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AUSTRALIA'S EIGHTH OPTOMETRY SCHOOL? Workforce
NEW SOFT CONTACT LENS FOR MYOPIA CONTROL
Three Aussie independent optometrists give their verdict on
THE FUTURE OF MONOFOCAL IOL s Arguments for why EDOFs should now be the standard of care in cataract surgery
AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975
NEW QUEENSLAND OPTOMETRY SCHOOL UNDER CONSIDERATION DESPITE OA OPPOSITION
A new optometry school – which would be Australia’s eighth – is being proposed in North Queensland, as debate about whether the country has enough optometrists for future demand enters a new chapter.
James Cook University (JCU) in Townsville confirmed it had received a request to establish the course that would become the state’s second such program alongside Queensland University of Technology.
“The university takes industry requests and community input seriously. We are committed to ensuring that any new educational initiatives align with local demand and are underpinned by robust planning and consultation processes,” a JCU spokesperson told Insight “At this stage the proposal is still under consideration.”
The idea – opposed by Optometry
Australia (OA) – spawned from a 2022 forum organised by the North Queensland Eye Foundation that heard from local primary eyecare providers that it was difficult to find optometrists and locums to fill gaps.
Noting there are around eight full-time equivalent (FTE) optometrists per 100,000 people in remote areas compared to 20 in major cities, the meeting concluded there was an “urgent need to identify sensible strategies to address the current and future workforce shortages in Northern Queensland”.
A new optometry school would align with the philosophy that those who are from and train in rural areas are more likely than their urban counterparts to return to rural areas as practitioners – referred to a “grow-your-own approach”.
Board chair and Townsville
ophthalmologist Dr Todd Goodwin said the NQ Eye Foundation was focused on promoting equity of access to eye healthcare for North Queenslanders.
“We see the holistic implications, on all forms of health outcomes, that result from inadequate access to eye healthcare as a key determinant of health and one worthy of focus,” he said. “Optometrists are an integral part of that healthcare service delivery. We will continue to
PATIENT COMPLAINTS SYSTEM SHAKE-UP?
An independent review into the complexity of the system regulating health practitioners has proposed a new single point of entry for patients making a complaint in each state or territory.
The potential overhaul of the complaints pathway has been detailed in the final phase of the probe into “unproductive and unnecessary complexity” within the National Registration and Accreditation Scheme (NRAS).
Optometry Australia (OA) has been involved during a two-part consultation phase, and noted a low level of confidence in complaints handling, inconsistency and delay in notification/complaints decision-making.
moving forwards would seem to support a more efficient complaints and investigation process, which is critical to relieving distress experienced by practitioners subject to lengthy investigation time frames,”
OA chief clinical offer Mr Luke Arundel said.
“Optometry Australia appreciates the difficulty in identifying a simple solution in our complex regulatory landscape, but strongly supports the imperative for reform in this area.”
Currently, she said the Australian Health Practitioner Regulation Agency (Ahpra) manages more serious complaints about “registered” practitioners. If less serious, but still requiring action, it must be raised again elsewhere, frustrating consumers who often carry the burden of locating the appropriate authority.
support any and all evidence-based initiatives that promote alignment with this equity of access, especially in North Queensland.”
But OA said there were “clear indicators that Australia already has more than enough optometrists to meet current service demand”.
“A recent workforce study commissioned by Optometry Australia supports this understanding. We also have a healthy pipeline of new entrants to the profession through established optometry programs. In this context, the establishment of a new optometry program is unnecessary and inappropriate,” the peak body said.
“However, there are areas where localised workforce shortages persist due to maldistribution. The
continued page 8
Testing accommodation in children
The final report by Ms Sue Dawson outlined four areas for reform, with one of those being the implementation of a unified national approach to health complaints. She also urged an immediate focus on improved management of high-risk matters with the National Scheme.
“Professions also confirm a deeply unsatisfactory experience … highlighting the protracted and stressful processes on matters that often could be easily addressed or dismissed at an earlier stage,” Dawson’s paper said.
“This is significant, noting that well over 85% of notifications to
“Encouragingly, recommendations continued page 8
Two orthoptists and an ophthalmologist from Children’s Eye Centre in Wentworthville, Sydney, outline seven pitfalls optometrists should look out for, along with insights into the latest evidence, and practical advice.
59
James Cook University. Image: EQRoy/ Shutterstock.com.
Image:
Yuliya
IN THIS ISSUE
39 Cataract cosmos
From robotic surgery to managing refractive surprises, four ophthalmologists answer the industry's burning questions.
With the spotlight on optometry workplace conditions, G&M has a renewed focus on career fulfilment and progression.
Challenging convention
Few eye diseases are as cruel, or as controversial to manage, as sympathetic ophthalmia, writes Annette Hoskin.
In a conversation with a Queensland cataract surgeon for this edition, something he said stayed with me. “You know, it’s funny,” he remarked, “because we’re supposed to be purely rational, scientific beings in this industry – but we’re not. All of us, to some extent, are guided by personal experience.”
It’s a sentiment many will recognise. While evidence-based medicine remains the backbone of ophthalmology, there’s no denying the emotional weight of a single unhappy patient. Even if 95% of the others are thrilled. As he put it, eye surgeons aren’t in the business of saving lives, they’re in the business of improving them. That means the occasional outlier experience can carry disproportionate weight in how one makes decisions about intraocular lenses (IOLs), techniques, and technologies.
It was this perspective that partly inspired Insight to develop the new IOL Directory, launching in our annual cataract edition this month on page 27.
This comprehensive guide brings together key specifications from Australia’s main IOL suppliers. Without fully agreed upon terminology in the industry yet, we’ve worked hard to develop an accessible, side-by-side comparison tool that might encourage surgeons to consider lenses they haven’t used before – or simply reaffirm their current preferences.
As this year marks the 76th anniversary of the first implanted IOL, developed by Rayner and performed by Sir Harold Ridley, it’s remarkable to consider the innovation pushing the boundaries of what ophthalmologists can offer patients.
From toric and multifocal, to extended depth of focus and the long-anticipated promise of true accommodating lenses, it’s an exciting time. And this 32-year-old with high astigmatism often wonders what IOLs I’ll be able to choose from when the time comes circa 2060. Will I be able to score a free lunch?
As always, the challenge is staying open: to new ideas, tools, and outcomes. We hope this resource supports that mindset in some small way.
MYLES HUME Editor
UPFRONT
Just as Insight went to print, DR MICHAEL STEINER , a New South Wales ophthalmologist with more than 40 years’ experience in eye surgery, was recognised in the King’s Birthday honours list. The other industry figure was ACT’s Mr Peter Granleese, from the Canberra Blind Society, recognised for his service to people who are blind or have low vision. Dr Steiner was appointed a Member of the Order of Australia (AM) while Granleese was awarded the Medal of the Order of Australia (OAM) in the 2025 list.
WEIRD
A recent study out of Germany revealed subtle eye movements, called drift movements, are strategically aligned with the fovea's structure, enhancing sharp vision by directing stimuli to areas with higher cone density. These synchronised movements, occurring within milliseconds, ensure that visual stimuli are repeatedly brought to the fovea's centre, where the highest concentration of cones for detail perception is located.
WONDERFUL
An inexpensive, long-approved HIV drug can improve vision in patients with diabetic macular edema more effectively and a much lower cost than many existing treatments, an initial clinical trial out of the University of Virginia suggests. Further, the drug is taken orally, potentially offering patients an alternative to regular intravitreal injections, the study authors said.
WACKY
In an ironic twist, fear of vision loss may deter some patients from undergoing necessary cataract surgery, according to a newly published study in The Journal of Clinical Ophthalmology. Among those surveyed, 36% reported fear of cataract surgery, and more than half specifically feared it would lead to vision loss – even though there was no correlation between this fear and a patient’s health literacy level.
IN OTHER NEWS,
private healthcare provider Healthscope has entered administration. The company, which lists 44 ophthalmologists working within its facilities, is owned by North American private equity group Brookfield and runs 37 private hospitals across Australia, making it the nation’s second-largest private hospital group. Its lenders appointed McGrathNicol Restructuring to work with Healthscope management "to complete an orderly sale of the business" with no plans for hospital closures or redundancies. FINALLY, for the sixth consecutive year, Specsavers has been voted as the most trusted
optometry brand in both Australia and New Zealand, as recognised by Reader’s Digest magazine. Dr Ben Ashby, clinical services director for Specsavers ANZ, said: “Our customers rely on us for expert eyecare delivered by highly qualified local optometrists. Being consistently recognised in this way shows we’re making a real impact. Every Specsavers team member – from our store partners to support office staff – plays a vital role in earning and maintaining the trust of our customers.” EssilorLuxottica-owned OPSM and Laubman & Pank received ‘highly commended’ recognition for the optometry category in Australia.
Every diopter counts
With every additional diopter of myopia progression, this increases the risk of myopic macular degeneration by 67%. Page 17
WHAT'S ON
THIS MONTH
AUSCRS 2025
16-19 July
This is a chance for Aussie ophthalmologists to reconnect with colleagues and international experts on the key challenges and innovations in cataract and refractive surgery. auscrs.org.au/2025-conference
Complete calendar page 68
NEXT MONTH OPTOMETRY CLINICAL CONFERENCE
17-18 August
The Optometry Australia-run Melbourne conference will feature new research, interactive workshops, and insightful presentations. occ.optometry.org.au
solution is not more graduates, but targeted strategies that support optometrists to build rewarding careers in underserved regions. Optometry Australia is actively investigating potential solutions to address these imbalances.”
WHAT PROJECTIONS SAY
Whether Australia needs more graduate optometrists has been a focus in separate and recent workforce studies commissioned by Specsavers and OA.
There are currently seven optometry schools graduating 400-450 new optometrists into the workforce each year.
The most recent started at the University of Western Australia in 2021, with 100% of the first graduating cohort (40 optometrists) securing jobs in 2024. Ninety per cent stayed to work in WA.
The Specsavers-backed workforce report – by Deloitte Access Economics and released in 2023 – forecasts a shortage of 1,102 FTE optometrists nationwide in 2042.
This is despite projections the supply of optometrists will increase from 5,266 FTE in 2022 to 8,261 FTEs by 2042, a 57% increase.
It noted Queensland “is the largest driver of the national undersupply by 2042” with a 741 FTE optometrist deficit.
“Queensland is forecast to have the largest growth in demand for optometry services over the period (89% growth) while it is the
second slowest growing region for supply of optometrists (28% growth),” the report said.
“The growth in demand is attributed to a large population growth (53% increase), particularly amongst the population aged 65+ years. The slow growth in supply of optometrists in Queensland is a function of limited growth in the number of additional graduate enrolments available at Queensland University of Technology, as well as only a small proportion of graduates from other states/territories moving to Queensland.”
Meanwhile, the OA-commissioned workforce report, undertaken by the Centre for the Business and Economics of Health (CBEH) at The University of Queensland and released in early 2025, did find optometry is in oversupply nationally when compared to current demand for eyecare services.
But it’s more nuanced than that. In fact, it found a stark gap exists between the number of optometrists currently practising and the number required if everyone accessed the services they actually needed (true population needs) towards 2040.
Noting the latter (population needs) should be the preferred method in workforce calculations, it found the current workforce wouldn’t be able to meet demand (9,010 optometrists to meet population need for 2025, increasing to 11,479 in 2040).
OA said it would "continue to oppose approaches that would increase workforce supply in the short term, including new optometry programs, and at the same time
“AT A 5.1% EXIT RATE, THE SUPPLY OF NEW GRADUATES AND OVERSEAS TRAINED PRACTITIONERS REPLACES THOSE WHO HAVE LEFT THE PROFESSION BUT DOES NOT ADDRESS THE GAP BETWEEN SUPPLY AND PROJECTED POPULATION NEED.”
CENTRE FOR THE BUSINESS AND ECONOMICS OF HEALTH, UNIVERSITY OF QUEENSLAND
recognises that future planning must begin early and strategically".
CBEH said if optometrists left the profession at a 2% rate (lower threshold), a shortfall is predicted in 2025, 2030 and 2035, but reaches equilibrium by 2040 with population needs modelling. But with a 5.1% exit rate (most likely scenario), the modelling shows an undersupply of 1,776 in 2025 extending to 3,056 by 2040. At 10% (upper threshold), the shortfall is 6,124 by 2040.
“A review of optometry education and training programs is recommended in the short-term to maximise workforce supply,” the CBEH authors noted.
“At a 5.1% exit rate, the supply of new graduates and overseas trained practitioners replaces those who have left the profession but does not address the gap between supply and projected population need. While optometry programs have expanded over the last two decades, the annual number of graduates is small and any changes to a training program (including the development of a new program) is likely to take several years.”
While increased optometry graduate numbers should improve workforce maldistribution, the CBEH said research suggests most graduates establish practices in metro locations.
“This distribution pattern has proven resistant to change, despite a range of rural placement initiatives and financial incentive programs,” they said.
OA 'TENTATIVELY' SUPPORTS COMPLAINTS HANDLING PLAN
continued from page 3
Ahpra ultimately result in no jurisdiction to consider the matter or no further action required by Ahpra.”
It was also concerning and confusing for complainants and practitioners that Ahpra didn’t have powers allowing a notification to be dealt with by conciliation, mediation or other less formal restorative means.
“This deficiency affects complainants seeking closure in a way that acknowledges their experiences when the matter may not warrant disciplinary action,” Dawson said.
“It is equally concerning for practitioners, who feel too frequently confronted with the prospect of a disciplinary-oriented process, even when this is not proportionate or appropriate … and they
would be very willing to apologise or engage in alternative resolution processes.”
Under a unified national health complaints system, complaints about registered –and even non-registered/self-regulated practitioners like orthoptists – could be lodged through a single Health Complaints Entity (HCE) in each state and territory. From there, the HCE would triage complaints, seeking to resolve matters not warranting disciplinary action. Serious allegations would be referred to Ahpra.
In its round one submission, OA said it would “tentatively support” this approach.
“As it may potentially improve the patient complaints experience – and if it allows Ahpra to focus on only the 25% of complaints received which do require more concerted regulatory attention, this may assist with desperately needed
improvements to Ahpra’s notifications processing timeframes,” the body said.
Meanwhile, Dawson’s review noted a lacking national health workforce strategy and acknowledgement of an “inextricable link” between workforce supply, service access goals and the protective purpose of the National Scheme.
“We had noted the potential benefits of aligning regulatory functions and broader workforce strategy when considering regulation of clinical scope,” Arundel said, “and that it seemed apparent many entities within the scheme see their remit and responsibility as relating singularly to public safety without consideration of workforce strategy or health service access.
“Optometry Australia strongly supports re-alignment to the broader remit envisioned on the statutory objectives.”
Luke Arundel, Optometry Australia. Image: Optometry Australia.
NEW MOVEMENT TO UNIONISE AUSTRALIAN OPTOMETRY
A new group called Phoropter Free Fridays (PFF) – motivated by concerns about burnout, workloads, and clinical standards – wants to unionise optometry through the Health Services Union (HSU).
The movement was formed in late 2024 by employee optometrists and independent owners advocating for fair working conditions, professional autonomy, and patient-centred care.
“The next step is to unionise – to build strength in numbers,” the group said.
“We don’t need a majority of optometrists in Australia – though that is the long-term goal. Even a modest number of unionised employees across different businesses allows us to enact meaningful, localised change that can ripple outward.”
PFF cites two key optometry surveys in recent years to highlight the “systemic barriers” the profession faces.
The first was from Professor Sharon Bentley at Queensland University of Technology (QUT) in 2021, which found more than 30% of optometrists reported moderate to severe psychological distress.
Then early in 2025, a Flinders University
survey led by Professor Nicola Anstice and the Phoropter Free Fridays administrators found only 23% of optometrists surveyed were satisfied with career growth, and 25% with their income. Many also reported receiving little to no feedback outside of retail-driven KPIs, with 41% reporting dissatisfaction with their level of clinical scope and autonomy – the impetus behind the name ‘Phoropter Free Fridays’
It's working to instigate change through the Health Services Union. Image: leungchopan/ stock.adobe.com.
More than a third felt professionally isolated, and the majority were allocated zero minutes per week for administrative tasks.
“PFF is run by its members, using their own time and resources.
"It exists to amplify these voices, call out institutional complacency, and push for systemic change, so optometry can centre on ethics, clinical excellence, and sustainable careers,” the group said.
PFF believes it can instigate the most change through the HSU, which exists to solely represent employees in industrial matters.
“The HSU is a national union that represents health and community services workers, including optometrists,” PFF said.
Tokai's original honeycomb structure ensures both natural appearance and comfortable wear while effectively controlling myopia progression
“Unlike professional associations, the HSU exists solely to support employees in achieving fair, safe, and sustainable working conditions.”
With the HSU, PFF is “mobilising around our Charter for Change”, which prioritises scheduled and regular breaks during shifts, higher pay rates for Saturdays, Sundays, public holidays, and overtime. It is also seeking mandated, protected time for patient care and a stronger emphasis on clinical autonomy, alongside compensation for training the next generation of optometrists, and increased transparency and foresight in employee contracts.
PFF said it had already taken steps to spotlight systemic issues and advocate for structural reform across the profession. It has launched focus group research into how consult times, practice modality, and KPIs affect clinical care outcomes, and submitted to the Jobs and Skills Australia occupation shortage review.
“Most importantly, we’re maintaining a safe, collective space for optometrists to speak out, share experiences, and push for change,” PFF said.
IN BRIEF
BIGGER AND BETTER
CooperVision ANZ has opened its newly expanded warehouse facility in Torrensville, South Australia, marking a 65% increase in capacity to support continued growth across Australia and New Zealand. The company says the expansion forms part of its multi-year investment in the region to meet growing demand, navigate increasing complexities in its operating environment, and maintain its commitment to service excellence for its customers. “The Torrensville site is our central hub for customer service and distribution across ANZ, and this expansion ensures we can keep pace with growing demand while delivering even better outcomes for our customers,” said Mr Sam Ng, CooperVision APAC head of distribution. CooperVision’s expanded warehouse uses advanced Voice Pick systems and real-time inventory control across more than 40,000 SKUs.
OPTIPLUS IN ANZ
Lumenis BE ANZ has announced the launch of OptiPLUS in Australia and New Zealand, described as the first dual frequency radiofrequency (RF) device designed specifically for eyecare professionals. A media release said the new technology delivered therapeutic heat across multiple skin and tissue layers, boosting circulation to support both medical efficacy and aesthetic enhancement. It is designed to work with OptiLIGHT – the “world’s first and only light-based technology that targets the root cause of dry eye disease due to meibomian gland dysfunction”. According to the company, OptiPLUS introduces a novel RF approach that penetrates various skin depths, enabling targeted treatment of the meibomian glands while simultaneously stimulating collagen production and periorbital skin tightening.
ZEISS ACQUISITION
ZEISS Vision Care is bolstering its myopia management portfolio with the acquisition of Brighten Optix, a leading player in orthokeratology (orthok) and specialty contact lenses. Announced on 4 June 2025, Carl Zeiss Vision International GmbH entered a definitive agreement to acquire 100% of the shares in the company, listed on Taipei Exchange. “The capability and products of Brighten Optix will now play an important role in ZEISS Vision Care’s long-term strategy and success,” ZEISS said. “With this acquisition, ZEISS Vision Care is making a strong addition to its already successful myopia management portfolio.” Brighten Optix products – including some of the market’s most advanced brands such as myOK – are widely available and used by eyecare professionals and eye clinics in Greater China and across Southeast Asia.
OPSM, SUNGLASS HUT BOOST ESSILORLUXOTTICA REVENUE
OPSM and Sunglass Hut have been singled out as strong contributors towards a successful, €6.8 billion (AU$11.9 b) first quarter (Q1) of 2025 for EssilorLuxottica
The group posted its financials for the first three months of the year on 23 April 2025, with the Asia-Pacific region showing double-digit growth – up 10.4% on the same period in 2024, at constant exchange rates.
The APAC region, which counts Australia and New Zealand, generated €852 million in revenue (AU$1.5 b), which is €84 million (AU$147 m) more than Q1 2024.
In a presentation to investors, the 375-store OPSM optical network was highlighted for “growing with higher conversion and price-mix”.
Also, Sunglass Hut Australia had a positive result, helped by the introduction of Ray-Ban Meta smart glasses.
Other APAC highlights included a “sound performance in China, supported by myopia solutions and pick-up in frames”, myopia solutions up by around 30% in China led by Stellest and Nikon DOT, and Japan continuing double-digit same-store sales trajectory.
OPSM optical network was highlighted for “growing with higher conversion and price-mix”. Images: EssilorLuxottica.
a year-on-year increase of 7.3% at constant exchange rates compared to Q1 2024 (+8.1% at current exchange rates).
The company reported “sound growth” across both its professional solutions (products and equipment supplied to independents) and direct-to-consumer (optical practices and shopfronts) channels, with comparable-store sales up 8%.
“In the first quarter, we successfully maintained strong momentum, with all regions and businesses contributing to steady growth (in constant currency terms) – each playing an integral role in advancing our journey in the wearables and med-tech space,” said Mr Francesco Milleri, chairman and CEO, and Mr Paul du Saillant, deputy CEO.
