Insight May 2020

INSIGHT MAY

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

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INTRODUCING SENSITY 2

RANZCO has developed new triage guidelines as missed appointments cause alarm.

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INSIGHT MAY

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

NEW TRIAGE GUIDELINES AS MACULAR DISEASE PATIENTS GAMBLE WITH VISION AMID COVID-19

RANZCO has developed new triage guidelines to help ophthalmologists navigate challenges posed by the COVID-19 pandemic, as advocates voice concerns over the number of patients cancelling appointments for macular disease treatment.

The college has adapted the Moorfields Eye Hospital Guidelines to produce its own RANZCO COVID-19 Triage Guidelines, which can be accessed to inform clinical decision-making during the crisis.

It advises on the appropriate way in which ophthalmologists and other healthcare professionals should manage 13 specialities, including cataracts, glaucoma, cornea/refractive, medical retina, vitreoretinal surgery and uveitis.

The guidelines, which could be

if they breach the governmentimposed elective surgery rules.

subject to further review, came after the Federal Government suspended all elective procedures in both public and private systems from 1 April, except for Category 1 and urgent Category 2 cases.

The measure is designed to preserve medical supplies and free up hospital beds for COVID-19 patients. The college also believed that continuing non-emergency elective surgery unnecessarily placed patients and staff at risk of coronavirus infection.

The RANZCO guidelines define cases into high, medium and low urgency categories. High and medium urgency are deemed 'time sensitive' and should be reviewed within three months – and continue for now. It states low urgency cases

The government has suspended nonurgent elective surgery.

should be deferred for four to 12 months at the clinician’s discretion.

During the development of the guidelines, RANZCO and the Australian Society of Ophthalmologists (ASO) sent an alert to ophthalmologists to advise elective cataract surgery is not a priority. They stated day surgeries could place their accreditation to operate in jeopardy

“RANZCO and the ASO are making it very clear to Fellows that we do not consider elective cataract surgery fits within these [urgent] categories,” the college told members.

“Some Fellows may think they should be able to continue as normal or to categorise their patients in a way that might meet some urgent criteria. There can be no reason why cataracts cannot wait until this crisis is over.”

The communique said sacrifices were being made across the entire Australian medical sector.

"We need to play our part. We continued page 6

SECTOR ADOPTS TELEHEALTH INNOVATION Australian optometry providers have been pushing for an expansion of telehealth services during the coronavirus emergency to prevent the cancellation of routine eyecare, and ensure the continuity of appropriate referral and critical care.

At the time of writing, Specsavers, Luxottica and Optometry Australia (OA) were lobbying the government to allow eyecare professionals to deliver telehealth under the Medicare Benefits Schedule (MBS).

Specifically, they were advocating for modifications to optometry MBS item numbers 10916 (brief initial consultation) and 10918 (subsequent consultation). If adopted, it is believed telehealth services will protect eyecare providers and

patients from potential infection and allow patients to access critical eyecare at home.

Older Australians requiring regular ocular medications will also have easier access to services, while triaging and referral services can be maintained both to eye specialists and in-person optometry services.

Specsavers director of optometry Dr Ben Ashby told Insight the COVID-19 crisis has led to a significant reduction in optometry visits, with the optical chain itself announcing a scaling back of operations to remain open for urgent and essential care only.

It has been providing its services via a combination of in-store, telephone and video consultations.

“Introducing telehealth for optometry will help to ensure appropriate referral and critical care is maintained around Australia,” Ashby said.

“Reduced access to optometry would [also] result in people having to go straight to a general practitioner for any eye-related issues, including referral to an ophthalmologist.

Inevitably this will contribute to overstretching general practitioners, ophthalmologists, hospital eye services, and hospitals which are focused on COVID-19 patients.”

In direct response to the crisis, Melbourne-based company Oculo unveiled a new videoconference function for its e-referral platform to continued page 6

INNOVATION AND OPPORTUNITY SHINE IN TROUBLED WATERS Although few can compare with the magnitude of COVID-19, crises are an inherent part of business. Insight examines how the ophthalmic sector can bounce back from this latest crisis and capitalise on new opportunities it presents.

page 30

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UPFRONT Just as Insight went to print, OPTOMETRY AUTRALIA developed a guide for triaging urgent and critical care after health authorities recommended optometrists postpone face-to-face services if they can be carried out safely during COVID-19. The association has also published a reference guide for clinical urgency of eye disease. “Given the fastchanging context we are all now operating in, it is important we ensure people who require eyecare are aware of what services

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WEIRD

your practice is prepared to provide – including whether these include telehealth and/or offering urgent or emergency faceto-face care, even if further restrictions on the operation of services are introduced,” OA stated. IN OTHER NEWS, Melbourne biopharmaceutical company Opthea announced it has completed patient dosing and all follow-up week 12 patient visits for its Phase 2a trial evaluating the safety and efficacy of its lead drug candidate, OPT-302, administered in combination with Eylea for treatment of diabetic macular edema. “We are extremely grateful to have reached this clinical milestone, particularly given the current challenges presented

by the COVID-19 pandemic and restricted movements of patients globally,” CEO Dr Megan Baldwin said. FINALLY, Vision 2020 Australia has welcomed the Department of Health’s release of a Request for Tender for a Second National Eye Health Survey. The sector has been advocating for a follow up survey to build on the initial 2016 report and provide additional data. Vision 2020 believes it will improve targeting of future activity and investment. “Enabling further monitoring of progress is especially important if we are to end avoidable blindness in Aboriginal and Torres Strait Islander communities by 2025, a priority of Australia’s Long Term National Health Plan,” the organisation stated.

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WACKY

A US mother potentially saved her child from blindness after realising her daughter had a yellow glow in one eye, as opposed to typical red eye, in flash photographs. An ophthalmologist diagnosed her with Coats’ disease, a rare congenital, non-hereditary eye disorder. Left untreated, it can cause full or partial blindness due to abnormal development of retinal blood vessels.

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Blind golfers and caddies from around Australia competed in the annual Victorian Blind Golf Open recently.

Rosebud Country Club has hosted the open for 30 consecutive years, with club members and staff supporting the event each year by volunteering as caddies, spotters and administrators. Blind golf is now played in 14 countries.

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A Greek woman sought help from her ophthalmologist after experiencing blurred vision and a progressive bulging eye socket. The MRI scan stunned doctors who discovered a cyst filled with baby tapeworms in her orbital cavity. The cyst displaced her optic nerve, and paralysed the muscles that control eye movement. n

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INSIGHT May 2020 5

NEWS

CANCELLED APPOINTMENTS SPARK CONCERN continued from page 3

have been advised that any day surgeries found to be flaunting the directive of government may find their accreditation to operate or any future financial support from the government very quickly cancelled," it continued.

“In the meantime, there are patients who will require urgent and essential treatments to keep their sight. It is our job to service these patients. It is up to every one of us to ensure that individuals do not damage the profession of ophthalmology during these difficult times.”

MISSED TREATMENTS Meanwhile, the Macular Disease Foundation Australia (MDFA) recently told the nation’s leaders there could be a “massive increase” in vision loss because patients with neovascular agerelated macular degeneration (nAMD) are cancelling treatments.

Professor Paul Mitchell, national research advisor for MDFA, said an increasing number of patients were concerned they would be penalised for leaving their homes in breach of COVID-19 public health measures.

“In my own clinic, up to one third of patients with conditions such as wet AMD or diabetic macular oedema are skipping

continue as scheduled. Clinics are taking even more precautions now and waiting rooms must comply with social distancing protocols,” Hunyor said.

these crucial appointments. However, none of these people have, or are suspected to have, contracted the virus,” he said.

“Projecting from my clinic, that means thousands of Australians are gambling with their vision. Without these regular injections, there’s a high risk that people will go blind or suffer significant vision loss, which is often then irreversible.”

RANZCO has advised that intravitreal injections can be continued.

“Given that a large majority of patients undergoing intravitreal therapy are in high risk categories (age and comorbidities), COVID-19 Triage Guidelines recommend minimising unnecessary investigations and establishing maximal treat-and extend-intervals," the college stated.

"A mask should be worn by the treating physician and any assistants.”

"IN MY OWN CLINIC, UP TO ONE THIRD OF PATIENTS WITH CONDITIONS SUCH AS WET AMD OR DIABETIC MACULAR OEDEMA ARE SKIPPING THESE CRUCIAL APPOINTMENTS" PAUL MITCHELL, MDFA

Mitchell said eye injections are considered essential medical treatment, while any sudden loss of vision in either eye was an eye health emergency requiring urgent attention.

“Many practices are asking patients to wait in their cars and calling them to come in only when required.”

Mitchell stressed that if a patient has a scheduled eye injection – and if a family carer or someone needs to take a patient to a scheduled eye injection – they are not breaching public health measures to attend the appointment.

The MDFA also advised that people living in residential aged-care facilities need to have a discussion with their provider or manager to ensure they continue to have access to eye injection appointments.

“Some facilities have currently unfortunately stopped such appointments,” MDFA CEO Dee Hopkins said.

“We urge all Australians to take care of their eye health and attend scheduled treatment appointments during the coronavirus crisis.

MDFA medical committee chair Associate Professor Alex Hunyor said, where possible, ophthalmologists are rescheduling non-urgent appointments or treatments. “Eye injections are essential medical treatments and need to

The last thing we need is to emerge from this pandemic with another health crisis of people who are blind or have severe vision loss as a result of not treating their AMD, or diabetic eye disease,” she said. n

CORONAVIRUS CRISIS IGNITES NEW PARTNERSHIP continued from page 3

videoconference feature, for an initial sixmonth period.

ensure optometrists and ophthalmologists can continue caring for patients requiring ongoing support for chronic conditions.

OA CEO Ms Lyn Brodie said the organisation recognises the huge impact COVID-19 is having on its members.

CEO Dr Kate Taylor said that Oculo's 11-strong development team worked around the clock to implement the new feature before launching in early April.

“We want to do everything we can to protect the health of our members, their staff and their patients,” she said.

More than 3,000 optometrists and 700 private ophthalmologists have signed up with Oculo. Its customers include Specsavers, Luxottica Australia, Bupa Optical and other corporate and independent optometrists.

On 7 April, Oculo and OA also announced a new partnership that would allow all OA members access to Oculo’s telehealth platform, including its real-time

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INSIGHT May 2020

“During this pandemic, telehealth provides a great opportunity to ensure patients with eyecare needs that cannot be postponed, can access the optometric care they need.

“This is why we are supporting our members to access Oculo’s platform as it is a way of ensuring they have the systems they need to provide ongoing care.”

Taylor said that Oculo was “delighted” to work with OA and its members.

She said it was important to ensure the platform “supports as many eye health professionals and patients as possible at this difficult time”.

Lyn Brodie, Optometry Australia

"The implication of cancelling significant amounts of routine outpatient activity are going to be felt long after the crisis phase of COVID-19 has passed,” she said “There is an acute need to ensure there are appropriate innovations in place not just to relieve the burden of these appointments but to move them away from centralised sites where virally-infected patients are likely to congregate to sites that are closer to and safer for patients.

Doing so will ensure continuity of care, minimise risk for hospital staff and prevent unnecessary travel posing significant health risks to patients.” n

NEWS

SECTOR EMBRACES GOVERNMENT APPROVAL OF STANDALONE MIGS From this month, surgeons can perform standalone minimally invasive glaucoma surgery (MIGS) under Medicare, seeing Australia become the first major developed economy to universally approve the procedure in both public and private settings.

In the 2019-20 Mid-Year Economic and Fiscal Outlook, the Federal Government announced it would support a Medical Services Advisory Committee (MSAC) recommendation to list a new item for the insertion of micro-bypass glaucoma surgery (MBGS) devices – also known as MIGS. The item commenced on 1 May and is available to patients with open angle glaucoma for whom conservative treatment has failed or is contraindicated.

It follows years of advocacy led by the Australian Society of Ophthalmologists (ASO) after a 2017 change in item number regulations threatened funding for all MIGS procedures.

The issue was partially addressed in October 2018 when the government approved a new item number, but limited its availability to those simultaneously undergoing cataract surgery.

Ophthalmologists believed the measure did not go far enough because glaucoma patients not needing cataract surgery, or who had already had the operation, weren’t eligible.

“There are a few good stories to come out of this latest approval,” ASO vicepresident and glaucoma surgeon Dr Ashish Agar, from the Prince of Wales Hospital in Sydney, told Insight.

“Firstly, Australia is leading the world now to allow this level of access to MIGS, as the first universal healthcare system in the world that will now allow this new technology as a standalone procedure.

RANZCO and Glaucoma Australia.

Agar said MSAC set the bar high in terms of evidence of the safety, effectiveness and cost of MIGS compared with other existing treatments such as trabeculectomy.

“And, as a result of that, we secured the approval but it has been designed to increase the level of science coming out the other end,” Agar said.

“This is not an all-comers process; patients will be screened for their eligibility and will have to meet specific criteria within the mechanism set up by RANZCO and ANZGS to ensure this process is followed.

“It also differs from a normal item number listing; this is a sophisticated approval where we are going to continue collecting data and outcomes and that will actually improve the evidence base going forward.”

At the time of writing, Agar said the ASO had not received documentation on the MBS fee for the procedure.

When it approved the item number last year, MSAC compared MIGS alongside trabeculectomy and concluded that although MIGS was slightly less effective, it was safer and may allow some patients to delay or avoid trabeculectomy.

“Secondly, it shows the system can work. We spend a lot of time criticising the Australian healthcare system, but this outcome demonstrates that if you approach an issue in a positive light as a team, and work hard through the process and technical work, we can achieve an excellent result for our patients.”

Other analysis shows MIGS generally costs less than trabeculectomy, and is projected to save the MBS approximately $500,000 per annum by the fourth year of listing. This saving is driven by fewer initial and revision trabeculectomy services, however the true financial impact will depend on the efficacy of MIGS in reducing trabeculectomies, which is uncertain.

The ASO’s successful application to MSAC comprised a team including health economists Thema Consulting, industry (particularly Glaukos but also crucial data provided by Ivantis), with supporting statements from the Australia and New Zealand Glaucoma Society (ANZGS),

MSAC also supported establishing a registry to record outcomes. n

“MSAC will review the use of [MIGS] after two years to see what effect it has on the number of trabeculectomies being done and make sure it is still cost-effective,” the committee stated.

IN BRIEF "THIS IS A SOPHISTICATED APPROVAL WHERE WE ARE GOING TO CONTINUE COLLECTING DATA AND OUTCOMES AND THAT WILL ACTUALLY IMPROVE THE EVIDENCE BASE" ASHISH AGAR, ASO

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COVID COLLABORATION

Cairns Private Hospital has offered to perform public elective surgeries, including ophthalmic procedures, to ensure the region’s main public health facility can treat COVID-19 patients. The hospital, which is part of Ramsay Health Care and has nine eye specialists, announced the plan with Cairns Hospital. “We are willing and able to perform a range of ortho, ENT, ophthalmology, gynaecology, general surgery, plastics and urology cases to lighten the load on the public hospital,” Ramsay Cairns CEO Mr Ben Tooth said.

“While we face the unknown in terms of the extent of the impact of COVID-19 on the Gold Coast, it’s vital that health providers work together.”

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FDA APPROVAL

The US Food and Drug Administration has approved Allergan’s Durysta bimatoprost implant. The therapy is now the first intracameral, biodegradable sustainedrelease implant indicated to reduce intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. The approval is based on results from the two 20-month Phase 3 Artemis studies evaluating the efficacy and safety of Durstya versus twice daily topical timolol drops. Durstya reduced IOP by approximately 30% from baseline over the 12-week primary efficacy period. “[This] marks a breakthrough milestone for the glaucoma community and provides a much-needed option for patients challenged with topical drops or needing alternative options,” Allergan stated.

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MIDO 2021

Organisers of Milan’s international eyewear trade show Mido have moved the 50th edition of the event to February 2021. “The ongoing COVID-19 pandemic in Italy and its swift spread to the rest of the world, along with doubts about when the crisis will normalise globally, have forced us to make the painful, but crucial, decision,” president Mr Giovanni Vitaloni said. It will be held about three weeks earlier between February 6-8, in a move that was to be announced at this year’s show. “By moving the date forward, we can give an additional boost to the eyewear business globally and in Italy,” Vitaloni added.

