Insight May 2025

MAY 2025

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975 MAY 2025

Is your vision becoming blurry up close?

The reforms also include banning NDAs preventing complaints about practitioners

BULK-BILLED EYE INJECTIONS

36

SEXUAL MISCONDUCT ON REGISTER PERMANENTLY

17

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03

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MAY 2025

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

PATIENT-PROTECTING AHPRA REFORMS WILL MEAN MORE TRANSPARENCY ON PUBLIC REGISTER Optometrists, ophthalmologists and other registered Australian practitioners proven to have committed sexual misconduct will have this information permanently published against their name on the public register.

It’s part several reforms from the Australian Health Practitioner Regulation Agency (Ahpra) to improve transparency and protect the public. Others include increased protections for people who make complaints, making it an offence for practitioners to enter into non-disclosure agreements (NDAs) that prevent complaints being made to regulators.

The move has been accepted by the Australian Society of Ophthalmologists (ASO), which says patient safety, clinical or otherwise, has always been a cornerstone of

its advocacy efforts.

“The ASO’s position stands that any disciplinary data published publicly on the National Register should only be the outcome of timely and thorough investigative and judicial processes,” the organisation said.

“The ASO supports the implementation of these transparent measures that ensure the personal and clinical safety of Australian patients in our healthcare settings.”

Sexual misconduct has been a major focus of Ahpra in recent years, which the regulator said had prompted a spike in reports and the number of practitioners facing regulatory action.

Allegations of ‘boundary violations’ have increased in recent times, from as low as 75 in 2012-13 to 1,156 in the latest 2023-24 data.

Across the 16 professions, medical

There were 1,156 allegations to Ahpra of ‘boundary violations’ in 2023-24.

Image: Pormezz/Shutterstock.com.

practitioners receive the most complaints with 472 (no ophthalmology-specific data available) followed by 320 complaints about nurses and 139 about psychologists. There has also been a steady rise in complaints about physiotherapists, with 32 sexual boundary notifications relating to that profession in 2023-24.

Optometry has consistently had one of the lowest complaint rates,

with 12 alleged boundary breaches since 2012-13. Three of those took place in 2023-24.

The changes are being made under the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2024. Ahpra Acting CEO Ms Kym Ayscough said it was a milestone in patient protection.

“Everybody has the right to expect their practitioner to be safe and fit to practise, and these reforms strengthen that right,” she said.

“We support these changes, which align with the range of reforms that Ahpra and the National Boards are progressing as part of our actions to improve public safety involving sexual misconduct in healthcare.”

Ahpra said the new protections for people who make complaints continued page 8

Optometry employment conditions could be in for a shake up, with non-compete clauses for employees earning under $175,000 facing potential abolishment.

The reform, that would come into effect in 2027, was a headline item from the recent Federal Budget, but it hinges on whether Labor wins the 3 May 2025 election.

Treasurer Mr Jim Chalmers said the change would make it easier for workers to switch to a better job while lifting the wages of affected workers by up to 4%, or about $2,500 per year for a worker on median wages.

It would also spur new business entry and competition, with non-compete clauses “a handbrake on business creation and a speed bump on aspiration”.

The government believes around three million Australians have a clause of this nature in their contract. Many of those are optometrists.

In fact, Optometry Australia (OA) CEO Ms Skye Cappuccio told Insight non-compete clauses “are currently standard” in most contracts the organisation’s optometrist advisor team or HR legal service review for OA members.

One of the most common questions OA fields from optometry employees relates to the legality of non-compete/ restraint of trade clauses in their contracts, their enforceability, and whether employers can legally restrain from working for local competitors.

Mr Mark Corduff, business services manager for the 450-practice ProVision network of independents,

said complexities due to non-compete clauses often came across his desk when an optometrist decided it was time to leave their employer to open or purchase an independent practice.

“Non-compete clauses are contractual agreements that restrict an employee from working for a competitor or starting a competing business for a certain period after leaving a company, typically this is a six months but can be longer, with a geographical boundary attached,” he said.

“Most of these cases are isolated to corporate chains and are designed to protect the employer’s investment in building a patient-base, continued page 8

Image: Rahul Chakrabarti.

DO NON-COMPETE CLAUSES HOLD OPTOMS BACK?

Phaco's new phase Some of Australia’s top vitreoretinal surgeons have told Insight Alcon's new Unity Vitreoretinal Cataract System is unlike anything they've experienced and now Melbourne cataract surgeon, Dr Rahul Chakrabarti, is echoing those sentiments.

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IN THIS ISSUE MAY 2025

EDITORIAL

FEATURES

IT’S A TOUCHY SUBJECT

14

44

At the helm New Australian Society of Ophthalmologists boss Katrina Ronne has a long list of political problems to tackle.

The workhorse How this Australian-made device became the linchpin of Jillian Campbell's advanced contact lens practice.

31

52

Expansion plans Liz Barrett’s bold move to open a standalone dry eye clinic appears to have paid off – she’s set to open her eighth.

Only the best Vision Hospital Group's day surgeries are reducing the burden, allowing eye surgeons to do what they do best.

EVERY ISSUE 07 UPFRONT

62 MANAGEMENT

09 NEWS THIS MONTH

63 SOAPBOX

60 OPTICAL DISPENSING

64 CALENDAR

61 ORTHOPTICS

66 PEOPLE ON THE MOVE

Another election year, another Macula Month and another decisive win for Australia’s macular disease community.

It’s been a little over four years since the taskforce review into ophthalmology Medicare items was finalised. Within that were two controversial proposals. The first was to cut the rebate for intravitreal injections (IVIs) from $250 to $75, and the second was a reclassification of IVIs meaning they could no longer be claimed via private health if performed in a hospital setting.

But interfering with the frameworks supporting these sight-saving treatments appears to be a political hot potato.

Prior to the 2022 election, both political parties agreed to scrap the proposed rebate cut. Then, two months out from this election, the government said it would put off the reclassification decision until July 2026 and undertake further consultation.

Both measures, according to Macular Disease Foundation Australia (MDFA), would have had serious ramifications for people with neovascular age-related macular degeneration (nAMD) and similar diseases in terms of out-of-pocket costs.

Considering that cost burden is the biggest barrier to continued treatment, the impact would have been big and immediate.

It also exposes delicacy within the IVI ecosystem.

Although the treatment landscape has largely remained unchanged for 18 years, it won’t be long before we look at the way things were done in astonishment. An injection in the eye every one to two months, administered by ophthalmologists, is far from optimal – but then again, we should be thankful treatments exist.

What could change in the short term is the IVI bulk-billing rate. It’s around 20% in private settings – that perform the lion’s share – and on page 17 as part of our Macula Month coverage – we explore why, speaking to those who have made it viable. We also investigate the merit of MDFA’s proposed $150 IVI incentive per bulk billed patient (two eyes).

For macular disease patients, IVIs keep their eyes, their portal to the world, open. There’s a clear appetite to change the status quo among policymakers. But it’s also clear a foolproof Plan B is required, so patients continue their treatment regime uninterrupted.

MYLES HUME Editor

INSIGHT May 2025

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UPFRONT

WEIRD Tennis star Novak Djokovic’s eye caused intrigue at the recent Miami Open. Cameras quickly picked up on swelling around his right eye, with a red mark also visible on his cheek.

He was also seen using eye drops to treat the issue during a break in play. Post-match, and after being defeated, he declined to comment on what the issue was.

continuing to provide the highest level of care to patients," he said. IN OTHER NEWS, the Federal Government is deferring the controversial private health insurance reclassification of intravitreal injections for another 12 months and will undertake further consultation. “It provides an opportunity to address the wider issue of the lack of access to affordable sight-saving treatment in Australia,” Macular Disease Foundation Australia CEO Dr Kathy Chapman said.

The move would have resulted in more than 12,200 people no longer being able to use their health insurance to cover the cost of intravitreal anti-VEGF injections,

if performed in a hospital setting.

FINALLY, Korea-based pharmaceutical company Celltrion has announced approval from the Therapeutic Goods Administration (TGA) of its ophthalmic treatment Eydenzelt (aflibercept). The drug is a biosimilar of Bayer's Eylea and is approved for the treatment of myopic choroidal neovascularisation.

As reported in a number of outlets, the approved formulations include injectable and prefilled syringe versions.

It is the first aflibercept biosimilar approved in Australia, and the company expects to gain a competitive edge in the market.

STAT

Image: Teeradej/Shutterstock.com

Just as Insight went to print, GEORGE & MATILDA EYECARE has partnered with Eyescan in Toorak, Melbourne, known for its combination of ophthalmology, optometry and optical dispensing, all under one roof. G&M CEO Mr Chris Beer said founder and ophthalmologist Dr Harry Unger and the Eyescan team had created “a standout model of integrated eyecare that complements our vision perfectly". "This partnership is an exciting opportunity to support a well-established, forward-thinking practice while

WACKY Kmart pulled a skincare product off its shelves after a Victorian teenager who used it suffered eye pain and was rushed to hospital, the ABC reported. The girl’s mother created a post on social media that went viral after her 13-year-old daughter used a hyaluronic acid cleansing balm, which she purchased for $2 using her pocket money.

