid economic uncertainty.

Email: info@myhealth1st.com.au

24

INSIGHT December 2020

MODSTYLE’S AVANTI JASON C4 ORANGE With the introduction of colour into the Avanti collection in recent years, the Avanti Jason C4 Orange catapults the range into the vivid colour arena.

The eyewear, distributed Australia-wide by Modstyle, bursts with bold fluorescent colour on the outside of the frame.

“Never before has Avanti offered such vibrant colour on the outside of a men’s frame,” the company stated. “This bright orange Stainless steel frame and TR90 temple is a truly eyecatching statement piece.”

The Jason eye size is 54/17, which will fit a large proportion of men in the Australian market.

According to Modstyle, Avanti is a respected brand in the Australian optical industry – earning the reputation as an affordable, colourful and durable eyewear range offering a wide variety of styles and materials to suit any wearer.

Email: info@modstyle.com.au

NEW MISSONI COLLECTION ARRIVES Australian optical practices now have access to the latest female collection from Italian luxury fashion brand Missoni.

Safilo Australia, which manufactures and distributes the eyewear label, launched the range in September comprising 30% sunglasses and 70% optical, which are available in 33 styles and 161 colours.

The collection is said to feature premium quality materials in the distinctive colour combinations and modern reinterpretation of Missoni’s iconic textures.

The optical price point ranges from $260 to $420, while sunglasses are $310 to $420. Missoni has split the range into a heritage and seasonal collections, featuring cat-eye wraparound sunglass, squared sunglasses, butterfly sunglasses, pilot sunglasses and squared optical frames designs. Missoni’s signature knitted graphic patterns – such as the distinctive zig-zag – are also said to be a distinguishing feature of the new collection.

Contact: 1800 252 016

OPTOS UNVEILS UPGRADES TO ITS LEADING RETINAL IMAGING DEVICE Optos has incorporated new hardware and software technology into its California ultra-widefield imaging (UWF) device, enabling practitioners to see and treat a greater range of ocular pathology.

After its launch to the Australasian market, California is said to be Optos’s premium offering to optometry and ophthalmology practices. It’s available in three versions and can offer up to six modalities.

The company’s California fa (fluorescein angiography) version incorporates the features of all Optos UWF instruments such as the ability to capture 200 degrees or up to 82% of the retina in a single image (in multiple modalities). Practitioners can also view 50% more of the retina when compared with conventional imaging devices. California fa’s design now includes a motorised head and chin rest for patients requiring extra assistance during imaging.

It's multiple imaging modalities include; 3-in-1 colour depth imaging (color, red-free and choroidal in a single image), as well as autofluorescence and fluorescein angiography.

Email: auinfo@optos. com

ACCESSORIES COMBINE FASHION WITH FUNCTIONALITY With glasses cases now considered as much a fashion statement as handbags, clutches or wallets, Good Optical Services has introduced the Sorella Double Take case.

The collection has been split into two styles – Milan and Glam – and seeks to combine contemporary design, fashion and functionality – with each case designed to carry two pairs of glasses that can double as a clutch bag.

The Milan collection is oval-shaped and available in red, black and brown leather with plain black or animal print lining. It was inspired by the styles of Melbourne and Milan where Good Optical sourced a manufacturer skilled in handmade craftmanship and a range of top grain leathers. Sorella Glam is a round-shaped collection that adopts a glamourous, luxury approach; available in a luxe rose gold, silver or black – all with a soft grey suede fabric lining.

Separately, the company has a rectangular Quad Case for travelling, which can hold four pairs of glasses or store jewellery in one half and glasses on the other. Finally, Good Optical is supplying OptiPets – creative and collectible eyeglass holders.

Originally introduced to spice up storefronts and frame counters, they have become popular with consumers, particularly children and pet owners, and could make an ideal Christmas gift.

Email: goodopt@ozemail.com.au

GLAUKOS INTRODUCES THE IPRISM SX Glaukos has unveiled a new single-use surgical gonioscopy lens that is said to provide exceptional clarity with expanded views of angle structures.

FACE A FACE MODEL ACHIEVES ‘TRUE ARTISTRY’ Eyes Right Optical has launched Bahia 2, new from French eyewear brand Face à Face Paris.

According to the Victorian eyewear distributor, the model (seen here in the colour: c.100) offers sophisticated elegance with voluptuous curves and graceful feminine silhouette.

Bahia 2’s unique acetate has its colour complemented by its absence, creating a sharp contrast and new attitude.

“This is a stunning Face a Face model which elegantly highlights the brow with bold colour distinction accentuating the beauty of the eyes,” the company stated.

“True artistry is achieved with this model offering the iconic sharply polished elegance associated with Face à Face together with adjoining integrated flex hinges.”

The frame is available in five acetate colour combinations.

Email: sales@eyesright.com.au

The iprism SX also possesses enhanced design characteristics, including integrated stabilisation features, to provide surgeons with precise lens handling during intraoperative gonioscopy procedures.

According to the company, the device can help practitioners optimise implantation of its iStent inject W, a trabecular micro-bypass procedure for glaucoma.

The iprism SX’s small, lightweight handle is designed to be held in either hand, with the short handle length also preventing interference with the microscope or advanced microscope attachments.

The biconic optic is said to offer a 1.25 magnified view of angle structures and an overall wide, clear view of the anterior chamber, while the lens dimensions account for expanded incision access.

Additionally, the gentle stabilisation features that are integrated into the gonioprism helps to centre the view and provide steady control. Alignment guides also enable confident stent placement for the practitioner by optimising positioning and clock hour spacing.

Contact: www.glaukos.com

INSIGHT December 2020 25

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NEW DEVICE COMBATS GROWING MYOPIA AND DRY EYE CRISES Topcon Healthcare's latest instrument for eye health practices wanting to strengthen their myopia and dry eye services is now available in Australia.

Myah, exclusively distributed by Device Technologies in Australia and New Zealand since October, is a versatile device providing the key tools for myopia management and an evolving platform for dry eye management.

According to Topcon, the instrument’s myopia features include optical biometry, corneal topography, pupillometry, comparison and differential map, contact lens fitting simulation and keratoconus screening. In dry eye, practitioners can conduct non-invasive tear break-up time, meibomian gland analysis, blink analysis, tear meniscus height analysis and real fluorescein imaging and video acquisition. The instrument is also said to be compact, simple to operate, and offers rapid capture.

“Myah is ideally suited to combat the growing crises of both myopia and dry eye disease. Its versatility and ease of use allows eyecare professionals to easily build a myopia service within their practice, educate patients on the implications of myopia and dry eye disease, manage their patients’ conditions, and grow their service offerings,” Topcon stated.

Email: topconmyah@device.com.au

FRESH CAMPAIGN SUPPORTS POLARISED LENS SALES THIS SUMMER In time for the summer sunglass selling season, Younger Optics has launched a stunning NuPolar campaign to be used by optical stores.

The campaign – ‘You’ve never seen better’ – uses what the company describes as incredible scenery images that are bright, vibrant and crisp, which are intended to represent the visual experience of NuPolar polarised lenses.

Younger Optics has produced new NuPolar window posters, window decals, counter cards, patient brochures and digital resources to use in-practice. Also available are polarised lens demonstration tools and glare demonstrators. The campaign resources and tools are designed to better support patient polarised lens discussions and to refresh store materials.

According to the company, NuPolar is available in the widest range of colours, styles and materials on the market and can be fit into almost any frame including nylon, three piece and wrap. Styles include solid tint, gradient tint, mirror finish and polarized photochromic.

Email: info@youngeroptics.com.au

COOPERVISION RELEASES TORIC MULTIFOCAL FOR DISTINCT PATIENT COHORT

SOFTWARE FOR EFFICIENT CATARACT WORKFLOW The EQ Workplace is the latest addition to the Zeiss Cataract Suite helping surgeons streamline their refractive cataract workflow.

From biometry and calculating IOLs to surgical planning and postoperative data collection, the software helps surgeons to save time, access data from anywhere and avoid human error.

Based on Zeiss’s Forum, EQ Workplace enables single-click transfer and auto-population of data, saving time pre-operatively.

Biometry data from the IOLMaster may be accessed remotely, allowing calculation and selection of IOLs in any location.

Surgery can also be pre-planned remotely and surgical assistance functions prepared by connecting to the Zeiss Callisto eye so when surgery begins, all relevant assistant functions are already pre-set. With the separately available EQ Mobile app, biometric and surgical planning data automatically uploads to the cloud for remote access via iPad or iPhone.

In July this year, CooperVision Australia and New Zealand added a toric multifocal to its extensive family of Biofinity contact lenses.

The new design helps eyecare professionals address the demands of more patients, providing more than 200,000 unique prescription options for patients who are both astigmatic and presbyopic.

According to the company, existing and emerging presbyopes represent a major practice growth opportunity – and a significant proportion of them have astigmatism.

“Optometrists now have an easy-to-fit lens, using familiar lens design technologies and the proven Biofinity silicone hydrogel material, helping them address the vision and lifestyle needs of more presbyopes,” the company stated.

The Biofinity toric multifocal is made to order with a normal lead time of 10 to 15 working days.

Email: cs@au.coopervision.com

Email: med.au@zeiss.com

INSIGHT December 2020 27

REVIEW MARCH The government announces unprecedented measures to bring COVID-19 under control, shutting down elective surgery and limiting eyecare services.

JANUARY South Australian ophthalmologist Dr James Muecke announced Australian of the Year.

Insight takes a look at the innovations, breakthroughs, setbacks, events and stories that shaped the Australian ophthalmic sector in 2020.

2

020 has been a tough year for the nation and its businesses, first ravaged by bushfires before being brought to their knees by the ongoing public health pandemic.

But – as it has done through previous downturns and disasters – the eyecare sector has proven resilient as Australians continue to place great importance on their eye health.

While concerns remain about the backlog of undiagnosed and untreated conditions, we have seen a new frontier in ophthalmic treatments emerge, while eye health practitioners have received some of the country’s highest honours.