AWARDS CELEBRATE EXCELLENCE IN AUSSIE MANUFACTURING
Australian manufacturers in the healthcare sector, including eyecare, are being encouraged to put themselves forward for the 2025 Endeavour Awards
Nominations are now open for the country’s premier manufacturing industry awards. Presented annually by Manufacturers’ Monthly, the Endeavour Awards are the premier national awards program recognising outstanding achievement in the Australian manufacturing industry.
The 2025 Endeavour Awards Gala is more than just an awards night; it’s a celebration of innovation, resilience, and excellence across the sector.
It brings together manufacturers from all corners of the country to honour achievements, connect with industry peers, and spotlight the inspiring people and companies shaping Australia’s manufacturing future.
And, for the first time, manufacturers in
healthcare are invited to get involved. Organisers have introduced the Innovation in Healthcare Technology Award, which recognises “technologies that improve healthcare and medical manufacturing”. It is among a number of new categories in the growing event. Others include the Outstanding Start-up and Innovation in Aerospace.
“The Healthcare Technology Award is for companies developing innovative health solutions, including medical devices, digital health platforms, biotechnologies, and pharmaceuticals,” said Prime Creative Media Events general manager Ms Siobhan Rocks. All products and technologies must be manufactured and/or commercially available in Australia. “Eligible technologies must have undergone advancements within the two years prior to the nominations closing date.” Get involved at endeavourawards.com.au/ get-involved/.
The
The Endeavour Awards is a big night out for Australian manufacturers. Image: Prime Creative Media.
How did PNG eliminate trachoma?
As Australia works to shake the unenviable badge as the only developed country with endemic trachoma, its closest neighbour has welcomed official recognition of its elimination efforts.
Vanuatu, Malawi, Iraq, India, Vietnam, and Mauritania. Since 2022, these countries have all been validated by the World Health Organization (WHO) for eliminating trachoma as a public health problem. Now, Papua New Guinea (PNG) has joined those ranks.
This “landmark public health achievement” was announced during the 78th World Health Assembly in Geneva in May 2025, following a rigorous review of PNG’s elimination dossier.
For many Australians working in ophthalmology and public health, it’s bound to bring both celebration and reflection. While the nation’s closest neighbour has succeeded in stamping out the world’s leading infectious cause of blindness, Australia is the only developed country where trachoma remains endemic.
It impacts a relatively small number of Aboriginal and Torres Strait Islander communities. Efforts have seen the national trachoma prevalence rate in screened children aged five to nine fall from 14% in 2009 to 3.3% in 2021, but Australia may now be on the verge of adding its name to the list of successful countries, according to Mr Mitchell Anjou, from Minum Barreng: Indigenous Eye Health Unit at the University of Melbourne.
"[We are] pleased to learn that trachoma prevalence rates in NT, WA and SA are being maintained at under the WHO elimination requirements," he said.
"We understand that a national dossier will be submitted to WHO later this year, from where we expect certification that Australia has eliminated trachoma as a public health problem. This achievement would not be possible without work such as that undertaken by Ms Lesley Martin, a Central Arrernte woman who has worked as community engagement health promotion officer with Minum Barreng for the past seven years."
With good community engagement and stakeholders working together Anjou said efforts had been successful in reducing trachoma rates across Central Australia.
"The job is not finished yet – as we still need to focus on healthy homes to sustain the elimination of trachoma and tackle other infectious diseases."
According to the WHO, trachoma thrives in areas where the water is scarce, and sanitation is poor. The infection is easily spread through personal contact and by flies that have been in contact with people’s eyes or noses. And it disproportionately affects mothers and children.
Unlike many countries that have required widespread surgical interventions, mass drug administration, and water and sanitation upgrades, PNG’s own elimination strategy was distinctly epidemiology-led.
“Papua New Guinea’s achievement is an example of medical science in action,” said Dr Saia Ma’u Piukala, WHO regional director for the Western Pacific. “It reflects a deep understanding of local epidemiology and a commitment to using the right interventions for the right reasons.”
Surveys conducted in 2015 detected signs of active trachoma in children, but very low prevalence of the bacteria Chlamydia trachomatis and minimal rates of trachomatous trichiasis – the advanced stage that leads to blindness. A follow-up ancillary study in 2020 confirmed children were not progressing to more severe disease. This pattern, also observed in other Melanesian countries, underpinned WHO’s validation.
According to the agency, rather than defaulting to blanket treatment campaigns, key to the success was PNG’s National Department of Health, with support from numerous partners, that conducted rapid assessments, prevalence surveys, and in-depth community investigations. These demonstrated that mass interventions were unnecessary, a finding that ultimately shaped PNG’s trachoma strategy.
The Fred Hollows Foundation played a key role in supporting PNG’s elimination efforts, especially since 2018.
Dr Ana Cama, The Fred Hollows Foundation’s trachoma co-ordinator, noted trachoma in PNG has been complex and presented atypically.
“Additional research and ancillary surveys looking at levels of scarring on the inner eyelid and limbal signs pathognomonic for trachoma in 10 to 14-yearold-children was crucial in understanding the picture of trachoma in the country and ultimately moving the country into drafting its dossier,” she said.
WHO director-general Dr Tedros Adhanom Ghebreyesus congratulated PNG, saying: “This success demonstrates what can be achieved when science and sustained partnerships come together to serve the health and dignity of communities.”
The accomplishment is particularly notable as trachoma is the first neglected tropical disease (NTD) eliminated in PNG. The country now joins 22 others that have eliminated trachoma as a public health problem, and is among 56 countries that have eliminated at least one NTD.
Image: The Fred Hollows Foundation.
Trachoma in PNG has been “complex” and presented atypically, according to The Fred Hollows Foundation.
Optometry, then the sequel
One Australian woman’s story about her rise through optometry and the pursuit of a long-held passion is almost more compelling than the one she’s set to splash across the big screen.
“Former optometrist.”
So says the LinkedIn profile of Ms Tsu Shan Chambers. She acknowledges that one probably stings a little with her parents, as they assess the wind-down of their daughter’s respectable 20-year career in eyecare and an unpredictable, riskier journey into the TV and movie industry.
“I know, seriously, that's what my parents remind me of every day,” she says.
But like the child who gazed in wonder at the big tent and its curious, exciting occupants, Chambers has finally followed her heart and joined the circus.
She’s talking with Insight from her Sydney home, the day before flying to Brisbane for the first stop of an Australian tour to promote her film, My Eyes
In the movie, she plays Alana – an optometrist who discovers her daughter has a rare inherited eye condition that will rob her vision. But the girl’s only hope involves a revelation that might destroy her parents’ marriage and the family.
Chambers started to write the script during COVID. She also produced the film.
The irony is that the woman who has largely left optometry behind turned to the profession for inspiration and her big break.
Two decades of working in the ophthalmic sector, including roles around the country and with the International Centre for Eye Care Education (now known as the Brien Holden Vision Institute), gave her plenty of knowledge to draw on.
“I got into medicine, actually after year 12, and also got into musical theatre full-time,” she says.
“But being Asian and having very conservative parents, there was no way that I was ever going to do the arts over anything like medicine, right?”
However, a life of trudging the dusty halls of academia for years also didn’t appeal for a young woman already volunteering in hospitals and the community, already working in an OPSM store, and keen to make a difference in the field.
“If I had to stare at the human body all day long, it would have to be the eyes –windows to the soul and all that, so that's how I got into optometry.”
Cue the movie montage: an active, earnest young woman graduates from UNSW in 2001 and makes her way through her profession; she volunteers in Bangladesh as an optometrist; gains insight into the plight of vulnerable minorities and women; sets up an integrative health centre;
and furthers her education in public health and teaching.
The arrival of her first child (she has three now – aged 18, 16, and 12) heralded the beginning of the third act, and possibly the beginning of the end.
It was the early days of women taking on leadership roles in business, and as Chambers began moving into senior executive positions in optometry, she encountered headwinds.
“With those levels of jobs you did incredibly long hours back then and there wasn't really maternity leave,” she says.
“They weren't too friendly with me needing to breastfeed on demand.”
One fellow senior executive told her that women shouldn’t be paid not to work.
“So I couldn’t do the corporate thing and decided to start my own business where I could also be there for my children.”
If one door had closed, another was re-opening, just a little.
While looking for something to occupy her children during the school holidays, she came across the National Institute of Dramatic Arts (NIDA).
She decided to do something for herself and auditioned for one of NIDA’s programs; she got in and reignited that passion for the stage and screen.
Cue another montage: audition after audition; small roles in various online shorts and TV shows; her first film in 2018 – horror Let Me In 2; the juggling of career, passion and family.
Then COVID.
Prepare the credits on the optometry career. Set the scene for the sequel.
The disease that isolated much of the globe helped to liberate Chambers’ creative side and finally set her on the path of pursuing her greatest passion.
“I'm still on the books for the Optometry Council of NSW,” she says. “They've called me in a few times to be an assessor.”
But she’s more likely these days to be assessing the viability of independent TV shows and films that come across the desk at her company, Wise Goat Productions. While she waits for that next role in front of the camera.
“It's very easy to find a lot of creatives, but very hard to find good financial producers and people who know actually how the hell to do a budget, finance plan and interpret a cost report.”
There’s a subplot from her previous life: she’s working to advance the great work of independent film-makers in a market increasingly dominated by large corporates.
That’s now her day job, and she concedes it’s hardly glamorous.
“But this is definitely more empowering.”
The woman who previously worked to advance the aims of minorities and vulnerable others through eyecare is now doing that in her second career.
“This keeps my soul alive. I'm still very big on public health advocacy and hold the same values. I just now do it through storytelling and in the work that I choose to produce.
“Impact entertainment - you can make a lot of positive change.”
Sounds like a good LinkedIn entry.
Images: Wise Goat Productions.
Tsu Shan Chambers drew on her previous life as an optometrist to play Alana, in the movie My Eyes
She’s front and centre in this film, but Tsu Shan Chambers’s day job is producing and production accounting on other TV and film productions.
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Abiliti 1-Day is a new soft contact lens for
progression of myopia in children.*3
Now registered with the Therapeutics Goods Administration (TGA), Australian optometrists with early access, such as Dr Margaret Lam, Dr Carina Trinh and Dr Jim Kokkinakis, believe it will address some of the limitations not only in contact lens-related myopia control, but in general management.
“The ACUVUE Abiliti 1-Day lens represents a significant advancement in myopia management,” says Dr Lam, head optometrist at 1001 Optometry Bondi.
“I have really appreciated it as a new best-in-category lens, offering a combination of efficacy, comfort, and convenience that aligns well with the needs of our younger patients and their families.”
J&J cites a survey showing more than 95% of children wearing the lens achieved 6/6 visual acuity or better.||4 Other benefits include its material platform that has reportedly never been beaten in ‘comfort’ in six clinical studies posted on ClinicalTrials.gov.‡4
Myopia meets its match
One of the industry’s biggest contact lens manufacturers has developed what one Australian optometrist is describing as a new best-in-category product that ticks some important boxes in myopia management.
The nation’s first optometrists to access a new myopia control soft contact lens from Johnson & Johnson Vision (J&J) can already see how it’s going to break through some of the barriers practitioners come up against when treating progressing myopes.
Inconsistent wear, handling and insertion issues, discomfort, upfront cost, and feeling held back by spectacles. These are just some of the issues that can stand in the way of children realising the full benefit of a myopia control intervention – even with many modalities now available.
And it’s important business, given myopia is a growing epidemic1 affecting children, with every additional diopter of progression increasing the risk of myopic macular degeneration by 67%. 2
J&J’s R&D team – with many industry firsts in the contact lens space –has delivered again with ACUVUE Abiliti 1-Day, described as the first daily disposable silicone hydrogel lens designed specifically for slowing the
That’s not to mention its convenience-factor – vital for compliance in myopia management – and new RingBoost technology with a specialised optical design. 3
But efficacy is arguably the most important performance measure to optometrists. Abiliti 1-Day has been shown to slow axial elongation by 0.25 mm, on average over a two-year period,**5 with almost 65% showing no clinically meaningful myopia progression.
In the real-world, Dr Lam’s observations so far indicate patients using the lens “exhibit a much slower rate of progression of myopia compared to previous treatments”, with improved visual acuity and comfort.
“Some have even shown no progression at all in this time period in the last two years, which is quite impressive from their previous states of high rates of progression with various other means of myopia control,” she says.
Like Dr Lam, Dr Trinh’s initial experience with Abiliti 1-Day was for cases when existing treatments are unsuitable or ineffective.
She first came across Abiliti 1-Day in a 2021 webinar featuring Canadian optometrists. At the time in her Carina Eye Care practice, she had several challenging cases that had proven resistant to dual therapy (soft daily disposable contact lenses with 0.1% atropine eye drops).
“Now that the lens has received TGA approval, I suspect Abiliti 1-Day may prove even more effective for a broader patient base. I believe it presents an excellent first-line or second-line therapy option,” she says.
Her early experience – all highly challenging cases – has shown the lens performed well.
One notable case involves an 11-year-old experiencing axial elongation of approximately 0.25 mm every three months, despite being managed with 0.1% low-dose atropine and myopia control contact lenses. Further expert input was sought from Dr Langis Michaud in Montreal, who supported the recommendation to transition to Abiliti 1-Day lenses in combination with overspectacles to correct 0.75DC residual astigmatism. With this, the patient’s axial elongation significantly reduced to 0.02 mm over a six-month period.
Similarly, another 11-year-old was elongating 0.1 mm every three months with myopia management soft contact lenses and 0.1% atropine. Since transitioning to Abiliti 1-Day, his axial length has slowed to 0.02mm every three months.
WHO STANDS TO BENEFIT?
Dr Trinh says Abiliti 1-Day is proving an especially good option for progressive myopes leading highly active lifestyles. Perhaps they’re seeking greater freedom from spectacles, or maybe they’re not well-suited to orthokeratology (orthok).
She comes across children who feel apprehensive about the initial discomfort with orthok, while others aren’t yet responsible enough to properly manage the care routine. Additionally, the upfront cost of orthok
ACUVUE
myopia control.
Image: Jonhson & Johnson Vision.
“Abiliti 1-Day lenses are exceptionally comfortable, and children are often pleasantly surprised by how good they feel on their eyes. Many quickly become enthusiastic about the experience and are eager to transition to full-time wear,” she says.
“Parents appreciate the convenience of a daily disposable lens too, its high level of comfort, excellent oxygen permeability, built-in UV protection, and particularly its ease-of-handling, which helps children adapt more quickly.”
Additionally, they value the flexibility of a three- to six-month trial period, “knowing that treatment will be continuously monitored and adjusted as needed rather than committing to a long-term solution upfront”.
Dr Kokkinakis, who has been performing orthok for vision correction and subsequently myopia control since the mid-1990s, says this part of his work has reduced since Abiliti 1-Day came along.
This is because it’s capable of simultaneously treating myopia and correcting vision while being relatively simple for patients to take up. Plus, if a lens is lost or damaged, it’s easily replaced. It’s also less technically demanding for busy practitioners.
“Now, if I’m presented with a patient 16 years or less, and certainly younger, they'll be offered Abiliti 1-Day. And if you can teach patients as young as six-years-old to put them in, without lumping the burden on the parent, I'd do it,” Dr Kokkinakis, from The Eye Practice in Sydney, says.
“Anecdotally, I think soft contact lenses are better for controlling myopia progression because kids stick them in first thing in the morning, and take them out last thing at night, therefore you're controlling the situation better.”
Dr Kokkinakis believes previously one of the biggest issues in soft contact lens-based myopia control is that children have been fitted with lens designs more suited to an adult eye.
“It’s taken some years for J&J to enter the myopia management space, and the reason is they've gone back to square one and re-designed the whole platform to make sure they fit children,” he says.
He’s referring to the smaller lens diameter and steeper base curve in Abiliti 1-Day.
It’s something that stands out to Dr Trinh too. She says the way the lens retains its shape “makes insertion significantly easier”, allowing both new and existing wearers to adapt quickly and gain confidence in handling their lenses.
“Abiliti 1-Day is remarkably easy to fit and insert, with patients consistently finding the learning process smoother compared to many other contact lens options on the market,” she says.
Dr Lam says because the lenses are tailored “with paediatric anatomy in mind” children are often mastering insertion and removal within one session, especially with proper guidance and support.
In terms of its optical design, Dr Kokkinakis has been intrigued by Abiliti 1-Day’s “distinct and extreme blur zones” that he thought would defy the
laws of optics, but offer an impressive level of vision quality in his patients.
Abiliti 1-Day also features a +10 D Central Boost zone that maximises the treatment strength, according to J&J. This is accompanied by a +7 D Ring Focus design allowing rays to focus off the line of sight, so the lens can be built with a stronger treatment power while maintaining q uality vision.
Dr Lam says this, known as J&J’s RingBoost technology, is providing “a high treatment power while maintaining clear vision”, while Dr Trinh appreciates the level of clinical confidence such a design offers.
But for all this technology to be effective, it requires consistency.
Dr Lam says a simplified regimen like daily disposables encourages consistent use, while comfort ensures it is worn for extended periods.
“The lenses are made from senofilcon A, the same material as ACUVUE OASYS 1-Day, known for its comfort and breathability. For a paediatric patient who we want potentially having a long lifetime of contact lens wear, having something we know meets the metabolic needs of the eye provides peace of mind,” she says.
“Feedback from patients is that [comfort] is better than their previous contact lens options. This is crucial for children, as discomfort can lead to non-compliance. Our patients have reported excellent comfort, leading to consistent wear and better myopia management outcomes.”
Beyond the convenience of daily disposables, this modality also offers more assurance around lens hygiene, especially compared with orthok, Dr Lam says.
GETTING STARTED
Dr Kokkinakis is now placing Abiliti 1-Day as his new go-to product – but says it will be vital parents are educated on costs, with it coming in at a higher price point for a myopia control soft contact lens.
“That message must be clear – because it's a premium product. People don't mind paying premium prices, as long as they can perceive premium advantages like those mentioned above,” he says.
For practitioners to start prescribing Abiliti 1-Day, they need to complete a CPD-Accredited accreditation program on the JNJVISIONPRO online leaning platform.
“Given the rising awareness of myopia's long-term implications and the lens's benefits, and given its ease compared to prescribing orthok,” Dr Lam says, “I anticipate a significant uptake among Australian practitioners committed to the best results possible for their paediatric patients for their eyecare.”
NOTE: References and disclaimers are available in the online version of this article or upon request.
ABOVE, L TO R: Sydney optometrists Dr Margaret Lam, Dr Carina Trinh and Dr Jim Kokkinakis were among Australian practitioners with early access to Abiliti 1-Day.
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‡ Based on worldwide IOL unit sales, 2023.
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# Based on in vitro examinations of glistenings, surface haze and SSNGs; as compared to Clareon CNA0T0, TECNIS* ZCB00, TECNIS* OptiBlue, Eternity* W-60 and enVista* MX60; n=30 per group; p<0.001.
References: 1. Alcon data on file, 2023; [REF-22137]. 2. Market Scope 2023 IOL Market Report; [REF-23630]. 3. Alcon data on file, 2024; [REF-24102] (available on request). 4. Modi et al. Visual and Patient-Reported Outcomes of a Diffractive Trifocal Intraocular Lens Compared with Those of a Monofocal Intraocular Lens. 2020 Sep 28;S0161-6420(20)30677-1. 5. Clareon Vivity Directions for Use; [REF-20979]. 6. Alcon data on file. US Patent 9968440 B2. 15 May 2018; [REF-03130]. 7. Alcon data on file, 2017. TDOC-0055576; [REF-09755]. 8. Bala C et al. Multi-country clinical outcomes of a new nondiffractive presbyopia-correcting intraocular lens. J Cataract Refract Surg 2022;48(2):136–143; [REF-17338].
One Australian eye surgeon believes many of the 250,000 people who have cataract surgery each year are not getting the results they deserve. He’s urging the industry to take a wider view to ensure patients are getting the best outcomes.
Dr Rahul Chakrabarti has a challenge for many of his ophthalmic colleagues.
And it’s potentially a controversial one.
He’s urging a substantial portion of fellow surgeons around Australia – a figure he believes is about one-third of the sector – to end their blinkered over-use of monofocal intraocular lenses (IOL) in cataract surgery and instead offer patients more and better options, including the quality outcomes available in extended depth of focus (EDOF) lenses.
In fact, he goes further.
Dr Chakrabarti believes EDOFs should now be considered the standard of care in ophthalmology, that monofocals should only be used in a small number of specific situations, and that surgeons who don’t provide options beyond monofocal IOLs may be straying into medico-legal issues.
Now let’s make one thing clear: there is no official standard of care designation around which IOLs a surgeon should use. But it appears monofocals have been used for so many years, and have proven their cost-effectiveness, particularly in public health settings, that they have become the default ‘go-to’ for many.
But as Dr Chakrabarti and others point out, that has been overtaken by significant advances in IOL technology over the last decade, including the rise of the EDOF as a powerful and often preferred alternative.
A momentum driven not only by the industry but also growing patient expectations.
Dr Chakrabarti is a general ophthalmologist in Melbourne and only recently stepped down as director of training at The Royal Victoria Eye and Ear Hospital. He also has consultancy roles at a number of private practices around the state.
Common conditions treated include cataracts, diabetic eye disease, age related macular degeneration and retinal vein occlusions, and glaucoma. He’s reasonably young and has a passion not only for optics but also the constantly changing technology in the sector.