Published by:

379 Docklands Drive, Docklands VIC 3008 T: 03 9690 8766 www.primecreative.com.au Chief Operating Officer Christine Clancy christine.clancy@primecreative.com.au Publisher Sarah Baker sarah.baker@primecreative.com.au Editor Myles Hume myles.hume@primecreative.com.au Assitant Editor Rob Mitchell rob.mitchell@primecreative.com.au Commissioning Editor, Healthcare Education Jeff Megahan Business Development Manager

WONDERFUL An early study has shown promise for a retinal-surgery robot invented at the University of Utah. The experimental technology aims to give surgeons “superhuman” hands, described as “extremely precise, executing movements as small as one micrometer”.

insightnews.com.au

Luke Ronca luke.ronca@primecreative.com.au Client Success Manager Isabella Fulford isabella.fulford@primecreative.com.au

Dry eye decisions

Head of Design

The cost of treatment with a commercial ciclosporin formulation for dry eye has been shown to be around AU$2,045 annually per patient. Page 40

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WHAT'S ON

Complete calendar page 64

THIS MONTH

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OPTOMETRY VIRTUALLY CONNECTED

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INSIGHT May 2025

7

NEWS

BULK OF OPTOMETRY CASES DUE TO CLINICAL CARE continued from page 3

about health practitioners were to guard against reprisals.

The bill will make it an offence to threaten, intimidate, dismiss, refuse to employ, or subject a person to other detriment or reprisal because they intend to or have made a notification or assisted people performing functions under the National Law. It will also be an offence to enter into a NDA unless the agreement clearly sets out, in writing, that it does not limit a person from making a complaint or assisting regulators and others performing functions under the National Law. In other changes, practitioners who have their registration cancelled, or who have been disqualified from applying for registration by a tribunal, will be required to obtain a reinstatement order from a responsible tribunal before applying for re-registration.

National Boards will retain their decision-making authority to decide whether to grant registration, as well as any conditions that a practitioner must comply with.

“Choosing a health practitioner is a critical part of protecting your health and wellbeing.

These reforms will ensure that people have access to the information they need to make an informed choice,” Ayscough said.

“These reforms provide strong new protections for patients and notifiers, while also providing clarity and consistency for practitioners seeking to have their

registration reinstated.”

The legislation was passed by the Queensland Parliament on 3 April 2025 as the host jurisdiction for all states and territories, and the changes will take effect on a date determined by governments.

The changes will be implemented over the coming year, allowing stakeholders time to prepare and for state and territory tribunals to establish necessary processes.

OPTOMETRY COMPLAINTS

PROFESSION

TOTAL 2023/24

Aboriginal and Torres Strait Islander Health Practitioner

2

Chinese medicine practitioner

6

Chiropractor

16

Dental practitioner

47

Medical practitioner

472

Medical radiation practitioner

8

Midwife

11

Nurse

320

Occupational therapist

9

Optometrist

3

Osteopath 14 Meanwhile, the latest Ahpra complaints Paramedicine 39 data shows the number of optometrists with Pharmacist 32 complaints made against them is the highest in five years.

Physiotherapist 32 The figures were contained in the Podiatrist 6 Optometry Board of Australia 2023-24 Psychologist 139 annual report. During that period, there were TOTAL 2023/24 1,156 75 complaints, or notifications, about 69 Ahpra notifications received about boundary violations in 2023-24. Source: Ahpra. optometrists made Australia-wide.

There were 34 notifications closed during That’s the highest number during the past the period, with the majority requiring no five years when there were complaints further action. Breaking this down, the data about 55 optometrists in 2019-20, 44 in shows 17.6% of closed optometry cases had 2020-21, 61 in 2021-22 and 57 in 2022-23. conditions imposed on their registration, At the same time, however, the number of 38.2% were referred to another body or optometrists has risen sharply. retained by a health complaints organisation, Five years ago, there were 6,043 and 44.1% required no further regulatory optometrists in 2019/20. Now there are action, including where the practitioner has 7,051 – a 16% rise during that period. taken steps to address the issue.

And year-on-year (2022-23 vs. 2023-24) Complaints against medical professionals there are 4.3% more optometrists. also reached a five-year high. In 2023-24 The bulk of complaints in the latest data there were 11,207 notifications about 8,418 related to clinical care (50%), followed by medical practitioners Australia-wide. That’s communication (13%). Behaviour, offence almost 1,200 more than 2019-20 when against other law, and documentation there were 7,254 medical practitioners with accounted for 5% each, and 21% were an allegation against them. categorised as other.

'SHOULDN’T NEED A LAWYER TO GO TO A HIGHER PAYING JOB' continued from page 3

training staff, and maintaining confidential business practices.”

He said while the news of potential abolishment of non-compete clauses would depend on the election outcome result followed by being passed in parliament, removing them could be an “opportunity for independent optometry”.

“The devil will be in the detail and we’re keeping a close eye on these developments from both an employment and acquisition perspective at ProVision over the coming 12 months.”

Chalmers said Labor would also close loopholes in competition law that currently

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INSIGHT May 2025

allowed businesses to use “no-poach” agreements to block staff from being hired by competitors.

He noted Treasury’s Competition Review heard troubling accounts about the misuse of noncompete clauses, including minimum wage workers being sued by former employers and workers being threatened with legal action if they switched jobs.

Insight understands non-compete clauses are less prevalent in optical dispensing contracts.

“Australians shouldn’t need a lawyer to go to a higher paying job. Even where noncompete clauses are legally unenforceable, they can lower worker mobility,” Chalmers said.

Overall, he said the restrictions prevented

Non-compete clauses are common in optometry contracts.

Image: Ground Picture/ Shutterstock.com.

workers from “setting up their own shop and pursuing entrepreneurial ambition”.

The ban on non-compete clauses would apply to workers earning less than the high income threshold in the Fair Work Act (currently $175,000).

If re-elected, the government will consult on policy details, including exemptions, penalties, and transition arrangements. It will also consider and consult further on non-solicitation clauses for clients and co-workers, and non-compete clauses for high income workers.

Following consultation and passage of legislation, the reforms would take effect from 2027, operating prospectively to give businesses and workers time to adjust.

OPTOMETRY AUSTRALIA LAUNCHES ‘OOO’ MYOPIA CAMPAIGN Optometry Australia (OA) has launched a myopia awareness campaign called ‘Off Screens, Outside, Optometrist’ (OOO).

The initiative, which is supported by HOYA and other industry partners, was produced in collaboration with Society Studios and created in response to the projections from an Australian-led study showing that, in 15 years, half of Australians are predicted to have myopia.

The OOO campaign uses “a vocal sting”: ‘Off Screens, Outside, Optometrist’, designed to “become an ear worm” in the minds of Aussies and join the vernacular encouraging healthy behaviours that will help manage, reduce, or prevent myopia risk.

OA CEO Ms Skye Cappuccio said the campaign was created off the back of new consumer research conducted with UNSW showing that public awareness and understanding of myopia remains very low.

“In the latest survey in November 2024, 21% of the survey respondents had never heard about myopia, while 32% had heard about myopia but were unaware of myopia symptoms. Concerningly, a large majority

(85%) of respondents were unaware of myopia control options or treatments.

“By spreading awareness of OOO, our mission is not only prevention but early diagnosis and management of the condition, in a bid to halt its projected rise and limit the serious pathological changes associated with high levels of myopia.”

HOYA, the campaign’s diamond sponsor, and other industry partners have collaborated to ensure this campaign can reach as many Australian families as possible. The company broke new ground when in 2020 it released MiYOSMART lenses with specialised D.I.M.S. Technology to provide 60% reduction in the progression of myopia.

“We have been a partner to eyecare professionals in Australia for over 50 years and are proud to join Optometry Australia’s important and timely OOO campaign,” said Mr Craig Chick, managing director of Hoya Lens Australia. ”With our evidence-based spectacle lens treatment, we support optometrists in providing Australian children better futures through the prevention, diagnosis and

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Part of the campaign’s goal is to make eye exams as routine as dental check-ups.

The campaign will provide professionals with tools to educate families and implement effective myopia management strategies.

A dedicated myopia microsite will offer downloadable resources, fact sheets, management guides, and videos designed to equip optometrists with the tools they need to excel in myopia care.

To augment the OA campaign, HOYA is also launching its own MiYOSMART consumer campaign from May 2025, to further raise awareness of myopia and the importance of early treatment for children, and choose products backed by evidence.

Running from 7 April to the end of June, the ‘OOO’ campaign will go live across out-of-home, digital and social media channels, with the aim of reaching families and ensuring they take the simple actions to help reduce the cases of myopia.

As part of the partnership, HOYA will also collaborate with OA to provide education and training at various events and clinical conferences.

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NEWS

OPTHEA DISCONTINUES nAMD TRIALS AS COMPANY SOLVENCY IN SPOTLIGHT

IN BRIEF G&M DEAL German ophthalmic device manufacturer OCULUS has appointed Ophthalmix as its new distributor for Australia. The manufacturer – famous for the Pentacam family, Myopia Master, Keratograph 5M and many other instruments – confirmed the move in April 2025. Ophthalmix was established in 2024 by Mr Brad Grills, the son of the late Mr Richard Grills who founded Designs For Vision in 1978. Securing OCULUS is a major win for the distributor. “In a short period of time, we have pulled together some amazing manufacturers and, certainly with respect to the others, OCULUS is our marquee brand,” Brad Grills said. “My relationship with OCULUS goes back decades, so it’s fantastic to be back together with them. Ophthalmix is a new name however our relationship-driven business model combined with experienced familiar faces and cutting-edge technology is something we are excited about.”