Insight examines what made headlines this year across business, therapies, technology, policy, leadership, research and Indigenous eye health.

BUSINESS For many optometry and ophthalmology practices and their suppliers, the stress and uncertainty endured through March, April and May will remain one of the defining periods of 2020.

28

INSIGHT December 2020

MAY The Federal Government approves standalone MIGS under Medicare after advocacy from the sector.

As state and federal governments took unprecedented action to bring the COVID-19 outbreak under control, eye health providers were limited to urgent cases and required to usher in a raft of costly hygiene and infection protocols, the likes of which they have never seen before.

A survey to gauge the pandemic’s impact on the eyecare sector and quantify industry confidence demonstrated that half felt the pandemic had a ‘very negative’ effect on businesses and the industry was split on how long it would take for their businesses to return to normal levels of service.

Despite these concerns, when business resumed in June, practice owners reported record sales, with the size of the rebound surprising many several months on. However, a second wave forced Victoria into lockdown again from August to October, causing more pain.

COVID-19 also delayed the Federal Budget announcement until October, with the government unveiling a fiscal plan aimed at creating jobs and kick-starting investment.

In addition to an immediate asset write-off on the full value of new equipment, one of the most notable items was a 50% wage subsidy for practices that employ and train new optical dispensers.

As Australia emerged from the pandemic, Specsavers unveiled further expansion plans, with five new stores in Seaford and Port Lincoln in South Australia, Warwick in Queensland, Newcastle in New South Wales and Belgrave in Victoria, with more to be announced.

The Australian Competition and Consumer Commission (ACCC) also put several eyecare businesses under the microscope.

JUNE

OCTOBER

Australia begins to reopen after the first lockdown, leading to a record surge in eye appointments and product sales.

Major wage subsidy in the Federal Budget for optical dispensing.

Routine eyecare returns in Victoria.

AUGUST

NOVEMBER

Second COVID-19 outbreak takes grip in Victoria, with Stage 4 restrictions leading to a shutdown of routine eyecare.

TGA also approves Luxturna – Australia’s first true gene therapy.

New AIHW data shows more Indigenous Australians are accessing eye health services than ever before.

First, it cleared Ellex Medical Lasers’ $100 million sale of its laser and ultrasound business to French technology company Lumibird in June, with Ellex subsequently changing its name to Nova Eye Medical and focusing on glaucoma.

In the dry eye segment, Sun Pharma’s Cequa (ciclosporin 900 microgram/ mL) became the first TGA-approved immunosuppressant for the treatment of moderate-to-severe dry eye. And the highly anticipated Xiidra finally reached Australian shores and is being marketed by Novartis.

In September, the ACCC ordered Oscar Wylee to pay $3.5 million in penalties for making false or misleading representations about its charitable donations and affiliations. In the same month, the authority approved a merger between global pharmaceutical companies Mylan and Pfizer-owned Upjohn on the condition that they sell two glaucoma treatments (Xalatan and Xalacom) to Aspen to appease competition concerns.

TECHNOLOGY

Just as Insight went to print, Australian firm The Optical Company (TOC) announced it had been a acquired by ASX-listed allied health group Healthia for $43 million. TOC is a 14-year-old vertically integrated optical group specialising in optometry services, retail and eyewear distribution, which operates 41 stores under multiple names.

THERAPIES Aside from COVID-19, another marquee moment of 2020 occurred in August when the Therapeutics Goods Administration (TGA) approved Australia’s first true gene therapy, Luxturna, for a rare form of inherited retinal disease. With many similar therapies in active clinical trials, it’s anticipated that this could open the floodgates for other forms of retinal disease.

The following month Novartis announced TGA approval of Lucentis (ranibizumab) for treating proliferative diabetic retinopathy in adults. It is the first pharmacological therapy in Australia for the vision-threatening complication of diabetes – and the sixth indication for Lucentis.

Earlier in the year, Australian regulators approved another Novartis’ therapy – anti-VEGF treatment Beovu (brolucizumab) – for neovascular age-related macular degeneration (nAMD). However, the company is still pursuing a Pharmaceutical Benefits Scheme (PBS) listing after the Pharmaceutical Benefits Advisory Committee (PBAC) recommended not to list the therapy on several occasions.

The technological advance that created most fanfare was Alcon’s new AcrySof IQ Vivity Extended Vision IOL, which some Australian ophthalmologists have billed as a new class in presbyopia-correcting intraocular lens (IOL) technology due to its ability to negate visual disturbances – the bane of many EDOF and multifocal IOL designs.

In the spectacle lens segment, Hoya introduced its new myopia control lens MiyoSmart, developed on the back of a two-year double-blind randomised clinical trial in Hong Kong that showed wearing defocus spectacle lenses daily significantly slows progression and axial elongation in myopic children aged eight to 13. Children wearing defocus lenses reportedly had 60% less myopia progression compared with those wearing single-vision lenses.

Melbourne-based OCT manufacturer Cylite continued to chase European and a subsequent TGA approval for its Hyperparallel OCT (HP-OCT) system, which snared Engineers Australia's top award in November.

In Hobart, optometrist Mr Ben Armitage revealed he is working with designers in Melbourne to develop the third prototype of a patented handheld device to test driver vision by the roadside, known as Acuidrive.

POLICY In a major win for glaucoma patients, the Australian Society of Ophthalmologists (ASO) and other stakeholders in May successfully lobbied the Federal Government to support a recommendation for standalone minimally invasive glaucoma surgery (MIGS) under Medicare.

As a result, Australia become the first major developed economy to universally approve the procedure in both public and private settings.

This came after a 2017 change in item number regulations threatened

INSIGHT December 2020 29

REVIEW

funding for all MIGS procedures. The issue was only partially addressed in 2018 when the government approved a new item number but limited its availability to those simultaneously undergoing cataract surgery, prompting the ASO to take further action.

subsequently emerged as key methods of addressing ballooning waiting lists. However, it was not initially well-received in NSW where medical lobbyists stated that surgeons in private hospitals would be reluctant to help clear the public elective surgery backlog at Medicare rates.

The optometric sector didn’t have the same luck in its own battle with Medicare. With the pandemic limiting patient movements, Optometry Australia was joined by Specsavers, Luxottica and Diabetes Australia in advocating for inclusion of optometry-specific telehealth items during the pandemic period and when face-to-face care wasn’t accessible.

Before the issue could be debated further, the second COVID-19 crisis struck Victoria in July, resulting in a series of announcements that ultimately placed a ban on all Category 3 and non-urgent Category 2 surgeries.

Despite much optimism – and the fact rebates were created for other health services – it never eventuated. This was viewed as a missed opportunity, with OA stating the Federal Government’s reticence was exacerbating the sector’s recovery.

Meanwhile, the sector continues to eagerly await the final report of the MBS Taskforce Reviews into ophthalmology and optometry items.

The most controversial proposals relate to ophthalmology, which – if approved – could result in a dramatic drop in the fee for intravitreal injections and allow trained optometrists and nurses to perform the procedure.

PEOPLE AND LEADERSHIP This year’s most notable accolade went to South Australian eye surgeon and Sight for All co-founder Dr James Muecke who was named Australian of Year for his efforts to reduce rates of preventable blindness both locally and abroad.

Muecke has also supported lobbying of the South Australian state government to develop Adelaide’s first dedicated public eye hospital.

Spearheaded by his colleague Professor Robert Casson, the new outpatient facility would be based in the CBD and replace ophthalmology departments within larger general hospitals in Adelaide.

In June, RANZCO Fellows Dr Harold Spiro and Dr Arthur Briner, both from Queensland, were each awarded the Medal of the Order of Australia (OAM) in the Queen’s Birthday Honours. NSW optometrist Dr William Trinh received an OAM for service to international humanitarian medical programs and optometry, while theatre nurse Ms Alison Plain was recognised for her service to Indonesia through the Sumba Eye Program.

Professor Nitin Verma became the new RANZCO president in October, taking over from Associate Professor Heather Mack, the first female to hold the position in the college’s 50-year history. Verma is a prominent ophthalmologist based in Hobert who co-developed one of the world’s first foldable intraocular lenses (IOL) made from silicon in 1985 and set up the East Timor Eye Program in 2000.

Leadership at the ASO also changed hands; vice-president Associate Professor Ashish Agar stepped into the role of president, while his predecessor Dr Peter Sumich became his deputy.

ELECTIVE SURGERY In late March, Prime Minister Scott Morrison took the unprecedented step to suspend all non-critical elective surgeries as the health sector braced for a looming public health emergency in response to the COVID-19 pandemic.

Within days, RANZCO published new triage guidelines and warned of the potential ramifications for ophthalmologists that performed unnecessary procedures during the government-imposed suspension.

After a month-long pause, in late April, the college released a new resource to help ophthalmologists navigate the return of elective eye surgery, cautioning that operating lists and through-put would be restricted by social distancing and infective precautions.

The subsequent backlog of patients became a major concern, reaching fever pitch in early July when most state governments unveiled a multimillion-dollar elective surgery blitz to tackle the growing problem.

Public treatment in private hospitals and after-hours surgery lists

30

INSIGHT December 2020

More than two months later, the Victorian Government announced a gradual return to elective surgery with limits on capacity.

RESEARCH The pandemic sparked a multitude of studies investigating ocular manifestations and the risk of transmission to eyecare practitioners.

Aerosol and spatter generation in some ophthalmic procedures had been a concern during the COVID-19 pandemic, but University of Auckland researchers found no visible contamination above the neckline of cataract surgeons performing phacoemulsification.

In separate research led by Australia’s Professor Mark Willcox, a review of evidence indicated the eye is an unlikely site for SARS‐CoV‐2 infection, suggesting coronaviruses are unlikely to bind to ocular surface cells to initiate infection.