“When I started training as an eye surgeon in 2013 we only had monofocal
lenses, and in the public health setting there was a very high threshold for toric lenses,” he says.
“Initially, the threshold in Victoria was 2.50 D of astigmatism for a public patient to have a toric lens implanted. And over the years, I think with evidence, as well as looking at cost effectiveness, the toric thresholds have come down.”
That heavy use of monofocal IOLs continued when he entered private practice six years ago.
“But I think the landscape has changed dramatically, even over the last 10 years,” he says.
Image:
Andrew Angelov/shutterstock.com.
Many patients in the public health system could be missing out on the best options with their cataract surgery.
Dr Rahul Chakrabarti is passionate about being up to date with the latest IOL technology.
Image:
Rahul Chakrabarti.
“I'm finding I'm putting in fewer monofocal lenses, and in the majority I have put in what we call enhanced focus lenses (EDOFs), with about 20% of my patients having trifocal lenses.”
Dr Chakrabarti often uses Johnson & Johnson’s PureSee IOL and says most of his patients have achieved excellent long, intermediate and even reading vision.
That choice is based on discussions with his patients but also the mounting evidence backing the evolution of IOLs and technological advances in EDOFs, especially in the past few years.
“We now have a new range of lenses which offer much better functional near vision without compromising the patient’s distance vision, and I think that's what I'm passionate about, and most of my patients similarly, over the last four years, as I've transitioned to majority EDOF IOLs, almost as a routine.”
He still uses monofocal IOLs in about 10-15% of cases.
“That might be in patients who have fluctuating retinal conditions or other ocular pathology that interferes with their eyes’ ability to have excellent vision.”
But in the absence of those conditions, Dr Chakrabarti believes that surgeons putting in a monofocal lens are using a “somewhat inferior option compared to the enhanced depth of focus”.
Which is why he is disappointed that so many of his colleagues have not yet widened their own view beyond the traditional, tried and true monofocal IOLs.
“We have a luxury of choice in Australia in particular, and I know that we have access to many different types of lenses in our practices, so it might be the level of comfort that a surgeon has in a particular type of technology,” he says.
“They may have previously had negative experiences with certain types of lenses, which then makes them reluctant to consider that as an option.”
Those “negative experiences” often involved issues with night vision, including halos and glare. But since around 2020, many of the EDOFs have evolved to effectively address those problems.
“I'm more open minded. I think the companies and the industry are moving more rapidly in terms of their design and also auditing the outcomes, both industry outcomes but also real-world outcomes from clinicians.”
PUBLIC PATIENTS GETTING ‘INFERIOR OPTION’
Dr Chakrabarti believes that it’s largely the patients in the public health setting receiving the “somewhat inferior option” of a monofocal IOL, when another lenses might mean better outcomes.
“The majority of public hospitals will have monofocal lenses,” he says. “Very few, such as The Eye and Ear Hospital, actually have a range of EDOFs.”
That largely comes down to cost, with EDOFs and other multifocal IOLs
costing a little more than their monofocal counterparts.
Dr Chakrabarti believes that’s wrong on a number of levels.
“Public patients should have access to the best technologies.
“Even if that means having a flexible funding model where patients are offered this option and are aware of maybe an additional cost, that should at least be open to discussion.”
But he believes it’s also short-sighted.
“There's a cost to the entire system in not having those options. Yes, a product might be more expensive, but there's also a cost in patients going to their optometrist to have glasses updated.”
And a potential impact on the value of training as well.
“From a surgical education perspective, offering enhanced depth of focus lenses to public patients in Australia, beyond standard monofocal lenses, is crucial for advancing ophthalmic training for the modern eye surgeon,” he says.
“Limiting public access to monofocals restricts residents' exposure to diverse intraocular lens technologies and their nuanced clinical planning, discussion, counselling and implantation techniques.”
He believes that helps create a two-tiered system where future surgeons in the public sector are less prepared for the full spectrum of patient needs and technological advancements found in private practice.
“Broadening access to EDOF lenses in public hospitals ensures comprehensive surgical experience, fostering well-rounded, adaptable ophthalmologists equipped to deliver optimal visual outcomes for patients with all visual demands.”
So Dr Chakrabarti is essentially saying the jury is in, the evolution and efficacy of EDOFs have been proven, and colleagues not offering them, at least as an option, are guilty of not giving their patients the best quality of care.
But what do the studies say.
Firstly, they appear to back his contention that EDOFs are clinically better than monofocals.
One study, published in the Journal of Cataract and Refractive Surgery, asked if there was enough scientific evidence to “confirm the clinical superiority of enhanced monofocal over conventional monofocal IOLs”.
Researchers in the 2024 study combed the results of three reviews and 66 articles.
They concluded that, yes, in the debate over what should constitute standard of care (SoC), enhanced monofocals had demonstrated clinical superiority.
“The first condition for establishing the use of enhanced monofocal IOLs as SoC in cataract surgery is accomplished,” they said.
That view was supported in a number of other studies, prompting the
Image: Rob Paul.
When he is not in surgery, A/Prof Rob Paul often spends a fair bit of his chair time explaining to some patients why they are getting a monofocal when an EDOF is not the best choice.
European Society of Cataract and Refractive Surgeons to promote the use of EDOFs and multifocal IOLs in recent guidelines.
But while the research in the Journal of Cataract and Refractive Surgery said EDOFs had met the “first condition” in resolving the debate, it suggested there was one area where the jury was still out, especially in public healthcare.
“Cost-effectiveness studies are still needed and highly recommended to demonstrate that the clinical benefit obtained with enhanced monofocal IOLs is greater than the cost increase compared with conventional monofocal IOLs.”
That very question was examined in another study by Italy’s National Healthcare Service.
Researchers developed a cost-utility model incorporating both healthcare and non-healthcare costs, using data from a socio-economic questionnaire administered at three clinical centres in Italy.
They investigated aspects related to the quality-of-life of patients and the social and economic impact after cataract surgery, including the cost of follow-up visits and treatments, the costs of paid support for the person, and impacts on productivity.
The study concluded that the monofocal IOL was indeed more cost-effective when considering its “direct healthcare costs” within the Italian system, “making the standard option more favourable in terms of immediate healthcare expenditures”.
But the enhanced monofocal IOL saved costs in other areas, “reducing the overall economic burden by lowering both direct and indirect costs while maintaining patients’ quality-of-life”.
Researchers said “these broader benefits, such as reduced dependency on corrective measures, visits and exams, formal and informal assistance, highlight its value to society”.
“This contrast underscores the importance of a holistic approach to healthcare decision-making, where long-term societal savings and patient benefits are considered alongside short-term healthcare costs.”
That holistic approach, the greater consideration of patients’ needs and the offering of more effective options, is at the heart of Dr Chakrabarti’s passionate advocacy – it’s not necessarily that EDOFs alone should be the new standard of care but that they should be part of the conversation for each and every patient.
‘PARADIGM SHIFT’ IN PATIENT OPTIONS
It’s a sentiment Western Australia surgeon Associate Professor Rob Paul agrees with.
“What should be the standard of care is that any cataract surgeon or refractive surgeon should be offering an EDOF lens as a first-line treatment in patients who are suitable,” he says.
The medical director of WA Laser Eye Centre, consultant ophthalmologist and associate professor at the University of WA optometry school was an early adopter of multifocal IOLs almost 20 years ago, even though they often offered “good reading vision but pretty ordinary distance vision and absolutely no intermediate vision”.
Like Dr Chakrabarti and many others interviewed by Insight, he has been
“With the advent of EDOFs there's been a real paradigm shift in terms of what we can offer patients.”
impressed with the evolution of EDOFs and the quality they provide compared with traditional monofocal IOLs.
“With the advent of EDOFs there's been a real paradigm shift in terms of what we can offer patients,” he says.
“For those wanting more spectacle independence, I usually put an extended depth of focus lens in the dominant eye and a true multifocal in the non-dominant eye, because it reduces the glare, the halos and the dysphotopsias – that's my preferred option now.”
Similar to his colleague in Victoria, A/Prof Paul is not dismissing monofocal IOLs out of hand.
He too uses them in 10-20% of cases.
“Monofocal lenses are ideal in patients who are, say, high myopes or myopes that are actually using a monovision set-up where we set one eye for distance and one eye for near – that's an ideal situation.”
He’s also happy to recommend them for certain patients prioritising distance vision, including pilots, and target and clay shooters.
“When you give them the option, they say, ‘Oh, look, mate, just set both eyes for distance or give me a bit of monovision, and I'll be happy with that.”
But he too is concerned at the number of patients, and particularly those going through the public system, who are not offered EDOFs or other presbyopia-correcting lenses as part of their surgery and treatment plans.
That’s despite companies closing the gap on the cost of an EDOF compared with a monofocal IOL.
“In the public system, I think the companies have been quite good,” he says. “They've brought it down to maybe a $200 difference, so it's quite acceptable.”
He believes bureaucracy is also to blame, “because they have to change the itemisation of the numbers”.
What that adds up to is a sizeable portion of the 250,000 Australians who receive cataract surgery every year being implanted with potentially a “somewhat inferior option”. And it’s an option that’s not easy to reverse.
“It's wrong,” says A/Prof Paul, “because it should be a fair and equitable system for everybody, but it's not.”
Many of those patients are becoming increasingly aware that they are missing the train of that “paradigm shift”; that the evolution of EDOF technology has opened what he calls “a whole new world” – from which they are excluded.
“There was a market survey done that actually showed that one in three patients are expecting to be spectacle independent after cataract surgery,” he says.
“When they simulated presbyopic correcting lens vision to them with the technology that they use, 90% of people said, ‘look, I want that’ – 50% wanted EDOFs and 50% wanted multifocal.
“So the patients are now more demanding and more informed than they ever were five years ago.”
In fact, A/Prof Paul spends a fair bit of his chair time explaining to some patients why they are getting a monofocal when an EDOF is not the best choice, including cases of significant corneal or macular disease.
“This is a reverse of what used to occur in the early EDOF/trifocal era,” he says.
Dr Chakrabarti is also noticing this demand pull, to go with the supply push of frequent new products from various companies.
And that’s what has him worried.
Insight suggests to him that some patients, armed with knowledge about EDOFs and the advances in the technology, might simply vote with their feet and go to another ophthalmologist offering more and better options.
“I'll flip it the other way,” he says.
“I'll say, from a medical-legal perspective, we have an obligation as modern and safe clinicians to provide evidence-based information to our patients, to have the conversation and guide them in making an informed decision.
A/Prof Rob Paul WA Laser Eye Centre
“If you don't provide them the range of options, even though you might not think a particular lens is a safe option for them, then I think that is in some ways negligent.”
Clearing up nomenclature confusion
Presbyopia management has been the holy grail for intraocular lens technology development for 30 years, but sub-classifying lenses has become confusing and ad hoc, says DR PETER SUMICH. He offers a way out.
As biometry became predictable and 90% accurate for achieving reliable emmetropia, intraocular lens (IOL) companies geared their development teams towards solving the presbyopia puzzle. Right from the start the goal has been to maximise near vision while minimising unwanted side effects.
I approached this brief review to describe the current approaches to presbyopic IOLs in an agnostic, non-manufacturer specific way. For simplicity, we start with the three common paradigms.
The first is monofocal monovision that works well for those who accept anisometropia and variable reduction in stereopsis, somewhat proportional to the degree of monovision.
The second is diffractive multifocal technology which has the most potent benefit for presbyopic relief but common and well-described photic side effects.
The third and most recent paradigm is extended depth of focus (EDOF) technology which extends the depth of focus through a variety of optical means. EDOF implants, whilst not providing as much presbyopic benefit as diffractive light splitting, do hit the sweet spot for lifestyle vision with little downside for photic side effects and are the fastest growing category.
But with so many companies working on so many solutions it has become evident that we have nomenclature confusion.
In a recent edition of the Journal of Cataract & Refractive Surgery (JCRS), Professor Ribiero’s group suggested a new framework towards
In general, every surgeon will have a preference for the type of presbyopic implant they use and understand. Fine-tuning and tweaking these implants takes only a short time but has been extremely rewarding for our patients who are seeing great lifestyle benefits. Most patients will still use occasional spectacles for fine tuning of nearer vision or night driving but in most cases they are functionally spectacle independent for their day-to-day home activities such as cooking, cleaning and gardening. Other prized benefits usually achievable are Google Maps when driving, mobile phone, social media and iPad use.
The implants need to be individualised to the patients visual demands with their expectations and tolerance for unwanted side effects factored in. Mix and match approaches are sometimes used and varying degress of mini-monovision are often sucessful.
Understanding defocus curves is essential to appreciating the
Image: Peter Sumich.
Cataract and refractive surgeon
Dr Peter Sumich.
TABLE 1: Criteria for classifying IOLs. This is based on best distance corrected monocular visual acuity defocus curves’ range-of-field and shape.1
bothers computer users and one Lego fanatic who modelled at arms length and made my life hell.
A smoother transition, without the missing intermediate vision, is provided by a trifocal lens. The ‘Enhance’ and ‘Extend’ EDOF categories describe the 'mini EDOF' and 'maxi EDOF' which extend the depth of focus to a lesser or greater extent respectively.
My patients are generally accepting of the need for reading glasses for phone banking, pill bottles and phone bills. It is always important to remind even refractive surgery patients who expect the most, that such occasional spectacles are usually required, because it sets expectations to a manageable level. However in many cases patients surely are complete in their independence – but it is foolish to promise. Also noteworthy is the unexplained individual variation in presbyopic outcomes which defies optical explanation.
The role of optometrists is largely to counsel patients that presbyopic IOL solutions are available to a greater or lesser extent. Rather than getting lost in a deep dark hole trying to explain the technologies, the simplest approach is to broadly outline the issues of presbyopia and instill a reasonable level of expectation. I ask my patients to return to their optometrist for refraction at one month, but many patients will resist the need for an immediate reading script until six months of exploring their newfound vision. At that six-month stage they give in more willingly to the reality that occasional glasses are necessary. So don’t forget the six-month review to follow up on the patient who rejects readers at the one-month refraction.
Evidence-based functional classification of simultaneous vision intraocular lenses: seeking a global consensus by the ESCRS Functional Vision Working Group. Journal of Cataract & Refractive Surgery 50(8):p 794-798, August 2024. | DOI: 10.1097/j.jcrs.0000000000001502
BIOMETRIC INTELLIGENT GLASSES
REFERENCE:
1. Ribeiro, Filomena MD, PhD; Dick, H. Burkhard MD, PhD; Kohnen, Thomas MD, PhD; Findl, Oliver MD, PhD; Nuijts, Rudy MD, PhD; Cochener, Beatrice MD, PhD; Fernández, Joaquín MD, PhD.
Unlock Full Visual Range With
High Visual Quality
The journey to high-quality, full vision range begins with TECNIS Odyssey™ IOL.* 1 TECNIS Odyssey™ IOL consists of a combination of features that are designed to improve the lives of your patients:
• Enhanced tolerance to refractive error †2
• Optimised dysphotopsia profile ‡2,3
• High image contrast in low light conditions 4
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Australia: AMO Australia Pty Ltd, 1-5 Khartoum Road, North Ryde, NSW 2113, Australia. New Zealand: AMO Australia Pty Ltd, 507 Mount Wellington Hwy, Mount Wellington, Auckland 1060, New Zealand.
IOL DIRECTORY
Insight is excited to launch this new comprehensive resource for intraocular lens (IOL) technology in Australia. Over the next 10 pages, ophthalmologists can find an up-to-date list of lenses from the country’s main suppliers, bringing key features and specifications into one place
While adopting an IOL takes much consideration, this is intended to showcase the various technologies available – split across presbyopia-correcting and monofocal categories –so cataract surgeons can consider new lenses for their patients.
T he directory will become a regular fixture, ensuring surgeons can continue to access timely and relevant IOL information.
PRESBYOPIA-CORRECTING
Clareon Vivity
BAUSCH + LOMB
LuxSmart/LuxSmart Toric
Teleon FEMTIS Mplus
JOHNSON & JOHNSON
Symfony IOL
TECNIS PureSee IOL with TECNIS SIMPLICITY Delivery System
OPHTHALMOPRO
RAYNER
RayOne EMV
SURGIVISION
Pty Ltd
+6.0D to +30.0D (0.5D steps); +31.0D to +34.0D (1.0D steps)
0D to +10D (1.0D steps); +10D to +34.0 (0.5D steps)
+10.0 to +30.0D (0.5D steps)
+10.0D to +30.0D (0.5D steps)
-10.0D to -1.0D (1.0D steps); +0.0D to +36.0D (0.5D steps)
+15.0D to +30.0D (0.5D steps)
+15.0D to +30.0D (0.5D steps)
-0.20
Modified L haptics
VariableQuad haptics
-0.22
Modified C with 5 degrees of angulation
• Hydrophobic acrylate/ methacrylate copolymer
• Hydrophobic acrylic copolymer
• Hydrophobic acrylic
• +6.0D to +30.0D (0.50D steps); +31.0D to +34.0D (1.0D steps) +1.0D to +3.75D1.55
• UV-absorbing hydrophobic acrylic • +5.0D to +34.0D (0.5D steps)
Hydrophobic acrylic
+5.0D to +36.0D (0.5D steps)
Hydrophilic
to +4.5D (steps are 1.0D, 1.5D, 2.25D, 3.0D, 4.0D, 4.5D)
Plunger Awaiting Reimbursement +0.0D to +30.0D (0.5D steps)
Hydrophilic acrylic
KG023 -3.0D to +3.0D (0.5D steps); -1.0D to +1.0D (0.25D steps)
+8.0 to +35.0D (0.5D steps)
-7.0 to -0.5D (0.25D steps); -0.5 to +0.5 (0.5D steps); +0.5 to +6.0D (0.25D steps)
0.0D to +32.0D (0.5D steps)
Hydrophilic acrylic
Double C-loop
Four point fixation for sulcus fixation
+8.0 to +35.0D (0.5D steps)
to +3.0D
Hydrophilic
Hydrophilic acrylic
-5.0D to +35.0D (0.5D steps) -0.18 Four point haptic • Hydrophilic acrylic • -5.0D to +35.0D (0.5D steps)
-5.0D to +35.0D (0.5D steps)
-0.18 Four point haptic • Hydrophilic acrylic
Range: +4.5D to +6.5D (0.5D steps); High Cylinder: +7.0D to 12.0D (0.5D steps)
-5.0D to +35.0D (0.5D steps) +1.0D to +4.0D (0.5D steps)
• PlungerCZ034
QQ273 (Standard Range), QQ272 (High Cylinder)
• PlungerQQ282
*For the purposes of this directory, full range of vision is intended to account for (but isn't limited to) trifocal, multifocal and full range of
From crossroads to bright future
Insight talks with an ophthalmologist and pioneer in Australia’s private health system about his part in the establishment of Cura Day Hospitals Group, which is now a leading player in the sector.
Forty years ago, when ophthalmologist Dr Keith Zabell returned to Australia after a number of years working in the UK, he saw a glaring gap in the private healthcare landscape.
He had graduated in honours in medicine from the University of Queensland, following that up with a specialist degree at Sydney Eye Hospital and post-grad fellowships at Britain’s Bristol and Moorefields eye hospitals.
But a career on the rise encountered a surprising crossroads when he returned home to find all was not necessarily green and gold in the lucky country.
“The hospitals were insistent that the surgeons purchase any new equipment such as operating microscopes and phacoemulsification machines, even though there was capex and amortisation component in the admission fee from the health funds,” he recalls.
That meant that eye surgeons were forced to use sometimes outdated equipment, unless they chipped in themselves to buy the latest technology.
He and others found this “frustrating”, but Dr Zabell and a colleague decided to do something about it.
After a visit to the US, they started a campaign to build a “day surgery” in Queensland, which would later prove a cornerstone of Cura Day Hospitals Group.
Once operational, this initial facility would help take the pressure off Australia’s public health system and encourage the use of up-to-date equipment.
“I tried to encourage the local hospital to create a free-standing facility, but it was declined,” he says.
Undaunted, they decided to build one themselves.
“We built Toowoomba Surgicentre in 1986 and eventually had 23 surgeons accredited.”
Making this happen didn’t come without a fight, though.
“We were the first day surgery to become licensed in Australia,” he says. “The health funds and hospitals were dead against this occurring – the latter for competition reasons.
“The former’s complaint was obtuse as day surgery would save them inpatient fees.”
That pioneering history in private health and the strong connection with the running of the Toowoomba Surgicentre made Dr Zabell an obvious choice to be chair of the board when Cura Day Hospitals Group was established in 2008.
His Toowoomba facility also became part of a wider private health enterprise.
CEO Mr Peter Freeleagus says Cura, which is majority-owned by London-based investment firm Intermediate Capital Group (ICG), is now the largest private day/short stay hospital group in Australia, with 37 facilities nationally.
“We provide high-quality care to more than 200,000 Australians each year, and we continue to expand our service offerings in response to community need,” he says.
Those 37 private hospitals across six states and the ACT are used by more than 1,100 admitting doctors and provide a broad range of surgical and procedural services, with key specialties including ophthalmology, gastroenterology, plastic and reconstructive surgery, ENT surgery, orthopaedics, urology and gynaecology.
Freeleagus says ophthalmology has always been a fundamental part of Cura’s portfolio, with approximately 50% of Australia’s cataracts in the private day hospital sector performed at a Cura hospital, according to AIHW data from 2023-24.