INSIGHT May 2020 7

NEWS

WA OPTOMETRY SCHOOL FUELS SUPPLY DEBATE “It’s our understanding this is one of the highest starting salaries for any health-related field in Australia, including graduating doctors and dentists.”

"WE STRESSED THE EXPECTED OVERSUPPLY OF OPTOMETRISTS IN AUSTRALIA AND CALLED ON THE UNIVERSITY TO TAKE THIS INTO CONSIDERATION BEFORE MAKING ITS DECISION" The University of Western Australia will offer the state's first and only Doctor of Optometry degree.

Australia’s largest optical chains have backed the establishment of Western Australia’s first Doctor of Optometry degree, believing it will alleviate an escalating shortage of optometrists and reduce a reliance on the graduate supply from eastern states.

Optometry Australia (OA), however, has expressed disappointment in the program planned for next year with an initial intake of up to 60 graduates.

The association lobbied the university to rethink its decision, stating it could fuel an oversupply of optometrists and potentially impact future employment prospects for many.

To be delivered at the University of Western Australia (UWA), the new threeyear postgraduate program will be led

by Professor Garry Fitzpatrick.

It is the first and only course of its kind in WA and students will gain experience through clinical placements with industry partners, including the Lions Eye Institute and Lions Outback Vision, Specsavers and Luxottica across metropolitan, regional and remote areas of WA.

“The new course will help to alleviate the serious and growing shortage of optometrists generally, and in WA that means employers will no longer have to rely entirely on the eastern states’ graduate supply, providing a balancing effect to the whole country and New Zealand,” he said.

Eighteen months ago, Specsavers commissioned Deloitte Access Economics (DAE) to examine the national supply and demand for optometrists.

“They came back with a comprehensive report looking out to 2037 which forecasts a shortage of some 1,200 optometrists [in Australia],” Bott said. “This was predominantly due to an ageing population, a larger total population and increased corresponding demand for services.”

According to Bott, many optometry employers are finding it harder to recruit optometrists from a limited pool, despite an increasing number of graduates.

UWA will become the seventh Australian university to offer an optometry course, reigniting debate between some optometry providers and OA about future optometry workforce supply in Australia.

“I remember the new optometry course at Deakin in 2011 being met by dire warnings about the potential for unemployed graduates and lower salary packages, whereas in reality Deakin graduates are snapped up before they graduate and salaries have continued to rise in all parts of the country.

Mr Paul Bott, executive director and general manager of optics at Specsavers, said until now, WA employers have recruited from optometry schools in Queensland, New South Wales, Victoria, South Australia and Auckland.

“For example, the starting salary we now pay for a newly graduating optometrist in regional areas is $85,000 plus super and we also need to add a $10,000 to $20,000 sign-on bonus with a further $5,000 in relocation allowances.

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INSIGHT May 2020

DARRELL BAKER, OPTOMETRY AUSTRALIA

Luxottica director of eyecare and community for Australia and New Zealand Mr Peter Murphy said the new program will ensure the eyecare needs of Western Australians are properly addressed.

“Demographic trends point to an aging population and with an increase in chronic eye health conditions such as diabetes, macular degeneration and glaucoma we are seeing first hand an increase in demand for eye health professionals across the country, especially in regional and remote areas across Australia and New Zealand.”

OVERSUPPLY CONCERNS OA president and Western Australia optometrist Mr Darrell Baker said a key concern among the association’s members was that the profession is fast tracking toward an oversupply.

“Despite a recent report that there is an undersupply of optometrists in the foreseeable future, our research and key workforce indicators clearly indicate the opposite,” he said.

“We stressed the expected oversupply of optometrists in Australia and called on the university to take this into consideration before making its decision. We asked them to think of the future of the profession and of the students they hoped to enrol.”

Baker did note that, at present, all WA-based based optometrists have to complete their studies at eastern-based universities and the university wanted to offer courses to help residents achieve their career aspirations locally.

“Although we appreciate this sentiment we remain very concerned about supply within optometry and that we are producing a workforce of highly-skilled practitioners where a fair proportion may not be able to find employment," he said.

OA has launched a campaign calling on the Commonwealth to amend university funding approaches to require consideration of community need for specific disciplines. It also recently contacted the Federal Minister for Education Mr Dan Tehan to outline its concerns. n

Maintaining an essential service A month ago we made the critical decision to hibernate our normal retail service while remaining Open for care.

To find out more about how we are providing urgent and essential optometry and dispensing care to patients, and how we have adapted our store environment, go to spectrum-anz.com

NEWS

OPTOMETRISTS MOVE TO URGENT CARE MODEL "OPTOMETRISTS PLAY A CRITICAL PRIMARY HEALTHCARE ROLE, AND CAN KEEP PEOPLE WITH EYE COMPLAINTS AWAY FROM HOSPITALS AT THIS CRITICAL TIME"

Optometrists across Australia, including the country’s largest optical chains and independent groups, have adapted their service models in response to the COVID-19 emergency and are hopeful of restoring normality to their businesses this month.

It follows advice that Optometry Australia (OA) received from the Department of Health, which stated optometrists should exercise discretion and limit themselves to urgent cases.

“We recommend that optometrists use their clinical judgement to determine if appointments can be postponed without undue risk to patient health or well-being and that they should begin working within that framework for now,” OA CEO Ms Lyn Brodie said.

In the largest announcement impacting sector, Specsavers revealed it was “hibernating” its normal retail service. It subsequently stood down all store team members from 29 March to 30th April.

The chain, which operates 350 optical stores and 150 audiology businesses in Australia, has been providing only urgent and essential care via a combination of instore, telephone and video consultations.

The stores were staffed by an optometrist store director, an optical dispensing director and, where necessary, an

audiologist. Mr Paul Bott, Specsavers executive director and general manager, said the company operates under a franchise partnership model, meaning its optical stores and audiology businesses were owned and operated by optometry, dispensing and audiology professionals.

LUXOTTICA SPOKESPERSON

Elsewhere, Luxottica announced its OPSM and Laubman & Pank stores would also remain open to provide essential care to patients requiring urgent care.

“Optometrists play a critical primary healthcare role, and can keep people with eye complaints away from hospitals at this critical time,” a spokesperson said.

Mr Steven Johnston, CEO of Australia’s largest independent optometry group ProVision, said the 460 practices within the company’s network had been advised to follow OA’s advice. He said some had chosen to close, while the remainder remained open.

George & Matilda Eyecare, which has 92 stores within its network, announced the majority of its stores will remain open.

However, it had temporarily closed 35 stores at the time of writing.

“Given the serious impact the coronavirus has had on their revenues and cashflows, it is critically important that we act decisively to help protect their businesses for the future so that when the current situation eases, they are in a position to open once again,” he said at the time of print.

“This decision has been made in the interest of looking after the well-being of our team members, customers, patients, and the local community,” the company stated on its website.

Bailey Nelson, which operates 43 boutique stores across Australia, also shut all physical stores across Australia for at least four weeks in support of efforts to keep our communities safe. Oscar Wylee also closed several of its 61 stores across Australia. n

Bott added that Specsavers hoped to reopen all stores after 30 April, however this would be dependent upon government and health department advice.

A MESSAGE FROM THE CEO TO OUR VALUED PARTNERS As Australia’s largest B2B publisher we have been looking at how we can best support our many sectors through the changing COVID-19 situation.

Fortunately, through our media brands we are in a position to facilitate the necessary lines of communication that must be kept open between staff, suppliers, and clients.

We are committed to keeping our industries connected and supporting our clients and readers through this challenging time.

We are in a strong position to support our industries through our media platforms: magazines, e-newsletters and websites. To that end, using print and digital platforms to communicate with the market has never been more important.

We recognise that meeting in person will be limited in the months ahead.

Major conferences and events have been postponed for the next six months, including some of our own. Many companies have stopped face-to-face meetings, and have organised for team members to work from home.

With the potential for companies and individuals to become isolated we recognise communication within the industry has never been more important.

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INSIGHT May 2020

Prime Creative Media is committed to continuing our frequent communications.

Our regular newsletters, web sites, and printed magazines will continue to be produced on schedule, with our entire team prepared to work remotely as needed. With so many other businesses moving to remote workplaces, we are now offering complimentary home address delivery of our publications to

ensure continuity of service to our existing subscribers. Additionally we will offer three-month complimentary subscriptions to anyone else in the industry who would like a subscription to stay informed.

John Murphy, Prime Creative Media

The economic challenges we face with COVID-19 are significant, but temporary.

At Prime Creative Media we are taking a long-term view to our business, marketing, and investments, and it has been encouraging to hear this week from many clients who share our mindset.

We look forward to supporting our industries through our communication platforms in the coming months, so that our economy can push through this challenging time.

Please don’t hesitate to contact me directly to discuss your situation and how we can help. n

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NEWS

AUTHORITY TO BE FLEXIBLE WITH CPD AMID PANDEMIC Optometry Australia (OA) has identified a growing appetite for online CPD amid COVID-19, as the regulator confirmed it won’t penalise optometrists who fall short of their CPD requirements this year.

OA president Mr Darrell Baker also announced the organisation will unveil a new initiative relating to online continuing professional development (CPD) after the pandemic forced the cancellation of face-to-face conferences.

In a video message to members, Baker said: “Optometry Australia has significantly ramped up the range of CPD programs that you [members] can access online, including delivery of an expanded range of quality webcasts.

“Two webcasts we presented to support the virtual WAVE program attracted a combined 1,250 attendees which demonstrates the growing appetite among members for this type of education.”

WAVE 2020 was due to take place 21-22 March in Perth but was revised to be delivered via a series of free 60 or 90 minute webcasts on Sundays from late March. The Australian Vision Convention (AVC) took place 4-5 April, also as a virtual event.

Baker said OA has also introduced a new COVID-19 bulletin which members can opt-in to receiving.

“It provides links to the most up-to-date information available on managing this pandemic. It supplements our regular more comprehensive communications which members automatically receive.”

Baker added that the organisation is “continuing to press the Optometry Board of Australia about CPD requirements in this current crisis”.

The Optometry Board of Australia (OBA) updated its position on CPD on 3 April, encouraging optometrists to continue to undertake CPD relevant to their scope of practice.

“However, we understand that optometrists may have difficulty meeting CPD requirements this year as a result

"THE OBA WILL NOT TAKE ACTION IF OPTOMETRISTS CANNOT MEET THE CPD REGISTRATION STANDARD DUE TO THE PANDEMIC" IAN BLUNTISH, OBA

of withdrawn or denied leave requests, conference cancellations and the reprioritisation necessary to meet workforce needs,” OBA chair Mr Ian Bluntish said.

“The OBA will not take action if optometrists cannot meet the CPD registration standard due to the pandemic when they renew their registration this year,” he said.

The OBA was also set to publish two new CPD guidance documents on its website to help optometrists understand the revised continuing professional development registration standard.

“The revised CPD standard was initially published in July 2019 and will replace the existing standard on 1 December 2020," Bluntish said.

"It is important that optometrists remember they do not have to declare they have met this standard until they renew their registration in 2021.

"The board will keep a close watch on the situation to determine whether the 2021 renewal year is affected."

During COVID-19, Bluntish added that professional judgement will be critical as resources become limited and the demand on services intensifies. n

STUDY EXAMINES OCULAR TRANSMISSION OF COVID-19 Researchers investigating links between COVID-19 and the eye have found there is a low risk of transmission via tears, after other studies established a link between the virus and conjunctivitis.

In a recent study published in Ophthalmology, the journal of the American Academy of Ophthalmology (AAO), scientists from the National University Hospital (NUH) in Singapore said there was uncertainty surrounding ocular transmission of COVID-19.

Lead author Dr Ivan Seah, from NUH, worked with colleagues at the National Centre for Infectious Diseases and Dr Rupesh Agrawal, from Tan Tock Seng Hospital, to assess the viral shedding and infectivity of tears in coronavirus disease in 64 tear samples collected from 17 infected patients between day three to day 20 from initial symptoms.

Neither viral culture nor reverse

12

INSIGHT May 2020

transcription polymerase chain reaction detected the virus, suggesting a low risk of ocular transmission.

Seah also took samples from the back of the nose and throat of patients enrolled in the study. While their tears were clear of virus, their noses and throats were said to be teeming with COVID-19.

However, the research team noted one important caveat: none of the patients in the study had conjunctivitis.

Health officials believe conjunctivitis develops in 1-3% of people with coronavirus, with the AAO citing two recent cases that suggest it is possible that SARS-CoV-2, which causes COVID-19, is transmitted by aerosol contact with the conjunctiva.

In a Journal of Medical Virology study of 30 patients hospitalised for COVID-19 in China, the AAO said one had conjunctivitis.

That patient – and not the other 29 – had SARS-CoV-2 in their ocular secretions.

“This suggests that SARS-CoV-2 can infect the conjunctiva and cause conjunctivitis, and virus particles are present in ocular secretions,” the AAO said.

In a larger study published in the New England Journal of Medicine, researchers also documented “conjunctival congestion” in nine of 1,099 patients (0.8%) with laboratory-confirmed COVID-19 from 30 hospitals across China.

Seah concluded that his team’s findings, coupled with the low incidence of conjunctivitis among infected patients, suggest that the risk of virus transmission through tears is low.

He hopes their work will guide more research into preventing virus transmission through more significant routes, such as droplets and faecal-oral spread. n

NEW 1

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: February 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: March 2020. CEQ03/2020ad1 Reference: 1. CEQUA™ Product Information. 2020 Feb, 2020; Available from: Sun Pharma by calling 1800 726 229.

NEWS

HISTORIC FINANCIAL RESCUE PACKAGE UNVEILED TO AID BUSINESSES IMPACTED BY CORONAVIRUS The Australian Government and major banks have unveiled a multi-billion dollar wage subsidy program, mortgage and rent deferrals and changes to insolvency laws to help businesses remain operational amid the coronavirus crisis.

In the largest of those announcements, Prime Minister Scott Morrison established a JobKeeper payment that will provide approximately six million employees a flat payment of $1,500 per fortnight, through their employer, for up to six months.

The $130 billion-dollar program brought the total economic COVID-19 package to a remarkable $320 billion, or 16% of GDP, at the time of writing.

The payment, for businesses who have had their turnover drop 30% or more, is designed to ensure eligible employers and employees stay connected while some businesses move into hibernation.

It follows other initiatives such as the Boosting Cash Flow for Employers scheme, seeing the government provide between $20,000 and $100,000 to small and medium sized businesses, and not-for-profits, with aggregated annual turnover under $50 million.

The payments are designed to help businesses maintain cash flow to keep operating, pay rent, electricity and other

bills, as well as retain staff. They will be paid through two phases from 28 April to support employers to retain their employees during the downturn.

Employers will receive a payment equal to 100% of their salary and wages withheld. The maximum payment is $50,000, while businesses that pay salary and wages will receive a minimum payment of $10,000, even if they are not required to withhold tax.

“By linking the payments to business to staff wage tax withholdings, businesses will be incentivised to hold on to more of their workers,” Morrison said.

Meanwhile, the Australian Banking Association announced businesses with total business loans of up to $10 million can defer repayments for six months.

"BY LINKING THE PAYMENTS TO BUSINESS TO STAFF WAGE TAX WITHHOLDINGS, BUSINESSES WILL BE INCENTIVISED TO HOLD ON TO MORE OF THEIR WORKERS"

Combined with measures already announced, the loan holiday will apply to up to $250 billion-worth of loans, with extra cash available to 425,000 businesses to cope with the crisis during the COVID-19 pandemic. The scheme covers 98% of businesses with a loan from an Australian bank.

SCOTT MORRISON, PRIME MINISTER

Morrison urged affected tenants, landlords and financial institutions to “sit down, talk to each other and work this out” to ensure businesses survive.

The National Cabinet also announced a moratorium on evictions for the next six months for commercial tenancies in financial distress due the coronavirus.

The government will also establish the Coronavirus SME Guarantee Scheme which will support small and medium enterprises (SMEs) to get access to working capital.

Under the scheme, the government will guarantee 50% of new loans issued by eligible lenders to SMEs. The government is also temporarily increasing the threshold at which a creditor can issue a statutory demand from as low as $2000 to $20,000. The minimum amount of debt for a creditor to initiate bankruptcy proceedings will increase from its previous level of $5000 to $20,000. n

STIMULUS PACKAGE TO DRIVE ‘BIG-TICKET’ PURCHASES The government’s vast expansion of the instant asset write-off threshold to $150,000 as part of its coronavirus stimulus package is set to benefit Australian practices seeking new ophthalmic instruments.