INDIGENOUS AWARD A Torres Strait Islands woman on track to become the first female indigenous ophthalmologist has been named the Australian National University’s (ANU) 2025 Alumni Volunteer of the Year for her commitment to community service and contributions to indigenous ophthalmology. Dr Hannah Wood felt “very privileged to have been nominated for this award, let alone receive it. I am so excited for the future of ophthalmology in this country”. After studying politics at the university and working as a parliamentary researcher, Dr Wood returned to the university to study medicine. Today, her team at the Ear Eye hospital runs an outreach clinic through the Victorian Aboriginal Health Service. This means care is supported and guided by an Aboriginal liaison officer, so that as much care as possible “can be facilitated in a more culturally safe and comfortable environment”.

RAYNER DOUBLES UP Rayner – a global leader in solutions for cataract surgery – has completed an extensive expansion of its Worthing production facility in the UK, doubling the number of intraocular lenses (IOLs) it can manufacture annually to four million. Since opening its purpose-built manufacturing facility in 2017, every Rayner IOL has been produced in Worthing, including more than six million RayOne fully preloaded systems. “This development enables us to uphold our rigorous quality control standards as we continue to grow, including four meticulous inspections of every single IOL,” Mr Tom Heron, head of manufacturing, said. “Combined with the opening of our new global warehouse near Gatwick Airport in 2024, this expansion reinforces our commitment to an uninterrupted supply for customers worldwide.”

10

INSIGHT May 2025

Dr Megan Baldwin (top right) has been the driving force behind the company for about a decade.

Images: Opthea, Shutterstock.com & stock.adobe.com.

Melbourne biopharmaceutical company Opthea has abandoned efforts to develop its therapy sozinibercept for neovascular age-related macular degeneration (nAMD), after two pivotal trails failed to meet their primary endpoints.

It comes after the ASX- and Nasdaq-listed firm first revealed on 24 March 2025 that its Phase 3 COAST (Combination of OPT-302 with Aflibercept Study) trial was not able to show a mean change in best corrected visual acuity (BCVA) from baseline to week 52.

The negative result prompted the company to warn that its solvency was now in question.

Opthea then brought forward the announcement of topline results from its second Phase 3 trial ShORe (Study of OPT-302 in combination with Ranibizumab) for nAMD. On 31 March, it revealed this also failed to meet its primary end point.

Both COAST and ShORe were evaluating the efficacy and safety of sozinibercept in combination with aflibercept and ranibizumab, respectively, compared with standard-of-care monotherapy.

“We are disappointed that COAST and ShORe did not demonstrate the improvements in vision with sozinibercept combination therapy compared to standard-of-care that we had hoped for,” said Opthea CEO Mr Frederic Guerard.

“We are grateful to all patients, clinical investigators and their staff around the world who participated in the sozinibercept Phase 3 clinical program, and for their contributions in investigating new treatments for wet AMD.” Opthea, along with its Development Funding Agreement (DFA) investors, have now decided to “discontinue the

development of sozinibercept in wet AMD with immediate effect”.

The company’s future still remains uncertain, and comes as a significant blow and surprise for its founders, staff and shareholders.

As recently as December 2024, Guerard was quoted saying he was “fairly confident” the therapy would be on sale and in paying customers’ eyes by early 2027. But warned: “As a biotech, I don’t know if you ever exit the valley of death. It’s a tough business. But we’re in a very good place.”

One of its biggest backers, Regal Partners, has since written off hundreds of millions of dollars invested in Opthea.

“The company’s management team were so confident of success they were able to attract some of the leading experts of the industry to join the company in the last 12 months,” co-founder Mr Phil King said in a letter to investors.

Given these developments, Opthea said it remained possible that under the DFA it could be required to “pay a multiple of the amount funded by the DFA investors” that would have “a material adverse impact on the solvency of the company”.

It could be required to pay up to US$680 million (AU$1.08 b) to development fund investors.

“As previously disclosed, termination can be triggered by a range of events, including, among other things, Opthea’s insolvency, in which case Opthea will be obligated to pay a multiple of the amounts funded by the DFA investors,” a statement said.

Opthea is continuing “to explore possible options to deliver the best outcome for the company and its shareholders”.

The company estimated it would have unaudited cash and cash equivalents of US$100 million (AU$166 m) at the end of March 2025.

“In light of these matters, there remains material uncertainty as to Opthea's ability to continue as a going concern. Discussions with the DFA investors are ongoing and Opthea cannot be certain as to the outcome of those discussions or when that outcome may become known.”

Trading in Opthea shares was suspended on the ASX until it was in a position to provide the market more clarity on these issues and the impact of its financial position.

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NEWS

OPTOS MONACOPRO 'NEXT GENERATION' DIAGNOSIS TOOL

BAUSCH + LOMB RECALLS ENVISTA ENVY IOL IN ANZ Bausch + Lomb has confirmed a 27 March 2025 voluntary recall only relates to the new enVista Envy intraocular lens (IOL) in the Australia They represent an “extremely and New Zealand small percentage” of implanted region. lenses. Image: It comes after OleksandrShnuryk/ the company Shutterstock.com. announced a recall of IOLs on its enVista platform, a move “taken out of an abundance of caution” after reports of complications, the cause of which could not immediately be explained at the time of writing.

It relates to an increased number of reports of toxic anterior segment syndrome (TASS) with enVista Aspire and enVista Envy IOLs, and certain enVista monofocal lenses in the US. While the recall affects multiple IOL lenses in other countries, B+L’s ANZ business said it was limited to the enVista Envy in Australia and New Zealand, which only became available in recent months.

For example, the enVista monofocal is part of the recall overseas but those lenses are still safe to use in Australia and New Zealand, due to it being a different model.

“We look forward to addressing this situation as soon as possible and being able to provide the enVista Envy again to surgeons and patients across Australia and New Zealand,” B+L ANZ business manager Mr Chad van Staden said.

The company’s chairman and CEO Mr Brent Saunders said: “As much as we believe in the enVista platform, patient safety will always be our number one priority."

All enVista TASS cases reported to B+L responded quickly to treatment, and none have required removal of the lens, the company reported.

“These reports represent an extremely small percentage of implanted lenses, with a positive prognosis for everyone involved,” Saunders said.

“We look forward to identifying a root cause and bringing the enVista platform back to market.”

12

Optos has launched MonacoPro, describing it as the next generation in ultra-widefield (UWF) SLO and spectral domain retinal imaging.

Building on the legacy of its existing Monaco system, MonacoPro introduces features designed to elevate diagnostic precision, and streamline workflow for eyecare professionals.

“MonacoPro represents our commitment to continuous innovation in ophthalmic imaging,” said CEO Mr Robert Kennedy.

“With new advancements in automation, and data analysis, we are empowering clinicians with tools that enhance efficiency and diagnostic confidence while maintaining our industry-leading ultra-widefield imaging capabilities.”

Optos said the system came with some key features, including OCT image quality providing highly detailed and precise retinal images that “meet the needs of even the most demanding eyecare practices”.

“With MonacoPro, practitioners can visualise and analyse retinal layers with greater accuracy, supporting diagnosis and treatment planning.

"When combined with the integrated 200° single-shot optomap imaging, MonacoPro increases the identification of macular pathology when compared with fundus imaging alone by 29.4%.”

It also marks the introduction of the

MonacoPro introduces features designed to elevate diagnostic precision. Image: Optos.

AreaAssist tool designed to improve the efficiency of retinal imaging workflows.

It enables users to automatically measure continuous areas of matching colour and adjust the sensitivity of the selected area with a simple click and drag of the mouse.

“By automating and simplifying these processes, AreaAssist removes the need for time-consuming manual tasks, allowing practitioners to focus on patient care and clinical decision-making,” Optos stated.

Optos chief product officer Mr Bradley Yates said AreaAssist would improve the speed and efficiency of any provider, even when the lesions may be more complex.

MonacoPro will be available in Australia from May 2025.

It will be launched at ODMAFair25 in June where attendees can take part in live demonstrations.

RECYLING 'FIRST' PAVING THE WAY FOR AUSSIE OPTICAL INDUSTRY

Each pair of glasses is broken down and reused and repurposed into new products, including pavers. Image: Specsavers/Opticycle.

Specsavers is partnering with Opticycle, seeing the introduction of what it says is the first end-to-end recycling solution for glasses and lens waste for the national optical industry.

The company is expecting to recycle more than 50 tonnes of glasses and lens waste through the program each year, which includes used customer glasses, discontinued display frames, demo lenses and swarf (offcuts from the glazing process), ensuring all product materials are responsibly recycled into new products in Australia.

Specsavers ANZ head of sustainability, Ms Cathy Rennie Matos, said finding a viable recycling solution had been a top priority, but came with challenges.

“Firstly, we wanted to make sure that the materials from our products are kept in circulation for as long as possible and don’t end up in landfill, and unfortunately only a small percentage of glasses can actually be reused by charities. Secondly, our customers want to be able to return their glasses when they no longer need them and know that they are being responsibly recycled,” she said.

“We’ve spent the past two years working with Opticycle to develop a solution and pilot a program with our stores and Melbourne-based glazing lab.”

Opticycle also provides reporting and data that allows Specsavers to trace material flows through the processing facility and provides visibility of where product waste goes.

INSIGHT May 2025

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PROFILE

At the helm, in a storm

New ASO CEO Katrina Ronne has a long list of political priorities.

KATRINA RONNE’S loyalty and commitment to the Australian Society of Ophthalmologists have been recognised in her appointment as the new CEO. A host of issues await her, as she fights for the interests of her members and patients.

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Image: ASO.

P

rotect the status quo, protect the ophthalmologist-patient relationship.

The aims of the Australian Society of Ophthalmologists’ (ASO) new CEO sound simple enough, but under the hood there’s a quagmire of critical issues for her to address – each threatening the way ophthalmologists go about their business.