Dr Zabell has done a number of those himself and fully endorses Cura’s business model, from the surgical suite to the boardroom.
“People have asked me, why do we need free-standing day surgeries? There are a number of reasons; some relate to the patient’s experience, some to nursing satisfaction of personalised care, a lot is related to efficiency and lower and set fees, and finally doctors feeling comfortable in a smaller institution with independence.”
He says that is a feature of Cura hospitals, despite the group’s size and national footprint.
“Part of the Cura model is that it doesn’t have to be involved in how the doctors run their practices,” Dr Zabell says.
“They have complete control of their choice on equipment and prosthetic decisions. The doctor’s fidelity has been a crucial component to Cura success.”
Surgeons, including ophthalmologists, get access to not only the best equipment and nursing staff, but also a small, efficient support and administration team that ensures streamlined workflows and issues are handled quickly.
“Cura constantly monitors outcomes, workflow, the satisfaction of patients, staff and doctors, and costings,” says Dr Zabell.
“Communication and education between all levels ensure a harmonious and safe work environment.”
Surgeons play a key part in that communication.
“When Cura was formed, the business model was underpinned by a mission of trying to create centres of excellence,” he says.
Doctors provide feedback to “ensure we have the most advanced equipment with the best support staff in the best facilities”.
They are also involved in annual surgical advisory meetings that bring board members and other support staff together.
“The support staff must feel valued and have the satisfaction of being in a team that produces safe and satisfying outcomes
Images: Cura Day Hospitals Group.
Eye surgeons using Cura facilities get access to high quality equipment and support staff.
Dr Keith Zabell.
for patients. Cura can deliver this as surgeon equity and involvement at the ‘coal face’.”
Dr Zabell believes doctors’ independence and the level of communication help set Cura apart from other players in the private day hospital sector.
“Cura can pride itself, historically, on great working environments and few, if any, grievances. This reputation encourages more doctors and nurses to join the organisation.”
But Dr Zabell is not only focused on the history of Cura. He remains on the board because he knows there are plenty of challenges and opportunities in the group’s future.
“I have continued on as there is an ongoing battle in the industry to maintain doctors’ independence from the threat of managed care as well as appropriate reimbursement,” he says.
“The ever-changing nature of healthcare and its issues needs constant illumination to the heath funds and the respective governments.”
Freeleagus acknowledges the private healthcare sector is “dynamic”.
“We do face challenges – including workforce shortages and cost pressures,” he says. “Workforce is a focus for us, and we are investing in developing and retaining our talented clinical teams across Australia.”
But he believes the recent issues between private hospitals and health insurers, including the financial struggles of some hospital networks, reveal the “significant opportunities for the day and short stay hospital model”.
“Patients, doctors and funders are increasingly recognising the benefits of day procedures,” Freeleagus says.
“Cura’s scale and excellent relationships with both doctors and private health insurers position us very well to lead in this space.”
The group’s ownership model works to ensure alignment, clinical engagement, and respect for medical sovereignty.
“This ownership structure fosters professional partnership and ensures that
“Cura’s scale and excellent relationships with both doctors and private health insurers position us very well to lead in this space.”
Group
our specialists, including ophthalmologists, have a direct voice in shaping the hospitals where they operate, and can share in the overall success of Cura,”
That success included support from Intermediate Capital Group for innovation
“Cura is also committed to staying at the forefront of ophthalmic technology and our strong relationship with key ophthalmic suppliers means our surgeons often gain early access to leading innovations,” he says.
“Cura is the only private hospital group in Australia to secure access nationally across multiple sites for Alcon’s new UNITY Vitreoretinal Cataract System from July 2025.”
Freeleagus says Cura’s future is positive and secured.
“With the support of ICG, and our doctors, we will continue our strong growth trajectory by acquiring and building of state-of-the-art facilities, investments in advanced technology and expanding our clinical offerings to meet local doctor and patient needs,” he says.
to +35.0D (1.0D steps); +10.5D to +29.5D (0.5D steps)
Teleon FEMTIS FB313 Device Technologies Aspheric monofocal hydrophillic acrylate Plate with additional clips 0+15.0D to +30.0D (0.5D steps)
IQ MEDICAL
MBI Precisal SAL P302A, SAL PT302A IQ Medical Aspheric hydrophobic toric monofocal C-loop 0.21 +1.0D to +10.0D (1.0D steps); +10.0D to +18.0D (0.5D steps); +18.0D to +30.0D (0.25D steps)
JOHNSON & JOHNSON
TECNIS 1-Piece ZCB00 AMO Australia Pty Ltd Biconvex anterior aspheric surface C-loop squared haptic -0.27+5.0D to +34.0D (0.5D steps)
TECNIS 1-Piece with TECNIS SIMPLICITY Delivery SystemDCB00 AMO Australia Pty Ltd Biconvex anterior aspheric surface C-loop squared haptic -0.27+5.0D to +34.0D (0.5D steps)
TECNIS Eyhance with TECNIS SIMPLICITY Delivery System DIB00/DIU100-600, DIU700-800 AMO Australia Pty Ltd Continuous anterior higherorder aspheric C-loop
TECNIS Toric II
ZCU100-600, ZCU700-800 AMO Australia Pty Ltd anterior toric aspheric surface C-loop squared frosted haptic
SENSAR Monofocal 3-Piece IOL AR40M AMO Australia Pty LtdMeniscus C-Loop Modified 60% Blue Core PMMA
SENSAR Monofocal 3-Piece IOL AR40E AMO Australia Pty LtdBiconvex
SENSAR Monofocal 3-Piece IOL AR40e AMO Australia Pty LtdBiconvex
• Standard: -3.0D to +3.0D (0.5D steps); MTO: -7.0D to +7.0D (0.5D steps) Standard: +1.0D, +2.0D, +3.0D; MTO: +1.0D to +6.0D (0.5D steps)
• Hydrophilic acrylic 1.46UV, blue light
• Hydrophilic acrylic
• Hydrophilic acrylic
• -20.0D to +60.0D in (0.5D steps) +1.0D to +30D (0.5D steps)
• -20.0D to +60.0D (0.5D steps) +1.0 to +30.0D (0.5D steps)
• Hydrophilic acrylic 1.46UV
• Hydrophobic acrylic • +10.0D to +30.0D (0.5D steps) +1.0 to 1.5D (0.5D steps); +1.5 to +6.0D (0.75D steps)
• Hydrophilic acrylic
• -10.0D to 0.0D (1.0D steps); 0.0D to +30.0D (0.5D steps); +30.0D to +35.0D (1.0D steps)
+1.0D to 1.5D (0.5D steps); +1.5 to +9.0D (0.75D steps); +9.0 to +24.0D (1.0D steps)
• Hydrophilic acrylic • +36.0D to +40.0D (1.0D steps) +1.0D to 1.5D (0.5D steps); +1.5D to 3.75D (0.75D steps)
• Hydrophilic acrylic
• Hydrophilic acrylic
• -10.0 to +10.0 (0.25DS steps) +1.0D to +1.5D (0.5D steps); +1.5 to +9.0D (0.75D steps); +9.0D to 11.0D (1.0D steps)
blue light
UV-absorbing agent
KG008/ (Made To Order) KG024
• Plunger SO075
• Plunger SO067
SO060/SO059
SO057/SO058
• Plunger SO083
• Push plunger VU006/VU003
•
•
•
• Hydrophilic acrylic
• Hydrophilic acrylic
• Hydrophobic
• Hydrophobic
• -4.0D to +32.0D (0.5D steps) Standard Range: +1.0D to 6.5D (0.5D steps); High Cylindar: +7.0D to +12.0D (0.5D steps)
• -8.0D to +28.0D (0.5D steps) +1.0D to +4.0D (0.5D steps)
QQ288 (Standard Range) QQ286 (High Cylinder)
• Plunger QQ287
A look into the future
Techniques and technology are constantly changing in cataract and refractive surgery. S everal Vision Eye Institute surgeons offer their insight about some of the changes coming and how they might impact the sector.
New intraocular lenses (IOLs) are being released regularly, including extended depth of focus (EDOFs) implants that are consistently removing previous compromises and challenging monofocals’ traditional status as the standard of care in the sector. Artificial Intelligence (AI) and other tools are raising new opportunities for surgeries and surgeons, increasing the amount of data available and potentially easing and improving the patient journey. But there are challenges as well in data sovereignty and security.
In considering the impact of these various changes, among many more, Insight approached a number of Vision Eye Institute surgeons and asked them various questions about future opportunities and challenges for the sector.
Included were Professor Gerard Sutton, NSW; Dr Christolyn Raj, Victoria; Dr Alex Ioannidis, Victoria; and Dr Rushmia Karim, NSW.
1. Given the shift towards refractive cataract surgery, how do you balance the expectations of patients with realistic outcomes, especially in complex or comorbid cases?
Professor Gerard Sutton: In many ways this is the ‘art’ of cataract surgery. There is no doubt that in countries like Australia expectations of spectacle independence after cataract surgery are very high. I don’t see that as a problem, but as a surgeon it is critical you inform the patient of the likely outcome, which is really very good with the newer EDOF IOLs. But never promise spectacle independence.
Dr Christolyn Raj: We now have the technology to triage patients to ascertain how they would benefit from a certain IOL choice. In my practice, we do this by getting to know what the patient knows and what they are willing to compromise. In my opinion this is the silver bullet. There are tested questionnaires I have used to help me here but spending time with a patient during a consult and appreciating their hobbies, what is entailed in a typical
day, their commitments, etc is often enough to reach a decision on the best suited IOL. In my experience, this then needs to be weighed up with their co-existing conditions.
Dr Alex Ioannidis: This will involve a very thorough examination of the patient at the time of the assessment, because you have to make sure that you can meet the patient's expectations for the final visual outcome. If you have comorbidities you have to guide the patient towards the best possible implant that would achieve a realistic outcome, hence a tailored approach for each patient. In saying that, it is important to discuss all IOL options with the patient so they don’t feel they’ve “missed out” on any current technology.
Dr Rushmia Karim: The key is customisation of the individual's visual needs to the current lenses available. Ensuring patient expectations match the reality of visual outcomes after refractive lenses exchange is managed by clear, honest communication. Visual simulations can help as, does old-fashioned tables highlighting the patient’s lens option. Pre-operative planning with contact lens trials, patient questionnaires and understanding their current and future visual needs is important.
Image: VEI.
ABOVE, L to R: Prof Gerard Sutton, Dr Christolyn Raj, Dr Alex Ioannidis and Dr Rushmia Karim.
The future will present plenty of opportunities and challenges for patients and practitioners in cataract surgery.
2. What are your experiences with current presbyopia-correcting IOLs, and how do you see next-generation lens technologies improving patient satisfaction and visual outcomes?
Prof Sutton: I use both the Alcon Vivity and J&J PureSee EDOF IOLs. I think with a small amount of blended vision, spectacle independence is very high but there is still sometimes a need for extra near-visual assistance. This technology will continue to improve incrementally but the real question is whether we can get true accommodating IOLs. There are currently a number in development. Intrabag approaches include the Juvene, Fluidvision and OmniVu, whilst those taking a ciliary body approach include the Lumina, which is CE marked in Europe, and the Opira. We will have to wait and see whether these concepts, which have been around for decades, will finally bear fruit. I think we will see one of the accommodative IOLs come to the fore in the next five years.
Dr Raj: I recently conducted an audit of IOL types used in my surgery and the breakdown of EDOF and multifocal versus monofocal (all astigmatism-correcting) was 40% to 60%. Given I operate on a large number of patients with co-existing retinal disease, I was pleased with these results. It suggests that co-morbid disease does not exclude patients from having a premium IOL, as they are often referred to, however expectations have to be clear from the outset. In my opinion the current EDOFs on the market are unable to offer effective near-vision that patients are after. In the context of retinal conditions, where maculopathy can further compromise near-vision, these patients are often better off with a monofocal IOL and wearing reading glasses.
Dr Ioannidis: There has been an explosion of new IOLs in the market that help to control and correct presbyopia and I've been using diffractive IOLs for the last 10 years, with very good outcomes. Patient selection is critical. I find that the newer generation, extended depth of focus IOLs such as the Alcon Vivity and TECNIS PureSee can
offer patients with ocular comorbidities something that was not actually available to them previously – the ability to extend the range of vision for common intermediate tasks. The other advantage of the EDOFs is the low-risk profile transient dysphotopsias which can be an issue with some diffractive IOLs.
Dr Karim: After a recent audit, my use of multifocal IOLs has reduced, although I still use them in a select group of suitable patients. My use of EDOF lenses has increased over the last five years with greater reliability and comfort using these lenses. It is also important not to exclude the use of monovision. I have a large post-refractive laser cataract practice and the majority of patients coming for cataract surgery already have monovision post-LASIK. I use EDOF lenses in about 30% of my cataract and refractive lenses exchange patients. They suit a particular type of patient – usually an emmetrope or hyperope whose near-vision you are improving. A myope whose near-vision has been good all their life may not be suitable if taking away their ability to read very close, so the patient’s original refraction is also important in lens choice.
3. With increasing digitisation of surgical planning and outcome tracking, how do you manage patient data and outcomes analytics, and what would improve its clinical utility?
Prof Sutton: Mainly in IOL optimisation and surgical audits.
Dr Ioannidis: We have available a lot of information these days from a lot of devices, both diagnostic and also biometric, and this can help us focus the outcomes for the patient we have. We are able to marry together all of this information and analyse it in increasing detail. The advent of artificial intelligence is going to be interesting, because AI will be able to make refractive outcome suggestions for our patients based on the clinical data that is introduced into the algorithm, and in the future it will have a bigger role in how we how we plan surgery for our patients.
Robotics is tipped to play a big part in the future of ophthalmic surgery.
Dr Karim: I love looking at the data, however, information governance of the data is very important and having robust safety mechanisms to protect data.
4. Automation and robotic enhancements are increasingly available. How comfortable are you with increasing automation in cataract procedures, and where do you see the line between assistance and autonomy?
Prof Sutton: I use the femtosecond laser for capsulotomy and nuclear fracture for most cataract cases. It’s a preference but not essential for good outcomes. There are a number of robotic systems being developed around the world with, I think, three already placed in hospitals in Europe. The first partially robotic device was developed back in 1989 and we are yet to see large-number clinical trial outcomes, but they are coming. The challenge of course is precision. The posterior capsule is 3.5um thick and that’s the difference between a perfect and suboptimal outcome in cataract surgery. Is the sensitivity and responsiveness of these systems adequate to ensure safety? We don’t know yet but having just ridden in a driverless taxi in San Francisco recently, I don’t see why not.
Dr Raj: Having used a semi-automated process - laser assisted cataract surgery (FLACS) – now for the majority of my patients, I can definitely say that there is a role for this. Automated processes allow a technique to be performed with great precision that is repeatable. However, manual and automated surgeries are so different that they require a different pre-operative set-up, a different array of instruments, an understanding of the limitations of each, and alternative techniques to assist with these limitations (the latter enhanced with experience). At this stage, semi-automated rather than completely automated processes are probably the way to go - each person is different and so is each eye we operate on, so we need to be able to be versatile in our surgical approach, which a fully automated process does not lend itself to.
Dr Ioannidis: Yes, we're finding that robotic surgery is becoming more prevalent in different specialties, and ophthalmology will also see its role. Current surgical interfaces basically replicate human motion, so they're not really truly independent. You have to teach the robotic system how to respond to a given scenario. With increasing advances in these systems, you will find that robotic systems become more independent of the human operator. There is no doubt in my mind that robotic surgery will have a major role in optimising outcomes in the future. It remains to be seen whether patients will actually like to be operated on by independent artificial intelligence devices and robots or prefer to have a human-to-human interaction. This will be an evolving field in the next few years.
Dr Karim: I am an early adopter for any form of technology that will ultimately make surgery safer and more reliable. Lensx is a perfect example of how we have the ability to use a femtosecond laser to perform a near-perfect rhexis. Robotics has evolved rapidly in surgery and will continue in the future.
5. What is your perspective on the future role of femtosecond laser-assisted cataract surgery (FLACS) in routine practice? Has it reached its full potential or is there room for renewed relevance?
Prof Sutton: It provides good symmetrical capsule overlap and long-term IOL stability and is kind to the corneal endothelium. There is a new system, Keranova, which may be more efficient in nuclear fracture and eliminate the need for any phaco energy. It uses a laser detection system to assess how much energy is required for nuclear fracture. It is also in the operating theatre and doesn’t require an extra room.
Dr Ioannidis: In my 10 years’ experience with this technology I can tell you that FLACS has a role in complex cases and can effectively reduce surgical risk. In my practice patients are given a choice whether to have surgery with FLACS or via the conventional method and many do prefer the added technological advancement. With increasing advances in the future, you will find that these systems will become much smaller in size, more compact, potentially becoming incorporated into the operating microscope and within the operating theatre.
Dr Karim: I would have it for my cataracts when older. No matter how perfect you are as a surgeon, FLACS can give a near-perfect rhexis and reduce risk. I am part of the RANZCO cataract coaching seminars and repeatedly there is consensus that this step of cataract surgery is crucial. Why would you not use technology to reduce risk?
6. How has your approach to managing post-operative refractive surprises evolved, and what tools or techniques do you find most valuable for achieving optimal outcomes in such cases?
Prof Sutton: The most important tool in managing unhappy patients with refractive surprises is my voice. I personally go through likely post-operative refractive outcomes and spectacle independence with all my patients and document it in the digital file. When it does happen, I remind the patient that there was always that possibility and then tell them we have options to deal with it. Glasses work quite well actually but if these are unacceptable to the patient, I will offer either a corneal refractive procedure or a secondary IOL.
Dr Raj: My approach is fairly straightforward and hinges on open disclosure to the patient with an emphasis on the ways we are now able to manage this. I always mention the possibility of refractive surprise to my patients during the initial consultation. Should this occur, my team and I would go back and look carefully once again at the pre-op and post-op data looking for anomalies. It can be useful here to use some calculators on the American Society of Cataract and Refractive Surgeons website. AI platforms that take into account wavefront aberrometry can hopefully be more useful for this scenario in the near future. When considering options, I try to simulate this using a trial contact lenses or glasses to demonstrate "improvement " to the patient. Then I consider one of three options: refractive laser enhancement; surgical IOL replacement/augmentation; or conservative glasses/cl correction.
Dr Ioannidis: A discussion about refractive outcomes has to happen well before you proceed to performing surgery on a patient, and you have to give the patient realistic expectations, especially if their expectations are very high, because sometimes patients don't understand the complexity of the visual system and complex concepts such as neuroadaptation. For any refractive surprise we have a lot of tools at our disposal to manage it. We have laser enhancements that can reduce the refractive error, we have the option to do piggy-back IOLs, which can also effectively reduce any residual ammetropia. In most cases, I find patients actually accept they have a minor refractive surprise and they're willing to accept the use of glasses, rather than undergoing another surgical intervention. I must admit in the last 10 years I have not had to explant an IOL just because there was a minor refractive surprise.
Dr Karim: The key is consistent, repeatable algorithms, reducing human error in the calculation process, and meticulous checking. Evaluating true refractive surprises have tended to occur with wrong lens selection, with errors along the cataract surgery process. Having an experienced team who understand the implications of errors and repeatable, reliable processes means this error is reduced.
Up close and personal with Vivity
Alcon’s IOL prompted a shift in the way DR LEWIS LEVITZ approached patients seeking presbyopia correction. Here’s what he’s learned after more than 1,500 implants.
Melbourne cataract surgeon Dr Lewis Levitz operates under the simple philosophy: “I like to use what I feel is best for patients … in my hands.”
The last three words in that quote are an important distinction. While it’s easy to pivot and chase the next craze in intraocular lens (IOL) technology, it’s a sense of familiarity and intimacy with a lens that’s most important to him, manifesting in excellent outcomes.
Right now, that lens is the Alcon Vivity IOL. In the 4.5 years since its arrival to the Australian market,1 it has withstood a flurry of competing extended depth of focus (EDOF) IOLs also offering a monofocal-like visual disturbance profile along with an increased range of vision.
With more IOLs joining this new class in presbyopia correction, Dr Levitz has stuck with Vivity. The non-diffractive lens was the catalyst for him to swap from multifocals for the majority of cataract operations to EDOFs, which today account for around 50% of his surgeries.
He has now implanted more than 1,500 Vivity lenses, including many with Alcon’s updated Clareon material. After auditing and fine-tuning his use of the IOL every 200 cases, he’s gained a level of understanding to extract every ounce of performance from the lens.
“My patients seem to be delighted with their vision and a happy minority can even read at near. I find it a superb lens when used in the right circumstances,” he says.
“The big thing for me is that Vivity is on a known platform, one that I’ve relied on for the past 17 years. I know how it behaves when being injected into the eye as well as how controlled it unfolds. I'm also happy with the Clareon material because it is clearer.
“Prior to Vivity, I implanted multifocals from various manufacturers, and was also pleased with their results. It might turn out one day that another lens performs as well or better, but the reason I'm not changing from Vivity is that I've invested a lot of time and effort, more than four years, to optimise my results with this lens.”
While Dr Levitz likes to rely on his own analysis, many of his
“My patients seem to be delighted with their vision and a happy minority can even read at near. I find it a superb lens when used in the right circumstances.”