The $17.6 billion initiative was unveiled as the government aims to support small and medium sized businesses during the economic downturn.

The government announced it will spend $700 million to increase the instant asset write off threshold from $30,000 to $150,000 (per asset).

It will also expand access to the scheme by including businesses with an aggregated annual turnover of less than

14

INSIGHT May 2020

$500 million. This is compared with the previous cap of $50 million.

Ophthalmic equipment manufacturers and distributors, including Zeiss, have moved notify customers that any asset – new or second-hand – purchased before the end of the financial year will fall under the expanded thresholds.

"This means that Zeiss ophthalmic diagnostic instruments will qualify for the initiative, including the Cirrus 6000 with AngioPlex, Clarus 500/700, Humphrey Field Analyser 3 and IOLMaster 500/700," the company stated.

Chartered Accountants Australia and New Zealand Australian tax leader Mr Michael Croker said the economic

stimulus package presents a unique chance for small to medium sized businesses to take the economic fight to the coronavirus.

"Before, small businesses had been able to claim immediate tax deductions of up to $30,000 for things like vehicles, tools and office equipment," Croker said.

“This is a big win for Australian businesses and the economy and will drive purchases of more big-ticket items."

He added: “The question now becomes one of confidence: will businesses open their cheque books in the current economic environment? Will lenders provide loans if needed to fund the purchases? n

50% off

membership fees 2020/21 all membership categories equating to

Six months free membership

Don’t pay until October 2020 Contact your state organisation for details: Optometry NSW/ACT:

(02) 9712 2199

Optometry QLD/NT:

(07) 3839 4411

Optometry TAS:

(03) 6224 3360

Optometry VIC/SA:

(03) 9652 9100

Optometry WA:

(08) 9321 2300

NEWS

WOMEN AND CHILDREN FEATURE IN RECORD 10 MILLION EYE EXAMS

UPDATED OCCUPATIONAL OPTOMETRY GUIDE TO HELP CURB EYE INJURIES Optometry Australia (OA) has produced an occupational optometry and safety eyewear guide to help eyecare professionals prevent workplace eye injuries.

The free 2020 Occupational Optometry Guide includes information on preventing occupational eye injuries, vision assessments, eye protection products, Australian vision and eye-protection standards and screening protocols. It also advises about eye safety consultations and how to conduct workplace screenings.

The 28-page booklet is an updated version of an earlier guide and was mailed to OA members with the March edition of its Pharma magazine. It is also accessible to members only on OA’s website.

According to the organisation, the guide provides a timely update on changes to safety standards and prescribing safety eyewear for use in general practice when encouraging patients to look after their eyes while doing DIY jobs around the house.

Results from OA’s own 2020 Vision Index report found 21% of Australians had sustained an eye injury through a DIY project at home, which might include building projects or mowing the lawn.

However, only 12% always wear eye protection for such projects.

Occupational optometry encompasses more than just the prevention of occupational eye injuries, OA clinical officer Mr Luke Arundel said.

“Occupational optometry may seem straightforward but there are many legal, ethical and professional obligations that make it a complex process."

Arundel said workplace screenings were a good way for optometrists to build their patient base.

In addition, employees who fail a workplace screening often go on to have a full eye examination and even employees who pass the screening often need correction for other non-workrelated activities. n

"THIS IS POSITIVE AND INDICATES INCREASED AWARENESS OF THE ROLE OF OPTOMETRY AND THE IMPORTANCE OF EYE AND VISION CARE" SKYE CAPPUCCIO, OPTOMETRY AUSTRALIA

New figures have revealed the country’s optometrists performed a record number of Medicare consultations last year, while children’s vision assessments increased at a greater rate than population growth.

Optometry Australia (OA)’s analysis of the Optometric Medicare Benefits Schedule (MBS) statistics for 2019 has also shown that women remain significantly higher users of optometric services, with females making up 58% of patients accessing optometry services under Medicare.

The figures were revealed following an analysis by OA standards and policy advisor Ms Cassandra Haines.

In her most notable finding, she found that 10,125,281 consults were provided overall last year, which represents 39,530 services per 100,000 people.

She said it was the greatest number of total, and per population, services provided under Medicare by optometrists in any calendar year.

Ms Skye Cappuccio, the organisation’s general manager of policy, said the figures suggested that an increasing number of Australians are accessing primary eyecare from optometrists.

“This is positive and indicates increased awareness of the role of optometry and the importance of

Her analysis for OA reveals there has been very little change in the total number of item 10918 (subsequent consultation) billed in the last five years, and this is falling as a proportion of total items billed.

Haines noted that billing of the low vision assessment item (10942) and domiciliary visit items (10931-10933) have remained relatively steady.

Interestingly, there had also been a notable recent increase in perimetry items (10940 and 10941), with a nearly 15% increase in 2019 on those provided in 2018. Cappuccio said the statistics indicatied the contribution optometrists made to the healthcare system. n

George & Matilda Eyecare (G&M) has announced the signing of its 92nd practice, reinforcing its position among the largest optometry groups in Australia since launching in 2016.

Recent additions include Barry Meyerson, of Meyer Optica in Balmain, New South Wales, and Kirsty Banfield of Mount Martha Optical in Victoria.

“If you are an independent practice who is looking to retain your uniqueness and focus on your patients, but also have some peace of mind at a time

INSIGHT May 2020

While there had been sustained overall growth in number of optometry consults under Medicare during the past decade, according to Haines, changes in specific item number usage varied.

GEORGE & MATILDA NETWORK NEARS 100-PRACTICE MILESTONE

G&M CEO Mr Chris Beer said the group had secured funding and supportive investors to accelerate further practice acquisitions.

16

eye and vision care,” she said.

Barry Meyerson, Meyer Optica.

of such turmoil in the economy, then we believe we offer a very compelling opportunity,” Beer said.

“In times of uncertainty it is always reassuring to know you have people in your corner fighting with you.” n

NEWS

ELECTRIC BUSES POSE SAFETY RISK TO LOW VISION COMMUNITY

DEVICE-DEPENDENCE ALTERS VISUAL BEHAVIOUR One in 10 Australians spend more than 10 hours per day looking at a screen, according to findings of a new Zeisscommissioned study revealing the extent and risks of device dependence.

The survey of Australian consumers was released prior to the launch of Zeiss’ new SmartLife lenses, which have been designed to address a modern-day dependence on digital devices and its impact on vision, particularly in relation to frequent gaze changes between various directions and distances.

Zeiss’s Changing Vision Survey 2020 found one quarter of Australians have experienced a ‘near miss’ due to device distraction while walking or driving. Young adults are especially at risk of digital distraction with one in five experiencing a near miss when behind the wheel.

Nearly half of those surveyed reported ‘feeling lost’ without their phone, while 63% experienced tired eyes at the end of the day. In total, 46% were worried about the long-term impact of screen time on their vision.

Despite such concerns, 48% said they can’t exercise without looking at a device.

Ms Hilke Fitzsimons, general manager Zeiss Vision Care Australia, said the survey aligned with other international studies and clinical trials that informed the development of Zeiss SmartLife lenses.

According to Zeiss, the SmartLife lens can be compared to the invention of UV protective lenses and is something the company believes should become a global standard for device-dependant adults of the modern age.

It adopts Zeiss Smart Dynamic Optics, which support a dynamic visual behaviour, from very close to very far, and include changed lens periphery to allow smoother, clearer vision for frequent changes of head and eye posture.

SmartLife lenses became available across Australia last month in single vision, digital and progressive lens forms. n

"IT IS EASY TO WALK STRAIGHT IN FRONT OF A SILENT ELECTRIC VEHICLE WITHOUT KNOWING IT IS THERE" VISION AUSTRALIA

A government inquiry into electric buses has heard more than one third of vision-impaired people surveyed have experienced a collision or near-miss with an electric vehicle.

Vision Australia cited findings from a 2018 Monash University survey in its submission to a New South Wales Government inquiry, which is examing the benefits of electric buses and barriers to their wider use on city and country public transport fleets.

Blind Citizens Australia (BCA) has also lodged a submission that raises safety concerns for blind or visionimpaired pedestrians if they are unable to determine the proximity of vehicles through audio cues.

In its submission, Vision Australia stated a key finding from the Monash research demonstrated 35% of people who are blind or have low vision have experienced a collision or near-collision with an electric or hybrid vehicle.

Further, 75% indicated the introduction of the vehicles has reduced their confidence to walk and cross roads because they no longer feel safe.

“Electric vehicles are near-silent, and so cannot be detected audibly. People who are blind or have low vision rely on audible cues such as traffic noise for orientation

In recent years, the US and Europe has introduced new standards requiring all electric/hybrid vehicles to be fitted with Acoustic Vehicle Alert Systems (AVAS) so they emit detectable levels of noise.

Vision Australia has met with Federal MPs and senior staff in the Department of Infrastructure, Regional Development and Cities who have assured that AVAS will be required for electric cars entering the local market in future. n

Sunglass Collective, the latest venture from the team behind Eyes Right Optical, has appointed a new optical mechanic with 30 years’ experience as its head of prescriptions (Rx).

Since launching in January with exclusive distribution rights to Bollé Sunglasses and Serengeti Eyewear, the company has implemented a full sales and support team across Australia and New Zealand.

“With a script sunglass program offering +6.00 to -8.00, the Sunglass

INSIGHT May 2020

“Without such cues, crossing a road can be dangerous, because it is easy to walk straight in front of a silent electric vehicle without knowing it is there, giving the driver no time to avoid a collision.”

EXPERIENCED OPTICAL MECHANIC JOINS SUNGLASS DISTRIBUTOR

Mr Mark Wymond, managing director of Sunglass Collective, said the new optical mechanic was new to the wholesale industry, but is already familiar with the Bollé and Serengeti product range from working with it in practice.

18

and determining when it is safe to cross a road,” the submission stated.

Sibling owners Ms Lisa and Mr Mark Wymond with head of sales Mr Paul Harrison.

Collective head of Rx will be the contact person for anything to do with Bollé and Serengeti Rx program and can offer help on any technical questions," he said. n

THE

The evolving COVID-19 emergency has drastically altered the 2020 trade fair calendar, with key ophthalmic shows being affected across Australia.

In absence of these events, it’s important the industry’s leading distributors and manufacturers continue to connect with local optometrists, dispensers, ophthalmologists, orthoptists, ophthalmic nurses and other practice staff.

In this issue, Insight brings together a host of suppliers to showcase their latest equipment, devices and products to help eyecare professionals obtain the best outcomes for their patients.

INSIGHT May 2020 19

EYES RIGHT SHOWCASES NEW FACE A FACE EYEWEAR

BOC INSTRUMENTS BRINGS NEW FUNDUS CAMERA TO AUSTRALIAN MARKET BOC Instruments has introduced Optomed Oy Finland’s new Aurora device, the only hand-held fundus camera with 50 degrees field-of-view According to the company, the non-mydriatic retinal camera brings a new concept in fundus imaging and design, adopting high quality imaging and sleek design to ensure simple use. It features a high-quality screen display, practical and modern design, an exceptional lens system, dual charger, eye surface imaging module, and an intuitive graphical interface with simple icons. “Its versatile compact size with nine internal fixation targets for peripheral imaging, internal image storage and WLAN or USB connectivity makes the Aurora ideal for hand-held or slit lamp mounted use for colour and red-free fundus imaging and anterior eye imaging anytime and anywhere,” a BOC spokesperson said.

Email: sales@bocinstruments.com.au

Eyes Right Optical has unveiled its latest designs from Face a Face Paris. The Victoria-based eyewear distributor has launched ‘Milli’ (pictured), a new Face a Face Paris concept that draws its inspiration from the light painting experiments of Picasso and photographer Gjon Mili. The design is a hand painted, luminescent model where transparency echoes the electric colours.

The ‘Bocca Song’ release from Face a Face Paris is said to be an elegant new addition to the Bocca collection. It is the first Bocca shoe in full titanium, a delicate cut-out of a boot, that features on the temple tip. The design has the ‘light and thin’ elegance of a catwalk, while the double arcade at the front also draws a ray of light within the eyes.

Email: sales@eyesright.com.au

SUN PHARMA INTRODUCES AUSTRALIA’S LATEST DRY EYE TREATMENT

ZEISS SMARTLIFE LENS FOR CONNECTED LIFESTYLES In response to relevant consumer insights and extensive research on modern visual behaviour, Zeiss has developed a new lens portfolio consisting of single vision, digital and progressive lenses to help spectacle lens wearers keep up with the times. The Zeiss SmartLife Lenses are said to provide effortless and comfortable vision in all distances and directions, larger fields of view and seamless transition from near to far distances. It also considers the evolution of vision needs in every age. According to Zeiss, these products feature exciting new technology that has been carefully thought through to make it simple for eyecare professionals to choose – and sell – the correct lens for each patient.

Email: renay.lotz@zeiss.com

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INSIGHT May 2020

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-101-2014-001 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-1012016-001 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

Break Your Routine

For more information about OZURDEX® implant, please contact your local Allergan representative

OZURDEX® implant delivers rapid and sustained improvements in visual acuity in patients with DMO* and RVO†1,2 *Significant improvement in BCVA at 2 days, maintained through to 90 days, compared to baseline (both p<0.01)1 † Significant improvement in BCVA at 1 month (p<0.001), maintained through to retreatment at 6 months, compared to sham (p=0.006)2 On average:

5.0

OZURDEX INJECTIONS ®

are needed over 24 months to treat DMO (N=46)‡3 Mean number of injections3

‡

PBS Information: OZURDEX® – Authority required for the treatment of DMO, RVO and non-infectious posterior segment uveitis.

Refer to PBS Schedule for full authority information.

Before prescribing, please review approved Product Information available on request from Allergan by phoning 1800 252 224 or from www.allergan.com.au/products Australian Minimum Product Information. OZURDEX® 700 µg dexamethasone intravitreal implant is a prescription medicine containing 700 µg of dexamethasone. Indications: Treatment of diabetic macular oedema (DME); treatment of macular oedema due to Branch Retinal Vein Occlusion (BRVO) or Central Retinal Vein Occlusion (CRVO); treatment of non-infectious uveitis affecting the posterior segment of the eye. Contraindications: Hypersensitivity to ingredients; active/suspected ocular or periocular infection including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases; advanced glaucoma; aphakic eye with rupture of the posterior lens capsule; eyes with an anterior chamber intraocular lens (ACIOL), iris or transscleral fixated IOLs, and rupture of the posterior lens capsule. Precautions: Proper aseptic injection techniques must always be used. Monitor patients for infection or increased IOP. Patients who had a tear in the posterior lens capsule or who had an iris opening to the vitreous cavity are at risk of implant migration, which might lead to corneal oedema. Corticosteroids have been associated with posterior subcapsular cataracts, increased IOP, glaucoma and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses; history of or active herpes simplex; use with caution in patients taking anti-coagulant or anti-platelet medicines; and in patients who are pregnant or breast-feeding; use in children has not been studied; temporary visual blurring may occur after injection of OZURDEX®, therefore, patients should not drive or use machines until this has resolved; administration to both eyes on the same day is not recommended. Adverse Effects (≥1%): Cataract, cataract subcapsular, cataract nuclear, lenticular opacities, IOP increased, ocular hypertension, conjunctival haemorrhage*, vitreous haemorrhage*, eye pain*, vitreous detachment*, vitreous floaters*, conjunctival oedema*, vitreous opacities*, anterior chamber inflammation*, visual acuity reduced, endophthalmitis, hypotony of eye, retinal detachment, complication of device insertion, device dislocation, conjunctival hyperaemia*, visual disturbance, photopsia*, headache, myodesopsia, blepharitis , abnormal sensation in the eye*, eyelid pruritus, scleral hyperaemia*, visual impairment, migraine. Dosage: 700 µg per eye (entire contents of a single-use OZURDEX® device). Last Amended Date: 06 June 2017 Note: “*” indicates adverse drug reactions considered to be related to the intravitreal injection procedure.  Please note change(s) in Product Information.

REFERENCES: 1. Veritti D et al. Opthalmologica 2017;238:100–5. 2. Haller JA et al. Ophthalmology 2010;117:1134–46. 3. Fraser-Bell S et al. Ophthalmology 2016;123:1399–401.

ABBREVIATIONS: BCVA, best corrected visual acuity; DMO, diabetic macular oedema; RVO, retinal vein occlusion.