“The turbulence within the private health insurance space is particularly concerning right now,” says Ms Katrina Ronne, who took the reins on International Women’s Day (8 March 2025).

“We’ve seen that build, peak and trough over the last 15 years, but the intensity is reaching a boiling point. We’re now seeing health insurers vertically integrate and showing a strong interest in purchasing or setting up hospitals, heading further down the road of ‘managed care’.”

There’s also tension between health funds and private hospitals, some who are scaling back or closing in the face of rising costs. Elsewhere, the ASO and other bodies are perplexed over the way overseas-trained specialists are being funnelled into the country, and the general health of public ophthalmology services.

It’s clear there’s plenty for Ronne, the ASO’s first female CEO in its 43-year history, to sink her teeth into. But there’s arguably no one more equipped after serving as the ASO’s general manager of policy and strategy for much of the past decade.

She’s always had a keen focus on medico-political issues, having previously worked for the Australian Salaried Medical Officers Federation Queensland and Salaried Doctors Queensland.

It means she has compiled countless submissions, driven campaigns and spent a lot of time in Canberra fighting to have the ASO’s voice heard. She’s gleaned a lot from outgoing CEO Mr Kerry Gallagher AM, who will stay on the ASO Board as executive vice chair.

“He has many strengths, one of those being his leadership. They are obviously big shoes to fill,” Ronne says.

She joined the ASO at a crucial time following the infamous 2009 ‘Grandma’s Not Happy’ campaign that prevented a Medicare rebate cut to cataract surgery. There’s been many more victories along the way, including preventing health funds from forcing specialists to confirm if a procedure is medically necessary (pre-approvals), and securing a Medicare item for minimally invasive glaucoma surgery (MIGS).

“For me, making a practical difference in the way ophthalmologists practise and the subsequent impact on patients is what I am really proud of.

Some of the more meaningful work has been about protecting the status quo of Australian healthcare,” Ronne says.

“Fostering that relationship between ophthalmologists and their patients is a primary goal of the ASO, and it always will be. We've been willing to get out there and engage and present those issues affecting our patients, and the credibility we have built continues to give us a seat at the table on a variety of policy issues.”

The ASO has been at the roundtable of many discussions about the state of private health in Australia.

It has been pushing for the Federal Government to establish a private health commission or independent authority, and after launching an e-petition with 268 signatures, met the threshold for Health Minister Mark Butler to respond.

The standoff between the Healthscope hospital group and health funds (now partially resolved), along with hospital closures and reduced surgical lists, all need urgent attention.

“We’ve seen a lot of regional hospitals close and now we're seeing a lot of hospitals say to our doctors they’re not interested in certain procedures that don't deliver as much income back into the hospital," Ronne says.

“Oculoplastics procedures are one example; they’re being given less priority than higher paying surgical procedures, which is scary for patients who can't access the care they need. If nothing is done now, it's only going to get worse.”

Increasingly, health funds are “interfering” in the patient care pathway, while tightening government budgets are eating away at public ophthalmology lists. In turn, there’s fewer opportunities for trainees.

Now, Ronne says the government is trying to patch this up by fast-tracking overseas trained specialists into Australia, with ophthalmology earmarked for some point in 2025.

“There is an ongoing risk our trainee doctors won’t receive enough surgical experience to pass their training, and we’re concerned by the government's approach to cherry-pick doctors from overseas settings.

“We have a distribution problem, but these doctors aren't being directed to those areas where we need them; they’re free to go anywhere, there’s no limitations.”

Gallagher described Ronne’s appointment as “historic” for the ASO, reinforcing that the organisation continues to evolve.

It’s something Ronne is equally proud of.

“I’m honoured to be the first female CEO of ASO. It comes as we continue to work to elevate women in ophthalmology.

“We are upholding the RANZCO Women in Ophthalmology tick for events with female representation exceeding 35%, the ASO recently appointed another female ophthalmologist to the ASO Board (Dr Tricia Drew), and we've also celebrated achievements of our female members through International Women's Day. “These are small steps, but they all encourage and inspire women in ophthalmology.”

INSIGHT May 2025

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MACULAR DISEASE

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Bulk billing – it’s good for business

Frequent intravitreal injections are vital to help many older Australians keep their eyesight, but the costs can be prohibitive. Insight assistant editor ROB MITCHELL speaks with those who have found ways to deliver bulk-billed services that maintain people’s vision and the practice’s bank balances.

D

r Devinder Chauhan is used to doing things a little differently.

When he arrived in Australia from Britain in 2006, the altruistic ethos of the NHS drove much of the ophthalmologist’s approach to his work.

Used to the collaboration that FFoften comes from necessity and working with stretched resources, he looked beyond his own cohort to how he could help others in the wider ophthalmic catchment.

“I didn’t know any better,” says the Melbourne-based Vision Eye Institute retinal subspecialist. “Unlike other Victorian retina subspecialists at the time, I basically went out to lots of optometrists to do teaching.”

When his work took him beyond Melbourne, to Victoria’s rural, regional and remote centres, he realised there were many patients who lived far beyond the city’s seemingly gated healthcare community.

“They couldn’t get to the clinic, so I hired a bus to get patients from Bairnsdale, Sale, Traralgon to bring them to Wonthaggi; I would treat them, give them eye injections and send them home.”

When he later retreated back behind the walls of that community in urban Melbourne, the bus journeys continued for those patients.

But Dr Chauhan realised that despite his efforts to ease access to these vital injections and other services, many people were still facing significant out-of-pocket expenses to treat their macular degeneration and maintain their vision.

“It became obvious that there's a whole bunch of patients for whom cost was a significant issue.”

That inspired him to set up a clinic in Boronia, in Melbourne’s east, in which intravitreal injection services are bulk billed, meaning no out-of-pocket cost to the patients.

That includes intravitreal injections for people living with neovascular age-related macular degeneration (nAMD), and other forms of macular disease, most of whom are pensioners on fixed incomes.

The only cost is $7.80 for the drug administered, which is the cost of the

“Even when the country is not in a cost-of-living crisis, accessing affordable or bulk-billed treatment is an insurmountable problem for too many.”

Dr Kathy Chapman Macular Disease Foundation Australia

ABOVE: The cost of intravitreal eye injections to manage macular degeneration can discourage many older Australians from continuing treatment.

prescription at the pharmacy, subsidised via the Pharmaceutical Benefits Scheme. Patients don’t pay for scans or consultations. The injections, including the time and expertise of Dr Chauhan and others in his team, are covered by Medicare.

Those injections, item 42738 in the Medical Benefit Schedule, are currently reimbursed at $342.65 in the schedule.

Under the schedule’s calculations they are paid out at 85% benefit in ophthalmologists’ rooms ($291.30) and 75% benefit in a private hospital/ day surgery ($257).

Dr Chauhan and NSW colleague Professor Mark Gillies believe that this arrangement is financially sustainable while preserving patients’ vision.

Especially when those patients may need those injections regularly and frequently for the rest of their lives, and the procedure can be done in barely a few minutes.

But most ophthalmologists and other specialists do not accept the rebate.

Because of the limited capacity of the public system to provide these injections – and with more than 90% of ophthalmologists working in private healthcare – patients have little choice other than to see and pay for a private specialist.

Most of those private practices do not bulk bill for the injections, often only doing so in exceptional cases, meaning the cost of the appointment can be three or four times higher than the Medicare fee. In some parts of Australia, that means patients may have to pay $1,000 or more, or more, with part of that refunded by the rebate and any additional rebates after reaching Medicare Safety Net thresholds.

A PLAN FOR CHANGE That is something Macular Disease Foundation Australia (MDFA) is hoping to change.

In its 2019 economic modelling report, MDFA found that intravitreal injections were primarily delivered in private ophthalmology clinics in Australia, with only around 20% of them offering bulk billing, leaving more than 72,000 people with no choice but to pay out-of-pocket cost.

It believes the magnitude of that higher cost is felt beyond the practice and the patient.

MDFA says there are an estimated 1.9 million people in Australia with some form of macular disease. In 2023, more than 108,000 people with a treatable macular disease, including nAMD, diabetic macular oedema, and retinal vein occlusion, received eye injection treatment. The total annual economic cost of vision loss in Australia is estimated to be $16.6 billion.

INSIGHT May 2025

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MACULAR DISEASE

MDFA says just 20% of ophthalmologists allow bulk billing to pay for intravitreal eye injections.

Image: kerale/shutterstock.com.

SPECIAL REPORT

It says that, for almost one in 10 Australians who receive eye injections, the cost of living with their condition, including eye specialist appointments, injections and vision aids, is more than $6,000 every year.

Many of those are on a fixed income. For those paying out of their own pocket, the median total cost equates to 12% ($3,621) of their annual government pension.

As with so many other areas in healthcare, that cost increases for those living beyond the main centres.

For people living in those regional and rural communities, the median total annual cost was over $400 more per person compared with those in major cities.

The highest cost is more than $1,700 more per year for people living remotely, compared with people living in a metropolitan area ($8,911 vs $7,127).

Boronia-based Dr Chauhan understands what that gap in cost and access means for many of his clients.

“I have patients who live in Queensland and Tasmania for whom, if they book the flight early enough, it’s cheaper to fly here, have an injection and go back,” he says.

“It's cheaper for people to fly interstate than it is to have injections, because in the really expensive states, New South Wales and Queensland, they literally charge them $1,000.”