Internationally, one small study revealed the potential for asymptomatic carriers who have passed COVID-19 triage to leave traces of viral material in the ophthalmology exam room – even after wiping down chin and forehead rests between patients.

A group of international ophthalmologists developed a video simulation demonstrating that slit lamp breath shields did not provide full protection from respiratory droplets, but spread was minimised significantly when patients wore a mask.

In other research, Australia’s first myopia management survey (conducted in 2016 and results released in 2020) revealed single‐vision distance spectacles are the mainstay of myopia correction in school‐ aged children, despite awareness among practitioners of the potential effectiveness of other interventions.

And it was also revealed that Australian agencies are collaborating with technology firm Big Picture Medical in a $12 million project to develop an AI-assisted platform that can reduce inappropriate patient management and cut the false-positive rate at the primary point-of-care.

INDIGENOUS EYE HEALTH In February, a long-term plan to establish the first eye health clinic outside of the Perth metropolitan region came to fruition when Lions Outback Vision commenced work on transforming a former backpacker accommodation into a new eye health clinic in Broome.

Known as the North West Hub, it will feature at least two resident ophthalmologists available for 24-hour emergency support. Through a hub-and-spoke model, it will also service six towns through outreach services, while providing access to ophthalmology and telehealth clinics, seminar rooms and space for community diabetic health education.

In June, there were fears the cataract surgery backlog could unfairly disadvantage Aboriginal and Torres Strait Islander patients.

With public wait times expected to blow out by up to two years, RANZCO and The Fred Hollows Foundation jointly encouraged private hospitals to offer capacity and encouraged ophthalmologists to bulk bill Indigenous patients.

Then last month, the Australian Institute of Health and Welfare published its fourth annual report into Indigenous eye health measures showing that more Indigenous Australians are accessing eye health services than ever before, with significant strides reported in cataract surgery rates and the suppression of trachoma. n

MiSight 1 day: * available now ®

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Daily disposable soft contact lenses Proven to significantly slow the progression of myopia1 The first and only FDA-approved product to slow myopia progression^

*Available for practices who meet accreditation criteria. Contact MiSight1day@au.coopervision.com for more information. 1. Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. A 3-year Randomised Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019; 96(8):556-567. ^Applicable in the USA: Indications for use: MiSight® (omafilcon A) daily wear single use soft contact lenses are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 dioptres (spherical equivalent) with ≤ 0.75 dioptres of astigmatism. The lens is to be discarded after each removal.

CONTACT LENSES

KIDS AND CONTACT LENSES A multitude of studies both on self-esteem and myopia control show kids as young as eight can manage contact lenses safely and competently. Insight speaks with eyecare practitioners and academics about treating this younger age group.

S

port has many benefits for children beyond their physical health, with studies showing it can have a bearing on their emotional and social development by teaching them important life skills.

For many children, their vision – or use of spectacles – can be a barrier to these vital interactions, hence why researchers and practitioners note that it is a common entry point into contact lens wear.

Contact lenses also give children new-found confidence.

A randomised trial of the effect of contact lens wear on selfperception in children published more than a decade ago showed pre-teen children aged eight to 11 felt their physical appearance, athletic competence and social acceptance improved compared with spectacle wear.

The same study concluded that eyecare practitioners should consider the social and visual benefits of contact lenses when choosing the most appropriate vision correction modality for children as young as eight.

Today – with the alarming rise of myopia – there has never

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INSIGHT December 2020

been greater demand for contact lenses among the paediatric population, which is fuelling rapid advances in lens design and technology.

But contact lenses generally come with greater safety risks through noncompliance. And perceived complexity of management, increased chair time and cost to parents can be key concerns for practitioners.

CUSTOMISATION IN GROWING MARKET Dr Philip Cheng is director of The Myopia Clinic, in the Melbourne suburb of Kew, offering a comprehensive myopia control and orthokeratology (orthoK) service.

Alarmingly, during the past six months, he has noticed a drastic rise in myopia.

“I’m seeing more children diagnosed with myopia for the first time, young kids with high myopia who have progressed rapidly, and at-risk children with axial length increase. I’ve seen a discernible change, which I think is environmental, as a result of the extended Stage 4 lockdowns in metropolitan Melbourne,” he says.

Cheng is noticing more awareness of orthoK among parents and is receiving more referrals from friends and families of existing patients.

“Myopia management is growing as an area of expertise – a service – but until recently the products and the concepts have essentially been the same,” he says.

“Now, we’re seeing manufacturers developing lenses specifically for myopia control. Soft multifocal contact lenses such as CooperVision’s MiSight 1day have gained traction. Once it got FDA approval in the US [in November 2019], it bought it into frame a bit more here, and now we’re seeing the real-life results.”

Cheng keeps abreast of developments in this segment and says research results can be sceptical but seeing soft multifocal contact lenses work in real-life quells any doubts.

“As the MiSight power range is limited to -6 dioptres, I also prescribe NaturalVue Multifocal 1 day contact lenses from Visioneering Technologies (VTI) in the US which goes up to -12.25 dioptres,” Cheng says.

“Spanish company mark’ennovy produce a monthly-replacement contact lens, Mylo, which has been on the market for about a year. They licensed the Brien Holden Vision Institute (BHVI)’s extended depth of focus (EDOF) technology to create their customised lens but it takes around three weeks to get trial lenses.”

With a greater body of evidence supporting the use of soft contact lenses for myopia control in children, more companies are investing to get a foothold in the market.

In July, Johnson & Johnson reportedly received FDA’s Breakthrough Device designation for its myopia control lens. Then, in October, Bausch + Lomb announced it had acquired an exclusive license for a myopia control contact lens design developed by BHVI. Cheng says although contact lenses for kids are a great option, the safety aspect is paramount.

“Parents worry about how their child might cope with trying contact lenses for the first time. I saw a 10-year-old child recently who was scared about trying contacts. It helps to demonstrate that it’s a soft piece of plastic; let them touch it. Once the lens was on her eye she loved it, and amazed she could see clearly again,” Cheng says.

“I also discuss safety risks and hygiene. I find kids do well when it comes to compliance – better than teens, who can get complacent.”

To help demonstrate this, in 2017, Professor Mark Bullimore, a name synonymous with myopia management from the University of Houston, published a review on the safety of soft contact lenses in children, in response to increasing interest in the past decade in fitting children with contact lenses.

The overall picture showed that the incidence of corneal infiltrative events

Dr Philip Cheng, director of The Myopia Clinic, has found young children do better than teens when it comes to contact lens compliance.

in children was no higher than in adults, and in the youngest age range of eight to 11 years, it may be markedly lower which he attributed to better compliance and closer parental supervision.

More recently, a study by Australian optometrist Dr Kate Gifford found the comparative lifetime risks of contact lens wear starting at age eight for myopia control are less than the lifetime risks of vision impairment with myopia more than 6 dioptres or axial length more than 26 mm.

In Gifford’s view, eyecare practitioners should be confident to proactively recommend myopia control contact lens wear to younger children, as both the safety profile and potential preventative ocular health benefits are evident.

Cheng says he also emphasises that myopia control contact lenses are a long-term treatment, not a quick fix. He cautions patients against only relying on treatment, highlighting environmental factors such as excessive screen time, reading and indoor time can have a detrimental effect on myopia.

TALKING THE TALK Like Cheng’s clinic in inner-Melbourne, optometrist Ms Jessica Chi at Eyetech Optometrists in Carlton is also noticing an increase in myopia progression in patients who have been otherwise stable.

“Generally speaking, we’re seeing more kids with myopia now than in the past – not just East Asian kids but now Caucasian kids too. And after seven months of lockdown in Melbourne, we’re seeing more myopia progression. Why? Kids are spending less time outdoors and more time on screens during home-schooling,” Chi says.

In June this year, Chi was invited to give a lecture at Optometry Australia’s Optometry Virtually Connected conference where she spoke about contact lens options for children and teenagers, and the benefits and challenges in managing this younger age group.

Drawing on 13 years’ experience in prescribing paediatric contact lenses, first at Richard Lindsay & Associates in East Melbourne and now at Eyetech, Chi says introducing kids and parents to contact lenses and their capacity to significantly improve quality of life is extremely rewarding.

“Language is important when discussing contact lenses. I talk about the benefits of contact lenses, and discuss the times when glasses are annoying; slipping and fogging et cetera. I show kids what contact lenses look like and encourage kids to touch them, so they get a sense

INSIGHT December 2020 33

CONTACT LENSES

of their softness. Many kids think inserting contact lenses is going to hurt. I wear contact lenses so I give a self-demonstration to show it’s not painful,” Chi explains.

“Sometimes kids aren’t ready to wear contact lenses after an initial introduction but at least by discussing it and handling a lens, they’re familiarising themselves with it and that plants a seed. Sometimes they’ll think about it and want to try again later.”

Chi says it’s also important to talk about the “why” behind wearing contact lenses.

“I talk about myopia control, and the repercussions of not wearing prescribed contact lenses. But this is more relevant for teenagers. I also believe it’s important to speak directly to the child – not just the parent – as this gives them a sense of ownership,” she says.

research into behavioural and host immune susceptibility to eye infections at UNSW and Westmead Institute for Medical Research.

She says it’s important for practitioners and contact lens wearers to have conversations about contact lens wear safety with all patients.

“Practitioners should also consider providing a consent form for patients.

Contact lenses are a medical device and like surgery – which requires a consent form – patients should know the risks.”

Crucially, she says patients should be aware that, contrary to popular marketing images, contact lenses and water don’t mix. Carnt was integral in getting ‘no water’ stickers for contact lens packaging endorsed by respective British, American and Australian contact lens associations.

In Chi’s experience, daily disposables are the best option for young children.

Optometrists can get the stickers from the Cornea & Contact Lens Society of Australia (CCLSA), which have right and left markings on them, so they can be placed on contact lens packaging and any paraphernalia, such as storage cases.

“The more disposable, the better. Parents worry about infections, and I explain kids are less likely to have infections with daily disposables, and kids thrive on routine.”