Allergan Australia Pty Ltd. 810 Pacific Highway, Gordon NSW 2072. ABN 85 000 612 831. ™ ® Trademark(s) and registered trademark(s) of Allergan, Inc. © Allergan, Inc. 2020. All rights reserved. Date of preparation: April 2020. AU-OZU-2050008 V1. ALL4445.

GOOD OPTICAL SERVICES INTRODUCES NEW INNOVATIVE DRY EYE PRODUCTS Good Optical Services is the Australian distributor of NuLids, a doctor directed athome dry eye treatment, as well as the new ‘Sterileyes’ antibacterial feature on the Eye Doctor Hot & Cold Eye Compress.

Produced by NuSight Medical, the NuLids treatment requires only one minute a day. Its oscillating Soft Tip design works by gently stimulating and rejuvenating the patient’s meibomian glands, and has been shown to remove scurf, improve meibomian gland effectiveness, and increase meibomian output by 2×1.

Studies have also demonstrated a 65% improvement in tear film breakup time and an 81% increase in meibomian gland yielding liquid secretions in less than 30 days.

Good Optical also supplies The new Eye Doctor ‘Sterileyes’ Antibacterial Hot & Cold Eye Compress.

Sterileyes is an antibacterial shield on the

compress that has been clinically proven to kill 99.9% of bacteria. The patented solution is bound to the fibres of the mask fabric to protect the eyes from potentially harmful bacteria. It also provides stain protection, extended product life and eliminates germs that synthesise fats and lipids, which create odour. The Eye Doctor ‘Sterileyes’ Eye Compress consists of a hygienic, removable and washable cover that can be used in the microwave, freezer or oven. Applied hot to alleviate dry eye symptoms, and cold to address inflammation, allergies and migraines.

Email: goodopt@ ozemail.com.au

MODSTYLE SHOWCASES THE LATEST FROM AVANTI Modstyle has introduced the latest ‘Somerset’ and ‘Heart’ models from the Avanti collection.

The Avanti ‘Heart’ (pictured) is said to be a celebration of love and style. It features glitter-filled acetate and a cute shape makes the model suitable for both optical or sunglass purposes.

The new Avanti model ‘Somerset’ features an ultrathin metal frame with what the company describes as a “beautifully coloured front”. It also adopts a modern twist on a vintage shape and is light weight, with the extreme fineness allowing for a range of options in terms of shape and colours.

Email: modstyle@modstyle.com.au

CIRRUS 6000 OFFERS MAJOR WORKFLOW BENEFITS To combat the challenges associated with imaging various patients in a fast-paced environment, Zeiss has developed the Cirrus 6000.

Offering high speed image capture, larger field-of-view and high definition scans, the OCT device is designed to reveal the finer details of the retina over a larger area while allowing eyecare

Cirrus 6000

22

INSIGHT May 2020

professionals to spend more time with their patients.

According to Zeiss, early adopters of the Cirrus 6000 have noted the new 100kHz scan speed offers significant workflow improvements and acquisition success, even for more difficult patients.

With OCT cube scans captured in as little as 0.4 seconds, this is said to bring an improvement of 270% on previous models. The Cirrus platform also ensures seamless transfer of raw patient data from previous generations of the device – enabling clinicians to maintain continuity of care, with trusted progression reports being a key factor in glaucoma management and other ocular diseases.

Meanwhile, the Clarus 700 is Zeiss’ latest imaging system offering 7µm

"THE OCT DEVICE IS DESIGNED TO REVEAL THE FINER DETAILS OF RETINA OVER A LARGER AREA" ZEISS

Clarus 700

resolution and ultra-widefield images in a variety of modalities.

Guiding the eyecare professional with live infrared imaging, and scanning almost the entire visible light spectrum, the fundus imaging system generates lid/lashfree, high resolution and natural colour images to accurately document clinical assessment of the patient.

Email: med.au@zeiss.com

Paired for Performance STELL ARIS ELITE™ + CAP SU LE GUARD ®

CapsuleGuard Handpiece Excellent in all phases of I/A ®

“ The aptly named CapsuleGuard is the best IA device

“ I believe that the Stellaris Elite is one of the most

advanced Phaco platforms on the market today, and one of the most efficient cataract surgical devices I have ever worked with. For cortical cleanup, CapsuleGuard is an excellent choice to combine with the Elite platform. The one piece disposable silicone I/A comes in several diameters which allows for a water tight closure of the incision during I/A which helps in reducing fluid utilization.

“

Built for the next generation.

But ready for this one.

I have used to date. It provides more degrees of freedom than any other I/A device: the soft, smooth, relatively transparent silicon tip obviates metal on capsule contact and three different tip angulations cater for various surgeon proclivities. The optimised aspiration port allows safe, efficient cortical cleanup and polishing of both anterior and posterior capsule and also, removal of epinucleus if required. The dual irrigation ports allow uniform capsular irrigation and maintenance of capsular bag space. Overall this device adds a safety margin previously unattainable.

Prof Minas T Coroneo

“

Dr Mitch Shultz Call Today to Test Drive Stellaris Elite ™ with CapsuleGuard ® 1800 251 150 © 2019 Bausch & Lomb Incorporated. ®/TM denote trademarks of Bausch & Lomb Incorporated and its affiliates. Bausch & Lomb (Australia) Pty Ltd. ABN 88 000 222 408.

Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) New Zealand Distributor: Toomac Ophthalmic. 32D Poland Road, Glenfield 0627 Auckland New Zealand (Ph 0508 443 5347) STE.0028.AU.19

ALLER GAN IM PLAN T O VER CO M ES IN JECTIO N B U R DEN FO R PATIEN TS Ozurdex, a biodegradable, intravitreal implant containing 700µg of dexamethasone, is associated with a reduced injection frequency compared with other therapies such as VEGF inhibitors.

First approved by the Therapeutic Goods Administration in 2015, the Allergan-produced therapy is listed on the Pharmaceutical Benefits Schedule (PBS) for the treatment of diabetic macular oedema (DMO). This includes DMO patients who are pseudophakic or scheduled for cataract surgery and have not responded sufficiently to anti-VEGF therapy, as well as appropriate naïve patients who are unsuitable for anti-VEGF therapy. It is also PBS-listed for branch and central retinal vein occlusion with macular oedema and non-infectious posterior segment uveitis.

The device is implanted by an ophthalmologist via a single use applicator and slowly releases dexamethasone directly to the retina over several months.

DMO is the leading cause of preventable vision loss from diabetes, affecting an estimated 72,000 Australians and costing the national economy more than $2 billion.

Email:medinfo.Australia@allergan.com

DEVICE LAUNCHES NEW TOPCON SOFTWARE APPLICATION Device Technologies Australia and Topcon Healthcare have announced the release and regulatory approval of Topcon Harmony.

The next generation device is a responsive HTML-5 browser-based software application for on-site or cloud-hosted environments. It allows eyecare professionals to connect their diagnostic instruments, regardless of manufacturer, in one secure, web-based platform.

Using the latest in data encryption and security, professionals can also access data from any location at any time.

According to Topcon Healthcare: “Connecting multiple sites has never been easier with our cloud-based hierarchy system, view one site or view all it’s up to you, with the peace of mind that your data is always secure and backed up.”

Email: customers@device.com.au

OSA ADDRESSES VARYING WORKING DISTANCES WITH NEW LENS

RODENSTOCK EXPLOITS FULL VISUAL POTENTIAL The Rodenstock DNEye scanner 2 transfers more than 7,000 measuring points into the individual lens.

By going beyond ametropia and measuring the individual biometric data of the eye, the company produces unique lenses that are suitable at every point of view and tailored to the individual eyes.

“The visual potential can be fully exploited for the first time resulting in an unprecedented sense of vision, with the wearer experiencing sharper vision, improved contrasts, best night vision, greatest fields of vision and natural visual impressions,” a company spokesperson said.

A survey of DNEye-optimised lens wearers has shown 96% feel ‘very comfortable’ with their lenses all around, while 88% experienced greater visual comfort compared with their old glasses.

Email: optics@rodenstock.com.au

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Optical Supply of Australia (OSA) has unveiled the EasyWork lens, designed to cater for modern-day demands on near and mid-distance vision. With a choice of designs that provide convenience and comfort, EasyWork is available in EasyWork Mid and EasyWork Long; these two different configurations cater for different work needs and distances. According to independent research, time spent in front of screens is constantly increasing, with 43% of employees using screens for prolonged periods during the work day.

Email: marketing@osalens.com.au

The most powerful tool yet for examining the retina The ONLY ultra-widefield retinal imaging device with integrated, UWF-guided swept source OCT. Silverstone produces a 200° single-capture optomap® in less than ½ second and enables guided OCT scanning across the retina and into the far periphery.

To find out more about optomap imaging or to put a device in your practice call 08 8444 6500 or email auinfo@optos.com

MENICON PRESENTS THE WORLD’S SLIMMEST CL BLISTER PACK Menicon Australia is now distributing the new Miru 1day Flat Pack, a user-friendly packaging design that aims to address the challenges of daily disposable lens wear.

According to the company, it is the slimmest contact lens packaging in the world and is easier to open than traditional blister packs. At barely 1mm thick, it is also designed to minimise lens handling, while reducing the likelihood of dirt and oil being transferred from fingers to the surface of the eye.

Menicon’s Miru 1day Flat Pack Toric range is also coming soon with the company’s renowned Smart Touch technology, as well as its Smart Fit technology that naturally orients the lens correctly no matter which way it is applied.

Email: mail@menicon.com.au

TRANSITIONS OPTICAL REINVENTS PHOTOCHROMIC SYSTEM IN NEW LENS DESIGN Transitions Optical has responded to consumer demand for a photochromic lens that features faster fade back without compromising lens darkness, with the launch of its nextgeneration Transitions Signature lenses.

Launched 1 April, Transitions Signature GEN 8 lenses have been developed on the back of surveys with more than 76,000 glasses wearers and 4,000 eyecare professionals over five years to determine the key attributes for a photochromic lens.

The new lens design – available in sapphire, amethyst, emerald, amber, graphite green, brown and grey – features a reinvented photochromic system and comes six years after the launch of the previous Transitions Signature VII lenses.

“The new Transitions Signature GEN 8 lens is up to three minutes faster to fade back and 30% faster to activate. Not only are the lenses faster, they are even darker than previous Transitions generations,” the company’s Asia Pacific general manager Mr Stuart Cannon said.

Email: info@transitions.com.au

MYOPIA DEVICE JOINS DFV DIAGNOSTIC PORTFOLIO The new Oculus Myopia Master is the world’s first device said to combine the important measurement parameters for myopia management: refraction, axial length and central corneal radii.

The German-developed device, locally distributed by Designs For Vision (DFV), has been developed to address an increasing demand to monitor myopia early on in life.

According to the company, all patient data is available at any time via the display or a linked computer.

Findings are illustrated with colour codings and elucidated with detailed information, with a take-home report also produced for the patient.

Myopia Master joins the DFV range of diagnostic devices for myopia, including the Nidek AL-Scan optical biometer and Oculus’ new multifunction Pentacam AXL WAVE. Email: orders@dfv.com.au

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Finally…a fast and effective at home treatment for Dry Eye disease YOUR EXPERTISE + NULIDS SYSTEM = IMPROVED PATIENT OUTCOMES • NuLids offers a simple Doctor directed at-home dry eye therapy for your patients

ALCON VITRECTOMY PROBE FEATURES HIGH-SPEED CUTTING

• NuLids treatments take only 1 minute a day • NuLids’ oscillating Soft Tip design works by gently stimulating and rejuvenating the patient’s Meibomian Glands

The Advanced Ultravit High Speed Beveled vitrectomy probe is the next evolution of the vitrectomy probes from Alcon. At 10,000 cuts per minute, the device features a unique beveled tip design that facilitates improved access to the tissue plane. Dual-pneumatic high-speed cutting in 25+ gauge decreases traction, while the optimised duty cycle helps to increase vitreous flow.

• NuLids has been shown to remove scurf, improve Meibomian Gland effectiveness, and increase Meibomian output by 2x1

Email: surgicalorders.au@alcon.com

MISIGHT SECURES FDA APPROVAL MiSight 1 day, the world’s first daily disposable contact lens for myopia management, recently became the first and only US Food and Drug Administration-approved product clinically proven to slow the progression of myopia. Three-year peer-reviewed results indicated that use of the CooperVision contact lens slowed myopia progression by 59% as measured by mean cycloplegic spherical equivalent and 52% as measured by mean axial elongation of the eye. First made available in Hong Kong in 2009, MiSight is also being distributed with a ‘myopia control indication’ in eight European countries, the Nordic region, Israel, Canada, Singapore, Malaysia and Australasia.

Studies have demonstrated a 65% improvement in tear film breakup time [TBUT] and an 81% increase in Meibomian Gland Yielding Liquid Secretions in less than 30 days1 C

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Email: MiSight1day@ au.coopervision. com

GLAUKOS TECH TACKLES GLAUCOMA TREATMENT BURDEN Glaukos’ new intraocular implant iDose is on track to complete US Food and Drug Administration trials in 2022, as the company seeks to address glaucoma treatment adherence.

The glaucoma device manufacturer believes its latest drug delivery system could offer an alternative to traditional topical drop medications. The device consists of a titanium intraocular implant filled with a proprietary, concentrated Travoprost formulation. A scleral anchor is designed to hold the device in place. With a miniature profile – 1.8mm by 0.5mm – the iDose is inserted through a clear corneal incision, enabling direct implantation into the anterior chamber, where it begins the process of sustained drug elution.

Contact: www.glaukos.com

HOT & COLD EYE COMPRESS

Sterileyes® is an antibacterial shield which kills 99.9% of bacteria. The patented solution is bound to the mask fabric to protect the eyes from potentially harmful bacteria.

• Hygienic - removable - washable cover • Microwave - Freezer - Oven Apply HOT to alleviate dry eye symptoms and COLD to soothe inflammation allergies and migraines

OPTOS POISED TO WELCOME SILVERSTONE TO AUSTRALIA This year Optos has launched Silverstone, the only ultrawidefield (UWF) retinal imaging device with integrated, UWFguided swept-source OCT. Producing a 200° single-capture optomap image in less than ½ second, the device also enables guided OCT scanning across the retina and into the far periphery. Three-in-one Color Depth Imaging provides important clinical data from the retinal surface through the choroid.

A 1050nm OCT light source provides deeper tissue penetration for clear, detailed choroidal imaging, while the company’s optomap feature has been shown to enhance pathology detection and disease management and improve clinic flow.

Email: auinfo@optos.com

SAFILO UNVEILS NEW DAVID BECKHAM COLLECTION Safilo has introduced the new Eyewear by David Beckham collection to Australia, bringing a new range of sunglass and optical offerings to the premium male segment.

Beckham, a former English footballer and global celebrity, has signed a 10-year licence agreement with the Italybased eyewear company, with the partnership recently launching its first Spring-Summer ’20 range comprising 23 sunglass styles and 19 optical designs. According to Safilo, Beckham has curated a collection of timeless frames made from quality materials, bringing together a contemporary aesthetic with traditional craftsmanship.

Contact: 1800 252 016

B+L CAPSULEGUARD REDUCES POSTERIOR CAPSULE RUPTURE In cataract surgery, the Bausch + Lomb (B+L) CapsuleGuard irrigation and aspiration (I/A) handpiece is said to provide more degrees of freedom, consisting of smooth I/A ports to help eliminate sharp edges for reduced risk of capsule rupture.

NEW PROGRESSIVE FROM HOYA

Available in three configurations for standard and microincision cataract surgery (MICS) procedures, ranging from 1.8mm to 2.8mm, the single use instrument is designed with a soft, smooth, relatively transparent silicone tip that improves visualisation.

Over the coming months, Hoya Australia will launch its latest progressive lens, the Hoyalux ID Myself.

It has also been developed with three different tip angulations to cater for the tendencies of each surgeon.

The lens is said to elevate binocular performance with Hoya’s Binocular Harmonisation Technology and the pioneering 3D Binocular Vision, which allows the lens to control the unwanted prismatic effect on the periphery. As such, progressive wearers benefit from significantly reduced distortion and swaying effect along all dimensions.

According to B+L, the optimised aspiration port facilitates safe and efficient cortical clean-up and polishing of the capsule, as well as removal of viscoelastic.