Dr Lewis Levitz Vision Eye Institute
Vivity has withstood the rigours of real-world studies, Alcon says.
colleagues have made Vivity a got-to lens thanks to the robust data supporting it. 2-4 That may explain why it’s now most-implanted EDOF IOL globally with more than one million implanted and counting. †‡5-7
A big reason is the wealth of real-world evidence confirming the outcomes observed in randomised clinical trials of Vivity. 2-4
To demonstrate how it has withstood the rigours of the real world, the Vivity IOL Registration Study – multi-centre, open-label and non-interventional in nature – involved 885 patients at 41 sites globally. 3 A third of patients had various eye conditions such as astigmatism, dry eye, glaucoma, monovision and age-related macular degeneration.*3
For distance (6/6),§ this study showed Vivity offered “monofocal-quality” vision with ~90% not needing glasses. The lens offered “excellent” intermediate vision (6/7.5, 66 cm)§ with ~80% not needing glasses at this focal point, and provided “functional” near vision (6/9.5, 40 cm)§ with ~50% not needing glasses. 3
Also, more than 91% of patients reported no halos, glare or starburst, and 92% of patients were satisfied.**,¶ 3
Dr Levitz agrees these numbers are comforting, but it’s his own statistical analysis, how the lens performs in his hands, that he’s especially interested in.
Being part of the Vision Eye Institute (VEI) private ophthalmology network has given him access to Dr Chris Hodge, VEI’s clinical research coordinator and a senior research fellow at the University of Sydney, who had audited Dr Levitz’s Vivity outcomes and elevated his results.
Dr Levitz admits that, early on, his Vivity patients weren’t as happy as those implanted with multifocals in his clinic.
“Some of my patients were unhappy because they were left a little
Image: Alcon.
Dr Lewis Levitz is more likely to achieve 6/6 if he aims for plano or “the first plus".
bit myopic; the last thing you want is a patient who was promised good vision who then can’t see well at distance,” he says.
The post-operative data on his first 200 patients went for statistical analysis, which found Dr Levitz was more likely to achieve a 6/6 result if he aimed for plano or “the first plus”, rather than aiming slightly negative as he might with a monofocal. Doing this, coupled with the release of the Vivity toric that corrected for small amounts of astigmatism, led to a marked improvement in outcomes.
“This helped me tighten my results, such that a repeat statistical review of my next 200 patients showed that 87% of my patients now have binocular uncorrected distance vision of 6/6, as well as being able to read at an intermediate distance,” he says.
“I was keen to verify this further, and I compared this to a study of multifocal lenses where they found that if you leave a patient with a multifocal between plano and +0.50 D, they are much happier than being left -0.5 D.” 8
Along the way, he’s also had the privilege to send any concerns to the Vivity inventor, Dr Xin Hong, who answered his questions on the use of
the lens in myopic and hyperopic eyes.
After more than 1,500 cases, Dr Levitz has also drawn the conclusion that “astigmatism is not your friend either”.
“I'm very happy to flip the axis if it leads to less astigmatism. My results have improved as I refine my outcomes every 200 patients, I aim for ‘plano’ or the ‘first plus’ and I correct as much astigmatism as possible.”
It’s also notable that Dr Levitz – a proponent of femtosecond laser-assisted cataract surgery – performs an identical capsulorhexis on each patient. This has remained unchanged in his past 6,000 surgeries. He feels that removing the variable of capsulorhexis size makes it easier to analyse his results and effect change.
“I try to be very scientific in my approach and won't recommend a premium lens to patients I think would do much better with a monofocal (i.e. epiretinal membrane, corneal pathology, dry eye).”
‘SOFTY PLANO, GENTLY PLUS’
It’s clear that being circumspect with his Vivity candidates has served him well, so who are these people?
Dr Levitz offers it to patients who would request distance vision after cataract surgery but are happy to wear glasses.
“I explain that they will have good intermediate vision and will be able to read their phones, or work on a laptop without glasses. They will still need glasses for reading,” he says.
“If the patient is interested in being able to read, then I would rather offer them a trifocal lens.
“I also do not offer EDOFs to patients who would like a clear lens exchange as those patients are more motivated to have, and get more value from, a trifocal lens.”
In saying that, around a third of his patients – “a happy minority” – can read at near with Vivity. “But I don't guarantee it, and in fact, I'm quite surprised and congratulate them, because that's not what they asked for and not what I offered.”
Prior to offering an EDOF lens, he writes to the referrer explaining what’s been discussed with the patient. Refracting a patient with an EDOF lens is not the same as refracting those with a monofocal lens, he notes.
“The optometrists who refer to me know the principle of ‘softy plano, gently plus’, which applies to patients who have an EDOF implant,” he says.
One of those optometry referrers wrote to Dr Levitz with a special request for his mother-in-law who’s also an engineer. He sought a plano Vivity in the dominant eye and a -2.00 D IOL in the non-dominant eye.
“Unlike most ophthalmologists, I am not an advocate of mini-monovision using an EDOF lens – I feel that there are other options available for a patient for whom reading is very important – but this optometrist, after seeing many of my patients, felt this would be best for his family member,” he says.
“So there are no rules per se, except that if you can deliver what you offer, then you can move the goal posts slightly.”
While Vivity certainly sparked a step-change in Dr Levitz’s cataract work, over the next five years he expects to see improvements in biometry incorporating artificial intelligence, ray tracing and understanding of ocular geometry that will take cataract surgery to a new level.
“ This will result in achieving tighter target refractions," he says. "This accuracy will improve patient outcomes and satisfaction."
NOTE: References and disclaimers will appear in the online version of this article and are available upon request.
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Surgeon DR DAVID GUNN was impressed with the RayOne EMV IOL as soon as he used it. Now he has the data to back up those first impressions, and the excellent feedback from his patients.
Dr David Gunn and his team have had a paper published highlighting the effectiveness of the RayOne EMV IOL.
Brisbane ophthalmologist Dr David Gunn knew he was on to a good thing pretty quickly with the RayOne EMV intraocular lens (IOL). The cornea, cataract and refractive surgeon at the Queensland Eye Institute and Focus Vision private practice has included lots of data and interesting numbers in a research paper published in the Journal of Ophthalmology Research Reviews & Reports
He and his team conducted a retrospective, single-centre analysis of 147 eyes of 74 patients implanted with RayOne EMV or EMV Toric IOLs, the lens designed in collaboration with Western Australia ophthalmologist Professor Graham Barrett
That study, published on May 14, 2025, merely confirmed the initial enthusiasm Dr Gunn felt for the product years earlier, when he performed his first implants.
“In that first approximately 20 patients, I probably had about four or five who were completely spectacle independent, and I really didn't expect that,” he says.
“I had some patients that were coming in at 6/4.5 and N5 – I can read my phone, I can read everything, I can read the computer. And they had zero halos, zero night-time aberrations.
“And that was quite a positive, because sometimes you start a lens and it's all bad for the first 10 or 20 cases.
"My first cases with the EMV, right at the start, I was quite impressed by the amount of reading vision they got from what effectively looks like a monofocal lens.”
Dr Gunn sees a wide variety of patients, including those with irregular corneas, people needing post-refractive surgery, patients with high expectations about spectacle independence, as well as Fuchs endothelial dystrophy and other anterior segment comorbidities that come with a corneal practice.
He reckons his work is roughly 50/50 for refractive and cataract surgery. In his practice, about 80% of the IOLs he uses are presbyopia correcting, half of those being multifocal and half EDOF lenses.
Dr Gunn has been using the Rayner EMV since the toric version was released in Australia in 2022.
He was impressed with the technology developed by Prof Barrett and the company, and particularly the spherical aberration of the lens.
He had noticed that patients with other EDOF IOL products implanted were not entirely happy with the resulting distance vision.
“They’d go, my reading is great but my distance isn't kind of what I was expecting,” he says.
“It seemed there was a tradeoff to be made, and EDOF wasn’t working out for everyone.
“So I started with the Rayner EMV when it came out, and then I started to get some really good results.”
When those first 20 patients became 200, he decided it was time to review his data to see if the results and outcomes matched the positive feedback from his patients.
Dr Gunn and his team reviewed results from 74 patients implanted with RayOne EMV and EMV Toric IOLs between November 2022 and November 2023.
All were assessed during a one-month follow-up.
Patients were categorised into four refractive target groups: bilateral emmetropia; mini-monovision; modest monovision; and full monovision. And it evaluated the impact of pre-operative parameters — corneal spherical aberration (SA), higher-order aberrations (HOAs), and Chang Waring chord (CW-chord) – on monocular and binocular vision.
They found that mini-monovision patients achieved high levels of uncorrected distance visual acuity (UDVA, 80.4% at 6/6 or better) and uncorrected near visual acuity (UNVA, 84% at N8 or better).
Dr Gunn and his team concluded that the findings “support the effectiveness of increased range of focus IOLs”.
“The RayOne EMV or EMV Toric IOLs, with their innovative design incorporating positive spherical aberration, demonstrate promising outcomes, particularly for patients seeking a balance between distance
Image: David Gunn.
and intermediate vision,” the study says.
“A mini-monovision approach delivers a useful range of distance and intermediate vision in most patients, even with variation of pre-operative aberration profile.”
He says those outcomes can be enhanced if practitioners follow Prof Barrett’s guidance for monovision implantations, with a few minor tweaks here and there.
“Professor Barrett, he often aims for minus one in the non-dominant eye.
“The issue that I have with that approach is that some patients don't accept that cross blur.
"With those larger amounts of anismetropia, one in 50 patients come back at a year saying, I haven't adapted, there's something wrong with this eye. It feels weird, it feels fuzzy.
“So you need to really do a lot of consenting beforehand, or maybe do a contact lens trial to simulate that cross blur.
“If patients have been doing contact lens monovision for 15 years, and they love it, I do exactly what Graham does – RayOne EMV aiming for distance in the dominant eye and -1.25 D or -1.50 D in the non-dominant eye and they're extremely happy with that.
“But for patients coming with cataracts who haven't ever tried monovision, for general surgeons who don't do a lot of monovision and have moved away from it, I think going much beyond 0.50 D or 0.75 D of anisometropia can probably increase the chance of ending up in situations where you have to do enhancements.”
He says one of the greatest attributes of the RayOne EMV is that it is a very “forgiving” lens with a wide range of intermediate and distance vision.
“When we looked at our data set, we found that it actually made no difference in terms of the lens performance if they had an abnormal angle kappa or increased higher order aberration profile.
"So if the lens was a bit de-centred from the visual axis or if the natural eye's optics were a bit abnormal, it made no difference to the visual outcomes with the EMV.”
That is unlike many of the more complex lenses that can come with compromises.
Using those lenses can be a bit “overwhelming”, he says, even for experienced surgeons.
“And you can be worried about using lenses that ask you to go check this and this and this parameter; you need to have a Pentacam and aberrometry, you need to have all this equipment,” Dr Gunn says.
“You can kind of ignore that with the RayOne EMV. You can just put it in patients. Even if you have basic biometry equipment and for most relatively normal cataract patients it's going to be completely fine.”
That simple, broad appeal, and the forgiving design of the Rayner IOL make it ideal for surgeons in general ophthalmology practices who might want to try an extended depth of focus lens.
“The EMV is a great choice for getting started with EDOF and using just the smallest amount of monovision in the other eye, -0.25 D or -0.50 D to start.
"They can put a little bit more if they would like and it really increases the quality of intermediate reading vision they get. I think it's a great platform for that.”
Dr Gunn’s patients agree.
Beyond the data, he has plenty of great anecdotal evidence and feedback about the quality of the RayOne EMV, his work, and the outcomes for the patients.
“In terms of the clarity of the distance and the quality of that distance vision, they've been very happy with it,” he says. “In terms of the reading vision, it's variable.
“Around a quarter to a third of patients I've talked to – I didn’t say they were going to be getting reading vision – they find that they're pretty much spectacle independent, no glasses at all, and no halos.
“The other three-quarters will often say, ‘oh, I can hold my phone away a bit, and I can read things, and I'm happy enough with that’, but they are happy with the quality of the distance vision.”
Dr Gunn acknowledges concerns remain that the RayOne EMV is a hydrophilic lens.
“There's always the concern of gas exposure to the lens, and that lens platform . . . that discussion has been going on for a while now. Potentially that argument is a bit overblown and perhaps it is less of an issue with the current generation of lenses. For some surgeons though, hydrophilic materials are an issue.”
Due to this he feels the lens is not the ideal choice for a patient potentially needing a vitrectomy or endothelial keratoplasty.
But he is happy to recommend the RayOne EMV in most situations.
It is great for patients “lifestyle-wise, you know, going to the shops, picking up a bottle, reading the shampoo and conditioner, seeing your dinner while you're eating – those sort of things that make life a lot more comfortable.
“And yeah, reading glasses still come on for the computer for two hours or reading the small print on their phone. But just day-to-day, for your standard cataract patients, they walk away happier than a standard monofocal.”
ABOVE, L to R: David Gunn has used a lot of the RayOne EMV IOLs since their release in Australia; The RayOne EMV was developed in collaboration with Australian ophthalmologist Prof Graham Barrett.
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Power of the pinhole
Two Brisbane surgeons explain why the IC-8 comes closest to a silver bullet solution, as far as intraocular lenses go, for a difficult-to-treat patient group.
When it came to his cataract surgery work, Dr Joshua Hann operated like most ophthalmologists. He had a handful of intraocular lenses (IOLs) he consistently used – and they were delivering good outcomes.
But he had a nagging feeling. There was a subset of patients, albeit small, who would emerge with an underwhelming result.
“I felt as though they were being forced into a compromise in their lens options, if you could say that, because of their irregular corneal topography,” recalls the Brisbane ophthalmologist who established Eastside Eye Care in 2017.
“I’d have to advise them of their unsuitability for EDOF (extended depth of focus) or multifocal options, and I would even end up under-correcting their toric correction, so they’re probably going to be relying on glasses still in most situations.”
But he’d heard about the IC-8 IOL sporadically in the 12 months prior, and how it might be a good option in these types of cases.
“I started implanting IC-8 and it didn’t take long before I realised patients were not only just getting their toric correction, but they were getting the same, if not better, outcomes in their range of focus than those without a corneal problem implanted with a typical EDOF lens,” he says.
Today, the IC-8 is implanted in around 10% of all his cases, a significant number given it’s not considered a mainstream EDOF.
But for Dr Hann, the results speak for themselves and – along with Dr Cameron McLintock, another Brisbane surgeon and IC-8 user interviewed for this article – he’s encouraging more of his colleagues to consider adding it to their repertoire when appropriate.
The IC-8 is as simple as it is unique. It combines the well-known, proven principle of small aperture optics with the reliability of a hydrophobic acrylic monofocal IOL.
This pinhole effect mitigates the reduction in visual quality caused by defocused peripheral or aberrated light that can degrade retinal image quality. By allowing only central light rays to focus on the retina, patients can achieve more than 2.00 D of continuous, functional range of vision.1*
The IOL was originally developed and commercialised by AcuFocus and Bausch + Lomb acquired it in 2023. 2 It was first launched in the Australian market in 2015.
It is recommended for unilateral implantation in the non-dominant eye, aiming for -0.75 D, with an aspheric monofocal or toric monofocal IOL in the dominant eye. Aside from its extended range of focus, it can tolerate up to 1.00 D deviation from the target manifest refraction spherical equivalent, and accommodate as much as 1.50 D of corneal astigmatism without requiring any axis alignment.1,3
When Dr Hann, also director of the Princess Alexandra Hospital Ophthalmology Department, first started implanting IC-8 he adopted this monovision approach, but he’s never been a major advocate due to his belief patients can be attuned to the asymmetry in their vision.
So he began implanting the IC-8 bilaterally and has been impressed with the outcomes in patients with irregular astigmatism. These include patients with keratoconus, or corneal scarring that didn’t reach the threshold for a corneal transplant and patients with previous pterygium surgery who have developed an irregularity transmitting to the centre of their cornea.
“Beyond that, I find the largest category is people with totally clear corneas that, in the routine of preparing for cataract surgery with their topography, have a central irregularity that is just not going to do well with any other type of lens,” he says.
Many of these patients wouldn’t have been identified if it wasn’t for corneal topography becoming standard in Dr Hann’s work-up. He marvels that it wasn’t routine earlier in his career. Today, everyone is scanned on his
“In my clinic I would estimate 50% of people have irregular astigmatism or irregular, higher order aberrations on their cornea – and I wouldn't have known that before routinely checking topography,” he says.
“These are the type of people who you perform operations on, fix their toricity, and they'd come back with an underwhelming result, and you wouldn't really know why. It's amazing how many people in their 50s and 60s you find out for the first time have keratoconus.”
Fellow Brisbane surgeon Dr McLintock adds that post-refractive surgery patients also benefit. At Vision for Life Institute, he analysed the outcomes of 166 IC-8 cases. Many of these had previous LASIK, photorefractive keratectomy (PKR), or radial keratotomy (RK) surgery.
“The IC-8 is a lens-based option to treat irregular astigmatism.
Image: Bausch + Lomb.
Images: Eastside Eye Care & Vision for Life Institute.
BELOW: Dr Joshua Hann (left) and Dr Cameron McLintock say the IC-8 IOL is a compelling option in patients with irregular corneal astigmatism.
ABOVE: The IC-8 IOL utilises small aperture optics.
IC-8 RESULTS IN DR JOSHUA HANN’S CLINIC:
Patient 1 (corneal maps pictured above)
Pre-op – UCVA R:6/24 L:6/36, BCVA R:6/9- L:6/9
Post-op – UCVA R:6/6 L:6/6=, UNVA:N6 OU (both eyes), UIVA:N6 OU
Patient 2
Pre-op – BCVA R:6/9= L:6/15+
Post-op – UCVA R:6/6 L:6/6, UNVA:N6 OU, UIVA:N5 OU
Patient 3
Pre-op – UCVA R:6/24+ L:6/30, BCVA R:6/6= L:6/9++
Post-op – UCVA: R:6/6- L:6/5-, UNVA:N5 OU, UIVA:N5 OU
That was the attraction because it's so hard to deal with that at the corneal level. Anytime you work on the cornea with laser or a transplant, often it's complex and unpredictable,” he says.
He too prefers to implant the IC-8 bilaterally.
“Out of the 166 eyes, we found with a target refraction of plano, 94% achieved 6/9 unaided distance vision, 81% achieved N5 unaided intermediate vision and 94% achieved N4 near vision,” Dr McLintock says.
“For eyes with irregular corneas, that's impressive.”
For Dr Hann, it was a relatively easy lens to introduce – “a low risk strategy” – because the expectations have always been set low for these patients.
He’s finding the IC-8 performs better with its range of focus than typical EDOF designs in the right patients. While many with the latter category can achieve N6 for near and intermediate, Dr Hann says they still require glasses occasionally.
His patients with an IC-8 achieve this too, but with a greater level of spectacle independence.
"I have many who are 6/6 for distance, but there's a little bit more 6/7.5, 6/9 in patients who didn't get close to that with their BCVA (best-corrected distance visual acuity) pre-operatively, but their near is probably 90%-plus at that N6 to N5 level,” he says.
It’s an excellent outcome considering that Dr Hann would have been concerned about implanting a toric monofocal in these patients, that would have only corrected for distance vision, and still may not have achieved 6/6.
“These people, with such good outcomes with the IC-8, are now the
standard result, which is why I think more ophthalmologists would benefit from using it.”
SELECTING THE RIGHT PATIENTS
In saying that, Dr Hann and Dr McLintock note some important considerations. There’s a couple of reasons they keep IC-8 only to cases with irregular astigmatism.
For instance, if the patient has retinal pathology, obtaining an OCT scan could be more challenging due to the small aperture of the lens, and the same goes for accessing retinal tissue with a laser.
“So if someone's got significant macular degeneration or diabetic retinopathy, I’d probably look to go down another path,” Dr Hann says.
“I’m mindful of not overusing it, because you're not going to be able to anticipate all the people who may need some retinal intervention afterwards.”
However, there is literature showing the IC-8 IOL does not negatively affect retinal visualisation.
In patient selection, both ophthalmologists are scrupulous about pupil size – because those with a larger pupil diameter can struggle more with dysphotopsias.
“We measure pupil size beforehand with the lights off, but I don't think that perfectly replicates the mesopic conditions people will find themselves in day-to-day. So although there is a threshold cut off that's recommended, 5.5 mm, if you just go by that, you'll probably get some who, for some reason or another, actually end up with a pupil a little bigger,” he says.
Apart from pupil size, Dr Hann can’t recall anyone with significant dysphotopsias.
“And it's such a forgiving lens. With other premium IOL designs, you have to be very precise in your measurements and the power you choose, whereas with IC-8 – and not that I make this my practise – you can be off by 0.50 D or even 1.00 D and patients still get a great range of focus.”
Dr McLintock notes all patients should be counselled they will need to adjust to dysphotopsias to some degree.
“I know they're marketed as an EDOF lens, but I discuss this lens as if it’s a multifocal. I explain the dysphotopsias can occur but are unlikely to be troubling – I haven't had anyone that hasn’t been able to drive at night because of it.”
He also discusses the importance of centration. All his IC-8 cases are performed under topical anaesthetic, and he ensures the patient is fixing on the microscope light. He also uses a capsular tension ring.