“The ‘no water’ stickers are what’s known in the industry as a ‘nudge’ to remind people, a visual reminder for patients not to use water with contact lenses,” Carnt explains.

She notes other innovations have helped make it easier to practice healthy contact lens wear, such as Menicon’s Miru 1-day flat pack, which keeps the inner surface of the contact lens facing downward to hygienically remove a contact lens without touching its inner surface.

Passionate about safer contact lens wear and minimising risk of severe infection, Carnt points to the latest data from leading academic Professor Fiona Stapleton on contact lens‐related corneal infection in Australia.

PHILIP CHENG

JESSICA CHI

THE MYOPIA CLINIC

EYETECH OPTOMETRISTS

Children are generally more compliant than anticipated, Chi says, because they are accustomed to following instructions and attend followup appointments as they are supervised by their parents.

“It’s a satisfying aspect of clinical practice when you see a young patient develop more confidence as a result of wearing contact lenses. It can significantly improve their quality of life – their academic and sporting life, and their self-perception.”

SAFETY AND CONSENT By her own admission, Dr Nicole Carnt, chair of the Australian Standards Committee on Contact Lenses, has become more vocal on contact lens safety during the past five years.

A turning point in her advocacy came during a stint at Moorfields Eye Hospital in London as part of her post-doctoral research on microbial keratitis.

There, she witnessed a 14-year-old boy who needed an eye removed due to a corneal infection from Acanthamoeba due to contact lens wear.

“He was a -3 myope who wore contact lenses to play football and happened to live in a suburb with ‘hard water’ – water that has high mineral content; in this case, limescale – on which bacterial biofilm grow, forming a food source for Acanthamoeba,” Carnt recalls.

A recent study led by Carnt conducted across greater Sydney found 29% of domestic tap water supply samples collected during summer and winter were contaminated with free living Acanthamoeba.

Now a Scientia Senior Lecturer at UNSW, Carnt leads a program of

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INSIGHT December 2020

In a paper published in Clinical and Experimental Optometry in May this year, Stapleton surmised that given the growing enthusiasm for contact lens modalities for myopia control, “it is timely to consider the rates and risks of microbial keratitis with both orthokeratology and soft multifocal contact lens use in a paediatric population”.

“Previous studies of contact lens‐related microbial keratitis have almost exclusively focused on adults and there are limited data on children wearing standard contact lenses. Hospital audits of paediatric microbial keratitis have been published but there are no population‐based studies,” Stapleton noted.

“One approach may be to use registry, myopia control product registration or case‐control studies to explore the risks in this population and to ensure that overnight orthokeratology and soft contact lenses rates are disaggregated.”

Despite the work of researchers like Stapleton and Dr Robin Charmers in the US, who has also studied safety of paediatric soft contact lens wear, Carnt says there are other considerations which are not often spoken about, such as how the immune system differs for a child compared to an adult, and how immune system status can change with prolonged contact lens wear.

“We don’t know how that will play out. Does it make kids more or less prone to infection? We don’t know. There are many unanswered questions,” Carnt says.

She also notes that skepticism of research results may be warranted.

“A lot of information and results from industry-sponsored trials don’t necessarily translate into real-world experience. People behave differently in trials; they receive regular care and are closely looked after. Trials generally recruit healthy people, and don’t represent the diversity of patients coming in the door of a regular practice,” she says.

“For example, silicon hydrogel extended wear clinical trials indicated a lower risk of microbial keratitis than hydrogels but in the market, this has not been the case, due to different demographics and different conditions.

“If it weren’t for the myopia epidemic, we wouldn’t be in this situation of being so proactive in fitting contact lenses in kids.”

MANAGING MOTIVATION

– and parents – at the UNSW Myopia Clinic are highly motivated.

Carnt’s UNSW colleague, Dr Pauline Kang, see’s several paediatric patients at the university’s Myopia Clinic, which opened in 2015.

“They’ve typically been referred to us, so they are motivated – they want treatment and results. But generally speaking, patients who are prescribed orthokeratology are particularly motivated. It’s a specialty technique, involves a significant financial investment, often paying up front, which motivates compliance,” Kang says.

“Our paediatric patients range from as young as five, to late teens. We get referrals locally, and we also offer an option to manage or co-manage patients, like a stepping-stone for optometrists gaining experience in myopia management,” Kang says.

“Multifocal soft contact lens compliance depends to some extent on how practices charge. It requires more chair time, so practices may charge extra, which in turn can motivate patients. We see our multifocal soft contact lens patients at least every six months.”

When it comes to safety, Kang says the clinic goes through a detailed safety discussion with patients and uses an informed consent form to make sure they’ve ticked all the boxes to protect both the patients and the clinic to mitigate risk.

“We educate parents and patients, including teaching them to recognise when there’s an issue, and what to do. I try to give the child a sense of responsibility; I give them homework for when they come to see me, which I find helps with compliance.

NICOLE CARNT

PAULINE KANG

UNSW, SENIOR LECTURER

UNSW, MYOPIA CLINIC

A senior lecturer who coordinates the clinic, Kang’s own research focuses on better understanding how different contact lenses induce myopia control effects.

She’s seeing a shift in practitioner mindset from the well-established use of orthoK towards the use of multifocal soft contact lenses. When it comes to contact lens wear compliance among children, Kang finds the patients

“I use multiple modes of instructions for contact lens wear. I provide instructions verbally and in writing, which all practitioners should do, and I also recommend websites and reputable online videos on how to insert and remove contact lenses. I also book patient’s after-care appointments in advance.”

She says practitioners shouldn’t be nervous or fearful to prescribe contact lenses to kids.

“I always find it’s the adults who complain – not the kids. Rigid lenses can be uncomfortable to wear but kids are adaptable. Practitioners should be open to trying contact lenses on kids – they handle lenses well and studies show contact lenses do improve quality of life.” n

ONLY MYOPIA CONTROL TREATMENT WITH FDA APPROVAL He says CooperVision is investing heavily locally and globally to support practitioners and wearers including the development of child-friendly instructional materials.

CooperVision professional services manager Mr Joe Tanner says the evidence supports the safety and efficacy of the company’s MiSight 1 day contact lenses.

“In terms of safety generally, we refer to Professor Mark Bullimore’s extensive 2017 review on the safety of soft contact lenses in children, and his finding that the incidence of corneal infiltrative events in children is no higher than in adults, and in eight- to 11-year olds, it may be markedly lower.”

Tanner says the ongoing multi-centre study CooperVision commissioned in 2012 has had excellent clinical results, with the first three years’ results published in Optometry and Vision Science in 2019.

“A large component was looking at the safety profile and the results echo those highlighted in the Bullimore review,” he says.

Tanner says the results of the first three years were integral to MiSight 1 day receiving US FDA approval.

“It [FDA] set a pretty tough standard

“Our ongoing MiSight 1 day study shows how quickly kids become self-sufficient at applying and removing lenses with the right support within the first few weeks,” he says.

“Importantly, the great majority of children express a preference for wearing contact lenses over spectacles.”

Mr Joe Tanner, CooperVision.

because the MiSight 1 day lens is specifically intended for children,” Tanner says.

“We were able to meet the FDA’s stringent safety and efficacy requirements. So far, MiSight 1 day remains the only treatment of any kind with FDA approval for slowing the progression of myopia in children."

INSIGHT December 2020 35

Dr Jayson Stone outside his new practice Seekers Optical in Melbourne.

FEATURE

NO BOUNDARIES: PURCHASING IN A PANDEMIC Opening a new practice during a pandemic in Australia’s hardest-hit city has thrown up its challenges, especially when it comes to purchasing big ticket items. But DR JAYSON STONE found a way thanks to the efforts of a major supplier.

O

ptometrist Dr Jayson Stone has just embarked on the biggest gamble of his career.

After almost 18 years in the optical industry, this month he opens a new practice – Seekers Optical – in Gertrude Street; an iconic strip brimming with bars, boutiques and galleries that’s a microcosm of the trendy inner Melbourne suburb of Fitzroy.

For Stone, who became an optical dispenser in 2003 before completing his training as an optometrist in 2016, this is his first incursion into business ownership, never mind the fact he is establishing a greenfield practice amid Australia’s first recession in almost three decades.

There is a lot to think about. He’s secured a supreme piece of real estate, arranged the finance and hired two optical dispensers. He’s also sourced his lenses and frame ranges and set aside a substantial marketing fund to announce his arrival.

But Stone is largely pinning the business’s future success on two aspects: the practice’s aesthetic and advanced diagnostic equipment.

“I’ve been an optometrist now for almost five years across both corporate and independent, but in my time, I have found independents have fallen behind with their interior design and the diagnostic equipment because the costs are so great,” he says.

“So, I decided to open my own practice and we have got a local wellknown architectural firm, Flack Studio, doing the fit out and interior so that

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INSIGHT December 2020

it looks like a global store. We’re also backing it with a large marketing budget and filling it with the most advanced diagnostic equipment so we can offer the best to our patients.”

The COVID-19 crisis has thrown many obstacles in the way of business owners. For Stone, two waves of restrictions in Melbourne thwarted his ability to conduct all-important face-to-face meetings with architects, builders and suppliers.

As a result, he faced the daunting prospect of purchasing equipment – his largest investment – that he couldn’t see or trial in-person. His extensive wish-list included a chair and stand, digital phoropter, Topcon Maestro2 OCT machine, slit lamp with retinal imaging, visual fields analyser, vertometer, autorefractor and keratometer.

“An optometrist is only as good as their tools, without them we’ve got nothing to diagnose with, so for me it’s important to get it right,” Stone says.

After contacting several companies, it was a phone call from Mr Joe Way at Device Technologies in Sydney that quelled anxieties he had about the process.

“From each of the suppliers I wanted to know the make and model they could supply, rough costing, time to deliver and time for installation.