MDFA says that higher cost leaves many pensioners around Australia with less money in their bank accounts for rent, bills, food and other essential life expenses.

For some it means making a choice between their eyesight and paying household bills.

'Treatment persistence' is a significant problem in Australia, with approximately 50% of people stopping the injections within five years of starting them.

MDFA CEO Dr Kathy Chapman says its findings highlight that cost and access are the two main reasons people delay or stop treatment.

“Our research underscores the immense financial pressure that these high costs have on people living with macular disease who rely on their pension payments to get by,” she says.

“Even when the country is not in a cost-of-living crisis, accessing

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INSIGHT May 2025

affordable or bulk-billed treatment is an insurmountable problem for too many low-income earners, pensioners, and self-funded retirees.”

That is why it believes a small investment of $11.1 million into Medicare would save the country $140 million annually in disability, aged care and other related health system costs.

Under the MDFA proposal, all ophthalmologists who bulk bill eye injections for eligible pensioners with neovascular age-related macular disease would be eligible to receive an incentive payment from the Federal Government.

That would be $100 per eye injection service per patient with a pension card.

If the patient needs injections in both eyes and this is performed on the same day in the same service, the reimbursement is $50 for the second eye.

Dr Chauhan and Prof Gillies both believe the incentive could make a difference and increase the number of specialists prepared to bulk bill for the injections. Although the former is a little sceptical that professionals used to charging $1,000 or more for the procedure will be happy to take half of that, even with the extra incentive.

SUSTAINABLE BUSINESS MODELS But they insist bulk-billed injections are viable from a business perspective, even without that incentive. Even if both have different ways of arriving at that conclusion.

Every Tuesday at Dr Chauhan’s Boronia clinic, he and a colleague are solely focused on intravitreal injections.

The procedure itself takes barely five minutes, but the patient will spend about 30 minutes in the clinic as they see several people for tests and consultations.

“They go in to see an orthoptist or a technician, who will measure their visual acuity and ask them some questions about their health,” he says.

“They also get their intraocular pressure measured, have questions asked about how their eyes are going, and whether they have any problems at all. If there's something that needs attention, I see them before we even consider having an injection.

"Everybody gets a scan of both eyes every visit.

“And then they'll go through and have anaesthetic drops, antiseptic washes – then they'll come through and we work between two rooms, assessing their scans and making decisions about their treatment before injecting.”

The testing and access to diagnostic equipment are free.

With Dr Chauhan and his colleague getting through between 100 and 120 patients a day, the practice can make up to $32,000 from the bulk billing.

The rest of the week is devoted to other retinal and general ophthalmology services, and those wanting injections who were unable to make the Tuesday clinic.

Many of those people will be back in a few weeks, and frequently, with MDFA numbers showing that people receiving eye injections for nAMD

“I'm never quite sure whether the proponents of the MBS actually realise that it is like trading in 1948 shillings rather than 2025 dollars.”

Dr Peter Sumich Australian Society of Ophthalmologists

Image: Mark Gillies.

Image: Devinder Chauhan.

have, on average, six treatments per year, usually for the rest of their lives.

Dr Chauhan acknowledges that might sound a little like “factory work”, but “patients appreciate the efficiency, consistency and respect for their time; they are in the clinic for 30 minutes or less”.

But he believes it is a good, sustainable business model, one that supports a clinic and eight staff, all while helping patients to hold on to what vision they have left.

Prof Gillies and his colleagues at Sydney Eye Hospital and Safe Sight Institute take a very different route to the bulk-billed patient journey – a public-private partnership.

He says the public health system is not set up to do intravitreal eye injections.

“The trouble with the injections is that they came in about 15-20 years ago, whereas public hospitals are modelled on diseases and their treatment from about 40 or 50 years ago, and the traditional way you learn in medical school.

“The public hospitals just didn't want to know about it,” he says. “It was too difficult to cope with; they would have had to set up big clinics and motivate doctors to do injections in these clinics . . . and it’s monotonous and quite hard work.”

Monotonous, hard, but important.

So patients at Sydney Eye Hospital are referred to the private Save Sight Institute, which conducts injecting clinics funded by Medicare.

“They can do high-volume clinics where people just do nothing but inject, inject, inject.”

That volume – a professional at the clinic can do about four injections every 15 minutes, 16 an hour – means the clinic is financially sustainable.

Those patients are then monitored by Prof Gillies and his colleagues in the public system. “We'll see them around their third injection and assess them – is the lesion active, is the injection interval too long, do we need to shorten the interval? Or is it stable?”

He says it is no secret why many of Australia’s healthcare specialists – not just ophthalmologists – do not offer bulk billing. And not just for intravitreal eye injections.

“Most specialists in any area of medicine in Australia do not choose to make less money.”

He believes the incentive promoted by MDFA might encourage more to lean on Medicare to fund the injections.

“If it does cost you $10 million, so that means you subsidise 100,000 injections, then that is probably worthwhile.”

But the government needs to address fundamental inadequacies in the Medicare system.

“Specialists hardly bulk bill at all because the rebate doesn't go up with inflation,” says Prof Gillies. “It’s a cost-cutting thing. So if it doesn't go up, the doctors aren't going to bear the cost. I don't think that's fair.”

Australian Society of Ophthalmologists president Dr Peter Sumich agrees.

“Ophthalmologists don't offer bulk billing as a standard, due to the same reasons they generally don't rebate every patient,” he says. “The Medicare rebate schedule is out of date and an imaginary number.

“In general the schedule fee in Medicare for all item numbers hasn't been indexed or increased to represent inflation, wages and the Consumer Price Index. I'm never quite sure whether the proponents of the MBS actually realise that it is like trading in 1948 shillings rather than 2025 dollars.”

He believes the MDFA proposal might be good for “an adjunct public hospital clinic set up nearby where infrastructure is provided by the hospital”.

But it may not work in private ophthalmology because it is simply a lump-sum practice incentive payment that would not allow for “difference billing”, the ability of a practice to seek a top-up from the patient to cover costs.

ABOVE, L TO R: Dr Devinder Chauhan runs a practice which focuses solely on bulk-billed eye injections once a week; Professor Mark Gillies favours a public-private partnership to deliver injections at no cost to patients.

SHOW ME THE MONEY Whether the government takes up the MDFA proposal remains to be seen.

Whether it might be a success is yet to be tested.

The current reality is that the system relies on the innovation and altruism of a handful of professionals, including Dr Chauhan and Prof Gillies, to try to prevent too many people falling through the gaps and losing their vision.

Other specialists do allow some of their patients to pay through Medicare.

They make judgements based on what they see before them, says Prof Gillies.

“I probably bulk bill about a third of my patients based on a personal basis. I’m not sure if I've got it right or wrong, maybe I'm charging people who are poor, you never know. It's very difficult – people aren't going to declare their income to you, but you just make a judgment.”

Dr Chauhan says many specialists do this so they can feel like they are making some contribution.

But perceptions can be wrong. And dangerous.

“Older blokes, particularly, and women too, will dress up to see the doctor,” he says. “And they would not dream of saying to a doctor, ‘oh, it's expensive. I can't afford it’. So they just shut their mouths, and then they're suffering outside the clinic.”

Suffering internally as well.

He sees plenty of patients from other clinics who should be having the injections every four to six weeks but have probably pushed it out to eight or more, simply because of the prohibitive cost.

Both Dr Chauhan and Prof Gillies are adamant that this is about one thing: money. But both are also adamant that there’s enough to be made, even if practices don’t go down the high-volume route.

Dr Chauhan wants it made clear that he’s not against specialists making money.

He acknowledges he’s certainly not struggling: he’s working from home as he talks with Insight, in the wealthy, pinot-producing Red Hill region of the Mornington Peninsula.

The success of his career, practice, even the bulk billing arrangement, has allowed him the freedom and time to develop Macuject – clinical decision support software to help “optimise treatment” for wet AMD patients.

He’s hoping to sell it into the massive US healthcare market, where healthcare costs are even more prohibitive.

It’s just that he and Prof Gillies believe professionals and practices can make enough while not undermining their patients’ health.

“I'm very happy to contribute towards patients not losing out, not having to choose between losing their vision and eating or keeping their vision and not eating,” says Dr Chauhan.

INSIGHT May 2025

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Image: And-One/Shutterstock.com.

MACULAR DISEASE

An “alarming” 29% of macular disease patients are less satisfied with life because they can no longer drive.

But can I still drive?

Macula Month is an annual campaign spearheaded by Macular Disease Foundation Australia to raise awareness and understanding of macular disease – the country’s leading cause of blindness and vision loss that can impede one’s ability to drive.

C

onversations about a patient’s ability to maintain a driver’s licence are among the toughest in an eyecare professional’s career.

For those with macular disease, the psychological impact of stopping driving runs deep, and is something Macular Disease Foundation Australia (MDFA) has laid bare in new research as part of this year’s Macula Month campaign in May 2025.

In collaboration with the UNSW School of Optometry and Vision Science, MDFA’s survey of close to 1,500 Australians living with macular disease found the high majority (79%) who have stopped driving due to vision loss feel less independent, with more than a third (38%) feeling socially isolated as a result.

While these findings may not come as a big surprise. Some sobering numbers show an “alarming” 29% of people with macular disease are less satisfied with life because they can no longer drive.

Plus, more than half (56%) of those who were still driving were very concerned about losing their driver’s licence, with 73% indicating they are worried about losing their independence if they stop driving. Almost one in three (28%) drivers have someone who relies on them to do so.