“I want to see the corneal light reflex in the centre of that pinhole,” he says.
“The other critical thing here is the angle alpha, because if you've got a very deviated visual axis, the patient might not be seeing through the centre of the pinhole.”
For Dr McLintock, “the trick” isn’t sticking to one IOL design or philosophy. It’s about selecting the lens that suits the patient's visual and lifestyle needs.
“The IC-8 certainly has its place,” he says.
“I think you've got to have a good reason to put these lenses in, but for those with irregular corneal astigmatism, it’s a great option, giving them more than what they might have achieved with more mainstream lens designs.”
REFERENCES:
* Negative defocus range at logMAR 0.20 threshold for binocular defocus curve
1. Food and Drug Administration. (2002). IC-8 Apthera Intraocular Lens (IOL) - P210005: FDA Summary of Safety and Effectiveness Data. Accessed April 27, 2023. https://www.accessdata.fda. gov/cdrh_docs/pdf21/P210005B.pdf
2. B ausch + Lomb acquires AcuFocus … and small aperture IOL tech – Insight January 2023 https://www.insightnews.com.au/bausch-lomb-acquires-acufocus-and-small-aperture-iol-tech/ 3. B urkhard Dick, et al. Prospective multicenter trial of a small-aperture intraocular lens. J Cataract Refract Surg. 2017;43(7):956-968
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Costumes, with just a little drama
The annual AUSCRS conference is a must-do on the calendars of the world’s leading ophthalmologists, and this year’s event in Australia’s Top End will be no exception, say organisers.
Costumes help to keep the atmosphere light at AUSCRS, even when the debate gets a little heavy.
ISPEAKERS:
f you are visiting Darwin in July, it’s possible you will stumble on something rather unusual.
You might witness a man dressed as a T-Rex grilling another posing as a medieval knight or maybe a woman in a superhero costume in friendly discourse with a pirate.
Don’t worry. Do not adjust your set. You haven’t stumbled into Comic-Con; it’s more likely you have happened upon some of the globe’s most esteemed ophthalmologists discussing their sector at the annual Australian Society of Cataract and Refractive Surgeons (AUSCRS) conference, being held July 16-19 2025.
Professor Gerard Sutton admits he was a little sceptical about the dressing-up and relaxed format when he and Dr Jacqueline Beltz took over as AUSCRS co-presidents three years ago.
But now he wouldn’t have it any other way.
“It's clear to me now that what it does is completely disarm people,” he says.
“You have a situation where, when people dress up, even to a small degree, they feel more relaxed, and they feel much more likely to ask questions, to criticise what they think is inappropriate, in a respectful way.”
In fact, so popular is the format that others around the world are now trying to replicate it.
Prof Sutton and Dr Beltz were invited to run a symposium at the recent American Society of Cataract and Refractive Surgery conference.
“It was called The Good, the Bad and the Ugly, a sort of Clint Eastwood theme,” says Prof Sutton.
Prof Michael C. Knorz is the medical director of the FreeVis LASIK Center Mannheim, which he founded in 2000. He is internationally recognised as one of the leading experts in the field of refractive and cataract surgery and was appointed as a professor of ophthalmology at the University of Heidelberg in 2000. Prof Knorz is a member of numerous professional societies, including the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the European Society of Cataract and Refractive Surgeons, and the International Society of Refractive Surgery.
Dr Başak Bostanci is a cataract and refractive surgeon and the medical director of World Eye Hospital, the biggest ophthalmology group in Turkey. She is also an associate professor and lecturer at Bahcesehir University School of Medicine, Istanbul. Her areas of expertise are corneal refractive surgery, phakic intraocular lenses, and advanced intraocular lens designs.
Dr Alice T. Epitropoulos is a board-certified ophthalmologist who specialises in refractive and cataract surgery. Her practice is focused on refractive cataract surgery with premium IOLs and laser technology. She also has a Dry Eye Center of Excellence. She is a founding member of The Eye Center of Columbus, an affiliation of more than 80 ophthalmologists located in the Arena District in Downtown Columbus, Ohio. Dr Epitropoulos also serves as a clinical assistant professor in the Department of Ophthalmology at The Ohio State University.
Prof Sri Ganesh occupies the position of chairman and managing director at Nethradhama Hospitals Pvt Ltd in Bangalore, India. He has earned fellowships in phaco and refractive surgeries and was awarded an Honorary Doctorate in Science from Rajiv Gandhi University of Health Sciences and an Honorary FRCS(Gla) from the Royal College of Surgeons, Glasgow. Prof Ganesh serves on the advisory boards of companies ZEISS and Biotech Vision care, playing a pivotal role in product development and holding patents for innovative solutions.
Dr David Lockington has been a consultant ophthalmologist at Tennent Institute of Ophthalmology, Glasgow, UK, since January 2014, following sub-specialist cornea, cataract and anterior segment fellowship training in Auckland, New Zealand. He is the national simulation lead for The Royal College of Ophthalmologists, the co-editor of EyeNews magazine and also featured in The Ophthalmologist magazine’s Top 100 Power List 2024. That year, he was inaugurated as UKISCRS’ youngest-ever president.
Dr Cathleen McCabe serves as chief medical officer at Eye Health America. She specialises in complex and premium cataract and refractive surgery at The Eye Associates in Sarasota, Florida. She has a keen interest in advancing the field of ophthalmology and has participated in numerous clinical trials, including innovations in intraocular lenses, perioperative medications, medications and devices to treat glaucoma, dry eye treatments and presbyopia correction. Dr McCabe has received many awards for her work, including the American Academy of Ophthalmology Senior Achievement and Secretariat Award.
‘Twas a good knight had by all.
Image: Prime Creative Media.
“There were multiple sessions going on at the same time, but our session was the one that had the most people in it.
“We asked people just to take their ties off, because the Americans all go to these conferences with ties and suits, and it was just like being at AUSCRS –everyone was into it, everyone was questioning, everyone was chatting.”
Dr Beltz says AUSCRS is well-known for its laidback attitude, which helps to elevate the interaction.
“The discussion really reaches a higher level at AUSCRS than any other conference that I’ve been to,” she says. “The costumes help to level the field –you’re much more likely to ask the big professor a difficult (or sometimes too easy) question if they’re dressed as a sumo wrestler than if they’re standing there in a suit and rushing to give their next lecture.”
Both expect more of the same in Darwin in July, where the theme will be ‘Disconnect to Reconnect’.
But there will be a few small changes, other than new and different costumes.
This year, lectures and discussions will be held in a central area featuring big screens. Surrounding that will be a concourse housing the trade displays and also small booths where people can sit and consider not only their colleagues’ costumes but also the new techniques and technology being pitched by the many international speakers and companies that supply the ophthalmic sector.
It’s that robust discussion, including hot topics in a “controversy corner”, that is a highlight of the event and attracts some of the world’s leading ophthalmologists.
This year is no exception, says Prof Sutton. In fact, they’ve had to reject a few, such is the high standard and popularity of the event.
Prof Michael Knorz, medical director of the FreeVis LASIK Center in Mannheim, Germany, and a leading global expert in the field of refractive and cataract surgery, will be delivering the keynote Barrett/Wolfe Lecture.
Prof Sutton is also looking forward to presentations by Dr Cathleen McCabe from the US and Professor Sri Ganesh, from India.
He believes the talk of Dr David Lockington, a consultant ophthalmologist at Glasgow’s Tennent Institute of Ophthalmology, who is visiting AUSCRS for the first time, will be a highlight.
“I think he will be the star of the show,” says Prof Sutton. “He is the president of the English version of AUSCRS and he's hilarious.”
Dr Beltz is keen on the return of another from Scotland, Professor Sathish Srinivasan, a consultant anterior segment surgeon at University Hospital Ayr. Both say that everyone who attends will learn a great deal during the conference. That will include developments in laser eye surgery and SMILE (Small Incision Lenticule Extraction) surgery techniques.
Dr Beltz says about 15 registrars have been sponsored to attend for the Advanced Training Day Program, run by Dr Ben LaHood.
“This is actually how I became involved with AUSCRS,” she says. “I attended the advanced trainee day as a fellow, ended up being the young member on the committee and running the training day for many years and now, eventually I’m co-president – so the model works.”
NOTE: People keen to know more about AUSCRS can visit: www.auscrs.org. au/2025-conference.
Prof Jodhbir Mehta is executive director of the Singapore Eye Research Institute and Distinguished Professor, Corneal & External Eye Disease and Refractive Department at Singapore National Eye Centre. He has won 79 awards for his clinical and research work, which has generated 18 patents, five of which have been commercialised and licensed to companies. He has published more than 550 peer-reviewed publications and 24 book chapters, with a H-index 76. He has been invited to speak at more than 300 international conferences and given 25 named/keynote lectures. He is the vice-president of international relations for the The Corneal Society (US).
Dr Lisa M. Nijm is a board-certified cornea, cataract and LASIK surgeon at Warrenville Eyecare & LASIK, licensed attorney, innovator and assistant professor at University of Illinois Eye & Ear Infirmary. She leads Women in Ophthalmology as its CEO and has taught more than 2500 ophthalmologists and mentor physicians through MDNegotiation.com. Dr Nijm also advises leading medical device and pharmaceutical companies on new innovations. She started Real World Ophthalmology to serve as an educational resource to aid young ophthalmologists in successfully transitioning from training to practice.
Dr Ravi Patel is director of Cornea and Refractive Surgery at Atlantic Eye, a multidisciplinary practice in New Jersey consisting of 11 providers. He is an attending surgeon on the Cornea Service at Wills Eye Hospital, where he is an assistant professor of clinical ophthalmology at Sidney Kimmel Medical College; and A/Prof of ophthalmology at the State University of New York-College of Optometry. His topics of interest include refractive cataract surgery, advanced anterior segment surgical techniques, keratoconus management, lamellar keratoplasty, ocular infectious diseases, management of ophthalmic surgical complications, laser refractive surgery and disruptive technologies.
Dr Matthew P. Rauen is a board-certified and fellowship-trained cornea and refractive surgery specialist. He joined Wolfe Eye Clinic in 2012 and sees patients in Ames and Des Moines. Dr Rauen is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgeons, and the Cornea Society, and he continues to publish in scientific journals and speaks on cataract surgery and refractive surgery throughout the country.
Prof Sathish Srinivasan is a consultant corneal surgeon at University Hospital Ayr, Scotland and professor of Health and Life Sciences at the University of West of Scotland. His interests are in lamellar corneal surgery, laser refractive surgery, complex cataract surgery and anterior segment reconstruction. He has published more than 140 papers in peer-reviewed journals, has more than 100 scientific presentations to his credit in national and international meetings. He is currently a member of the Publications and Educational Committee of the ESCRS and was voted as the one of the top 100 most influential ophthalmologists in 2024.
Dr Roger Zalvidar is the CEO of the Instituto Zalvidar in Mentoza, Argentina. He is past-president of the Refractive Surgery Alliance from 2018-2021. Dr Zalvidar graduated with honours from the University of Mendoza and completed a Fellowship in Ophthalmic Optics at The University of Arizona Department of Ophthalmology in Tucson, Arizona. He also completed a Specialisation in Management Skills at The George Washington University of Business and three separate programs at the ADEM Business School CPR, American Health Association, including a Major in Finance and a Major in Management Development.
AUSCRS co-presidents
Dr Jacqueline Beltz (left) and Prof Gerard Sutton at the 2024 event.
Educate to elevate
With recent workforce surveys showing dissatisfaction among Australian optometrists, one of the country’s fast-growing networks is setting new standards when it comes to career fulfilment and progression.
One of the second-order effects of the George & Matilda Eyecare (G&M) model is the wealth of clinical expertise embedded within the network, ripe for leverage. But until now, much of that expertise has largely remained confined to the individual practitioner’s local area, or sometimes within the four walls of their consulting room.
Independents who have built their practices on special interests in advanced contact lens fitting, myopia management, dry eye or advanced technology. These are the everyday practitioners who can impart wisdom across the group – even if they’re located as far west as Kalgoorlie, in regional Victoria’s Daylesford, or Burnie, on the northern Tasmanian coastline.
G&M will enter its 10th year in 2026, and in that time it’s gone from a start-up to one of the main players in the Australian optometry scene with 120-plus practices.
A recent part of that transformation has been the promotion of optometrist Mr Anthony Sargeant to the position of national professional services manager. Appointed in early 2025, he’s charged with bringing to life a network-wide professional services framework with some big aims: to elevate clinical excellence across G&M’s 180-strong optometry workforce, drive greater optometry engagement, and execute an aligned national professional services strategy.
“We're 10 years old next year, and as an optometrist at G&M you can now feel that there’s real clarity around our ambition and the patient-first direction we’re heading,” Sargeant says.
“G&M brings together some of the most experienced and communityfocused independent practitioners in the country. By working together and
sharing what we each do best, we’re building something much greater than the sum of its parts.”
What he’s referring to is an inherent part of the G&M model. From the outset, founder and CEO Mr Chris Beer has been clear the network will only partner with well-oiled independents woven into the fabric of their communities.
G&M has also vowed that its support office team won’t interfere with the practice’s clinical autonomy. This promise means some of the country’s best and brightest optometrists have joined its ranks.
Now, Sargeant wants to tap into that knowledge to a greater degree.
“While CPD-accredited webinars are one small part of the offering, G&M’s national professional services program is far more expansive,” he says.
“It blends structured education events, clinical workshops, in-practice coaching, and partnerships with leaders in ophthalmology, contact lenses, and therapeutics. Weekly case discussions circulate across the network, individual skill development is actively supported, and a formal graduate onboarding pathway links mentors and mentees for long-term success. This is all grounded in a grassroots understanding of modern clinical practice.”
The professional services team is now six-strong, led by Sargeant, who is a member of the leadership team. Each remains active in clinical practice, ensuring their guidance is grounded in real-world experience and carries the credibility of current, hands-on expertise.
While professional services managers continue to deliver many educational sessions, a key part of the strategy now involves identifying and empowering talented G&M clinicians to lead educational events, ensuring the depth of expertise within the business is recognised and shared.
“We've got some of the finest independent practitioners in the country.
“Leveraging that talent for the benefit of our optometrists and their patients is how you can start having a real impact; the bigger picture stuff.”
There’s another bigger picture at play too.
Sargeant hints at a much-discussed 2025 Flinders University optometry workplace survey, commissioned by Optometry Australia, revealing dissatisfaction among the national optometry workforce.
“We have a real opportunity to impact the workforce. It’s a hot topic, right? It starts with creating meaningful connection and time to focus on patient care. That’s exactly what we’re building at G&M. By attracting the right talent, supporting early-career optometrists, and building long-term partnerships rooted in clinical autonomy, we’re making G&M a great place to work, and keeping independent optometry thriving," he says.
“You've got these practices that can be four to five hours’ drive to the nearest fellow independent clinician, but despite the burden of distance, we’re offering opportunities to engage with each other, lift clinical standards, provide professional fulfilment and create real momentum.”
SCALING CLINICAL SPECIALTIES
Optometrist Mr Tom Ford, from George & Matilda Eyecare for Albert Ravanello Optometrists in Griffith, New South Wales, will deliver one of the first sessions under the new professional services framework.
A popular speaker at Optometry Australia events, he will discuss clinical pearls and pitfalls of prescribing corticosteroids for ocular disease. It’s an example
Images: George & Matilda.
LEFT: Anthony Sargeant still practises one day a week in G&M's Optiko practice, Brisbane.
RIGHT: Highly regarded G&M optometrists like Tom Ford will host educational sessions.
of the type of content that will be aimed at clinical excellence, setting the foundation for a successful practice.
“We’re focused on three core priorities: engaging our optometrists, developing clinical expertise, and strengthening commercial capability,” Sargeant says.
“In some practices, the original business leaders are still at the helm, but in others, those roles have transitioned. So part of our job is to support the next generation of leaders like Tom, not just to think clinically, but to think commercially. That means refining patient interactions, making full use of eyecare technology, and building a personal brand as a trusted health professional in the community.”
As for the future of G&M optometrists, Sargeant sees opportunities around growth, innovation and connection.
“There’s enormous potential in scaling clinical specialties. Paediatric eyecare is a key focus, while myopia management is now the standard of care. Both are powerful ways to stay deeply connected to our local communities” he says. “There’s growing patient demand in areas like dry eye and telehealth. But the bigger opportunity lies in deeper integration with the broader healthcare system through collaborative care and multidisciplinary teams.”
The recent partnership with Eyescan in Toorak, Melbourne, is a case
Cones that should be big
ophthalmology, optometry and optical dispensing, all under one roof. There’s no other practice like it in the G&M business.
“It's an exciting time for that sort of growth and innovation in the business,” he says. “Leveraging technology is a key focus too, and by the end of the year all G&M practices will have the latest generation OCT units available for their patients.”
There’s a lot to do, but Sargeant is excited about this heightened purpose and clarity behind G&M’s optometry direction.
“A lot has changed since G&M arrived in 2016, and I feel we’re going to be on the right side of history with the way in which we are supporting independent clinical excellence, ensuring our business and optometrists thrive,” he says.
“It’s an important step and reflects where we are in our journey as a growing network of independent practices, bringing national alignment and structure to the way we support our optometry team while remaining deeply committed to that local and connected community feel that made our practices so special in the first place.”
Cones that should be small
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ABOVE: The G&M professional services team (from left) Alem Catic, Michael Angelos, Karla Leyden, Anthony Sargeant, Reshma Seth, Shazaan Khambiye and Tristan Gutteridge.
TDeveloping 'trained and confident' dispensers
Specsavers lifts the lid on its optical dispensing education strategy blending hands-on experience with formal education, driven by the philosophy that training shouldn’t be treated as a one-off event.
he country’s largest trainer of dispensers recently released its largest graduating cohort into the national optical industry.
Of the 284 optical dispensers that graduated from the Australasian College of Optical Dispensing (ACOD), celebrated at the Optical Dispensers Australia International Conference in March 2025, almost half were dispensers from Specsavers stores across Australia and New Zealand. Each emerged from the program armed with a Certificate IV in Optical Dispensing and more skills and confidence to ensure the best optical solutions are prescribed for patients.
Victorian dispensers, Ms Alicia Simpson from Specsavers Cranbourne Park, and Ms Estelle Zaval from Specsavers Waurn Ponds, Belmont and Torquay, were awarded joint-second in 2024 ACOD class. They are also benefitting from a multi-pronged approach that Specsavers has built into its dispensing training strategy.
Simpson has always known she wanted a job that helped people and had an interest in the medical field, but having no prior qualifications, she wasn’t sure where to start.
“I saw that my nearest Specsavers was hiring for a basic entry level job needing no optical experience, so with my background in retail I thought it would be a great combination of what I had experience in and an opportunity to be involved in the industry I wanted to be in,” she says.
“I loved learning all the ins and outs of my job and because of my interest in learning, my previous boss told me of an opportunity to learn more and develop as an optical dispenser which was the Cert IV – and the rest is history.”
Specsavers head of dispensing advancement Ms Amy Kenefeck says dispensers like Simpson play a key role in bridging the gap between optometrists and patients, ensuring customers receive eyewear that meets both their vision needs and personal preferences.
As the optical industry continues to evolve with new technologies and changing consumer expectations, ongoing training for dispensers has become more important than ever, she says.
“Specsavers has developed a structured approach to dispenser education, combining hands-on experience with formal learning pathways. This ensures dispensers have the skills and confidence to assist customers effectively, covering essential topics such as frame selection, lens technology, and complex prescriptions,” Kenefeck explains.
“We actively support our interested dispensers to participate in ACOD’s Cert IV in Optical Dispensing course, a qualification that deepens their knowledge of the profession.”
For those who don’t wish to pursue a formal qualification, Specsavers also provides “award-winning in-store training, mentoring and support”, where dispensers gain direct experience with products, customer interactions, and technical concepts.
TRAINING EMBEDDED INTO EVERYDAY PRACTICE
For Zaval, she decided to study for a Cert IV qualification after working as an optical assistant for five years.
“What I enjoy most about dispensing is that you’re always learning. The optical field is always evolving, whether its technology, improving techniques or research. This is a job that you learn through hands-on experience, a learning style that is very suited to me.”
She notes that several dispensers from her store completed the ACOD course together, so she was never short of people to discuss dispensing theory with. Plus, everyone had time and support to complete the training.
“By becoming a dispenser, the company gains people who have a deeper understanding of what it means to provide better vision care,” she says.
“This means better customer service for the patient by someone who is skilled and confident in what they’re doing. When dispensers are trained and confident, it increases job satisfaction, motivation and builds a strong
“We’re not just supporting the professional development and upskilling of our team members, we’re also enabling the best possible experiences for our customers so that they continue to prioritise their eye health.”
Amy Kenefeck Specsavers
Images: Specsavers.
Specsavers is one of the largest employers of optical dispensers in Australia.
company culture, which is what Specsavers is all about.”
That culture is also galvanised through dispensing-specific events.
Every year, the network delivers the Specsavers Dispensing Conference (SDC) and SDC Mini training events which Kenefeck says have been delivered by both Specsavers leaders and internationally-renowned speakers such as Dr Alicia Thompson, director of education, research and professional development at the Association of British Dispensing Opticians, and the University of Ulster’s Professor Mo Jalie, the author of eight highly regarded textbooks on ophthalmic lenses and dispensing.