By then we were in lockdown and I received some emailed responses, but Device Technologies rang me, and their approach seemed the most holistic,” he says.

A series of webinar and Zoom meetings followed where Stone was systematically shown each piece of equipment followed by demonstrations. Additional meetings were held at later dates as more questions cropped up.

“I’m also familiar with the Topcon brand – which is very reputable – and have used some of it over the years, so not only were they providing me with the best service online, but some of their equipment was the best available,” he says. “Even though I’m the optometrist I’m not necessarily the only person using this equipment, sometimes you’ll have dispensing

staff taking measurements and scans, so for them to be able to demonstrate the ease-of-use was really important to me as well.”

OVERHAULING CLIENT INTERACTIONS The Australian headquarters of Device Technologies is located in the Sydney suburb of Belrose, an approximate 35-minute drive north from the CBD into the North Beaches Local Government Area.

There, ophthalmic diagnostics product manager Mr Angus Hatfield-Smith says one of the company’s greatest assets is its 144sqm showroom where the majority of its equipment has been assembled and configured for live scenario use.

Prior to the pandemic, eyecare professionals like Stone would visit from interstate to meet the sales reps and give the equipment a thorough workout.

“We are very lucky to have our showroom, it provides potential customers a unique opportunity to use the equipment we provide, which often will remain part of their clinic for decades to come,” Hatfield-Smith explains.

Device Technologies's showroom features fully operational equipment.

“It’s been well received by customers who can come in to see, touch and feel the equipment to get a comprehensive understanding for what they’re potentially going to spend a lot of money on. It’s equipment they’re going to have for the next 20 years, so it’s important to know exactly what you’re getting.”

But Device Technologies’ reliance on its showroom has been limited to Sydney clients only for much of the year due to COVID-19 state border closures. Travel restrictions have also blocked the company from getting in front of optometrists and ophthalmologists at the usual trade events this year.

As a result, it prompted a rethink of how the company could effectively market, sell and demonstrate its equipment to eyecare professionals, many whom have been keen to upgrade their instruments as part of the government’s instant asset write off scheme.

“We asked our marketing and digital team to provide video access to customers so they could see the equipment in a virtual tour, as if they were there in the showroom. It was pretty basic, but it had a really positive impact on customer interactions. They are making major purchasing decisions and it’s tough to do that from a brochure, so in the current context, it was a nice way to bridge of the gap,” Hatfield-Smith explains.

“In Jayson’s case, we took him through the functions of the chair and stands, the slit lamps, and automated refraction equipment, as well as the OCTs through the video link, enabling us to demonstrate basically everything we believe to be important with our technology.

“We also had the capability to give him a link to a PC that had our software containing our demonstration data which allowed us to take him from the live, showroom walkthrough feed, into another area where he could see our software on his computer screen as if he were at a trade show. That way he could see the same workflow and processes that he would if he was in practice.”

SHIFTING PRIORITIES In addition to the way ophthalmic device suppliers interact with clients, COVID-19 has altered the type of equipment in demand.

Hatfield-Smith says eyecare professionals have been keen to minimise the risk of infection, which has led to a surge in inquiries about breath shields, automated refractive equipment and tonometers.

“We have seen a growing interest towards digital refraction devices such as the Topcon CV-5000, which is a computerised refractor head. With a conventional phoropter head you need to stand close to the patient to adjust the dials manually. But in this current climate, there is increased risk in performing a refraction that way, and so the computerised version keeps clinicians away from the patient – they can sit at their desk with a digital touch screen controller and can change the refractive powers of the phoropter head at a safer distance to the patient,” he says.

The 144sqm showroom is located at the company's Sydney headquarters.

Another COVID-19-related trend has been increased interest in disposable, single use tonometer prism systems. Hatfield-Smith says conventional Goldmann applanation tonometry adopts a reusable prism that requires sterilisation between uses.

“Haag-Streit have a system called Tonosafe. It replaces the re-usable prism with a re-usable holder, and a disposable tip, allowing clinicians to simply dispose the component that touches the eye. It’s a very minor adjustment to their standard Haag-Streit tonometer system and a lot of customers feel it’s another small risk taken away,” he explains.

THE ROAD AHEAD In the lead up to opening his first practice, Stone doesn’t know if his stress levels are any different to what they would have been under normal circumstances, but the smooth equipment purchase process has been one less thing to worry about.

Since enlisting the services of Device Technologies, he says the company has also liaised with the architectural firm to ensure power and data points are correctly located so there will be no glitches once he goes live.

With everything in place, he’s been able to focus his attention on how he will run the practice. He’s feeling optimistic.

“When the practice I currently work at reopened in June, that was its highest grossing month in 12-plus years of operating. The restrictions brought people out spending, so now we’re out of another lockdown I’m hoping we can harness that along with the traditionally busy December and January period,” Stone says.

“People are also less likely to travel overseas or interstate, which means we have this captured audience, so we will need to show that we have got what they need for the Christmas, New Year or summer period. We’re excited and anxious to get going.” n

INSIGHT December 2020 37

BUSINESS

BUYING INTO THE INDEPENDENT

As the current economic climate prompts optometrists to reconsider practice valuations, exit plans and buyer interest, RHIANNON BOWMAN reflects on where opportunities lie for the next generation of independent practice owners.

B

uying an existing business generally carries less risk than starting a new one – and this holds true in optometry where the unique combination of clinical expertise and retail services provide the foundations for a resilient sector.

Purchasing an established independent practice has several advantages, including immediate cash flow and a proven financial history, which serve as a predictor of future success while providing a smooth pathway to securing financial assistance.

There’s also the acquisition of existing patients, goodwill, contacts, suppliers, equipment, stock and employees and managers.

These practical considerations aside, key industry figures agree the health component of optometry in an aging population ensures longevity, making independent practice ownership a sound investment.

They also agree that regional independent practices may provide the greenest pastures for

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INSIGHT December Month 2020 2020

prospective buyers due to lower overheads and less competition, while bucking the current economic downturn.

For those looking to buy into the independent optometry dream, there’s plenty to consider, particularly in a market where COVID-19 has prompted some owners to accelerate their exit strategies.

BUYING IN For optometrists considering purchasing an independent practice, it’s important to first understand the market forces brought about

by COVID-19 and how this is influencing the psychology of buyers and sellers.

In his role as national business development manager at independent optometry network Eyecare Plus, Mr Philip Rose works closely with practice owners to grow their businesses.

He says many owners are re-evaluating their personal priorities as a result of COVID-19.

“In some cases, it is accelerating their retirement and succession plans. At the same time, it is evident that these times are not exactly conducive for a buyer to make an investment decision,” Rose says.

He estimates most serious buyer inquiries are coming from the 30-40 age bracket.

“These potential buyers have gathered sufficient industry experience to know what they want to see in a practice. The younger the buyers, the more daunting self-employment seems. But that is also because they are underestimating the opportunities of an independent lifestyle,” he says.

As the CEO of Optometry NSW/ACT, Mr Andrew McKinnon has seen few active buyers in recent months. With many optometrists stood down or still working reduced hours, the market is still stabilising.

He says locums have also been affected, with job prospects evaporating, leaving them with 25-33% less income. “They’ve been hammered,” McKinnon says.

“No one is actively looking to buy. There is very little activity, largely due to uncertainty. When the market recovers, there will be opportunities because the profession is resilient, and optometry practice ownership is a sound investment.”

With a career in optometry spanning 40 years, Mr Phillip Fent, CEO of Optometrist Business Brokers, agrees with McKinnon’s sentiment.

A former optometrist who bought and sold 11 of his own practices before establishing an optometry locum and recruitment service, Fent has recently pivoted his business into a brokering service.

Having informally provided business advice to colleagues for many years, he has retrained, gaining real estate licenses in Victoria and NSW and is a member of Australian Institute of Business Brokers.

He says state governments’ restrictions to minimise the spread of COVID-19 has meant many full-time employed optometrists are working reduced, part-time hours and several locums have been unable to secure work since March.

Some final-year optometry students completing clinical placements have also been dismissed in the downturn, resulting in delayed graduation.

“Essentially, those who want to buy themselves a job have two options: open a greenfield practice or buy an existing practice,” Fent says.

If they opt for the latter, buying into a practice with the support of an optometry group can make the first foray into business ownership easier.

Those groups can help avoid the heavy lifting associated with areas such as marketing, suppliers and business platforms.

One such organisation is George and Matilda Eyecare. CEO Mr Chris Beer says inquiries to join its independent community have increased in recent months.

“It is perhaps no surprise that in such uncertain times, people are looking for more support and more security. What we are focused on, is ensuring we find the right partners, who are willing to work with us to ensure that their practices are taking the right steps to navigate these turbulent times,” Beer says.

“If people have been considering their exit strategy or plans to realise the value of their practice, the pandemic has clearly been a catalyst to accelerate these conversations.”

Among those interested in joining the nearly 100-practice network, Beer says there is a common factor.

“The profile of these practices is certainly diverse, but we are seeing people start these discussions with us much earlier now than previously.

We put this down to a recognition that it is getting increasingly tough to weather these storms without the kind of investment in your business’s marketing, platforms and people that we’ve made a cornerstone of its response to COVID-19.”

Mr Sean Roffey, of Health Business Sales, says the independent optometry market can be slow moving and the pandemic will prove to be a blip on the radar.

PUSH AND PULL In 2017, ProVision surveyed 59 optometrists who had graduated within the past five years to gauge their interest in independent practice ownership, including factors ‘pulling’ them toward this goal or ‘pushing’ them away.

Building long-term relationships with patients, and using the full scope of optometric skills, ranked as the top responses to the main benefits of independent practice ownership. Professional and financial autonomy, and the ability to focus on a specific area of optometry, also ranked highly.

The survey respondents also said help in identifying practice purchase opportunities and locations, and financial advice and support, would encourage them into independent practice ownership.

They nominated a lack of business experience and the cost of purchase as the main barriers to independent practice ownership.