Hoya has also built Adapt Ease Technology into the lens, which improves the near and intermediate visual width and gaze transition without influencing the far vision. With optimised visual fields, it offers a pleasant experience while using digital devices and during outdoor activities.

Email: hapl_marketing@hoya.com

“The dual irrigation ports allow uniform capsular irrigation and maintenance of capsular bag space,” Australian ophthalmologist Professor Minas Coroneo said. “Overall this device adds a safety margin previously unattainable.”

Email: customer.service@bausch.com

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M AESTRO2 Fully Automated OCT & True Colour Fundus Photography ...now with OCT-Angiography!

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FEATURE

INNOVATION & OPPORTUNITY IN UNCHARTED WATERS Although few can compare with the magnitude of COVID-19, crises are an inherent part of business. RHIANNON BOWMAN examines how the ophthalmic sector can rebound from this latest crisis and capitalise on new opportunities it presents.

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F

ew could have anticipated how widespread and sudden the coronavirus would shut down large sections of the Australian economy.

The weekend of 21-22 March, when the federal and state governments unveiled the first phase of strict lockdown measures, will be a moment etched into the memories of Australian business owners once they emerge from the other side of the crisis.

At the time of writing, the implications of ever-insreasing government restrictions were being felt through the eyecare sector, with the Department of Health advising that optometrists should only remain open for essential and urgent care.

Many optometrists, including optical chains and independents, adapted their service models accordingly, while others temporarily closed their shutters. The government also announced an historic $320 billion financial package (read more on page 14), offering a lifeline to affected practices who are hopeful of returning to full operational capacity this month.

While the disruption may be painful from an economic standpoint, optometrists have been quick to adapt and keen to share how they are handling the economic downturn. Sections of the eyecare community are also using this moment to pause and identify new opportunities in terms of innovation and business management.

Chief among those is expanded use of telehealth services, which has emerged as a chance for the sector to significantly change the service delivery model. Elsewhere, with employees stood down across the country, practices are being encouraged to mobilise their staff to drive the future direction of their business, while also invest in other key areas such as professional development.

TIME WILL TELL

Independent optometrist MR HARRY NOTARAS has made some tough staffing decisions, and is preparing to operate the business remotely if he's forced to close.

Independent optometrist Mr Harry Notaras, practice owner of EyewearYouwear in Surry Hills, Sydney, is no stranger to business disruption, but he says the COVID-19 pandemic is unlike anything he’s ever experienced.

In 2014, Notaras’ auxiliary practice Optometrix in Darling Street, Rozelle, closed for more than a week following a fatal explosion and fire in a neighbouring property.

The practice was located diagonally opposite but didn’t sustain any damage thanks to security screens fitted on his shop front windows.

However, concerns about asbestos contamination resulted in an exclusion zone being established around the blast site. He was unable to enter the premises, even to hear messages on his voicemail, and had to cancel all patient appointments. He also had to inform his staff that they were not to go to work until it was safe to reopen the business.

“The biggest difference between that experience, and the current disruption, is that I could see the light at the end of the tunnel very quickly.

Today, we don’t know what will happen, it’s changing day-by-day,” Notaras says.

As a member of Optometry Australia, Notaras is receiving regular notifications advising how coronavirus and government measures are affecting allied health practitioners.

“There is a lot of communication, from organisations and manufacturers.

It’s important to keep up with the latest information. You need to be proactive with the advice that Optometry Australia is giving.”

When Notaras spoke with Insight in March, the government was advising allied health practitioners to exercise discretion in order to limit the risk of infection and treat only urgent cases.

“We did tailor our practice, trying to minimise the risk of infection following guidelines that were provided by Optometry Australia, such as limiting time spent with patients, only seeing urgent patients. Patients are triaged according to what Optometry Australia guidelines have indicated to be an urgent consultation. We’ve called every patient with a booking, we’ve sent text messages and SMS reminders. We’re essentially triaging over the phone.

“Our staffing has also changed. Normally, we have four full-time staff, one permanent part-time, and two casuals. Unfortunately, we’ve had to let our casual staff go, and we’re splitting our hours to retain two optometrists and two dispensers working half-days to minimise the risk of infection for both patients and staff.”

An experienced businessman, Notaras anticipates the biggest challenge could be yet to come. He believes the longer the economic disruption goes on, the longer the recovery time will be.

“Our practice is fortunate in that we have no business loans, but we pay leases on expensive equipment. I’ve been in contact with the people we do finance through and discussed delaying payment for six months, but it could drag out to 12 months.”

Notaras has also spoken with his practice landlord about paying rent and “trying to come to a mutual agreement”. In the days following his conversation with Insight, the Prime Minister announced a ban on evictions over the next six months for commercial and residential tenancies who are unable to pay rent due to the impact of coronavirus.

“Our practice is street-facing in a retail strip. Every other business affects us. The popular local coffee shop, for example, brings people past our door, but that’s closed, as well as many other retail shops near us. All these closures affect us.

“If we’re forced to close the practice, I’ve made changes so we can access our database remotely and continue running the business in some capacity. We can still monitor phone messages remotely, take orders for specs and lenses, we can mail directly to the patient, patients can deposit payments into our account.”

CATALYST FOR CHANGE

Eyeclarity founder MR JIM PAPAS believes the eyecare sector could become more consumer-centric after COVID-19.

Eyeclarity founder Mr Jim Papas also knows how an economic slowdown can impact a business. He opened his first practice in Melton in 1986, not long before the 1990s recession Prime Minister Paul Keating infamously described as “the recession we had to have”.

Papas’ business survived the Global Financial Crisis (GFC) in 2007 too, and he eventually opened practices in Sunbury, Bacchus Marsh, Watergardens, Southgate, Hoppers Crossing and Melbourne CBD. “We have opened and closed practises based on the business case."

When he spoke with Insight, Papas – like many other optometrists – was reviewing his business on a daily basis, including his trading hours, leasing arrangements and staffing levels.

INSIGHT May 2020 31

FEATURE

He believes one challenge the eyecare profession is facing is the “problem of doing the same thing the same way for several years”.

He says the health and economic crisis COVID-19 has created could prompt significant change, with telehealth potentially becoming a more viable option.

“I think an important lesson that came out of the GFC is to make sure you’re close to your patients,” he explains. “The problem in optometry is it’s a provider-lead service; it’s on the provider’s terms.

“It has been this way for the last 20 to 30 years. Really, the industry needs to change to a more consumer-centric model. With 24/7 internet, access to latest offers and transparency on pricing, consumers are now making decisions.

“This crisis could be the catalyst to change the system to be more consumer-centric. The practices which provide eyecare this way are the ones which will thrive.”

WORKING ‘ON’ THE BUSINESS

ProVision CEO MR STEVEN JOHNSTON says the crisis creates an opportunity for practice owners to shore up business cash flow, work on their business plan and invest in professional development.

“Business planning can be team-based. It’s something that can be shared across the whole team. Establishing your practice values should be team-based, all your staff can contribute to that," he says.

“At an operational level, this is also a great time to look at your product range. Ask yourself: is it the right range for the clientele we want to attract moving forward? What marketing plan will you have in place to promote that your practice is back up and running?”

With 460 businesses, ProVision is the largest network of optometry practices in Australia. Amid the widespread economic disruption, CEO Mr Steven Johnston has made it a top priority to keep each practice informed with weekly updates on business management. He believes the COVID-19 crisis has raised three unique opportunities for practice owners, managers and staff.

The third important point, Johnston notes, is that the downturn presents an opportunity for personal development.

“This is an opportunity for practice owners to shore up business cash flow, work on their business plan, and invest in professional development,” he says.

“The lesson here is, if we’re all going to be working from home, use the time effectively. Business planning doesn’t have to fall on the shoulders of the business owner. It can be shared across all employees. There is going to be extraordinarily bored people over the next six months. Find a way to stay productive.”

Johnston described the Federal Government’s JobKeeper payment program as a “real godsend for practice owners and their staff”.

“The number one point to be considering is cash flow to take your business out to the end of this calendar year or at least for a six-month hiatus or hibernation. A business owner needs enough cash to get through the next six to nine months,” he explains.

Johnston says practices can utilise allowances like PAYG concessions and other government-led initiatives to survive financially. “But you’ve got to understand with cash flow that you need to reduce your obligations, and the biggest cost in small business is staff. That’s the same for everyone.”

He explains that temporarily closing or reducing practice opening hours creates other opportunities. “The second point to be considering, is that practice managers and optometrists will have a lot of time on their hands, if they are not consulting with patients.

“This is the time to plan for what your business is going to look like out the other side of this. Optometrists are practicing for most of the year, there is no down-time, they don’t get time to work on their business.

There will be time to take stock, re-evaluate your purpose, value, and mission. This is a perfect opportunity for practices to come out the other side different to how they went in; it’s an opportunity to work ‘on’ the business – not just ‘in’ the business.”

Further, Johnston believes the JobKeeper payment, which is designed to keep staff connected to businesses, is an opportunity to engage practice staff in driving the future direction of the business.

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“Fortunately, we launched ProLearn Max, an online learning platform for our members in October last year. So rather than having ‘stood down’ staff at home watching Netflix, ProVision practice staff can continue to improve their knowledge-base, learning from home.

TELEMEDICINE TRENDING

Oculo CEO DR KATE TAYLOR says the company accelerated a plan to add a videoconference component, recognising that practitioners immediately needed another way of communicating with patients.

At the time of writing, the ophthalmic community recognised telehealth as an ideal method to overcome challenges posed by COVID-19, and has been advocating for new optometry-specific Medicare items.

Last month, the Australian developers behind cloud-based telemedicine platform Oculo helped form part of the solution. They identified an emerging gap in patient care with COVID-19 and immediately added a new feature that will help eyecare professionals connect with their patients via videoconference.

CEO Dr Kate Taylor says Oculo is used for 90% of the teleophthalmology currently billed in Australia. She described COVID-19 as a “curveball” for the eyecare profession that is “creating a lot of challenges for everyone”.

“What the future of eyecare will look like after coronavirus hasn’t yet been spelt out; everyone is highly focused on the acute crisis,” she says.

unusually advanced disease, including vision loss that would have been better managed under normal circumstances.

“But we’re getting a sense of what could potentially happen, and that was the trigger to change our business response. Disruption can create opportunity.”

“This may be a turbulent time, considering how most public outpatients around the world were not adequately coping with demand before COVID-19,” she says.

At present, approximately 3,000 optometrists across corporate and independent groups and more than 750 ophthalmologists use Oculo to support communication with over 800,000 patient records.

While there may be greater demand for healthcare when self-isolation restrictions are lifted, Taylor also questions whether it will be provided through the same mechanisms.

Taylor says the company accelerated its plan to add the videoconference component, recognising that eyecare practitioners immediately needed another way of communicating with patients and each other. She foresees COVID-19 unfolding in three phases: acute, sub-acute and recovery.

“Patients may abandon their private health insurance because they see little benefit if they can’t use it for six months. So, post-coronavirus, patients whose cataract surgery was postponed during the pandemic may no longer be privately insured and now seeking surgery though the public health system.

“The acute phase is happening right now [early April]. As you look around, you can see the crisis management with emergency shutdowns, social distancing, and self-isolation measures to flatten the curve.

“We’ll move into the sub-acute phase when, speculatively, an antibody test becomes available and we can distinguish between people who have been infected and become immune, and those still at risk. We can progressively rebuild a partial workforce able to better care for the community.”

The final stage, Taylor says, will be the recovery phase as the population reaches a critical mass for herd immunity or a vaccine.

“This could be a phase marked by an enormous backlog in healthcare as people who have stayed away from care or not been able to access it will now seek to.”

Taylor suspects eyecare practitioners could have a period of detecting

"Ask yourself: what does that mean for my business?”

Ultimately, she believes telemedicine can play a part in each phase of the pandemic. “In the acute phase, telehealth can be used to screen patients, share clinical information, reduce duplication, reduce contact between patients and health care practitioners, keep people self-isolated at home and socially distanced.

“The sub-acute phase amplifies the potential for telemedicine. As more of the population becomes immune, more of the workforce can work remotely and/or virtually. With part of the population immune, we can create scalability – remote capture and telemedicine review give scale to a partially resourced health system.”

In the recovery phase, Taylor envisages telemedicine could hasten the process of working through heightened demand, while still protecting pockets of vulnerable people.

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FEATURE

PERFECT STORM GATHERING

DR BEN ASHBY, optometry director at Specsavers, is lobbying the government for optometry to gain access to telemedicine. The company is also making technology changes to support future telemedicine services.

Dr Ben Ashby, optometry director at Specsavers, believes the Federal Government is moving towards supporting telehealth, but as restrictions on social-distancing and self-isolation tighten, subsequently curtailing face-to-face optometric consultations, more needs to be done in the immediate term to help optometrists support their patients.

“If you look beyond COVID-19, a lot of older people who aren’t mobile, who are in aged care facilities, or regional and remote locations, have difficulty accessing eyecare,” Ashby says.

“Ten million people are not getting their eyes checked regularly and access has to be a significant factor in this worrying statistic.

“In the short-term, Specsavers is working hard alongside Optometry Australia and others within our profession to lobby the government for optometry to gain access to telemedicine but to be sustainable in the long-term, we’re also making technology changes within our software programs – Socrates and Genesis – to support telemedicine services.”

He says supporting off-site practitioners to provide care included granting remote access to health records and the ability to update them so as to accurately document telemedicine outcomes. This supports good clinical decision making and continuity of care over time.

“Telehealth in optometry is a critical tool for the profession to help those in the community who are challenged to physically attend practices. This unique time is an opportunity to research and measure what we’re doing, to demonstrate the benefit of telemedicine. Measuring referral patterns, patient outcomes, and clinical interventions is vital, so we can learn from it, and ultimately it is our patients that benefit from that.”

Ashby notes that four telehealth items have been previously added to the Optometry Medicare Benefits Schedule, but they are under-utilised mostly because the wording of the item code meant the optometrist and patient needed to be together while an ophthalmologist participates via video conference, a process that is inherently difficult.

“We hope this might change in the next tranche of announcements as telemedicine is ideal for short (10916) and subsequent (10918) eyecare consultations, which could be achieved by removing the need for physical attendance in the current descriptors, as part of the delivering of primary care,” he says.

Although optometrists have been advised to exercise discretion and limit themselves to urgent cases only, many are wondering how the profession will deal with a backlog of patients who have missed routine eyecare.

and closer working relationships with medicine.

“Currently optometry does not have a practice management system with all the needs of the future with integrated telemedicine, remote record access, clinical decision support and AI built into it," he says. "But the conditions are ripe for innovation to kick in. Circumstances such as the state of the economy, and people with time on their hands, makes for the ‘perfect storm’ for innovation.”

SUPPORT FOR STAFFING AND WAGES

MS KOBI SEDSMAN is director of WageLoch, a cloud-based staff rostering and time and attendance software for small businesses.

Clients have been inquiring about a new 'stand down' award category.

WageLoch is set up to “talk” to accounting software such as MYOB and Xero, so wage categories under the modern award system can be mapped and managed. Since starting the company with her husband, Lachlan, in 2006, director Ms Kobi Sedsman says the technology has been increasingly adopted in health professions including medicine, dentistry, pharmacy and ophthalmology where the modern award landscape is inherently complex and varies from state-to-state.

The company has been responding to shifts in staffing trends as the coronavirus outbreak has continued to affect small business.

“As a business-to-business software solution, many of our clients have been contacting us since a new category under the modern award system called ‘stand down’ has come to the fore.”

Under Fair Work legislation, employers may be able to stand down their employees without pay during the coronavirus outbreak. Employees that are stood down remain employed during the period of the stand down.

More pressingly, Ashby fears there could be an increased risk of vision loss in the community if patients break their appointment cycle.

“We’ve had a flood of customers asking us to set up a ‘stand down’ wage category as part of their WageLoch service. It’s a good option for businesses facing closure as a result of the government’s lockdown on non-essential services.”

“We’re already stretched as a workforce. We need to work together more closely, sharing the care of patients with other professions, and telemedicine can facilitate that.”

With more staff working from home, Sedsman says clients have also needed to access their services on home-office computers, as opposed to accessing the cloud-based software from their typical place of business.