Other ways driving cessation has impacted respondents, according to MDFA’s study, included feelings of becoming a burden on others, inconvenience when having to find alternative means of travelling, and not being able to participate in hobbies due to travel distance.

In 2024, MDFA launched a new service called Eye Connect, which provides people with AMD tailored support and information to navigate their diagnosis, including the possibility of giving up driving.

“Our Eye Connect support team receives many calls from people in the macular disease community who are distressed about having to stop driving because of their vision loss,” said Dr Kathy Chapman, MDFA CEO. “Our research emphasises the significant impact this lifestyle change can have on people’s mental health and well-being, which is largely due to a loss of independence and social isolation because they feel like going out or travel has become too difficult.”

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INSIGHT May 2025

In a separate survey, MDFA asked the broader Australian community how being forced to stop driving due to vision loss would impact them. The YouGov survey of more than 1,000 people aged 50-70 years revealed that stopping driving due to blurred or loss of central vision is the activity people would miss the most, ranking higher than losing the ability to read (71%), watch TV and movies (69%), and even continuing to live independently (64%).

Eighty-five percent said they would be significantly or somewhat impacted if they couldn’t drive anymore, including 70% who said it would significantly affect their independence, sociability and ability to perform daily routines.

Nearly half (45%) ranked loss of sight as their number one health concern, with 92% finding it among their top three health concerns. Loss of memory ranked second (35%), followed by loss of a limb/mobility (15%).

“Our free Eye Connect service can help people prepare for a life without driving and provide ongoing support to them during what can be a difficult transition," Dr Chapman says.

“Ninety-three percent of the people who join Eye Connect remain active, so we know that people are finding the service of value for guidance on how to transition to a life without driving, as well as general challenges or questions they have about living with macular disease.”

Some practical steps patients can take include: • Looking for local services or social activities closer to home.

• Making use of transport services offered by local community organisations and councils to get to shopping centres and other important destinations.

• Researching and familiarising themselves with public transport options in their area.

• Driving in the daytime only, when nighttime driving is too risky.

NOTE: Eye health professionals can refer patients to Eye Connect to find out more about how to navigate the changes in driving ability. Visit mdfoundation. com.au/health-professional/refer-to-eyeconnect, refer via Oculo or call MDFA on (AUS) 1800 111 709. Patients can also self-refer via MDFA’s website or over the phone.

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CPD – MACULAR DISEASE

ABOUT THE AUTHORS:

Jennifer Chin

BSc (Vision Science), BOptom (Hons) Research liaison officer, CUREOS Research Network

Exploring geographic atrophy: Managing patients and progress in treatments

Historically, a geographic atrophy diagnosis left patients with little hope as their condition worsened, but that’s changing as the first therapies emerge. Optometrists will play a pivotal role in identifying these patients, referring them for treatment, and even managing expectations.

Dr Long Phan

BPharm, MOrth, PhD Research officer, CUREOS Research Network

Prof Andrew Chang AM

MBBS (Hons) PhD FRANZCO FRACS Vitreoretinal surgeon and ophthalmologist Medical director, Sydney Retina Clinic Head of ophthalmology, Sydney Eye Hospital Clinical Associate Professor, Sydney University Conjoint Professor, Discipline of Surgery, UNSW

CLINICAL CPD HOURS This activity meets the OBA registration standards for CPD

LEARNING OBJECTIVES: At the completion of this article, the reader should be able to ...

• Manage patient expectations and adherence to treatment, in light of new and emerging product approvals • Identify key patient eligibility criteria for potential treatments • Learn how advanced diagnostics aid in monitoring GA progression • Recognise the role of optometrists in diagnosing and managing GA patients.

Images: Andrew Chang.

D

uring the past two years, the global ophthalmic sector has welcomed some major milestones that will bring significant changes in the way the eyecare providers manage patients with geographic atrophy (GA).

Historically a disease without a treatment, GA is an advanced form of AMD estimated to affect 1-2% of the population over the age of 50.1 It is characterised by progressive death (atrophy) of retinal cells. This results in loss of the photoreceptors, retinal pigment epithelium (RPE) and choriocapillaris (Figure 1).

In early stages, GA does not usually affect the fovea, so patients may only experience scotomas.

However, as it progresses and atrophic lesions extend into the fovea, central vision will be lost. This deterioration commonly impairs essential visual functions, including reading, driving and facial recognition, significantly impacting quality-of-life. 2 The diagnosis of GA has traditionally signified inevitable, irreversible vision loss with natural progression of the disease. Management has primarily focused on monitoring for the onset of neovascular (or ‘wet’) AMD, patient education on prognosis, improving modifiable risk factors (e.g. smoking cessation and dietary adjustment), and the use of low vision aids to maximise remaining visual function.

But the outlook is becoming more promising after the US became the first country to approve GA therapies in 2023. The first was pegcetacoplan (Trade name: Syfovre, Apellis Pharmaceuticals, Inc.) soon followed by avacincaptad pegol (trade name: Izervay, Astellas Pharma Inc.). In January 2025, the Therapeutic Goods Administration (TGA) approved pegcetacoplan for the treatment of GA secondary to age-related macular degeneration (AMD) for Australian patients. Avacincaptad pegol is currently under review by the TGA. These developments have prompted RANZCO to update its Referral Pathway for Age-Related Macular Degeneration (AMD) Management in 2024. Regarding GA, they originally recommended optometrists explain the disease to patients, identify and improve risk factors, recommend use of an Amsler grid, optimise spectacles, refer to low vision support services as appropriate, and review them in six to 12 months, depending on individual needs.

Along with stakeholders such as Optometry

FIGURE 1: Geographic atrophy secondary to age-related macular degeneration. (A) Near-infrared imaging shows hyper-reflectance (white) in areas of GA. (B) Colour fundus photography shows hypo-pigmentation with underlying choroidal vasculature visible. (C) Fundus auto-fluorescence shows hypo-autofluorescence (black) in areas of RPE atrophy. (D) OCT shows absence of RPE and outer retinal layers with hyper-transmission of light into the choroid.

FIGURE 2: (A) Non-subfoveal and (B) subfoveal GA (yellow bracket) as determined on OCT. The centre of the fovea (red arrow) is identified using a combination of indicators such as a hyper-reflective spot and absence of inner retina layers.

Australia and the Macular Disease Foundation Australia (MDFA), the guidelines now advise patients to be offered appropriate counselling on new treatments for GA. If interested, they can then be non-urgently referred to an ophthalmologist for baseline imaging, to ensure atrophy is secondary to AMD and to establish a review or treatment plan.

Given these developments, it is now vital for optometrists to understand their role in the new GA landscape and be able to accurately diagnose and counsel patients.

MECHANISMS OF ACTION Complement pathways are part of our innate immune system and is responsible for regulating our inflammatory response, usually to injury or infection. Dysregulation of the complement system has been linked to the development and

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CPD – MACULAR DISEASE

FIGURE 3: Despite extensive macular atrophy, visual acuity remains good at 6/6 and patient demonstrates two points of functioning retinal sensitivity and central fixation on microperimetry exam (top left) corresponding to island of intact RPE.

progression of GA, with abnormal activation leading to inflammation and the eventual formation of a protein complex which directly damages the RPE cells of the retina leading to atrophy.3 Current therapies for GA aim to slow down the progression rate of GA by inhibiting different proteins that mediate the process of inflammation along the complement pathway. Pegcetacoplan inhibits complement factors C3 and C3b, whereas avacincaptad pegol inhibits the C5 protein. Both treatments are administered via intravitreal injection.

The efficacy of pegcetacoplan was demonstrated in the DERBY and OAKS Phase 3 clinical trials, where treated patients showed significant reductions in GA lesion growth compared to those receiving sham therapy over 24 months (19% and 22% with monthly injections, 16% and 18% with every other month injections, DERBY and OAKS respectively).4 Meanwhile, the efficacy of avacincaptad pegol was demonstrated in the GATHER1 and GATHER2 Phase 3 trials. In these studies, patients who received avacincaptad pegol 2 mg on a monthly basis showed reductions in GA lesion growth rate over 12 months by 35% in GATHER1 and 17.7% in GATHER2, compared to sham.5,6 Results from the GATHER2 Phase 3 clinical trial further demonstrated avacincaptad pegol continued to reduce the mean rate of GA lesion growth by 14% with monthly dosing and 19% with every-other-month dosing at 24 months, compared vs. sham.7

WHICH PATIENTS WILL BENEFIT FROM TREATMENT? There are three specific requirements so far that clinicians need to consider: 1. GA secondary to AMD

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FIGURE 4: Longitudinal progression in atrophy (orange) from initial presentation (A) to two years (B) and four years (C) using infra-red imaging and OCT. The patient retained good vision at 6/6 despite the lesion reaching the foveal centre (red).

2. An intact fovea 3. GA lesion growth posing a threat to central vision These were established after reviewing data from pivotal trials to determine which patients would benefit the most from therapy. Only a minimal added benefit of a higher dosing frequency was shown, so the two-monthly regimen was chosen for pegcetacoplan to reduce burdens experienced by patients receiving intravitreal injections. Similarly, long-term data indicate that avacincaptad pegol achieves optimal efficacy with an every-other-month regimen, highlighting the need to balance dosing schedules with treatment effectiveness and patient burden.

It’s important to note, the current therapies approved or in development do not reverse GA growth or restore vision, so patients with non-subfoveal GA will benefit more, since they are more likely to have good central sight to protect and maintain.