Competition, the administrative load associated with business ownership, and access to finance were also considered prohibitive.

ProVision business services manager Mr Mark Corduff says those factors are still relevant today.

“ProVision is pro-active in educating prospective buyers on what a good practice looks like. We’ve created a new Pro-Launch platform to help any optometrist understand the intricacies of practice ownership and how ProVision can help them with the skills that they didn’t learn at university. Optometry students and employed optometrists don’t always get exposed to fundamental business concepts, so our job is to take the fear away from making critical business decisions,” Corduff says.

Through its extensive network of 460 practices and state-based business coaches, Corduff says ProVision introduces potential buyers to members who are looking to sell.

“While new buyers went quiet for a month or two, the entry of a significant number of new graduates into the profession will mean that more optometrists are considering practice ownership as their best option for a strong financial future. We have noticed an uplift in employed optometrists enquiring about either acquiring an existing practice or starting a greenfield practice from scratch,” Corduff says. “This is a healthy sign for practitioners who are at the other end of their journey and looking to sell. There will always be buyers for well run, profitable optometry practices.”

INSIGHT INSIGHT December Month 2020 39

BUSINESS

SELLING UP

The ‘push’ and ‘pull’ of practice ownership – and the value of reliable business advice – is also familiar to Mr Sean Roffey.

Regional practices have, on balance, withstood the market downturn associated with COVID, and in some cases are exceeding profit expectations, but each owner must have one eye on the future.

Roffey, who offers an optometry brokering service through his company, Health Business Sales, has more than 20 years’ experience selling retail pharmacy businesses in NSW. He has known McKinnon, the Optometry NSW/ACT CEO, in a business capacity for 10 years, in which time he has helped many young optometrists succeed in business ownership.

He says the market has been slow, possibly as a result of COVID-19, but overall, the pandemic is a blip on the radar.

“It is generally a slow-moving market – practice turnover is not high.

But new owners can succeed if the practice is run correctly with the right input,” he explains.

Drawing parallels with the pharmacy profession, Roffey says some optometrists aren’t typically business-minded, and tend to gravitate towards buying groups for support. But he notes others have a strong business acumen and are willing to take risks.

“There are young buyers interested. Pre-COVID, I sold a Sydney practice located in a smaller shopping centre to a young optometrist – they wanted to run a business. Young buyers come with a different mindset; more modern thinking, and depending on location, a different spin on retail.”

Roffey says it’s important young optometrists get the right advice.

“Advice and knowledge will see them succeed. Each business represents a different opportunity,” he says.

INSIGHT December 2020

In his experience, Fent estimates there are more than 2,000 independent optometry practices in Australia, and owners are predominantly aged over 55.

The disruption and uncertainty associated with COVID-19 has meant his clients in this cohort, who are potentially in the early stages of succession planning or preparing to sell, are delaying their plans in response to a “wait and see” attitude among buyers.

Fent has seen first-hand that regional practices have not been as adversely affected by COVID-19 as some city practices, who have operated under tighter lockdown restrictions and a significant drop in foot traffic.

He says regional practice has extra potential now that momentum is swinging in that direction.

“Goodwill is security. Goodwill counts for a lot. And seek advice – have the right team, have an accountant that understands the industry,” Roffey says.

40

“They were starting to think about retiring and had their own health concerns to consider alongside the government’s restrictions on allied health services. This pandemic was the nudge they needed to bring their retirement plans forward, and to start to ‘think aloud’ in speaking with me. But since then, there has been no further contact or progress on selling their practices, as far as I’m aware,” McKinnon says.

“Some regional practices are flat out; three graduates started in one central NSW practice last month,” Fent says, highlighting the opportunities that lay beyond city limits.

Roffey’s advice to buyers is not to be scared of goodwill; the established reputation of a business regarded as a quantifiable asset and calculated as part of its value when it is sold.

“My advice is don’t open a greenfield practice. Buy a known business, with a known income source, with patients already walking through the door.”

McKinnon, from Optometry NSW/ACT, says when the pandemic started to bite, a handful of practice owners – all male and aged in their 60s – called him to discuss their business options.

“Graduates, early career optometrists and employees need to be more flexible in their thinking. I was speaking to university students after giving a presentation in August last year, and the students were not interested in moving to the country for work. Now, that’s not the case.”

Rose, from Eyecare Plus, agrees with Fent’s assessment. “When seen through the lens of a practice owner, regional practices are performing

PHILIP ROSE EYECARE PLUS

PHILLIP FENT OPTOMETRY BROKER

MARK CORDUFF PROVISION

ANDREW MCKINNON OPTOMETRY NSW/ACT

"OVERHEADS ARE HIGHER IN CITY PRACTICES SO REQUIRE A LOT MORE TURNOVER TO MAKE ENDS MEET"

"BUYERS NEED AN ADVISER OR REPRESENTATIVE WITH REALLY GOOD COMMERCIALLY SAVVY LEGAL EXPERIENCE"

"OPTOMETRY STUDENTS AND EMPLOYED OPTOMETRISTS DON’T ALWAYS GET EXPOSED TO FUNDAMENTAL BUSINESS CONCEPTS"

"THIS PANDEMIC WAS THE NUDGE [SOME] NEEDED TO BRING THEIR RETIREMENT PLANS FORWARD"

consistently better than their metro counterparts – the same was true prior to COVID-19,” Rose says.

“The lower COVID-case count in addition to the lower levels of competition has led to a less significant drop in turnover, making the recovery and profit level maintenance much easier. In fact, many regional practices have grown their turnover relative to 2019.”

Rose says, generally speaking, regional practices present a better business opportunity.

“I always say, go regional where you can purchase a quality practice in a great location. In the city, you’re competing on price, and that’s not a viable long-term solution. Regional practices have a lower cost base and longer leases. Regional practices’ rental cost can be between 5-8% of turnover. In a busy metro shopping centre, it’s often 12-20% of turnover,” he says. “Overheads are higher in city practices so require a lot more turnover to make ends meet.”

Despite the clear financial benefit regional practices present, Rose says it has proven difficult to find buyers.

In his experience, a cultural disconnect between an older generation of optometrists in regional locations nearing retirement and looking to sell, and a younger generation of graduates and early career optometrists with strong ties to extended family and community in city centres, means buyers and sellers are not connecting on a personal or business level.

“I know of a practice owner who wants to sell their well-established, successful practice in a regional town within four hours’ drive of Sydney and two hours to the beach – and he can’t find a buyer,” Rose says in disbelief.

He says the problem is compounded by misinformed or risk-adverse financial and legal advisers who don’t understand the profession.

“For example, they don’t understand that most sellers are willing to continue working in the practice, phasing out over time, allowing for mentorship of the new owner/entrepreneur and passing on patient goodwill,” Rose says.

“I deal a lot with accountants of buyers and sellers – it’s an opportunity to inform them of how things work in the industry. When graduates aren’t taught business skills, nervous banks and accountants advise them it’s too high-risk to buy.”

As more optometry graduates enter the workforce, Rose believes there will be fewer city practices to employ them, and wages will go down.

“We’re not seeing growth in new practices opening. In fact, we’re seeing practices consolidating.”

According to Roffey, a broker, the pool of buyers in rural and regional locations is small.

“Without buyers, the only options for those practice owners are closure, consolidation or succession-planning. Despite rural and regional practices boasting lower rents, lower overheads, and more profit in owner’s pockets, the majority of optometry graduates with Asian heritage are culturally predisposed to live and work together in city-based communities. But with more graduates coming through, there will be a lack of job opportunity in city areas,” Roffey says.

McKinnon believes optometrists need to go beyond the city limits to see that opportunities are abound. At a UNSW careers event in September, he repeatedly urged graduates to look beyond cities for employment.

“I’ve spoken with 12 or so rural optometrists over the previous month and they’re absolutely smashing it. There is large pent-up demand for their services. One practice near the Blue Mountains I spoke to has doubled turnover year-on-year, up 100%. It is one of many getting into double-digit growth. Conversely, a number of practices – quality

Buying an existing practice ensures a known income source and established patient database.

high-end clinical practices – around Sydney have continued trading through COVID and have done sensationally well. It goes to show that you can still do well if you do it right, regardless of economic downturn,” McKinnon says.

Although buyers are thin on the ground at the moment, Fent says there are opportunists in the market who own small practices and are looking to acquire another.

“They’re looking for a bargain, but vendors are not keen to sell to this type of buyer. If it’s a business they’ve had for some years, they may not be desperate to sell. They may be managing to stay in business with government assistance such as reduced rent and JobKeeper, but when bank delays with repayment and JobKeeper finish, it will be a different situation, and that will put extra pressure on sales,” he says.

Based on his experience accumulated over four decades in the profession, Fent says there are three common reasons why businesses fail.“The first is monetary. Since the banking royal commission, the ‘big four’ only lend for the term of the lease, guaranteed by bricks and mortar. They’re no longer lending on ‘goodwill'.

“The second is an inadequate lease. Buyers need to make certain they secure a long lease with options. For example, a five-year lease plus an option for another five-years, and an option for another five-years on top of that, or three, plus three, plus three. The lease also needs to be transferrable to a new owner. The third is inadequate legal and accounting advice. I dealt with one practice in NSW that even before the signature stage, the buyer had spent more than $50,000 in legal fees.

Buyers need an adviser or representative with really good commercially savvy legal experience.”

Rose sums up the situation in the current market: "On one hand, we have the business owner wanting to achieve the best price for the practice, which they have built up over many years. On the other hand, we have the banks and accountants advising their customers to be careful, without really understanding how resilient our industry is. Optometry remains a very attractive investment, due to the ‘health’ component of our turnover and has never been forced to close during these difficult times.” n

INSIGHT December 2020 41

BUILDING ONLINE CPD CAPACITY THE PANDEMIC PROMPTED A RETHINK OF THE WAY ORTHOPTICS AUSTRALIA DELIVERED ITS EVENTS. THE UNEXPECTED ADVANTAGES MEAN SOME ONLINE COMPONENTS WILL BE HERE TO STAY, WRITES PRESIDENT JANE SCHULLER.