“SDC and SDC Mini have covered a wide variety of topics such as paediatric dispensing, aspheric lenses, new product launches and dispensing excellence to name a few,” Kenefeck says.
“We provide all our retail team members with a world class three-level training program called the ‘Specsavers Learning Journey’ which takes approximately 18 months to complete. This begins when a new team member joins and it takes them through everything from single vision, adjustments, and repairs, through to lens form and thickness, high index, atypical and visual defects. Following on from this, we provide continual monthly training to keep our teams up to date on the latest practice knowledge.”
This program was developed in 2018 and now has more than 100,000 pieces of learning completed each month across 7,000 Specsavers team members.
Kenefeck says by creating a structured yet flexible approach to training, dispensers remain informed, skilled, and confident in their roles, helping to maintain high standards of service and expertise.
“Training shouldn’t be treated as a one-off event or available for a select few only – it’s embedded into everyday practice for everyone,” she says.
“By investing in ongoing dispensing training, we’re not just supporting the
professional development and upskilling of our team members, we’re also enabling the best possible experiences for our customers so that they continue to prioritise their eye health.”
After many hours of hard work, Simpson says it’s all worth it.
“Whether it’s helping someone see clearly for the first time, saving someone’s sight by encouraging testing when they have concerns or even fixing someone’s glasses because they can’t see without them, these small things for us can mean a lot to those we do them for,” she says.
“Eyesight is the one sense no one wants to lose so if we can help in any way that makes it worthwhile.”
Did you know?
It takes most people an average of five years to seek support once they start to lose their vision.
At Vision Australia, our purpose is to ensure nobody feels like they have to face the confusion, frustration and loneliness of vision loss on their own. We’re here to support your patients to maintain their independence by helping them make the most of their remaining vision from day one.
Refer your patients to the low vision experts at Vision Australia today through Oculo or by scanning this QR code:
ABOVE: Alicia Simpson (pictured centre) from Specsavers Cranbourne Park was awarded joint-second in 2024 ACOD class, along with Estelle Zaval from Specsavers Waurn Ponds, Belmont and Torquay.
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Clinical senior lecturer, Discipline of Ophthalmology, Sydney Medical School, Director, Children’s Eye Centre, Wentworthville, Sydney
Potential pitfalls of testing accommodation in children
For any optometrist assessing accommodative disorders in paediatric patients, the goal is to avoid overdiagnosis and overtreatment. The authors provide critical insights into the latest evidence, highlight common diagnostic pitfalls, and offer a practical, conservative approach.
CLEARNING OBJECTIVES:
At the completion of this article, the reader should be able to…
• Understand that while prevalence rates are debated, true accommodative dysfunction is uncommon in children who have good visual acuity and are otherwise healthy.
• Integrate a child’s aesthenopic complaints into the context of their overall ocular and general health, including identifying any differences in symptoms between their recreational habits and compulsory tasks.
• Identify limitations, difficulties, and pitfalls in diagnosing accommodative defects in children.
• Educate patients and caregivers that measures of accommodation can be unreliable and often improve without treatment, making observation and monitoring an appropriate initial course of action.
hildren often complain of symptoms which might be caused by accommodation defects, however accommodative disorders are uncommon in children who have good visual acuity and are otherwise healthy. There are pitfalls associated with assessing and diagnosing accommodative disorders in children of which clinicians should be aware. The prescription of low plus lenses (with or without a bifocal) and other treatments should only be carried out when there is confidence that these interventions would be beneficial.
PITFALL 1: VALIDITY OF PRESENTING SYMPTOMS
An Australian study showed 82% of young children who reported eye strain symptoms had normal eye examinations.1 This questions the validity of treating conditions such as accommodative disorders on the basis of symptoms alone. Many children enjoy playing handheld games, which requires convergence, accommodation and higher order visual processing skills for prolonged periods of time. It would be anticipated that children would reject this activity if a significant accommodative defect were present. 2 It is therefore important to take a thorough history to determine whether a child is rejecting a particular task such as homework, or whether the reluctance relates to all near activities including the use of digital devices for leisure. This comparison can be helpful to explain to parents that eye functions are in fact normal.
PITFALL 2: VARIABLE PARAMETERS AND A LACK OF NORMATIVE DATA
Scheimann reported an incidence of 2% for accommodative insufficiency and 1.2% for accommodative infacility in a clinical paediatric population, 3 but multiple publications have noted a lack of consensus in the literature about the prevalence and diagnostic criteria of accommodative dysfunction.4-12 This is due to differing study designs, with significant variations in techniques of testing and measurement, and variability between age groups.
Accommodative amplitude
Accommodative amplitude (AA) can vary depending on what method is used, such as the push up or pull away methods, minus lens, or dynamic retinoscopy.6, 11, 13-15 The push up method appears to
produce comparatively higher values than both the minus lens technique13 and dynamic retinoscopy.11 There is also variation when monocular and binocular results are compared whereby monocular results are lower.16, 17 However, the value of testing AA monocularly is unclear as this does not reflect naturalistic conditions and hence the decision to treat should not be made on this basis alone.
Hofstetter (1950) estimated that the probable accommodative amplitude of a 10-year-old child was 15.5 D (with a range of 12.5 D to 21.0 D).18 This was confirmed in a recent study which showed that the median accommodation of a 10-year-old child was also 15.50 D.11 With such amplitudes in reserve, the prescription of low plus lenses and near adds should rarely be required for children.
Accommodative insufficiency
Accommodative insufficiency (AI) has traditionally been defined as an amplitude of accommodation consistently less than the level expected for the patient’s age. 5, 7, 19, 20 Some would add further criteria to a reduced AA, including a low positive relative accommodation (PRA) value, reduced monocular accommodative facility (MAF) or binocular accommodative facility (BAF) or an increased accommodative lag on monocular estimation method (MEM) dynamic retinoscopy. 3, 7 Others would add the presence of visual symptoms for a diagnosis of AI. 20, 21 Hence, the diagnosis of AI depends on what (and how many) criteria are used, which in turn will affect prevalence rates.
Prevalence rates of accommodative dysfunction in children are debatable, but are thought to be very low.
MBBS (Hons), FRANZCO, FRACS, FRCOphth
Complaints like eye strain may not indicate a true issue.
normal accommodative facility (AF) and how to test for it. 22 The expected mean values to diagnose accommodative infacility (AIN) are known to vary between different age groups and be consistently lower in children than in adults.6, 23 Results may also depend on which lens flipper power is used (ranging from +/- 1.0 D to +/-2.5 D). Suggested normative values for monocular AF can vary from an ‘unrealistic high’ of 20 cycles per minute (cpm) down to 2 to 4cpm. 22 Researchers have suggested the variability between the age groups is due to a lack of comprehension and lack of automatic naming of numbers (particularly of the younger age group) rather than reflecting accommodative ability. 23
KEY TAKEAWAYS
The goal is to avoid overdiagnosis and overtreatment, particularly in otherwise healthy children with good visual acuity. Given the uncertainties and variability around diagnosing accommodative issues in children, it’s crucial for optometrists to take a measured, evidence-based approach.
• Symptoms aren’t enough – complaints like eye strain may not indicate a true issue. Take a thorough case history to assess if there are patterns across different tasks (avoiding all near work or just homework?).
• Don’t rush to treat – only consider low plus lenses or therapy if clinical findings are consistently supportive and offer clear benefit to the child.
• Repeat tests before deciding –accommodative test results can vary between sessions, even in normal children. Retest to confirm any findings.
• Test limitations – accommodation tests often rely on subjective input, influenced by factors like fatigue or motivation. Whenever possible, use objective data.
• Manage expectations – many children improve naturally or with placebo, so symptoms don’t always indicate a real focusing disorder.
• Take a conservative approach – for borderline or inconsistent results, consider observation or retesting before initiating treatment.
criteria of MAF ≥11cpm and BAF ≥8 cpm, compared to 3.6% with pass criteria of MAF ≥6cpm and BAF ≥3cpm. 24 Hence, what is arbitrarily chosen as the cut-off values for AF have a significant impact as to the number of children diagnosed with AIN and then subsequently recommended for treatment.
Accommodative lag
Accommodative lag occurs when the accommodation response is less than the demand. However, comparison between results is difficult due to a lack of agreement regarding how accommodative lag is assessed. 25, 26 Additionally, accommodative lag has been reported to be quite variable in normal populations. 27 It can be seen that the definition of normal will influence whether subjects are considered to have an accommodative disorder. The higher the pass criteria the more likely children are to fail the test which can inflate detection rates. Additionally, with ill-defined pass/fail criteria, it is difficult to determine the success of treatment in children that do have accommodative disorders.
PITFALL 3: POOR REPEATABILITY OF ACCOMMODATIVE ABILITY, EVEN IN A NORMAL POPULATION
Repeated testing of accommodation can produce variable results, and discrepancies in measurement techniques may lead to inaccuracies in diagnosis.6, 28 In a study of 137 children (four to 12 years), Adler et al found substantial intra-individual variation of accommodative amplitude measurements between initial and subsequent tests, even without any intervening therapy. 29 Measurements of accommodative facility using +/- 2.0 D flippers on three separate occasions found that the vast majority of children who exhibited reduced AF values on initial testing improved to normal on repeated testing. This improvement occurred in the second minute session or on a subsequent test occasion, without any intervention. 24
This variability in findings represents a barrier
in identifying those who need treatment and if variations in AA and AF need to be treated at all. So it may be wise to ask the child to return for retesting to determine whether responses are consistently below expected ranges before consideration of treatment.
PITFALL 4: ACCOMMODATION TESTING RELIES ON SUBJECTIVE RESPONSES
A major weakness in the assessment of a child’s accommodation is the examiner’s reliance on subjective responses with little or no objective information. The cooperation as well as the effort and level of attention required to accommodate under testing conditions can vary greatly, and performance is influenced by many factors including, but not limited to, fatigue, hunger, illness, mood, stress and motivation. Cognitive factors may play a role in younger children in recognising letters and understanding the instructions given. 24 A study by Sheimann et al found that 31% of six year olds and 30% of seven year olds were not able to respond to binocular AF testing. At nine years of age, 10% were still not able to perform the test, which led the authors to question the reliability of testing accommodative facility in children. 23 Hence, wherever possible further data, such as behavioural patterns around devices, and associated symptoms such as red and watery eyes, should be correlated to subjective responses.
PITFALL 5: EXAMINER INFLUENCE
Another important factor in the accommodative response is the quality of instruction given. Horwood found that the most effective exercise to improve both accommodation and convergence was simple convergence exercises, but that even more effective was ‘just being encouraged to work harder by an enthusiastic tester’ – indicating the importance of therapist instructions and encouragement. 27
Tester identity can also be highly significant, whereby children examined by a particular tester will score higher than with other testers. 24, 29 This suggests that variations in communication and procedural explanations, the level of enthusiasm and encouragement by the tester, the technique of testing, and the interpretation of patient responses can influence the outcome of accommodation testing, particularly in children. Additionally, there may be a response bias, in that children may wish to please by giving the answer they think the examiner wants to hear. 21 Clinicians should be aware of the influence they have when testing a child’s accommodation.
PITFALL 6: FLAWS IN STUDIES
Early studies cited as evidence for the efficacy of treating accommodation dysfunction in relieving aesthenopic symptoms suffered significant methodological limitations. 30 These included very small sample sizes, ranging from three to five patients31-33 up to 19 patients.19, 34-36 In other studies,
Image: Prostock-studio/Shutterstock.com.
details about the training program were either not mentioned37 or had significant variability with the type or duration of treatment administered occurring within the one study. 38-41 Examiners had difficulty assessing compliance with training32, 35 or there was an over-reliance on subjective symptoms with little quantitative values. 37, 39, 42 Additionally, the earlier studies lacked either a placebo or control group19, 20, 31, 34, 35, 37-40, 42 or had an extremely small control group of one to three subjects, 32, 33, 43 or had unmasked examiners. 35-38, 40 Statistical analysis was also lacking in the early studies. 34, 35, 37, 39
The first large scale randomised clinical trial of children (nine to 17 years) with symptomatic convergence insufficiency (CI) was initiated in 2008 by Scheiman et al with the Convergence Insufficiency Treatment Trial (CITT). 44 Out of the 221 enrolled in the trial, 164 subjects were reported to have accommodative dysfunction.45
The children were randomised into four different treatment protocols for 12 weeks and upon conclusion the authors found significant improvements in accommodative facility in all groups including the placebo group. Of the placebo group, 35.7% no longer had reduced accommodative amplitudes, and 57.7% no longer had accommodative infacility at study completion. Therefore, the only large, randomised study to date showed that placebo treatment alone was
sufficient to bring a third to a half of subjects to within a normal range of accommodative function.45 These results would support a conservative approach with active treatment delayed until if and when results are repeatedly below expected values.
PITFALL 7: TESTING CONDITIONS DO NOT CORRELATE TO NATURALISTIC CONDITIONS
The relevance of some aspects of accommodation testing and the subsequent difficulties in measuring any significant change with treatment needs to be considered. The assessment of how quickly a subject can overcome a +2.0 D/-2.0 D flipper lens in one minute does not correlate to any naturalistic binocular condition. While accommodative function is often tested and treated monocularly, children do not focus monocularly in routine day to day activities.
CONCLUSION
Prevalence rates of accommodative dysfunction in children are debatable due to a lack of consensus regarding diagnostic criteria and intra-individual reproducibility, but are thought to be very low, especially in children with normal visual acuity and good general health.
The roles of motivation (both subject and clinician) and practice are difficult to isolate and control but should be considered as potentially
confounding. Studies frequently emphasise symptomatic improvement as a marker of success but self-reported symptoms in children are inherently unreliable.
Clinicians should interpret symptoms, especially if they are variable or lack any objective correlate, with caution. Indicative gains may be owing to placebo effects, with or without quantitative gains. Most significantly, evidence in the literature is lacking with only one large, prospective, randomised clinical trial demonstrating that although subjects improved with treatment, placebo alone was sufficient to bring accommodation back to within normal ranges in many participants. The discerning clinician should consider all the above factors prior to embarking on a treatment plan.
NOTE: References will appear in the online version of this article and are available upon request.
STRENGTHENING NDIS SUPPORT FOR AUSSIES WITH FUNCTIONAL VISION IMPAIRMENT
Orthoptists can play a key role in supporting individuals with complex vision needs, but they also need the support of an NDIS that does a better job of assisting people with disabilities to live ordinary lives, writes JEMILA KANU.
LEGISLATION HAVE MADE IT INCREASINGLY DIFFICULT FOR PARTICIPANTS TO ACCESS ORTHOPTIC CARE, AS THESE SERVICES ARE SOMETIMES EXCLUDED OR NOT CLEARLY RECOGNISED WITHIN FUNDING CATEGORIES."
As Australia’s world-leading National Disability Insurance Scheme (NDIS) continues to evolve, there are opportunities to enhance support for individuals with low vision and neurological vision impairments, particularly through improved recognition of the functional impacts of vision loss and the critical services that enable full participation in daily life.
A significant gap lies in the awareness and integration of vision-related supports, particularly for children with conditions such as cerebral visual impairment (CVI), retinopathy of prematurity, optic atrophy, or visual field loss.
These complex conditions do not always present as a traditional “eye problem” but can have a profound impact on how someone interprets the world, navigates space, and engages with others. When misunderstood or misclassified as purely medical, essential vision supports may be inadvertently excluded from NDIS plans.
This issue becomes especially apparent when families seek vision services such as orthoptic low vision assessments, vision therapy, assistive technology, orientation and mobility (O&M) training, or environmental adaptations, only to find that they fall outside the scope of current support pathways.
care.
Yet, for people living with neurological vision impairment,
these services are vital to building independence and safety.
Seven-year-old Maya is one such example.
Born extremely prematurely at just 23 weeks, Maya lives with cerebral palsy, epilepsy, and multiple forms of vision impairment, including bilateral optic atrophy, CVI, and severe visual field loss. A recent assessment of her functional vision showed a visual acuity of 6/24 with both eyes open and a visual efficiency of just 15%, factoring in visual field loss, contrast sensitivity, and visual processing difficulties.
For Maya, recognising faces, interpreting cluttered environments, and sustaining visual attention can be daily challenges. Her vision can appear to “switch off” when she’s overwhelmed or fatigued, affecting everything from learning in the classroom to safely navigating new spaces.
Without appropriate functional vision supports, children like Maya miss out on the chance to develop crucial life skills. These are the supports that can help them interpret visual cues, move through their environments safely, and participate in learning and play at a higher capacity.
Orthoptists are uniquely qualified to assess and support individuals with complex vision needs, particularly where neurological vision impairment is involved.
However, recent changes to NDIS legislation have made it increasingly difficult for participants to access orthoptic care, as these services are sometimes excluded or not clearly recognised within funding categories.
As a result, families are left navigating fragmented systems, often without access to the most appropriate vision professionals.
Despite Maya’s well-documented challenges, her requests for vision-related supports were not approved in her NDIS plan. The decision cited that her needs were
already met through ophthalmology follow-up – a valuable medical service but one that does not provide the day-to-day functional support required to use vision effectively. Similarly, it was suggested that an occupational therapist could provide orientation and mobility training, although such services require specific expertise and qualifications offered by Orientation and Mobility Specialists.
Maya’s case is not unique. Many families across Australia report similar experiences, particularly when the vision impairment stems from neurological causes. The need for better recognition of functional vision loss and specialist services within the NDIS is clear.
Fortunately, this represents a significant opportunity for positive change. Enhancing planner awareness, refining assessment processes, and ensuring access to qualified orthoptists and O&M specialists could make a meaningful difference for Australians living with low vision.
Recognising vision supports as functional, not just medical, would bring the NDIS into closer alignment with its core goal: to support people with disabilities to live ordinary lives. With greater understanding and integration of vision services, children like Maya can receive the support they require to thrive, not just medically, but functionally, socially, and developmentally.
It is a small shift that could bring a lasting impact.
ABOUT THE AUTHOR: Jemila Kanu is the founder of In-Sight Vision Therapy in Perth. An orthoptist with more than 13 years of on-field experience, she is dedicated to supporting individuals living with visual impairments and neurological conditions.
ORTHOPTICS AUSTRALIA is the national peak body representing orthoptists in Australia. OA’s Vision is to support orthoptists to provide excellence and equity in eye health care. Visit: orthoptics.org.au
BELOW: Changes to NDIS legislation have made it difficult for people to access vital orthoptic
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NO, YOU CAN’T HAVE THAT FRAME
JACOBUS BOSHOFF on why a good optical dispenser sometimes needs to dish out the harsh truth, and why frame choice starts with a prescription.
IS TO POSITION THE LENS CORRECTLY FOR OPTIMAL VISION. IT MUST FIT WELL ON THE NOSE, MATCH THE FACE WIDTH, AND HAVE APPROPRIATE TEMPLE LENGTHTO-BEND."
Picture this: Mrs Fancypants, a new patient at your practice, arrives driving a very flash car. She sports a diamond the size of a cricket ball on a ring and an even larger one on a gold chain around her neck.
She trots in 10 minutes early for her eye check with the optometrist. Eager to save time, you decide to browse frames beforehand, skilfully guiding her towards the latest designer frames fresh from France. She falls in love with a nice large inline frame and you hand her off to your optometrist, congratulating yourself on your efficiency.
The optometrist returns Mrs Fancypants to you. Her near script is R
+3.50/-0.25x180 Prism 4 Base In and L +3.00/-0.50x5 Prism 4 Base In… oops.
“Mrs. Fancypants, the frame we selected won’t work with your prescription…” Egg. All over. Your face. Now you have to explain why a 56-16 metal inline frame she LOVES won't accommodate her reading glasses, and start from scratch.
Mrs Fancypants is unhappy. The shell frame that fits her nose and prescription perfectly is not the ultralight, flexible designer frame she fell in love with.
This is why dispensers are taught in the Certificate IV in Optical Dispensing that frame selection always starts with an optical prescription. The frame’s job is to position the lens correctly for optimal vision. It must fit well on the nose, match the face width, and have appropriate temple length-to-bend (too long, we can adjust; too short, like a bad haircut, is just too short).
Dispensers need to explain optical reasoning behind our frame recommendations in layman’s terms. “Mrs Fancypants, that frame looks fantastic, and I’m sure they’re featherlight, but with your prismatic reading prescription, the lenses would be horribly thick nasally. The prism, which helps your eyes focus without strain, creates a wedge on the inside of the lens. Metal inline frames also require a minimum edge thickness. Even with high-index lenses, the result would be less than ideal.”
See, it’s all about her and her needs. How about we start the frame selection
with her prescription in hand and look like rock stars from the get-go?
A rock star optical dispenser considers the following:
• I ntended use/lens type: Single vision or anti-fatigue, office, bifocal, trifocal, or progressive? Some lenses require a minimum frame depth. Office lenses, in particular, do well with a bit more depth to get those long-corridor marvels space to do their magic. The same applies for progressives to a certain extent, although we have short-corridor options in most progressive lens designs.
• Prescription specifics: High spherical, cylindrical, or add powers? Cylinder axis direction? Remember power crosses! Prism? Where will the prism thickness sit? Try to visualise what the intended lens will look like, and where problematic edge thickness may occur. Frame shape and size can have a huge impact on lens thickness and weight.