AMD OR OTHER MIMICKING CONDITIONS Clinicians need to exclude other diseases in which retinal atrophy occurs because the approved and emerging therapies have only demonstrated efficacy in GA due to AMD. A detailed medical and family history, combined with multimodal imaging patients will aid in the differential diagnosis of GA. The main group of diseases that commonly masquerade as GA are inherited retinal diseases (IRDs). Common examples include pattern dystrophies, Stargardt’s disease and Best macular dystrophy. These diseases are typically caused by genetic mutations which lead to progressive retinal degeneration, however there are more common presentations to consider, such as atrophy following chronic central serous chorioretinopathy, retinal detachment and secondary to retinal laser.

INTACT FOVEA Having an ‘intact fovea’ will be another important aspect of treatment eligibility. In clinical trials, GA lesions are classified as either ‘subfoveal’ or ‘non-subfoveal’ (foveal-sparing) based on the anatomic location of the atrophy relative to the fovea centre (Figure 2). However, we know that some patients can maintain good visual function, such as by using eccentric fixation, even though anatomically the central macula may be affected.

Since the severity of disease on imaging may not always reflect the patient’s visual function, clinicians should evaluate each individual patient on an anatomic and vision assessment to determine the threat of GA progression on vision by correlating structure and function.

CORRELATING STRUCTURE TO FUNCTION Visual acuity is the main measure of visual function, but for GA it may not provide entire prognostic information as patients may retain very good visual acuity even with significant anatomic macular involvement. Traditional measures of change in visual acuity may not be appropriate for outcomes of treatment as vision loss GA is progressive and irreversible. For these reasons, other measures of visual function need to be explored.

Microperimetry is a visual field test which examines retinal sensitivity in the macular region.

Using concurrent optical imaging inside the eye, microperimetry devices track eye movements to precisely examine function at specific spots on the retina. Aside from mapping areas of scotoma which correspond to RPE atrophy, areas of reduced retinal sensitivity which may indicate future areas of GA growth can be identified (Figure 3).

Other functional indicators which have a role in assessing GA patients include low-luminance visual

acuity, contrast sensitivity testing, reading speed testing and questionnaires to capture vision-related quality of life (for example, the Vision Function Questionnaire-25 (VFQ-25)). Patients have shown changes in these measures related to GA progression despite having good visual acuity.8

DOCUMENTING PROGRESSION OF GA Clinicians are now required to monitor GA progression over time using multimodal imaging (Figure 4). In practice, recommended modalities include OCT, FAF and fundus photography. While practitioners may not have access to all these equipment in their clinic, repeated scans on at least one imaging modality will allow progression to be documented. With a variety of imaging devices found in various practices, it is important to assess progression on the same device to ensure consistent measurement for the individual patient.

Increase in GA lesion area (mm2) is the main indicator for progression. Some devices automatically provide measurements of RPE atrophy, such as the Advanced RPE Analysis on the Cirrus OCT (Carl Zeiss Meditec. Inc., CA, USA) which is based on infrared (NIR) images, whereas others offer a semi-automated method such as the RegionFinder software on Heidelberg Spectralis machines which rely on FAF images. Aside from GA lesion area, the distance from the closest border of GA to the centre of the foveae can be an alternative indicator for vision threat especially combined with lesion size, and most modern imaging devices have built-in measurement callipers.

RISK FACTORS FOR GA PROGRESSION Aside from actually measuring progression over time, certain lesion characteristics may provide an indication on the risk for future progression.

Data obtained by optometrists over time will form a critical part of the ophthalmologist referral and their decision-making process. Characteristics known to be associated with faster rates of progression are multifocal lesions, larger lesion sizes, foveal-sparing lesions, presence of reticular pseudo-drusen, and perilesional hyper-autofluorescence patterns of the diffuse-trickling type.9 The presence of these signs may warrant more frequent monitoring to capture progression in a timely manner.

DISCUSSING TREATMENT WITH PATIENTS Safety Endophthalmitis, intraocular inflammation and retinal vasculitis are rare but the most severe vision threatening complications associated with intravitreal injections. Approved and emerging GA therapies have been shown to be well-tolerated, with low rates of adverse effects. However, in 2023 in the US, there have been rare real-world reports of intraocular inflammation following initiating pegcetacoplan.10 These cases are being studied carefully and the exact cause is yet to be elucidated.

No cases of retinal vasculitis or retinal artery occlusion have been reported as of yet following real-world use of avacincaptad pegol in the US.

Concurrent GA and Neovascular AMD Macular neovascularisation and atrophy often co-exist in the same eye in advanced AMD. However, clinical trials of GA treatment exclude patients with nAMD at the time of enrolment so the efficacy of treating GA in this population remains unknown. In some trials, patients receiving GA therapy who developed CNV were allowed to initiate intravitreal anti-VEGF therapy and safely continue receiving both treatments concurrently.5,6 Another concern observed in clinical trials was that there was a slighter higher rate of new-onset nAMD.4,5,6 Two year data in GATHER2 showed a 7.3% rate in CNV incidence for those receiving avacincaptad pegol every month and 4.3% on an every-other-month regimen, versus 5.4% in the sham group (total difference was 11.6% for avacincaptad pegol versus 9% in sham).7 However, the underlying mechanisms of this finding is still unknown. Routine monitoring for signs of macular neovascularisation is warranted in patients currently under GA therapy.

Challenges of adherence to therapy Intravitreal injection of both complement inhibitors once every two months is necessary to maintain efficacy. Since the treatments proportionally reduce GA growth rate, larger reductions in area growth are produced over time.

The GALE study (NCT04770545) is the long-term extension study specifically for

which may further benefit patients in the future.

Most of these investigational therapies still aim to slow progression by targeting different components of the complement pathway (for example, ANX-007, Annexon, Inc, NCT06510816), however there are some which target other pathways associated with GA (e.g. Tinlaberant, Belite Bio, NCT05949593).

Some upcoming therapies aim to address the burden associated with treatment, such as using gene therapy (JNJ-1887, Janssen Pharmaceuticals, NCT05811351) to provide long-term effects or oral therapy as a less invasive route of delivery (ALXN2040, Alexion Pharmaceuticals, NCT05019521). Other upcoming therapies aim to target more specific patients, such as patients with gene-defects associated with GA (VOY-101, Perceive BioTherapeutics, Inc, NCT06087458), in order to potentially provide increased efficacy.

Meanwhile, there is also work looking into earlier stages of AMD to explore biomarkers associated with GA development which will allow an increased understanding of the disease and may provide avenues for prevention of atrophy (HONU study, NCT05300724).

CONCLUSION GA is a progressive irreversible disease which often presents bilaterally and causes inexorable loss of central sight. Identifying these patients will maximise benefit of the therapies, which includes maintenance of visual function and quality-of-life.

Patients will need to be carefully assessed on an individual level using a range of modalities, with considerations for both function and anatomy in mind.

“UNTIL NOW, THE DIAGNOSIS OF GA HAS SIGNIFIED INEVITABLE, IRREVERSIBLE VISION LOSS WITH NATURAL PROGRESSION OF THE DISEASE. ” pegcetacoplan, showing a 28% reduction in GA growth rate after 48 months of continuous treamtemt.11 Separately, the efficacy of avacincaptad pegol has been demonstrated with monthly dosing over 24 months, and ongoing research continues to evaluate its long-term benefits (NCT05536297).12 Patients should be educated on the ongoing commitment that comes with intravitreal injections in pursuit of preserving vision. The 24-month data for both pegcetacoplan and avacincaptad pegol both show that long term treatment, every other month, will be needed to maintain efficacy. Effectively managing patient expectations as early as possible will improve adherence to the long-term nature of this treatment.

Therapies in clinical trials There are also other promising therapies on the horizon that patients can look forward to, with several being studied in clinical trials within Australia

Patient education and support play a vital role in managing expectations and promoting adherence to therapy. In addition to clinical care, services such as Eye Connect, provided by MDFA, offer valuable resources for patients with AMD, helping them navigate their diagnosis, understand their treatment, and access ongoing support as part of a comprehensive management approach.

NOTE: References will appear in the online version of this article and are available upon request.

NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.

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CPD – MACULAR DISEASE

Screening and management of diabetic retinopathy: A comprehensive guide Optometrists are increasingly at the forefront of collaborative diabetes care, playing a crucial role in the early detection of diabetic retinopathy. DR TRACEY PHAN and DR AMANDA IE highlight essential screening guidelines, clinical signs, and referral pathways every optometrist should be aware of.

ABOUT THE AUTHORS:

Dr Tracey Phan BMed, GDip (OphthSci), FRANZCO Medical retina, glaucoma and cataract specialist

Dr Amanda Ie BMedSci, MBBS, FRANZCO Adult and paediatric vitreoretinal surgeon Westmead Hospital & Children’s Hospital Westmead

D

iabetes mellitus is a significant contributor to the burden of disease in Australia and worldwide. In 2021, the estimated prevalence of diabetes in Australia was one in 20 (around 1.3 million people),1 with projected numbers estimated to affect 700 million people globally by 2045.2 The National Diabetes Services Scheme reported that around 8% of the Aboriginal and Torres Strait Islander population live with diabetes, and in some remote areas, up to 40% are affected by type 2 diabetes – alarming figures that represent one of the highest documented rates of diabetes in the world.3 Of the diabetic subtypes, type 2 diabetes, remains the most common (86.7%) followed by type 1 diabetes (9.4%).3 Moreover, the prevalence of type 2 diabetes in the last 20 years has tripled and around 500,000 Australians are now estimated to be living with undiagnosed type 2 diabetes,3 providing optometrists a unique opportunity to be the first to diagnose diabetes in susceptible patients.