Ashby notes that the current crisis raises more questions, such as; how does optometry bring in more clinical decision support? How can the sector leverage artificial intelligence (AI) to reach best clinical decisions in a shorter period? With limited staffing, what can be done to upskill ancillary staff to support optometrists? He says the sector needs new triage protocols to reflect current workforce skillsets, the changing environment

“It’s been vital to employers to be able to shift their business to working from home, and not be reliant on being on site,” she says.

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“Contingency and business continuity planning is important, but some scenarios, like COVID-19, you can’t see coming. No one would have planned for this. You have to be flexible and creative and consultative as a small business owner.” n

COMPANY

ESSILORLUXOTTICA APPOINTS NEW DIRECTOR AND RELEASES REVISED 2020 ECONOMIC OUTLOOK Mr Paul du Saillant has been co-opted on to the EssilorLuxottica board as a director, following the retirement of former Essilor CEO Mr Laurent Vacherot, as the company braces for a financial slowdown due to COVID-19.

“I’m fully confident in Paul’s ability to write a successful new page in the integration of Essilor and Luxottica, together with a renewed team of energised young executives,” Mr Hubert Sagnieres, chairman of Essilor, said.

The company announced the appointment on 30 March, which will also see du Saillant assume Vacherot’s role leading Essilor International.

“I would like to warmly thank Laurent for leading our company in several key roles over the past 28 years. He leaves it in very good shape financially, with a strong mission and a solid operational foundation on which to build."

Du Saillant served as deputy CEO of Essilor since 2019 and as COO from 2010 to 2019. He joined the group in 2008 as director of strategy. He was also previously COO of Lhoist Group and senior executive vice-president of Air Liquide. He will work directly with Mr Francesco Milleri, deputy chairman and CEO of Luxottica Group, to implement the EssilorLuxottica strategy and ongoing integration process, according to the board’s announcement.

year targets,” a company statement said.

Hubert Sagnieres, Essilor

Meanwhile, EssilorLuxottica revised its financial outlook for 2020 due to the COVID-19 pandemic after originally anticipating further sales growth.

Last year, the European optical giant reported net profit of €1.08 billion (AU$1.9 billion), falling short of analysts’ expectations of €1.56 billion (AU$2.8 b).

“In January and February, the company delivered solid growth, in line with its full

“Business conditions began deteriorating in March as the virus shifted from impacting predominantly China to entire regions of Europe and North America. During the second quarter, the company expects revenue to further decelerate with a material impact on profitability. At present, the company has insufficient visibility to provide an assessment of the full scope of COVID-19 impact, as the situation remains volatile.”

Essilor temporarily closed all its industrial sites in France. However, production was able to continue due to the company’s worldwide network of plants and laboratories. On 27 March, 10 days after announcing a share buyback program, EssilorLuxottica abandoned the scheme due to COVID-19. A total of 1.55 million shares for an average of €102.54 (AU$183.87) were repurchased. n

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INTERNATIONAL

FUTURE OF GENE EDITING PROCEDURE RESTS ON VISION RESTORATION IN FIRST ATTEMPT US eye doctors are planning to test the new gene editing tool CRISPR on a larger pool of patients once the results of the first attempt are known.

In March, the gene-editing therapy was performed in a person – a Leber congenital amaurosis (LCA) patient – for the first time at the Casey Eye Institute at Oregon Health & Science University in the US city of Portland.

Massachusetts-based company Editas Medicine have developed the treatment with Dublin-based Allergan. It may take up to a month to determine if the therapy successfully restores vision.

If the first few attempts are deemed safe, doctors plan to test it on 18 children and adults, with the Massachusetts Eye and Ear in Boston saying it marks “a new era in medicine”.

According to Associated Press, patients in the study have LCA, caused by a gene mutation that keeps the body from making a protein needed to convert light into signals to the brain, enabling sight.

Scientists can’t treat it with standard gene therapy – supplying a replacement gene – so they’re aiming to edit or delete the mutation by making two cuts on either side with the intention that the ends of DNA will reconnect and allow the gene to work as it should.

One study leader from Massachusetts Eye and Ear, Dr Eric Pierce, who was not involved in the first surgical case, said that once the cell is edited, it has a permanent effect.

The cell will reportedly persist for the life of the patient because the targeted cells don’t divide.

Pierce said one of the biggest risks is that CRISPR could cause unintended changes in other genes. He said the companies have worked to minimise the risk and ensure that the treatment cuts only where it’s intended to. n

OPHTHALMOLOGISTS’ SALARY AMONG TOP-10 FOR PHYSICIANS "THEIR INCOME HAS INCREASED FROM THE PREVIOUS YEAR’S AVERAGE INCOME OF US$357,000 (AU$581,157)" MEDSCAPE PHYSICIAN COMPENSATION REPORT

With an average salary of AU$595,000, ophthalmologists are among the top-ten earning specialties in the US, and are the most likely to choose the same specialty again, according to a new report.

The 2019 Medscape Physician Compensation Report surveyed 20,000 physicians across more than 30 specialties, seeking salary information, employment settings, job satisfaction and more.

According to Medscape, ophthalmologists make US$366,000 (AU$595,808) on average, earning more than general surgeons, oncologists and emergency medicine physicians.

Their income has increased from the previous year’s average income of US$357,000 (AU$581,157).

Medscape reported that self-employed ophthalmologists make US$398,000 (AU$647,275) on average, while employed ophthalmologists make US$329,000 (AU$535,059). Income for both groups has been rising in general, the report stated.

More than half (53%) of ophthalmologists said they felt adequately compensated, an

INSIGHT May 2020

Difficulties getting fair reimbursement was cited as the most challenging part of their job for 26% of ophthalmologists in the US; 24% cited having so many rules and regulations as the top challenge.

According to the report, 96% of ophthalmologists – the highest percentage of all specialists – noted that they would remain in their chosen specialty if they could choose again.

In the US, the most common workplace for ophthalmologists was an officebased single-specialty group (44%), followed by office-based solo practice (19%), academic, research, military and government settings (8%), healthcare organisations (8%), hospitals (4%) and outpatient clinics (1%).

In the 2019 report, instead of only using physicians’ 2018 self-reported salaries, physicians’ compensation was modelled and estimated on the basis of a range of variables, including speciality, age, gender, geographic location, and survey year, across five years of survey data. n

MOLECULE REDUCES TREATMENT BURDEN FOR AMD PATIENTS The latest results from the largest clinical trials for neovascular age-related macular degeneration (nAMD) therapies has demonstrated patients responded well on a less-frequent dosing schedule of abicipar pegol compared with monthly treatment of ranibizumab (Lucentis).

According to the Cedar and Sequoia Phase III clinical trials, patients were able to maintain visual gains with the Allerganproduced abicipar pegol as well as they did with Lucentis.

“At the two-year end point, 93% of patients treated with abicipar every eight weeks after three loading doses or six injections in the second year had stable vision,” Dr Rahul Khurana, from the University of California Medical Center, said. “Ninety percent of patients treated with abicipar every 12 weeks after two loading doses or four injections during the

36

improvement from five years ago when 42% of ophthalmologists indicated they were satisfied with their compensation.

Dr Rahul Khurana

second year had stable vision, and 94% of patients treated with ranibizumab every four weeks or 12 injections in the second year had stable vision.”

Khurana said over the course of two years, patients receiving abicipar pegol averaged 10 injections compared with 25 injections with ranibizumab and had the same visual outcomes. n

RESEARCH

NO GENETIC LINK ESTABLISHED BETWEEN MYOPIA AND GLAUCOMA Australian researchers have featured prominently in research efforts that have determined no genetic link between myopia and primary open-angle glaucoma (POAG).

cases from ANZRAG, which examines genetic risk factors of glaucoma development. They also looked at 10,792 participants with POAG-related quantitative traits from the RS.

Their finding is based on data from the Australian and New Zealand Registry of Advanced Glaucoma (ANZRAG) and the Rotterdam Study (RS), an ongoing study in the Netherlands that examines factors in disease incidence and development in people aged 55 and older.

The researchers analysed the data to determine the relationship between myopia polygenic risk scores and POAG and its endophenotypes.

Many population studies have previously reported myopia is a risk factor for POAG, but a lack of evidence coupled with several other major studies, such as the Ocular Hypertension Treatment Study, have found no link.

According to the study, which was published in Investigative Ophthalmology and Visual Science, myopia polygenic risk scores and POAG were not associated with each other in the data collected from ANZRAG. The RS analysis showed the strongest association between myopia polygenic risk scores and disc area.

To determine a polygenic risk score of a certain disease, the patient’s genome is analysed to find if they have certain genetic variants at certain loci.

Although no correlation between myopia and POAG was estbliahed, they did observe a nominal association between polygenic risk scores for myopia and intraocular pressure in the high myopia subgroup, and a nominal association between polygenic risk scores for myopia and retinal nerve fibre layer.

The researchers, based in the Netherlands, Australia, the UK and the US, looked at 798 advanced cases of POAG and 1,992 unscreened control

The investigators conceded that their findings may be limited because most of the participants were of European descent. n

This latest study investigated a relatively new data point in research – polygenic risk scores – and looked for association with POAG and myopia.

DISPELLING MYTHS AROUND CONTACT LENS WEAR AMID COVID-19 Three of the world’s most published researchers are urging scrupulous contact lens hygiene amid COVID-19 and have warned against the potential for the virus to be transmitted among the presbyope population.

Dr Lyndon Jones, director of the Centre for Ocular Research & Education (CORE), Professor Philip Morgan, from The University of Manchester and Dr Jason Nichols, of University of Alabama, responded to COVID-19-related “myths and misinformation”, including blanket warnings against contact lens wear.

“When using contact lenses or spectacles, careful and thorough hand washing with soap and water followed by hand drying with unused paper towels is paramount,” they said in an article published on the CORE website They said contact lenses remain a safe

Lyndon Jones, Centre for Ocular Research & Education

PROTEIN IN BLOOD A DIRECT LINK TO AMD UK scientists have identified a new protein that could help establish improved diagnosis and treatment of age-related macular degeneration (AMD).

"MYOPIA POLYGENIC RISK SCORES AND POAG WERE NOT ASSOCIATED WITH EACH OTHER IN THE DATA COLLECTED FROM ANZRAG" STUDY AUTHORS

The research team report that elevated levels of factor H-related protein 4, or FHR-4, are present in the blood of people with the condition, a leading cause of blindness worldwide, according to findings published in Nature Communications.

Using eye tissue donated for medical research, the research team also showed that the protein is present within the macula, the specific region of the eye affected by AMD. “Apart from improving understanding of how AMD is caused, this work also provides a way of predicting risk of the disease by simply measuring blood levels of FHR-4,” study co-author Paul Bishop, an ophthalmologist at the University of Manchester in England, said. “[It] also provides a new route to treatment by reducing the blood levels of FHR-4 to restore immune system function in the eyes,” he said.

The researchers from Queen Mary University of London and the University of Manchester used a genetic technique called genome-wide association to identify specific changes in the genome related to the increased levels of FHR-4 found in people with AMD. Blood levels of FHR-4 were measured in 484 patients and 522 age-matched controls using two independent, established collections of AMD patient data; the Cambridge AMD study and the European Genetic Database.

Co-author Simon Clark, from the University of Manchester, added: “Up until now, the role played by FHR proteins in disease has only ever been inferred. But now we show a direct link and, more excitingly, become a tangible step closer to identifying a group of potential therapeutic targets to treat this debilitating disease.” n

and effective form of vision correction, however ill patients should cease wear.

They said COVID-19 can remain on hard surfaces, which can be transferred to spectacles wearers’ fingers and faces.

“Most presbyopes require reading glasses and they may be putting them on and off their face multiple times a day,” they said. n

Elevated levels of FHR-4 were present in the blood of people with AMD.

INSIGHT May 2020 37

MACULAR MONTH

ADHERENCE IN AMD As part of Macula Month this May, Insight explores why treatment adherence remains such a major challenge for some patients and how the sector is working to overcome it.

I

t was only a little over a decade ago that many patients with neovascular age-related macular degeneration (nAMD) resigned themselves to living the remainder of their years with blindness or severe vision loss.

Such a bleak prognosis swiftly eroded their quality of life, as well as those around them, while also impacting other measures such as productivity and the burden on the health system.

Today, thanks to the emergence of sight-saving anti-VEGF treatments, Australian Government reimbursement schemes and collaboration between researchers, healthcare professionals, the pharmaceutical industry and patient advocacy groups, Australia boasts some of the worldâ&#x20AC;&#x2122;s best statistics in terms of nAMD patient outcomes.

While these results are increasingly being translated into positive realworld outcomes, for some patients the journey is not always so smooth.

In Australia, according to the Macular Disease Foundation Australia (MDFA), there is a 20-25% non-adherence rate for intravitreal injection treatment in the first 12 months.

The issue could become more pronounced this year, with clinics

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INSIGHT May 2020

reporting that up to one third of patients are cancelling treatment due to confusion around whether they can attend appointments during COVID-19.

"15.5% OF PATIENTS HAD EITHER DELAYED RECEIVING TREATMENT OR CONSIDERED STOPPING TREATMENT BECAUSE OF THE COST OF TREATMENT AND OUT-OFPOCKET EXPENSES”

It also comes as new studies demonstrate just one missed ophthalmology appointment over a two-year period can lead to decreased visual acuity.

Insight examines what efforts are being made nationally to lift nAMD treatment adherence and how existing therapies are being utilised to ease the burden on patients.

DROP-OUT DESPITE WORLD-CLASS CARE MDFA CEO Ms Dee Hopkins and Professor Mark Gillies, director of research at the University of Sydney’s Save Sight Institute (SSI), agree that Australia is one of the top-ranking countries as far as treatment outcomes for nAMD patients are concerned.

- DEE HOPKINS

“This is because of the ongoing collaboration of government, eye health professionals, industry, researchers and patient organisations like MDFA,” Hopkins says.

“In the past decade, together we have been able to increase national awareness of the condition, move swiftly to register and reimburse anti-VEGF treatments, and foster the skills required by the eye health profession to provide world-leading care for patients living with macular disease.”

Despite these successes, Hopkins and Gillies point to the adherence rate as a key area that still requires close attention, particularly for those that drop out after a year of intravitreal injection treatment, even in Australia.

Gillies has unique insight into the patterns of nAMD treatment in Australia.

He is chief investigator of the Fight Retinal Blindness project, which captures data directly from clinicians worldwide on nAMD patients, as well as those with choroidal neovascularisation other than nAMD, diabetic macular oedema and retinal vein occlusion.

SSI established the project in 2009 and now has a cache of more than 10 years-worth of data.

“Australian clinicians have a ‘treat nAMD forever’ approach, whereas other countries try to stop the disease and discontinue treatment, but there is no clear set of criteria for that model. We get the best results because we treat indefinitely," Gillies says.

“In uncommon patients in whom the injections are discontinued, we see high recurrence rates, with 40% of patients recurring within 12 months and 80% within five years. Undertreatment is a major problem. Observational studies over 15 years show there is a 10% drop-out per year."

According to Gillies, a 10-year follow-up study of people who started injections soon after they were released in 2006 found a quarter of patients made it through treatment for 10 years, but three-quarters dropped out.

"Some drop-out can be explained by patients dying of unrelated illness, or moving to another doctor, but we estimate that at least half of the drop-outs were due to poor results," he explains.

Further, the Pharmaceutical Benefits Advisory Committee’s Drug Utilisation Sub Committee May 2018 report found that 23-41% of patients using ranibizumab (Lucentis) or aflibercept (Eylea) – the two most commonly used Pharmaceutical Benefits Scheme (PBS) listed medications in intravitreal injection treatment for macular disease – discontinued treatment after the first year even while they kept taking their other medications.

Hopkins adds: “This is a shared concern of peak bodies such as MDFA, as our purpose is to reduce the incidence and impact of macular disease and we therefore strive to avoid unnecessary vision loss for patients.”

She says the MDFA is now working with government and other stakeholders on behalf of the most vulnerable members of the macular disease community to improve access to affordable treatment. This will ensure that Australia can continue to be a global leader in treatment outcomes.

“WE’RE NOW INDIVIDUALISING TREATMENT, IT’S MORE NUANCED WITH DRUGS THAT CAN LAST LONGER, POTENTIALLY REDUCING TREATMENT FOR SOME PATIENTS TO SIX-MONTHLY INJECTIONS” - ANDREW CHANG

ADDRESSING KEY CHALLENGES TO ADHERENCE It is generally accepted that the key challenges that lead to poor adherence among Australian patients include travel, access to public care and financial constraints associated with private care.