T

he global events industry has borne the brunt of disruption caused by the coronavirus pandemic, with a slew of ophthalmic conferences and associated trade exhibitions wiped off the 2020 events calendar.

JANE SCHULLER

"AS WE MOVE BEYOND COVID-19 TO A ‘NEW NORMAL’, THERE IS NO DOUBT MANY ASPECTS OF THE NEW WAY TO DELIVER CONTINUING EDUCATION WILL BE HERE TO STAY"

With international travel off-limits and border closures across Australia, it is unlikely we will see face-to-face member educational and conference style events reinstated until at least the first quarter of 2021.

Despite many negative aspects of COVID-19, it has accelerated and forced positive change for Orthoptics Australia (OA). Pre-pandemic, many of our events were designed to bring people together often after work or at weekends – and at a time or location that didn’t always suit.

Our membership is unevenly distributed throughout Australia, with the majority of members residing in New South Wales and Victoria. This, and the impact of COVID-19, has forced a significant mind shift for us to move from a business model of mainly delivering face-to-face educational events – as we have done for several decades – to a heavier online focus.

As part of our overall strategy, one of our objectives has been to focus efforts on building our online continuing professional development capacity.

In January, OA launched its online learning management system ‘OAOE’ that hosts more than 80 meeting presentation recordings, online journal club modules and other content.

The benefit of OAOE is that it allows members the flexibility to access the content when and how they wish to learn, and to complete the modules at their own pace in topics that interest them most.

Since March, all our orthoptic continuing education seminars have been delivered as virtual events and several other state-based meetings have been converted into a combination of on-demand and live content for members.

Initially there was concern that the

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INSIGHT December 2020

networking aspect of these meetings would be lost, but we are embracing new ways for interaction to still occur.

We have incorporated measures such as Slido and live Q&A sessions so registrants can interact with speakers.

Our attendees still have opportunities to view content and interact with our sponsors through a virtual satchel.

Even our beloved annual conference – which has been an annual tradition for many of us to learn from and network with colleagues across Australia – has been transformed into a virtual feast; two days of research and clinical presentations, live Q&A sessions and a virtual exhibition. It has been an excellent opportunity to access several outstanding international speakers to diversify and further enhance the scientific program.

OA’s online transition was possible after we invested in a new user-friendly learning management system in early 2019 that allows us to create, share and track online learning. With the intuitive software, we can create a variety of content and incorporate material from different formats including videos, slideshows, PDFs – all on a mobile supported platform.

Members can access the content anywhere. The other benefit is it integrates with other technologies including our association management system so we can link CPD points to membership and analyse how members are engaging and learning with our content.

The platform is simple to use but the biggest challenge initially was slow user uptake. During the lockdown we provided additional member support by offering free access to CPD until 31 July and this gave people an opportunity to try out the platform without any financial investment.

The member feedback has been positive, particularly in states or regional and rural areas where face-to-face events are less accessible. We will continue to monitor the feedback and enhance the offerings as we move into 2021.

The pandemic forced many face-to-face ophthalmic events online in 2020.

OA industry supporters too have embraced the opportunity to engage with members and provide educational content via webinars and the OAOE platform.

As we move beyond COVID-19 to a ‘new normal’, there is no doubt many aspects of the new way to deliver continuing education will be here to stay.

Continuing to offer at least a portion of the continuing professional development events online allows great flexibility for members, greater opportunity for international speaker involvement and has the added advantage of reducing the cost of attending meetings for members.

There are other additional benefits of online learning that allow us to buy back time by eliminating travel – and it doesn’t matter where you’re located. n

ABOUT THE AUTHOR Jane Schuller is the president of Orthoptics Australia. She currently works at the Royal Melbourne Hospital and a number of private ophthalmology clinics.

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

DISPENSING

THE POWER OF LENS DECENTRATION THE SKILL TO DECENTRE A LENS SAVES BOTH TIME AND MONEY AND CAN BE THE DEFINING SERVICE THAT SEPARATES THE PRACTICE FROM THE REST OF THE PACK. ROWAN SMITH DETAILS THE CALCULATIONS INVOLVED.

W

elcome to the world of decentration. If you’re lucky enough to work in a practice with an on-site lab, having the ability and knowledge to decentre a lens is a handy tool in your repertoire.

ROWAN SMITH

"IT CAN SOMETIMES BE THE DIFFERENCE IN FITTING A STOCK SINGLE VISION LENS ON THE SPOT RATHER THAN THE TIME AND EXPENSE OF A SURFACED LENS"

It can sometimes be the difference in fitting a stock single vision lens on the spot rather than the time and expense of a surfaced lens.

To understand decentration in basic terms, it means how far the optical centre of the lens needs to be moved to be directly in front of the patient’s eye when fitted into the frame.

The formula for decentration on a single vision lenses is as follows: •F rame pupillary distance (PD) – Patient (Px) PD / 2 •F or example, frame size 50, bridge 17 = frame PD 67 •P x PD 62 •U sing the formula: 67 – 62/2 = 2.5 This means the optical centre needs to be moved in towards the nasal by 2.5mm on each lens in order to achieve the desired PD. Another key factor is understanding minimum blank size (MBS). It’s easy enough to decentre a lens but it’s important to ensure you have enough room to do so.

The formula for calculating minimum blank size is: •M BS = Frame PD – Px PD + frame diameter (DIA).

•F or example, frame size 50, bridge 17, Px PD 62 and DIA 53.

•M BS = 67 – 62 + 53 = 58mm blank.

As can be seen, the minimum size blank required for this patient is 58mm which allows plenty of room to decentre the size comfortably. Be aware, however, the narrower the PD and the larger the frame, the less room there is to work with. That’s why a correct fitting frame is so important.

Optical dispensers can also use the decentring method to create a wanted prism in a lens. This is where you can avoid the hassle of a grind lens and impress the customer. In order to do this,

Decentration refers to how far the optical centre of the lens needs to be moved to be directly in front of the patient’s eye when fitted into the frame.

there are a few things that need to be known first: 1. L ens power must be greater than the prism power.

2. P rentice’s rule.

3. M inimum blank size.

As a good rule of thumb, the lens powers generally needs to be at least double what the prescribed prism power is. If there isn’t enough power in the lens, you won’t be able to achieve the desired prism, no matter how much it is decentred.

remember all lenses are prisms. For plus, it’s two triangles base to base and for minus it's two triangles apex to apex.

It’s also important to remember the greater the lens power, the more prism you can create with the least amount of movement.

Once the decentration calculations are completed, you need to be sure you have a lens size big enough.

This is where you come back to MBS but you also need to remember to add the decentred prism amount. The formula is: Next, it’s important to consider how much MBS + decentred prism. the lens needs to be decentred in order to Of course, this all comes down to the create the prescribed prism. range of stock lenses and what limitations Keep in mind this is additional to the there are. already decentred patient PD that was The key thing to remember is if the mentioned earlier. stock blank will not cut out, you have lost This is done using Prentice’s rule of: absolutely nothing. It’s always worth a try • Prism = lens power x decentration / 10 because it can potentially be a win-win for the practice and the patient. It saves • For example, with a RE +5.50DS lens everyone time, money and can be that that we need to induce 2Base Prism In. extra defining service that distances you • Using the formula: 2 = 5.50 x D? from the rest of the crowd. n D = 2/5.5 x10 = 3.6mm The +5.00DS lens must be moved an additional 3.6mm in to create 2 dioptres of Base in prism.

Remember, in a minus lens the decentration can be in the opposite direction. But this will of course depend on the power and prism direction. If unsure,

ROWAN SMITH has 11 years’ experience in the optical industry and is a certified optical lens mechanic and optician. He’s an experienced practice and area manager in rural and metro practices, and is the online service manager for Dresden Vision, which produces fully recyclable and interchangeable frames.

INSIGHT December 2020 43

MANAGEMENT

IS YOUR HEALTHCARE ADVERTISING COMPLIANT? THE PANDEMIC HAS DRASTICALLY ALTERED THE HEALTHCARE LANDSCAPE AND PRACTICES MAY HAVE FORMULATED NEW ADVERTISING CAMPAIGNS ACCORDINGLY. KAREN CROUCH EXPLAINS HOW TO REMAIN COMPLIANT.

T

he COVID-19-induced ‘new norm’ is now a fact of life and we are now approaching the stage where ‘disease management’ has enabled us to re-focus on business and economics.

KAREN CROUCH

"OVERZEALOUS PRACTICES MAY BE TEMPTED TO UNWITTINGLY DEVELOP THEIR NEWLY FORMED MESSAGES IN A MANNER THAT MAY CONTRAVENE AHPRA GUIDELINES"

Naturally, practice marketing and advertising plays an essential role, not merely as a response to COVID-19 but as an opportunity during any future downturn.

The enforced flight to increased online communication during isolation and lockdowns has also highlighted the importance of a meaningful, informative online presence via a well-constructed website with convenient facilities, including consultation bookings, news updates and convenient mobile phone apps.

Consequently, practices will be keen to ensure their websites and other documentary materials are updated to reflect the new environment.

•C omment on the use of factual information in advertising.

•E xplain that advertisers of regulated health services (whether registered health practitioners or not) have responsibilities under other legislation administered by other regulators.

•E xplain the consequences of a breach of the advertising provisions of the National Law. These guidelines are not intended to stop members of the community and patients from discussing their experiences online or in person via platforms like social media.

The guidelines only apply when a regulated health service is being advertised.

Unfortunately, overzealous practices may be tempted to unwittingly develop their newly formed messages in a manner that may contravene AHPRA Guidelines for Advertising Regulated Health Services.

In terms of compliance, all advertisers of regulated health services must comply with the National Law, including the advertising requirements under section 133 – title and practice protection provisions under sections 113–120. They must also align with all other applicable legislation, such as the Australian Consumer Law and other laws regulating advertising.