• Frame evaluation: Front and side views. Pantoscopic tilt should ideally be negative 6-9 degrees. Positive panto (bottom angling away) is generally a no-no, even with high-end, digitally enhanced lenses. Back vertex distance (BVD): will eyelashes touch the frame? Is the BVD so large that the prescription needs correction? High BVDs work against field of view – keep this in mind for progressive lens corridors that may be compromised. Sometimes nose-pad
adjustments nip the issue in the bud, and sometimes you have to change to another frame.
Red flags: Very curved frames and oversized frames. High prescriptions in curved frames can induce unwanted prism. Oversized frames often make finding suitable lens blanks difficult, especially for reading glasses. Remember the minimum uncut size formula?
Check the Optical Dispensers Australia website’s calculators (https://www. odamembers.com.au/calculators).
I’ll stop my diatribe here. I’m sure you get the gist and can think of many more issues with improper frame selection from your own hard-earned experience.
In the meantime I have to get ready for Mr Dinnerplate, who is coming in shortly. He loves oversized frames for his progressives. They look great and fit well, but finding large enough lens blanks is a headache. I have sourced one supplier with progressives lens blanks that fit Mr Dinnerplate's previous set of glasses. But if he wants reading glasses, I can already hear myself saying, “No, you can’t have that frame!"
ABOUT THE AUTHOR: Jacobus Boshoff is a qualified optical dispenser and independent practice co-owner in Forster, a town in NSW’s Mid North Coast region. He is a member of Optical Dispensers Australia, serving on its advisory board.
Images:
Jacobus Boshoff.
What the customer wants in a frame will not necessarily be suited to the prescription they end up with.
PROTECTING PRIVACY: PREPARING FOR CHANGE
On top of greater Information Commissioner powers to issue infringement notices, individuals will also be able to sue for serious breaches. What will recent changes to Australian privacy laws mean for healthcare providers?
The new tort of serious invasion of privacy is the most significant of a suite of legal reforms in Australian privacy laws.
ENSURE ROBUST POLICIES AND PROCEDURES
respond to their privacy obligations (such as providing access to records).
“WE TOO OFTEN SEE AVOIDABLE MEDICO-LEGAL ISSUES TRACING BACK TO OUTDATED, UNCLEAR, OR INCOMPLETE POLICIES.”
These changes reflect growing community concern about how organisations collect, use and protect personal information, particularly sensitive health information. The new tort will apply where someone intentionally or recklessly intrudes on another’s seclusion – for example by “watching”, "listening to” or “recording”–or misuses private information, including unauthorised collection, use or disclosure of personal information. As the name indicates, the privacy breach must be serious.
This change marks a significant shift in Australian privacy law as individuals can now bring a personal claim for compensation or damages for the first time.
This change compliments the increased powers the government has bestowed on the Office of the Australian Information Commissioner (OAIC) to issue infringement and compliance notices from 10 June 2025, which impose financial penalties for lower level breaches of privacy.
BELOW: Responsibility may not stop with rogue employees, with the potential for employers to be held vicariously liable for breaches.
The government has made it clear the tort is not intended to capture appropriate healthcare or research activities. Even so, it will have implications for healthcare settings, including ophthalmology and optometry practices.
Australian courts have yet to test the extent of the new provisions. Some situations that have occurred in health contexts might now be covered by the tort, including, for example, covertly filming or sharing images of unconscious patients, publishing patient contact or health information, or stalking patients.
As with other civil causes of action such as negligence, employers could face vicarious liability for an employee’s actions if they cannot demonstrate they took reasonable steps to protect patient privacy.
Healthcare providers and practices must now ensure their privacy systems are robust. This includes implementing privacy policies and procedures, updating existing privacy policies, restricting access to information only to those who need it, ensuring staff are trained on their responsibilities when handling patients’ personal information and establishing policies to respond to requests for access to information.
Healthcare professionals working in hospitals can also expect increasing vigilance around privacy and records management policies as hospitals will also need to demonstrate they have reasonable safeguards in place. In a hospital context, it is even more important to be sure you understand and follow hospital policies to avoid an inadvertent breach, which may also impact your employment obligations.
PRIVACY POLICIES UP TO DATE?
Under current privacy law, all healthcare providers must have a clearly expressed and up-to-date privacy policy that explains how the practice manages personal information. This is a legal obligation, not a ‘nice to have’.
We too often see avoidable medico-legal issues tracing back to outdated, unclear, or incomplete policies. The OAIC now has expanded powers to issue infringement notices and civil penalties for lower-level privacy breaches, including if healthcare providers fail to ensure their privacy policy is compliant or fail to appropriately
Practitioners and practices may face financial penalties via an infringement notice if they do not ensure they comply with their privacy obligations. If your practice lacks a privacy policy that contains the required content, you should update it immediately.
LOOKING AHEAD; AUTOMATED DECISION-MAKING
From December 2026, privacy legislation will also require practices to disclose in their privacy policies whether they use any automated decision-making tools. Examples could include software that assists in diagnosing retinal conditions, interpreting visual field results, or supporting surgical planning based on biometric data.
Even if your practice does not currently use such tools, you will need to keep patients informed as technology advances. You must be transparent about the use of these tools, if and when you use them, to meet future obligations and maintain patient trust.
The changes to privacy law present a timely opportunity, and increased incentive, to strengthen your practice’s approach to privacy. Patients trust you not only with their vision but also their personal information. You can best protect both your patients and your practice against financial penalty by demonstrating that you take that responsibility seriously, through sound policies, secure systems, and informed staff.
Note: For more guidance, Avant members can access its privacy collection page via avant.org.au/cyber-collection and view its recent webinar on the upcoming changes at www.youtube.com/watch?v=5xUj4p6PWpM&t=1251s
education and research at Avant.
GEORGIA HAYSOM
ABOUT THE AUTHOR: Georgie Haysom, BSc, LLB (Hons) LLM (Bioethics), GAICD, is the general manager of advocacy,
CONTROVERSIES AROUND SYMPATHETIC OPHTHALMIA
condition, strategies to prevent SO, particularly following OGIs, have long
Historically, prophylactic removal of the injured eye has been considered a valid risk mitigation strategy, often within 14 days, and typically when only when the injured eye has no chance of
The rationale: by eliminating the source of the offending antigens, one might prevent the autoimmune cascade that
Enucleation (removal of the entire globe) and evisceration (removal of the contents of the globe while leaving the scleral shell intact) are both considered options to reduce SO risk by eliminating immune-sensitising uveal tissue, thereby
endure the trauma of a devastating ocular injury or invasive surgery to
possibility of their "good" eye failing
In other words, it punishes twice, with an ability to cause severe vision loss in both eyes, despite only one being injured – attacking the very eye that was meant to be a lifeline to an
SO is a rare, bilateral, granulomatous uveitis. It arises when ocular antigens, immune privilege, are exposed due injury (OGI) or intraocular surgery. This exposure can trigger a bilateral unpredictable onset, and the potential need to act quickly if deemed at risk.
The interval between the inciting injury and the onset of symptoms can vary dramatically from just five days to as long as 66 years. Most cases, however, present within the first several years after injury. Despite being first described in 1840, the epidemiology remains poorly understood due to its rarity and variable presentation.
In the face of such a high-stakes
But these approaches are steeped in controversy.
Removing an eye – especially one that might still offer some visual function – is an emotionally and ethically fraught decision for the patient and ophthalmologist. Eye removal is irrevocable, carrying significant implications for a patient’s psychological wellbeing, self-image, and quality-of-life. Phantom eye syndrome, vision loss, and the trauma of enucleation itself must all be carefully weighed against the threat of SO, especially when the latter remains such a rare outcome, as we recent reported.
This tension formed the impetus behind a recent multi-centre review of primary surgical management strategies for OGIs, which I was involved in. The study was published in Ophthalmology and synthesised data from seven separate studies, covering a total of 7,566 OGI cases. It aimed to evaluate whether primary repair, the restoration of the injured globe, was associated with any greater risk of SO compared to primary enucleation or evisceration. The findings were striking: there was no significant difference in the rate of SO between those managed with primary repair and those who underwent eye removal. In other words, removing the eye did not appear to reduce the risk of developing SO. Using our model, the rate of SO after primary enucleation and primary evisceration as treatments for OGI was not significantly different at
0.05% compared with a rate of 0.15% after primary repair.
We estimated that, if any effect exists at all, at least 323 eyes would need to be removed to prevent one case of SO, a very limited justification for eye removal based on SO risk, although the certainty of evidence is low.
Even so, this challenges a historic belief in ophthalmology and calls for a more nuanced, evidence-based approach to risk management following OGI.
For eyecare professionals, this study provides a valuable reference point when discussing treatment options with patients and interdisciplinary teams. It reinforces the idea that primary repair should always be attempted when possible, even when SO is a concern.
The potential morbidities associated with eye removal need to be balanced against the rarity of SO and its treatability with advanced therapies.
NOTE: This article was co-authored by Tim J Patterson and Richard J Blanch.
ABOUT THE AUTHOR:
Name: Annette K Hoskin
Qualifications: BSC (Optom), MBA, PhD
Affiliations: Senior fellow, Save Sight Institute, University of Sydney; Global standardisation director, EssilorLuxottica
Location: Perth Years in industry: 33
EYE REMOVAL IS IRREVOCABLE, CARRYING SIGNIFICANT IMPLICATIONS FOR A PATIENT’S PSYCHOLOGICAL WELLBEING, SELF-IMAGE, AND QUALITY-OF-LIFE.
ABOVE: Open globe injuries can trigger sympathetic ophthalmia.
Images:
Annette Hoskin.
EVENTS CALENDAR
To list an event in our calendar email: myles.hume@primecreative.com.au
JULY 2025
NAIDOC WEEK
Australia
6 – 13 July naidoc.org.au
AUSCRS 2025
Darwin, Australia 16 – 19 July auscrs.org.au/2025-conference
THE 2ND INTERNATIONAL MYOPIA SOCIETY MEETING
Singapore 19 July eventsthreesixty.com.sg/internationalmyopia-society-meeting/
AUGUST 2025
OPTOMETRY CLINICAL CONFERENCE
Melbourne, Australia 17 – 18 August occ.optometry.org.au
ASIA-PACIFIC ASSOCIATION OF CATARACT AND REFRACTIVE SURGEONS (APACRS) MEETING
Ahmedabad, India 21 – 23 August apacrs2025.org
OPHTHALMOLOGY UPDATES!
Sydney, Australia 30 – 31 August ophthalmologyupdates.com
SEPTEMBER 2025
EUROPEAN SOCIETY OF CATARACT AND REFRACTIVE SURGEON (ESCRS) MEETING Copenhagen, Denmark 12 – 16 September congress.escrs.org
TASMANIA'S LIFESTYLE CONGRESS
Tasmania, Australia 20 – 21 September tlc.optometry.org.au
SILMO PARIS
Paris, France 26 – 29 September silmoparis.com/en
NOVEMBER 2025
RANZCO CONGRESS
Melbourne, Australia 14 – 17 November ranzco2025.com
Image: Ophthalmology Updates!.
Image:
Image: RANZCO.
RANZCO's conference in November in Melbourne is a key opportunity for ophthalmologists to come together and discuss
social, political and technological issues facing the eye health sector.
Ophthalmology Updates! is returning to Sydney’s Fullerton Hotel in August, attracting some of Australia’s top ophthalmology talent.
Copenhagen, Denmark, is hosting the popular cataract and refractive meeting ESCRS in September.
CHANGING LIVES THROUGH BETTER SIGHT AND HEARING
SPECSAVERS STORIES: RHIAN EVANS
WHY DID YOU PURSUE AN
OPTICAL CAREER?
My father is an optometrist, and I used to help in his practices during school holidays. I was particularly fascinated by the dispensing side of the business. It was amazing to watch the dispenser select the perfect pair of glasses, follow their journey through the lab, and finally see them ready for collection. One of the most rewarding parts was seeing patients so happy and excited after finding their ideal pair of glasses.
I knew I wanted to go to university, and the Optical Management Degree in the UK was the perfect fit for me. After graduating, I continued my education to become a qualified contact lens optician.
HOW DID YOU COME TO WORK AT SPECSAVERS?
Name: Rhian Evans
Current position: Dispensing advancement manager
Location: Sydney
Years within the business: 14
When I relocated from the UK to Australia, I was fortunate to secure a position as an optical dispenser at the Sydney CBD stores. From the very first week, I was amazed by the in-store culture. The training opportunities for optical assistants and the ongoing education for dispensers truly impressed me. The store was supported by a dedicated Retail Support Team. Observing the remarkable work they provided to partners and team members inspired me to advance to my next role at Specsavers Australia, where I became a regional training manager for NSW/ACT. I loved traveling to new places and meeting extraordinary people along the way.
WHAT GROWTH OPPORTUNITIES HAVE PRESENTED THEMSELVES?
Transitioning from a regional to a national role – as dispensing advancement manager for ANZ – has undoubtedly offered even greater opportunities for growth, allowing me to collaborate with a wider range
of stakeholders. My role is to enhance dispensing performance by prioritising training, development, and the implementation of effective processes and systems that empower dispensers and optical assistants in-store to deliver the highest quality outcomes tailored to the customers' needs. I’ve embraced all the opportunities from enhancing my own technical optical dispensing knowledge or my personal development. A highlight was collaborating with Dr Alicia Thompson to deliver exceptional training for our dispensers on paediatric dispensing.
WHAT ARE YOUR TOP CAREER HIGHLIGHTS?
Within Specsavers, I was invited to join the Emerging Leaders program, a year-long internal development initiative. Through this program, I learned from external experts, our executive and senior leaders, and my peers, covering a broad range of focus areas including leadership, commerciality, business acumen, influencing, profile, and relationship building. As part of this program, I also completed a mini-MBA. This experience has strengthened my strategic thinking, which has proven highly valuable in my current role. A recent highlight for me has been joining the advisory board of Optical Dispensers Australia (ODA). I’m thoroughly enjoying the opportunity to collaborate with other like-minded optical professionals from various optometry businesses across Australia.
WHAT EXCITES YOU ABOUT WORK EACH DAY?
It all goes back to what I noticed during my very first week at Specsavers, 14 years ago: the culture. While my role and environment may have changed, the culture and the sense of satisfaction from knowing that I’m making a difference have remained constant. I feel a true sense of purpose in changing lives through better sight.
ALL SPECSAVERS STORES NOW WITH OCT
SO LET’S TALK!
In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today:
Joint Venture Partnership opportunities enquiries: Kimberley Forbes on +61 (0) 429 566 846 or E kimberley.forbes@specsavers.com
Designate Partnership Opportunity in Inverell with potential to earn up to $200,000! Specsavers Inverell is offering a rare opportunity for an experienced Optometrist to join our new store on a 2-year Designate Partner program, with no upfront cost and the chance to experience partnership before committing long-term. The store will feature the latest amenities, including optical test rooms, pre-test rooms, dispensing desks, state-of-the-art equipment like OCT, and a modern Specsavers fit-out with digital displays and illuminated shelving. Enjoy earning up to $200,000 with flexible rostering for a great work-life balance, plus the option to transition to a Joint Venture Partnership at a discounted share price. Embrace the peaceful lifestyle of Inverell while making a meaningful impact on your patients’ vision.
Optometrist opportunity – Specsavers Hornby, NZ
Thinking of making the move across the ditch? Join Specsavers Hornby in Christchurch, NZ! Enjoy a supportive team, modern equipment (including OCT), and a vibrant lifestyle. With relocation support and a $10k sign-on bonus on offer, it’s the perfect opportunity to combine clinical growth with a great work-life balance.
Optometrist Opportunity – Specsavers Dubbo, NSW
Join a high-performing, award-winning team at Specsavers Dubbo! We offer up to $145K salary (experience dependent) plus a $10K sign-on bonus for relocation. Choose full-time or part-time work, including one weekend day. You’ll work with 3 optometrists in a modern 5-test room store equipped with OCT and HFA III. Enjoy a strong clinical focus on eye diseases, contact lenses, and chronic disease management, with regular ophthalmologist collaboration. We’re proud two-time Doug Perkins Medal winners, recognised for excellence in patient care. Benefit from locally hosted CPD events and a supportive team environment. Apply now and thrive in Dubbo!
Graduate Opportunities
The Specsavers ‘Early Bird Package’ which offers our highest sign on bonus yet is nearing the end! For select opportunities across ANZ, final year optometry students will be eligible for either a $30,000 or $20,000 sign on bonus when they sign an employment contract before June 30 2025. Specsavers are the largest employer of Graduate Optometrists across Australia and New Zealand and we have continued to develop our comprehensive two-year Graduate Program to focus on your development. If you’re a final year student and you would like to find out more, please contact your Graduate Recruitment Consultant.
People on the move
EYE AND EAR HOSPITAL FINDS NEXT BOARD CHAIR
Ms Melanie Eagle is the new board chair of The Royal Victorian Eye and Ear Hospital. Eagle brings a wealth of strategic leadership across various sectors, including government, healthcare and the not-for-profit sector, and has a track record of leadership and innovation. She will commence her role on 1 July 2025, following the completion of Dr Sherene Devanesen AM’s 10-year term.
ORTHOPTIST JOINS ZEISS IN CHRONIC DISEASE MANAGEMENT PORTFOLIO
Mr Jeffrey Fung has joined ZEISS as clinical application specialist for the chronic disease management portfolio.
With more than 11 years of orthoptic experience, he will support ZEISS diagnostic equipment users across New South Wales. “ Jeffrey's experience with ZEISS equipment and delivering training to eyecare professionals will be advantageous in this position,” the company said.
OPTOMETRY
AUSTRALIA CEO ELEVATED ON AHPA BOARD
A PASSION FOR OPTIMISING OUTCOMES AND AN INTEREST IN COMPLEX OPTICS
Mr Owen Burton has recently joined Rayner as territory manager for south Queensland. As an orthoptist with a decade of combined clinical and industry experience, he “has a passion for optimising patient outcomes and a keen interest in complex optics”, Rayner said. His early career in a laser refractive clinic refined his patient-focused approach, while his subsequent role as a clinical and product specialist strengthened his ability to support complex ophthalmic procedures and refractive technologies.
ON FROM VISION 2020 AUST
Vision 2020 Australia chair Mr Christopher Pyne is stepping down from the board in November after five years’ service. He made the decision to scale back his board commitments following heart bypass surgery in March.
“Since joining the Vision 2020 Australia Board as chair, my professional responsibilities have steadily increased over the past five years – it’s the right time to strike a more manageable level of obligations,” he said.
“As sad as I am to step aside, I wouldn’t be making this decision if I wasn’t confident that the organisation was in a position of stability and strength to positively progress its agenda on behalf of members.”
Ms Skye Cappuccio has been appointed deputy chair of the Allied Health Professions Australia (AHPA) Board. The Optometry Australia CEO has a depth of experience in senior management in non-government organisations and close to 20 years’ experience in policy and advocacy roles in peak health bodies. “Skye holds a BA, PostGradDipPH, GAICD, and is ever so close to completing her MBA,” AHPA said.
G&M OPTOMETRIST TAKES ON PROFESSIONAL SERVICES ROLE
Regional optometrist Ms Reshma Seth has been promoted into the role of professional services manager for NSW Mid North Coast at George & Matilda Eyecare.
She has been based in the Mid North Coast town of Forster for more than 20 years, and today practises at George & Matilda Eyecare for Rolfe Optometrists, Forster.
"Reshma offers deep local knowledge, a passion for community care, and decades of optometric excellence," the company said.
CHRIS PYNE FOCUSING ON HEALTH AS HE MOVES
The next generation in Refractive Surgery
A personalised fit1 for your patient’s ablation profile
Just like the most refined haute couture, each wavelight plus procedure is fully tailored.1 InnovEyes™ Sightmap measures the unique optical system using biometry, tomography and wavefront.2
Innovative ray tracing methods create a personalised 3D model of the eye,1 used to plan a truly unique treatment with excellent visual outcomes.*3
Moss Vale Optical: 30 Years of Community-Focused Eyecare
Established in 1994 by husband-and-wife team Gary and Amanda, Moss Vale Optical has been a trusted provider of eyecare in the Southern Highlands for three decades. In 2024, to mark their 30-year milestone and ensure continuity of care into the future, they joined George & Matilda Eyecare. Their decision was driven by a desire to keep delivering exceptional eyecare to their local community, now and well into retirement.
Gary, a passionate advocate for cutting-edge technology, recalls his early days practicing in Hurstville. “We were ahead of the game,” he says, “and had an OCT even before the ophthalmologists did. I scan every patient so no one gets missed. It’s incredibly rewarding to know I’ve helped save people’s vision. The more scans you do, the more you learn. If you’re not scanning, you’re not doing your best.”
One powerful story Gary shared involved an 8-year-old boy referred to him late on a Friday evening by a GP. The GP suspected a virus but felt something wasn’t quite right. Gary conducted an OCT scan, revealing swollen optic discs. He immediately contacted the GP and urged an urgent MRI. That same night, the child was admitted to Westmead Hospital and diagnosed with a brain bleed. Six weeks later, Gary saw the boy again—walking happily down the street with a bandage on his head.
Maintaining clinical independence and delivering the highest standard of care has remained central to Gary and Amanda’s philosophy. Reflecting on the partnership with George & Matilda, Amanda adds, “We now have a wider selection of frames for our patients—and we can finally take a holiday!”