From her dealings with patients at MDFA, Hopkins identifies Australia’s predominantly private treatment model as a key challenge for patients, with only 18-23% being treated in public or bulk billing services.

Access to public care is also under further threat with the pending Medicare Benefits Schedule Taskforce Review into ophthalmology items, which, if the government adopts, would reduce the intravitreal injection MBS fee from $305.55 to $95.10. In turn, the patient benefit/rebate would drop 69% from $259.75 to $80.85.

The sector has warned this controversial proposal is well below the actual cost of providing the service, meaning bulk billers won’t be able to afford to provide the service.

As a result, many patients will likely be billed an out-of-pocket fee or have to find a public hospital that does injections. However, these are very few, advocates say, because state governments don’t fund it appropriately.

“The issue here unfortunately, is that public treatment is over-subscribed in most states and territories,” Hopkins explains.

“People just can’t get access or are put on a waiting list which can take months or years. This is why we are advocating for improved access to public or bulk-billed treatment which should be a joint responsibility of both the Commonwealth government and State and Territories.”

INSIGHT May 2020 39

MACULAR MONTH

For many AMD patients who live on a government pension, Hopkins says affordability is one of the key factors for accessing sight saving treatment.

“MDFA surveyed more than 600 intravitreal injection patients in 2019. The results showed that of those who responded, 99.3% continued to adhere to treatment, although 15.5% of patients had either delayed receiving treatment or considered stopping treatment because of the cost of treatment and outof-pocket expenses.”

She adds: “While the survey highlighted that anti-VEGF treatment is a high priority for patients, some sacrifices were necessary to remain on treatment.

For many these sacrifices were essentials, including food and groceries, mortgage and rent, transportation, exercise and fitness, and other medical expenses, which was most disturbing.”

Hopkins says that while MDFA’s survey showed a strong result in terms of adherence rate, the people surveyed are already connected to MDFA, have undertaken its education program and the organisation is in regular contact to promote adherence and compliance.

“Our work promotes referral to MDFA for newly diagnosed patients so that we can work with them as soon as possible to improve health literacy and reduce modifiable risks,” she says.

To help further improve patient outcomes, the MDFA developed the National Strategic Action Plan for Macular Disease in collaboration with the wider eye health sector including consumers, which Health Minister Mr Greg Hunt launched last year.

Hopkins added: “His department has since announced $3 million to fund extended consumer education and a new health professional education program targeting GPs, optometrists, pharmacists and Aboriginal and Torres Strait Islander communities and providers.”

The implementation of this new program is likely to be delayed due to COVID-19.

THE SCIENCE OF PATIENT COMMUNICATION According to Associate Professor Isabelle Jalbert, from the School of Optometry and Vision Science at the University of New South Wales, ‘cost of care’ and ‘patient not understanding what AMD is’ were the top two most cited barriers to treatment.

This was revealed in a qualitative study she co-authored, which received funding from the Blackmores Macular Disease Foundation Australia research grant to investigate AMD care from the perspectives of both practitioner and patient.

Based on opinion sought from interviews and focus groups, 'A qualitative exploration of Australian eyecare professional perspectives on Age-Related Macular Degeneration (AMD) care' was published in Plos One in February.

“We spoke with 67 optometrists, 10 ophthalmologists and 56 AMD patients for our research. We’re continuing to analyse the patient’s perspective and aiming to publish those results by the end of this year," Jalbert says.

“Anecdotally, we can see an interesting contrast between what messages optometrists and ophthalmologists think they are getting across to the patient, and what message the patients are taking away, keeping in mind that macular disease patients are typically elderly, and living with comorbidity.

“There is a science to patient communications and in our research we can see that communication – depending how it is delivered – can lead to confusion and misunderstanding on behalf of the patient.”

Jalbert says their “ground-up research” identified that eyecare professionals considered poor care pathways, poor patient understanding and denial of their disease, and cost of care and lack of funding, as the most significant barriers to AMD care.

Subsequently, their study yielded four recommendations, one of which is to assign a case manager for people diagnosed with AMD. “Not an optometrist or an ophthalmologist but a third-party to help patients 40

INSIGHT May 2020

navigate their treatment. The MDFA does that to some extent through their hotline and printed material, which is beneficial, but we think something more substantial, akin to the diabetes model where the GP performs the role of case manager, could help reduce patients dropping out of treatment,” Jalbert explains.

The study concluded that “research into the potential benefits and costeffectiveness of public funding support of case managers for people with AMD is warranted”.

Jalbert and colleagues also recommend that affordable, accessible transportation services for people with AMD need to be broadly available.

The authors thought appropriately designed educational interventions directed at people with AMD, ophthalmologists, and optometrists could also be beneficial.

“Decision aids – a one-pager written in lay terms that explains what treatment research suggests, such as the kind used by ophthalmologists to explain cataract treatment – can help communication,” Jalbert says.

Clear, effective models of care should be developed collaboratively – not in silo – tested, and adequately incentivised, Jalbert’s study notes.

From the MDFA’s perspective, Hopkins says the organisation has a laser focus on achieving optimal outcomes for the macular disease community.

“In our prevention and early detection pillar, our impact goal is that Australians at risk self-identify and take early action to save sight,” she says.

“Our support pillar provides a range of holistic and practical resources, education and telecoaching to assist people throughout their journey and to live optimally with their macular condition.

“Importantly, this includes proactive engagement to promote treatment adherence by improving the understanding of macular disease treatment and the impact of vision loss resulting from treatment non-adherence.”

INDIVIDUALISED, NUANCED TREATMENT Vitreoretinal ophthalmologist Associate Professor Andrew Chang is the medical director of the Sydney Retina Clinic, head of Ophthalmology at the Sydney Eye Hospital, and clinical Associate Professor at the University of Sydney.

He is familiar with the common reasons for missed appointments, pointing to a recent case concerning a nAMD patient requiring urgent treatment.

“The patient had two injections of Lucentis but didn’t think it was working as he wasn’t seeing a significant improvement from his point of view,” he explains. As a result, Chang had to explain to the patient that his vision could become even worse if he ceased treatment or missed an injection.

Such cases, he says, highlight why managing patient expectations and education is crucial to ensuring patients return for their appointments – because the cost of missed visits and loss of vision could have serious ramifications for the patient and their quality of life.

For example, the true impact of missed anti-VEGF treatments was outlined in new clinical-based international research from the new Penn Medicine Study, published in February.

In that randomised clinical trial of 1,178 individuals, patients were expected to attend visits every four weeks. Each missed visit was associated with an average visual acuity letter score decline of 0.7. Compared with patients who were on time, those who averaged between 36 and 60 days and more than 60 days between visits lost 6.1 and 12.5 letters, respectively.

Chang believes anti-VEGF therapy has been sight-saving for patients with macular oedema due to nAMD, diabetic macular oedema, and retinal vein occlusion, but optimal visual outcomes of intravitreal therapy in the long-term depends on continuous monitoring and treatment, and optimising adherence and compliance.

“The evidence in clinical trials of regular fixed injections demonstrated up to 10 letters of improvement in visual acuity. However, real-world outcomes often were not as good as in the trials. In the real-world, this loss of vision may be due to patients being under-treated,” he says.

According to Chang, barriers to compliance include addressing the burden of treatment, patient education, and setting realistic expectations.

"THERE IS A SCIENCE TO PATIENT COMMUNICATIONS AND IN OUR RESEARCH WE CAN SEE THAT COMMUNICATION – DEPENDING HOW IT IS DELIVERED – CAN LEAD TO CONFUSION"

“The burden is due to multiple factors: financial, travel time, and loss of income are the main ones,” he says.

“To receive treatment, patients need to make a time-commitment that might include travel, clinical assessment, and then recovery-time after surgery. Patients can be incapacitated for one-to-two days, particularly if they’ve had bilateral injection treatment.

“The direct financial cost of treatment can be defined, but the indirect costs associated with travel and time off work which are often significant must also be accounted for.”

Chang says the ‘burden of treatment’ also affects the carer of the patient; the accompanying patient’s spouse, son or daughter who is also required to take time off work to accompany them to appointments.

- ISABELLE JALBERT

“Surveys show carers are taking substantial time off work, and this alone can be a source of stress to the patient.”

Comorbidity – including hypertension, arthritis, and depression – is another factor that can affect a macular degeneration patient’s ability to attend surgical appointments for intravitreal injections. A younger patient with diabetic macular oedema has challenges of attending multiple medical appointments and clinics.

“Treatment adherence is a major public health challenge and a government funding issue of how to support ongoing treatment."

MAXIMISING EXISTING TREATMENTS For ophthalmologists like Chang who are looking at ways to overcome the treatment burden for his patients, proactive treatment regimes such as ‘treat-and-extend’ can maintain vision with fewer interventions.

He says there is a growing body of evidence that demonstrates a ‘treatand-extend’ approach can reduce treatment burden without compromising patient’s vision.

“AUSTRALIAN CLINICIANS HAVE A ‘TREAT nAMD FOREVER’ APPROACH, WHEREAS OTHER COUNTRIES TRY TO STOP THE DISEASE AND DISCONTINUE TREATMENT” - MARK GILLIES

“We are using different pharmaceutical drugs, and modifying the treatment regime, from fixed regular dosing to extending the time interval between injections based on an individual case approach, to help relieve the burden on patients.”

Anti-VEGF drugs such as Eylea (aflibercept) manufactured by Bayer, and Lucentis (ranibizumab) manufactured by Novartis, are now joined by newer drugs including Beovu (brolucizumab) also manufactured by Novartis, and Abicipar, manufactured by Allergan, which is on the horizon.

additional support.

The Therapeutic Goods Administration registered Beovu for the treatment of nAMD as recently as January this year. Novartis is currently applying for the drug to be accessible on the PBS.

“SmartSight is an evidence-based program for patients treated with aflibercept (Eylea) and is sponsored by Bayer Pharmaceuticals. It aims to support the patient through their treatment cycle, monitor vision, and provide support for carers,” he says.

Clinical trials of an alternative delivery method known as the ‘port delivery system’ are also in the pipeline.

Inservio, a company founded in 2007 to address an unmet need in the distribution of anti-VEGF in ophthalmology, also offers patient education.

The system acts like a reservoir, a long-acting drug delivery system with the potential to reduce treatment burden, while maintaining optimal vision outcomes by enabling the continuous delivery of a customised formulation into the vitreous.

“Newer drugs like brolucizumab (Beovu), as demonstrated in the Hawk and Harrier trials, and Abicipar, used in the Sequoia and Cedar studies, and the near-future port delivery devices have the potential to extend to three monthly dosing," Chang says.

Meanwhile, the SSI provides a patient care coordination service.

In addition to ophthalmologists, Chang says optometrists can play an important role in treatment adherence as well.

“Optometrists often make the initial diagnosis. They play an important role in supporting the need of patients to remain on therapy. These patients have other co-existent ocular conditions which also require monitoring and care.”

"Eylea may be extended according to ’treat-and-extend’ regimes, as the Altair and Aries studies show.

In reaching this point, Hopkins says it was only a little over a decade ago that people living with nAMD lost vision and often became legally blind.

“We’re now individualising treatment, it’s more nuanced with drugs that can last longer, potentially reducing treatment for some patients to six-monthly injections."

“It has only been the collaboration between the Australian Government, eye healthcare professions, research agencies, the pharmaceutical industry and patient-focussed organisations such as MDFA that we have been able to advance the continuum of care and treatment in this country,” she says.

Chang says clinicians need to assess the patient’s macular condition, but also understand their background, education, treatment affordability, and recommend a treatment plan accordingly. He cites the MDFA as a mainstay of patient support, but pharmaceutical companies also provide

“As more treatment options come to light, we hope that this high level of healthcare continues to lead the world.” n INSIGHT May 2020 41

SUPPORTING FAMILIES WITH USHER SYNDROME WHEN A CHILD IS DIAGNOSED WITH USHER SYNDROME, FAMILIES CAN BE LEFT FEELING OVERWHELMED AND ALONE. EMILY SHEPARD AND HOLLIE FELLER DISCUSS WHY THEY HAVE MADE IT THEIR MISSION TO HELP FAMILIES LIKE THEIRS.

U EMILY SHEPARD

sher syndrome is an inherited condition characterised by congenital hearing loss or deafness, progressive vision loss due to retinitis pigmentosa (RP) and, in some cases, vestibular dysfunction. It is the most common cause of deafblindness, affecting an estimated 400,000 people across the globe.

There are three types of Usher syndrome with more than 13 genetic changes or mutations identified.

HOLLIE FELLER

If the cause is confirmed through genetic testing, this can provide a more definite diagnosis on the syndrome, leading to a better understanding of whether the eye condition is more likely to remain stable or deteriorate. Once confirmed, a genetic diagnosis can also inform family planning decisions and eligibility for enrolment in possible research and clinical trials.

For many inherited eye diseases, including Usher syndrome, there have been no proven treatments to stop vision loss. However, it is exciting to see advances in gene and stem cell therapies that could potentially improve the quality of life for people with these conditions in future.

In the absence of such interventions, it’s vital individuals are regularly reviewed by their orthoptist, optometrist and/or ophthalmologist to check for associated eye conditions. It’s also important they maximise their residual vision with aids, adaptive technology and utilise vision support services.

While there is plenty of hope and support for families affected by an Usher syndrome diagnosis today, it hasn’t always been that way.

As two parents of young boys with the condition, we were both devastated by our sons’ diagnoses and went to great lengths to gather information and recommendations from specialists.

But with no specific support group in Australia, we travelled to an International Usher Syndrome Symposium in the US where we became motivated to improve the support and communication network for families here.

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INSIGHT May 2020

We established UsherKids Australia, a not-for-profit charitable organisation, in 2016 as a parent-led support group to enhance the lives of children diagnosed with Usher syndrome and their families.

Our mission is to ensure they have access to informed, committed and caring clinicians, service providers, educators, researchers and peer support networks to allow them to thrive in their daily endeavours. The organisational aims stem from our founding principles: To identify all with Usher syndrome to assist the collaboration of research efforts both in Australia and globally.

To educate by providing information to newly diagnosed families, as well as educating healthcare professionals, educators and support staff on the needs of children to maximise inclusion and best clinical practice.

To support families, children, siblings, healthcare professionals, communities, sporting clubs, schools, service providers and those involved in the care and education of these children to ensure they have the knowledge, resources and skills to help them thrive.

Advances in genetic and genomic testing make earlier diagnosis of Usher syndrome accessible to more and more children born with hearing loss. This leaves a distinct gap in the provision of services and support for families, as well as an evidence-based clinical pathway for clinicians to guide their care for these children.

Earlier diagnosis of children with Usher syndrome can also occur before the onset of the functional impact of RP. This creates an opportunity to provide children with the building blocks to cope with the deterioration of their vision loss. The long-term goal is to better equip them to engage in education, employment and community activities, increasing their independence and quality of life into adulthood.

UsherKids Australia will host a Transitions Conference in September 2020, either in Sydney or virtually (depending on COVID-19

Earlier diagnosis helps children develop the building blocks to cope with vision loss.

recommendations), bringing together families and professionals involved in the care, education, and support of children with the condition. It will explore the strategies of better managing crucial stages of transition, such as to and from early intervention, to and from primary and secondary school, as well as into higher education and the workforce.

When families are given a new diagnosis they may feel overwhelmed and alone. Clinicians may like to refer families to UsherKids Australia and/or our website for information and available services. n ABOUT THE AUTHORS: EMILY SHEPARD is a cofounder and Director of UsherKids Australia. She is committed to improving the lives of children with Usher syndrome and their families by supporting and guiding parents when they’re most vulnerable.

HOLLIE FELLER is a co-founder and Director of UsherKids Australia. She is a fierce advocate for early diagnosis through genetic testing, education of clinical professionals, as well as support for families to share research and information about the current generation of kids with Usher syndrome. Visit: www.usherkidsaustralia.com 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

HOT TIPS FOR SUCCESSFUL DISPENSING: PART 2 THERE IS A PLETHORA OF USEFUL INFORMATION TO ENSURE OPTICAL DISPENSERS GET THE BEST RESULTS FOR THEIR PATIENTS. JAMES GIBBINS CUTS THROUGH THE NOISE TO OFFER MORE ESSENTIAL ADVICE.

I

n part one, I delved into four key elements to help optical dispensers refine their practice. This ranged from emphasising the importance of the optical cross and frame selection, to pointers on how to execute a smooth handover to the customer.