GENERAL PRINCIPLES

PROHIBITED ADVERTISING

Advertising is a useful way to communicate services offered so consumers can make informed choices, but false and misleading information may compromise healthcare choices and is not in the public interest.

With prohibited advertising, section 133 of the National Law states a comprehensive list, including advertising that:

Unnecessary and indiscriminate use of regulated health services may lead to people purchasing or undergoing a regulated health service that may not be needed or required.

Additional obligations for advertisers are reflected in these guidelines with other codes and guidelines published by National Boards that convey expected standards of professional conduct for each regulated profession. The guidelines for advertising regulated health services were jointly developed by the National Boards responsible for regulating registered health practitioners in Australia.

They work to: •E xplain and provide guidance on the obligations of advertisers under the National Law.

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•D escribe advertising that is prohibited.

INSIGHT December 2020

• I s false, misleading or deceptive or is likely to be so.

•O ffers a gift, discount or other inducement without stating the terms and conditions of the offer.

•U ses testimonials or purported testimonials.

•C reates an unreasonable expectation of beneficial treatment.

•E ncourages indiscriminate or unnecessary use of health services.

•M isleading or deceptive advertising, directly or by implication, use of emphasis, comparison, contrast or omission.

•O nly provides partial information which could be misleading.

•U ses misleading or deceptive phrases like ‘as low as’ or ‘lowest prices’, or similar words or phrases.

With advertising, practices should consider the impression it will have on a layperson.

• I mplies that the regulated health services can be a substitute for public health vaccination or immunisation.

•U ses words, letters or titles that may mislead or deceive a health consumer into thinking that the provider of a regulated health service is more qualified or more competent than a holder of the same registration category.

•A dvertises health benefits of a regulated health service when there is no proof that such benefits can be attained.

•C ompares different regulated health professions or practitioners, in the same profession or across professions, in a way that may mislead or deceive.

When formulating your advertising campaign, one should consider: Am I skilled in the services I'm advertising?; If I display or promote my qualifications, is it easy to understand and is there any risk of people being misled or deceived? Is the basis for my use of title, qualifications, memberships, endorsements relevant to my practice, current, verifiable and credible?

Who is the audience and what is the advertisement likely to mean to them?

At a minimum, it's about the viewpoint of a layperson with little or no knowledge of the professional service you're selling. n KAREN CROUCH is Managing Director of Health Practice Creations Group, a company that assists practices with set ups, administrative, legal and financial management. kcrouch@hpcnsw.com.au hpcgroup.com.au

20/21 CALENDAR DECEMBER 2020 14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS Brussels, Belgium 12 – 13 December egs2020.org

JANUARY 2021 GLOBAL SPECIALTY LENS SYMPOSIUM Las Vegas, USA 20 – 23 January na.eventscloud.com

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

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

FEBRUARY 2021 ANZGS SCIENTIFIC MEETING Australia-New Zealand (virtual) 20 – 21 February kathpoon@bigpond.com

OV/SA BLUE SKY CONGRESS 2020 Adelaide, Australia 26 – 27 February bluesky.optometry.org.au

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

RANZCO VIC BRANCH SCIENTIFIC MEETING

MARCH 2021 SKI CONFERENCES FOR EYE CARE PROFESSIONALS Furano, Japan 6 March skiconf.com

Victoria, Australia 27 March ranzco.edu

OA VIC BRANCH JULY SCIENTIFIC MEETING

RANZCO NZ BRANCH ANNUAL SCIENTIFIC MEETING Christchurch, New Zealand 19 – 20 March ranzco.edu

AUSTRALIAN VISION CONVENTION 2021

ANNUAL CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: EUROPE Lisbon, Portugal 18 – 20 March cophy.comtecmed.com

ANZSS (SQUINT CLUB) Christchurch, New Zealand 21 March kathpoon@bigpond.com

Victoria, Australia 27 March orthoptics.org.au

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

APRIL 2021

NATIONAL ABORIGINAL AND TORRES STRAIT ISLANDER EYE HEALTH CONFERENCE Australia (virtual) 20 – 22 April mspgh.unimelb.edu.au

SPECSAVERS – YOUR CAREER, NO LIMITS A

ll SRS – Full time/part time positions in Perth Specsa ve stores rs At Specsavers, our vision is to passionately provide the best value eye care to everyone, simply, clearly and now w it affordably, exceeding customer expectations every time. We are currently seeking Perth’s most dedicated h OCT and driven Optometrists to join our Specsavers family. We have full-time & part-time roles available across the State. We will provide you with a fantastic working environment with a supportive team, state of the art equipment – including OCT, and the opportunity to deliver optimal patient care whilst further developing your clinical skills to their full potential.

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

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: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134

Specsavers Recruitment Services – Locums across Australia and New Zealand: Specsavers Recruitment Services (SRS) is the in-house recruitment support to Specsavers 400+ stores across ANZ. The team is made up of 7 experienced recruiters who act as the liaison between yourself and our stores to secure you the greatest opportunity to work in locations that suit your needs best, in either a full/part time, casual or locum roles. The team will manage every stage of the recruitment and placement process. The team work with you to find suitable matches – ensuring opportunities with Specsavers are always at your fingertips. To find out more about our services please contact us today.

Australia Employment enquiries: Madeleine Curran – Recruitment Consultant

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

New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

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

Receive a guaranteed market-rate salary in addition to your share of store profits along with guaranteed annual leave and access to exclusive wellbeing workshops.

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader

cindy.marshall@specsavers.com or 0450 609 872

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

SOAPBOX

IS CANNABIS A TREATMENT FOR GLAUCOMA? lifelong control. It is estimated that 24hr IOP control would require eight to 10 marijuana cigarettes. This dose would have significant psychoactive and cardio-pulmonary side effects and would also be more expensive than conventional glaucoma treatments.

Tachyphylaxis is another limiting factor. One study treated nine endstage glaucoma patients with inhaled THC capsules every four hours. All had a reduction in IOP but seven of nine patients lost the beneficial effect due to tolerance. All patients elected to discontinue treatment by one to nine months due to loss of benefit or systemic side effects.

M

edicinal cannabis is often presented as an alternative treatment for glaucoma.

Although there is evidence that cannabis lowers intraocular pressure, its role as a viable glaucoma therapy is limited by a short duration of action, psychotropic effects, and possible tachyphylaxis. In this article I attempt to clear the haze surrounding the topic of cannabis and glaucoma.

Cannabis is a genus of plant best known for producing a family of compounds known as ‘cannabinoids’.

Over 60 different cannabinoids occur naturally, but only a handful have been researched in detail. ∆-9 tetrahydrocannabinol (‘THC’) is the main psychoactive agent. Other commonly known cannabinoids include cannabidiol (CBD) and cannabinol (CBN). The cannabinoid profile varies according to the species of cannabis plant, the way it is grown, and which part of the plant is harvested. The two main species of cannabis are C. Sativa, which is rich in THC, and C. Indica, which is rich in CBN. Cannabinoids are also naturally produced by our body (‘endocannabinoids’). Cannabinoids bind to cannabinoid receptors (CB1 and CB2) to modulate neurotransmitter release throughout the nervous system.

In 1971 it was discovered that smoking cannabis can lower intraocular pressure.

To investigate the effect of cannabis on the human visual system, eleven healthy

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INSIGHT December 2020

subjects underwent comprehensive ophthalmic exams before and after smoking 2 grams of cannabis.

Unexpectedly, the subjects were found to have a change in intraocular pressure ranging from +4% to -45%. Subsequent studies have demonstrated that approximately 65% of glaucomatous eyes will experience a 30% pressure reduction after cannabis inhalation. The pressure-lowering effect lasts three to four hours and is dose-dependent.

THC is the main cannabinoid that lowers intraocular pressure. It is thought to bind to CB1 receptors on the eye to reduce aqueous production and increase aqueous outflow. The pressure-lowering effect of THC is not mediated through the central nervous system but is a local eye effect. This makes eyedrops a plausible route of administration. THC is also claimed to have a neuroprotectant effect on the optic nerve. However, evidence for this role appears weak.

It has been shown that CBD partially blocks the pressure-lowering effect of THC. This is important, as cannabis plants contain a mixture of cannabinoids including both THC and CBD. There are several problems with using cannabis to treat glaucoma. Firstly, the pressure-lowering effect is brief (three to four hours), which necessitates frequent dosing. This is impractical for a chronic disease that requires continuous,

Systemic side effects of cannabis could be reduced by manufacturing synthetic cannabinoids without psychoactive properties or administering the cannabinoids as an eye drop.

Both possibilities are being pursued.

A synthetic analogue of THC known as HU211 has minimal psychoactive effects but still achieves IOP-lowering.

Intraocular penetration of cannabinoid eyedrops has been unsuccessful so far due to their hydrophobic nature, however this could be overcome by using a microemulsion or cyclodextrin to help penetrate the tear film.

The cannabinoids hold promise as a new glaucoma pharmacotherapy.

Since they act via a different family of receptors, they could work synergistically with existing glaucoma treatments. However, inhaling or ingesting cannabis as a glaucoma treatment makes little sense due to systemic side effects, short duration of action, and likelihood of tachyphylaxis.

Future studies need to focus on individual chemicals rather than nonstandardised plant material. In my opinion, if cannabinoids have a role in glaucoma care it will be a synthetic analogue of THC delivered topically to the eye. n References can be found at insightnews.com.au.

Name: Dr Nick Andrew, MBBS, FRANZCO Position: Complex cataract and glaucoma surgeon, co-host of Ophthalmology Against The Rule Podcast Location: Gold Coast Years in the profession: 2

IF CANNABINOIDS HAVE A ROLE IN GLAUCOMA CARE IT WILL BE A SYNTHETIC ANALOGUE OF THC DELIVERED TOPICALLY TO THE EYE

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