JAMES GIBBINS

IF WE LET THE CUSTOMER EXIT THE PRACTICE WITH A POORLY FITTING FRAME, THEY COULD DROP INTO ANOTHER PRACTICE TO HAVE THE ADJUSTMENT ATTENDED TO

This month, I explore six additional factors to help practitioners ensure they obtain optimal results for their patients.

Tip No 5: The frame adjustment: Remember, business can be won and lost on the simple tweaking of a temple bend. Too often, optical dispensers (and sometimes experienced dispensers who should know better) allow the customer to leave without due attention to this.

The customer may say the spectacles feel fine on first wearing, but we all know what feels fine at first can be thoroughly distressing after a couple of days’ wear.

We must inspect the fit of every frame at pick up and look for any possible adjustments to ensure a comfortable fit.

The danger here is if we let the customer exit the practice with a poorly fitting frame, they could drop into another practice to have the adjustment attended to and find the discomfort and pain alleviated. They may believe this simple tweak reflects an outstanding practice, leading them to take future business, including that of family and friends, elsewhere. Ouch!

Tip No 6: Final checking of all spectacles is still recommended by our friends at the lab. The quality control (QC) of our lab work is arguably better than ever, but the reality is they are under constant pressure to work fast and often with reduced staffing levels. It is always possible that a data entry error or something else might result in a pair of spectacles slipping through QC. It remains the responsibility of the practice to ensure everything that is passed out is fit for purpose. We understand at the retail practice there can be extraordinary pressure to work at pace with fewer staff, meaning sometimes this step may not be completed before the collection.

When this arises, we recommend certain jobs be given an elevated priority –

Final checking is always best practice, but priority should be given to spectacles for children, first time progressive wearers and anything prescription atypical.

including spectacles for children, first time progressive wearers, and anything prescription atypical. Final checking all spectacles is always best practice, but in the panic of a busy period, these three categories are your priorities.

Tip No 7: Simple tips to help improve your progressives ordering include: • Always provide monocular pupil distances (PDs). If the monos are even, then state them that way, never reduce them to a binocular.

comes through surprisingly regularly.

Tip No 9: When ordering grind minus powered lenses for a wraparound style of sunglasses with a high front surface curve, check with the lab how advisable the job is. Fitting minus powered lens with a high front surface power can be challenging, and if the power is too high – depending on the refractive index and the front surface power – the final result may be unattractive or even impossible to achieve.

• If your monocular heights are significantly uneven, double check the frame has been adjusted for a level fit first. Many an inexperienced or inattentive dispenser has ordered uneven heights, only to find on pick up the customer actually needed even heights once the uneven frame has been straightened on the customer’s face.

Tip No 10: When assisting with the collection (or handover) of a first-time pair of progressives, remember there can be a psychological element for the customer. They may be feeling this moment represents their unstoppable journey towards old age, maybe they have heard from a friend who didn’t enjoy their first pair of progressives, or they may still be feeling surprised at the cost. It is absolutely critical the optical dispenser ensures this handover proceeds smoothly and that the customer is given simple and easy to follow advice on the use and care of their wonderful new spectacles. We want their first impression to be as positive as possible. n

Tip No 8: When ordering a high minus grind lens, never ask the lab to grind for a knife edge (a minus lens must be and is always thicker on the edge than in the centre). Our friends at the lab will tell you this strange and impossible-to-fill order

JAMES GIBBINS is a qualified optical dispenser with over 30 years of experience in both retail dispensing and dispenser training, and is a director and senior trainer with the Australasian College of Optical Dispensing.

• Always provide monocular heights, for similar reasons.

• If your monocular PD’s are uneven, take care not to mix up your rights and lefts. As surprising as this may seem, this mistake remains a huge cause of reorders among dispensers.

INSIGHT May 2020 43

MANAGEMENT

MANAGING RISK IN THE PRACTICE THE CORONAVIRUS CRISIS WAS A DISASTER FEW HAD ON THEIR RADAR. KAREN CROUCH EXPLAINS HOW A RISK MANAGEMENT PLAN CAN REDUCE A PRACTICE’S EXPOSURE DURING A DOWNTURN.

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uoting an ancient maxim “may you live in interesting times” is a serious understatement during the current crisis triggered by COVID-19.

But what this emergency has shown us is the importance of Risk Management.

KAREN CROUCH

MEANINGFUL RISK MANAGEMENT IS OFTEN OVERLOOKED, ULTIMATELY LEAVING PRACTICES OPEN TO POSSIBLE HARM OR FAILURE

This article views this concept as an umbrella term, embodying a combination of plans/actions aimed at keeping the practice operational and viable during a crisis.

Earlier articles highlighted the need to have various Risk Management plans in place such as: Change Management: Processes to address unexpected and planned alterations to normal circumstances or procedures which require behavioural or clerical/clinical changes in compliance.

Contingency Planning (or Business Continuity): To anticipate possible disruptions to daily operations and develop mitigation options to ensure smooth ‘disaster recovery’.

Succession Planning: To address possible loss of key personnel through cross-training of staff to ensure that single points of failure do not place the practice at risk.

Pandemic Plan: While this may be appropriate for medical conditions like Influenza outbreaks, COVID-19 highlights the need for an ‘action plan’ to help cope with a different set of protective measures.

While practice owners focus on quality healthcare – the primary objective of their vocation – some fail to recognise that practices are businesses with the exposures and risks of any commercial venture. So, while development of key ‘plans’ may be viewed as administratively burdensome, their relevance and applicability – or lack thereof – become key dependencies when a disruptive event occurs.

Consequently, meaningful Risk Management is often overlooked, ultimately leaving practices open to possible harm or failure. After all, serious disasters don’t occur every day, week or year, or can they? Did anyone include

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INSIGHT May 2020

COVID-19 in the most comprehensive Risk Management plan?

However, while appropriate behavioural actions such as washing hands and social distancing may be dictated by medical authorities, the potential impacts on daily practice operations will deserve consideration, including key absences, staff/client exposure.

Large companies have sophisticated plans, catering for all eventualities, positive or negative, whereas health practices may only require practical, smaller scale plans. By its very term, the process naturally starts with ‘risk identification’ in order to highlight mitigation options.

Generally, the basket of Risk Management plans should address the following:

Some fail to recognise that practices are businesses with exposures and risks.

exposure if patient care is heavily reliant on one or two individuals.

Succession Planning: A meaningful plan to cater for the short or long term absence of key personnel, including clinical and administrative staff.

Competitors: Have competitors established practices close by? To what extent may they attract business away? Is defensive action required such as a pricing review or an increase in marketing?

Technology: Given the criticality of IT, are there adequate back up plans?

Are records of down time kept and is maintenance efficient i.e. is system uptime adequate or is an upgrade appropriate?

Debt Collection: Many practices collect payment after consultations, so this task is generally lower priority, but proper procedures should be in place to recover outstandings.

Strategic & business plans: Are these in place and regularly reviewed for currency?

The current COVID-19 crisis will undoubtedly introduce the need for new measures, not previously thought essential.

Consider the current scenario where we now scrutinise the number of clients in the waiting room, ensure social distancing limits (and make furniture placement adjustments accordingly) and enforce hand sanitisation, among other measures.

Legal/regulatory compliance: Have recent audits been performed on OH&S, record retention/storage, Privacy Act and other legal compliance requirements?

Financial: Is a budget in place to manage expenses and track income to targets? Is it consistently monitored to avoid business risks, including cash flow planning, without which a practice may not meet its obligations as they arise?

Contingency: Are plans in place to cater for various disasters, ranging from loss of transport or communications to inability to access premises?

Plant & Equipment: Are supplies and practice assets in order, regularly checked for damage, and inventoried to avoid excessive stock storage?

Insurance: Is an annual review conducted with insurers/brokers to ensure standard risks are covered including ‘key man’

Risk Management may be as convoluted as the creator intends, but it need not be a complex document.

It is usually composed by an experienced business manager and should be regularly monitored by practice managers and practice owners to address the mitigants identified for listed risks. n

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

OPTOMETRIST – ESPERANCE, WA

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

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

OPTOMETRIST – KATHERINE, NT

Contact the relevant Professional Services Manager for the region to discuss these opportunities and more:

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

OPTOMETRIST – WHANGAREI, NZ

Why only visit the winterless north when you can live here?

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

Enjoy those long warm summer nights in subtropical Whangarei.

OPTOMETRIST – WAGGA WAGGA, NSW

OPTOMETRIST – BENDIGO, VIC

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

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

Graduates or recent graduates are very welcome to apply.

JOIN OUR TEAM

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

We have one full-time graduate or experienced optometrist position available at our OPSM Wagga Wagga Practice.

We are looking for passionate and motivated individuals to join the team.You will be part of our industry leading team and will have the opportunity to work alongside likeminded optometrists to ensure the highest possible standard of patient care. You will also play a pivotal role in building loyal and trusting relationships with the community to grow the practice.

High salary package is on offer for the right candidate. On your days off connect with nature at one of the many reserves, enjoy the Aviation Museum, or visit the local winery.

NSW/ACT: Elizabeth Kodari elizabeth.kodari@au.luxottica.com QLD/NT: Brendan Philp brendan.philp@luxottica.com.au VIC/TAS: Melissa Downing melissa.downing@luxottica.com.au SA: Sophie Pym sophie.pym@luxottica.com.au WA: Mario Basso mario.basso@luxottica.com.au NZ: Jonathan Payne jonathan.payne@opsm.co.nz

OPSM.COM.AU/CAREERS

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4/11/19 3:42 pm

Careers at EyecarePlus Optometrists ®

EYECARE PLUS OPTOMETRISTS

OPTOMETRIST – TAREE AND GLOUCESTER

Eyecare Plus provides business support and marketing services to over 155 clinically focused independent full scope optometry practices throughout Australia. Our practices are owned and operated independently by our member Optometrist and Dispenser owners. All of our practices have complete clinical independence and are equipped with the latest diagnostic equipment, including an OCT in the majority of our practices.

Eyecare Plus offers three membership options; branded, co-branded and unbranded.

Further benefits include marketing support, business tools and advice, exclusive territories, conferences, workshops and staff training. We also actively assist Optometrists and Dispensers who are looking to establish their own practice. If you are looking to buy, or sell, an optometry practice, please contact us.

We are seeking a full time Optometrist to join our established and growing practice. The Mid North Coast of NSW offers a relaxed lifestyle with a low cost of living, fantastic sporting facilities and schools all within 3 hours of Sydney. We need an Optometrist with good clinical skills, a caring nature and an ability to clearly explain concepts to our patients. We have an IPL, OCT, Topography, Anterior Segment Photography and Automated Perimetry. Plus, we have a highly skilled and experienced team of dispensers and assistants.

For more information call Philip Rose: 0416 807 546 or email: Philip.rose@eyecareplus.com.au.

OPTICAL DISPENSER - MELBOURNE An established independent optometry practice in the Northern suburb of Melbourne is looking for an enthusiastic, hard-working dispenser to join our friendly team.

We distinguish ourselves by providing an above and beyond service to our patients. We believe that our employees are important to our overall success. Our focus is simple, to provide a positive practice environment and deliver to each patient the best eye care experience possible. The successful applicant should have dispensing or optical experience, an ability to build rapport and demonstrate good interpersonal skills when dealing with customers and work cohesively and productively within a team. Flexibility to work retail hours which may include a late night and Saturdays.

If you want to join an independent practice, which provides ongoing career development opportunities, send your resume to g.campanella@eyecareplus.com.au.

Those seeking a part time position are welcome to apply. New or recent graduates are welcome. To Apply: Please apply with your CV and cover letter to: p.mckay@eyecareplus.com.au

DISPENSER - SYDNEY The practice is looking for a requires a part-time/casual dispenser. It is equipped with state-of-the-art equipment and the latest fashion eyewear. Essential requirements include a positive and professional attitude, a great work ethic, exceptional customer service skills, confidence in sales, attention to detail, effective problem solving skills, and the ability to learn quickly. At least two years’ experience is preferred but not essential. Flexibility to cover staff holidays and sick leave is highly regarded. This is a unique opportunity to work in a small team environment, where ongoing skill development is encouraged, and where remuneration is competitive.

If you believe you would be an asset to the practice, please apply by forwarding your resume in confidence to kingsgrove@eyecareplus.com.au.

Only potential candidates will be contacted.

CURRENT POSITIONS VACANT for more: www.eyecareplus.com.au/careers/

OPTOMETRIST - GOSFORD

OPTICAL DISPENSER / SALES ASSISTANT: Melbourne, Sydney.

Part time position available for an optometrist on the central coast of NSW. Based at Eyecare Plus in Gosford with one day in Kincumber. We require someone Wednesday to Saturday. This practice has a brand new fitout with an OPTOS. It is located in an area with great beaches but is also an easy commute from Sydney by train.

OPTOMETRIST: Taree & Gloucester, Gosford.

If you are interested, you can contact Don Granger on 0407 485 028 or d.granger@eyecareplus.com.au

SOAPBOX

KEEPING PACE WITH CORONAVIRUS AND BEYOND of the collaboration that has manifested itself over the past few weeks.

With a genuine video consult platform like Oculo now a sudden reality it is just as important to have relevant Medicare item numbers enabled for telehealth.

Having Oculo in place means we are not simply asking government for telehealth item numbers on the never-never but asking for them with the specifics on how the actual service can be delivered. And talking of collaboration, it was uplifting to see all participants work together to propose the same item numbers (10916 and 10918) to the Department of Health being Optometry Australia, Luxottica, Diabetes Australia, our team here at Specsavers and others too no doubt.

At this point we still have not heard the final word from the Department of Health, but we remain expectant and hopeful.

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ne thing we have all become accustomed to since the outbreak of the coronavirus is that the pace of change has been constant, and it has been relentless.

The landscape we were looking at last week – let alone two or three months ago – is almost unrecognisable from that of today.

And while each day of the past month has brought compounding bad news, we are also now seeing good news start to emerge in the form of government stimulus measures and slowing transmission rates (in Australia and New Zealand at least). While we probably all now have a handle on the bad news I will therefore focus this piece on the good news, the innovation, the collaboration and the coming together as an industry that I think we all have warmed to over the past few weeks as optometry has collectively sought solutions.

to commercial tenancies. Both of these items throw a critical lifeline to businesses, their employees and the economy as a whole and of course help us in our world of optometry. The JobKeeper allowance enables us all to maintain our teams in readiness for the period ahead when normal life resumes, supporting individual livelihoods and keeping some cash flowing through the economy.

So, I ask you to cast your mind back almost a month to the date of my writing (9 April 2020) and we will see how far we will have moved forward by the time you read this.

Looking at innovation I think we are all applauding today the great work that Oculo has fast-tracked to develop a powerfully functional telehealth platform for video and audio consults with patients. That all Optometry Australia members will now have access to the platform (many already do of course) is just one example

The good news: last night Federal Parliament passed its economic stimulus in the form of the JobKeeper legislation alongside that relating

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INSIGHT May 2020

The Commercial Tenancies Code of Conduct appears to set out a clear pathway for fair engagement between landlord and tenant. The ‘proportionality’ measures contained within the code provide a commonsense approach based on each tenant’s ability to pay, in direct proportion to their reduced turnover.

Between them it feels like these two key measures give the country and business the best chance of making it through the crisis.

Beyond this we know that optometry practices of all sizes have been working out how best to look after their patients and customers, reconfiguring and adapting their businesses to suit the times.

In our own world at Specsavers we have hibernated our normal retail service and adapted our store environment under what we are calling ‘Open for Care’. This means offering urgent and essential optometry and dispensing care to those in need.

We have closed our front doors and added a bell for one patient at a time to come in. Our team has been busy innovating on a practical level too with the installation due next week of clear Perspex barriers at reception desks and dispense desks in all our stores to give patients another level of comfort in addition to the health and hygiene guidelines all practitioners are following.

Suffice to say, once April is over and this issue of Insight is published, our hope at Specsavers is that we will have progressed significantly through the crisis and the other side might just be coming into view. n Name: Charles Hornor Business: Specsavers Pty Ltd Position: Support Office Location: Port Melbourne Years in the profession: 15

THE JOBKEEPER ALLOWANCE ENABLES US ALL TO MAINTAIN OUR TEAMS IN READINESS FOR THE PERIOD AHEAD WHEN NORMAL LIFE RESUMES

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