OPTOMETRY AT THE FOREFRONT Diabetic retinopathy (DR) occurs as a result of microvascular compromise to the retina, affecting up to one third of non-Indigenous and almost 40% of Indigenous diabetics,4 and remains one of the top

five leading causes of irreversible blindness in adults in Australia.5 The sequelae of DR can be potentially devastating, leading to visual impairment with progression to blindness, invariably resulting in poorer quality of life and loss of independence.

The role of the optometrist as a primary care practitioner is critical in the early detection of DR, recognising signs of disease progression, and identifying potentially blinding complications of DR at an early point of intervention. This should occur as part of a holistic model of patient care, with continued encouragement to patients to optimise their glycaemic control and other cardiovascular risk factors.

The three distinct forms of DR are: 1. Diabetic macular oedema (DME) – diffuse or focal vascular leakage within the macula, which affects 3.3% of individuals with diabetes.

2. DR caused by microvascular changes, which can be further categorised as: non-proliferative diabetic retinopathy (NPDR) – including microaneurysms, intraretinal haemorrhages, tortuous vessels (affects approximately 20% of patients with diabetes) 3. Proliferative diabetic retinopathy (PDR), which involves neovascularisation of the disc or retina (occurs in two per cent of diabetics)6

Table 1. Screening Guidelines for diabetic retinopathy. Adapted from RANZCO screening guidelines for DR in Australia.7 Condition

Definition

Recommendation

No diabetic retinopathy

Clinical modifiers present (See Table 2)

Repeat screening in 1 year

Clinical modifiers absent

Repeat screening in 2 years

Non-centre involving Microaneurysms, retinal haemorrhages, hard exudates, retinal thickening within 2 disc diameters of the foveal centre

Refer to ophthalmologist within 12 weeks

Centre-involving Microaneurysms, retinal haemorrhages, hard exudates, retinal thickening within 500 microns (1/3 disc diameter) of the foveal centre

Refer to ophthalmologist within 4 weeks

Mild Microaneurysms only, 1-year risk of PDR: 1-5%

Repeat screening in 1 year

Moderate Microaneurysms, plus any retinal haemorrhage or venous beading (less than severe NPDR), 1-year risk of PDR: 12-26%

Refer to ophthalmologist within 12 weeks

Severe 4:2:1 rule — 20-plus microaneurysms in all 4 quadrants, or venous beading in 2 quadrants, or intraretinal vascular abnormality in 1 quadrant. 1-year risk of PDR: 50%

Refer to ophthalmologist within 4 weeks

Proliferative DR

Noevascularisation at the disc, anywhere else in the retina, or iris neovascularisation, or vitreous or pre-retinal haemorrhage

Refer to ophthalmologist within 1 week

Hight Risk PDR

Neovascularisation of the disc (NVD) >¼ to disc area, or NVD of any size with vitreous or pre-retinal haemorrhage, or neovascularisation elsewhere >½ disc area with vitreous or pre-retinal haemorrhage

Refer to ophthalmologist within 1 week

Sudden severe vision loss

Likely a complication of proliferative diabetic retinopathy: vitreous haemorrhage, retinal detachment, rubeotic glaucoma

Refer to ophthalmologist same day

CLINICAL CPD HOURS This activity meets the OBA registration standards for CPD

Diabetic maculopathy

LEARNING OBJECTIVES:

At the completion of this article, the reader should…

• Have reviewed screening guidelines to assess diabetic retinopathy based on disease severity and clinical modifiers.

• Understand the role of digital fundus photography as the standard for DR screening and its advantages in documenting retinal changes.

• Integrate digital imaging techniques, including non-mydriatic and ultra-widefield cameras, in DR screening.

• Collaborate with healthcare providers to manage and refer patients for timely interventions in diabetic retinopathy.

Non-proliferative DR (NPDR)

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Images: Tracey Phan & Amanda Ie.

CPD – MACULAR DISEASE

CLINICAL DISEASE MODIFIERS Risk factors for patients who may progress • Poor glycaemic control • Hypertension • Diabetes duration >10 years • Hyperlipidaemia • Anaemia • Pregnancy • Renal disease secondary to diabetes • Ischaemic heart disease • Stroke FIGURE 1. ZEISS Clarus true colour fundus camera showing 133 degrees of retina with clinical signs of severe NPDR and maculopathy.

FIGURE 2. ZEISS Clarus image showing 200 degrees of retina with changes consistent with severe NPDR.

FIGURE 3. ZEISS Cirrus OCT through the fovea showing intraretinal fluid cysts from diabetic macular oedema.

SCREENING RECOMMENDATIONS Screening of diabetic retinopathy is essential as affected patients often remain asymptomatic even at advanced stages of disease. Importantly, visual impairment can be avoided in many of these patients.

Screening for DR at the time of diagnosis is vital, as patients may have had poorly controlled or potentially long-standing diabetes prior to the diagnosis. This visit also presents an opportunity to educate patients regarding the trajectory of diabetic retinopathy to sight-threatening disease and to encourage engagement in regular screening.

Several landmark trials, including the UK Prospective Diabetes Study, the ACCORD trial, and the Diabetes Control and Complications Trial (DCCT), have thoroughly examined the systemic clinical disease modifiers that may contribute to the

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Table 2. Clinical Disease Modifiers. Modified from RANZCO screening guidelines for DR in Australia.7

progression of DR.8,9 The presence of any of these risk factors will modify screening intervals (see table 2).

If no DR is present and no associated clinical disease modifiers are identified, screening is recommended every two years. However, annual eye screening is advised if DR is absent but any of the clinical disease modifiers are present. Annual screening is also recommended for patients whose HbA1c level exceeds eight per cent or 64 mmol/mol, or if the patient is of Aboriginal or Torres Strait Islander origin or from a non-English speaking background.

Certain vulnerable groups require special consideration. Children with diabetes should be screened at least every two years from the age of 12, and ongoing screening should follow the guidelines mentioned above (Table 1). The elderly, particularly those with common comorbidities, also require attention.

For pregnant women, routine screening is recommended during the first trimester for those with pre-existing diabetes, as pregnancy can increase the risk of developing DR or worsen existing retinopathy. To avoid exposing pregnant patients to dilating medications, screening may be performed without dilation using a non-mydriatic digital wide-field camera. Pregnant women who develop gestational diabetes mellitus (GDM) do not require screening unless the condition persists postpartum, in which case ongoing screening should be considered according to the guidelines outlined above (Table 1).

SCREENING PROCEDURES A comprehensive history should be obtained detailing the duration of diabetes, with treatment and recent history of sugar control (with an optimal HbA1C target of less than seven per cent as per the Diabetes Control and Complications Trial (DCCT).9 Comorbidities that pertain to risk factors and complications of diabetes should be noted, including hypertension, dyslipidaemia, and any smoking

history. Complications including cerebrovascular events, ischaemic heart disease, nephropathy and neuropathy should be documented. The presence of these complications represents a harbinger for severe microvascular changes and thus increase suspicion of diabetic retinopathy.

A comprehensive eye exam includes a thorough anterior and posterior segment examination, with documented best corrected visual acuity and intraocular pressures. Anterior segment examination should pay particular attention to cataractous formation as well as iris neovascularisation (rubeosis) – a late sign of severe and blinding diabetic ocular changes.

The retinal screening examination should be undertaken after adequate mydriasis, with a thorough examination of the posterior pole, looking for signs of neovascular changes at the disc, as well as examining the macula closely for microaneurysms, haemorrhages, exudates, and diabetic macular oedema. The presence of pre-retinal or vitreous haemorrhages should be noted as this may indicate proliferative DR. A mid-peripheral view of the retina is best to examine for dot-blot haemorrhages, cotton wool spots, venous beading, and intraretinal microvascular abnormalities which are evident in non-proliferative diabetic retinopathy. Signs of neovascularisation elsewhere are found in the mid periphery and often along the retinal arcades. Adequate dilation is essential as these mid peripheral signs may be missed through a constricted pupil.

Initial classification for DR is based as per the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines and has been further refined by the International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Severity Scale:10,11 •N on-proliferative diabetic retinopathy ° Mild disease: microaneurysms only oderate: microaneurysms with at least one of: °M - Retinal haemorrhages - Hard exudates - Cotton wool spots - Venous beading ° Severe: any of the following (4-2-1 rule): - More than 20 intraretinal haemorrhages in each of the four quadrants - Venous beading in two or more quadrants -P rominent intraretinal retinal abnormality in one quadrant PDR can be diagnosed by either presence of neovascularisation or any vitreous or pre-retinal haemorrhage. High-risk PDR, defined by the Diabetic Retinopathy Study (DRS), is characterised by the following features: - N VD larger than ¼ to ⅓ of a disc area - NVD of any size associated with vitreous haemorrhage - N VE of any size associated with vitreous haemorrhage

B.

B IN G

B of pr be G be

Go ro

The DRS determined that high-risk PDR was an indication for panretinal photocoagulation to reduce the progression of PDR and therefore identification of these characteristics warrants urgent referral to an ophthalmologist.12

THE ROLE OF DIGITAL IMAGING The RANZCO guidelines state that digital fundus photography is the expected standard for fundus examination.

Screening using imaging can be a valuable tool offering an objective means of documenting the status of the retina. Dilation may not be required if a high-quality image is obtainable through a non-mydriatic or ultra-wide field camera. If the image quality is poor, the pupil must be dilated and 0.5-1% tropicamide drops are required, unless the patient is pregnant.

Ultra-wide field images can be used to screen for diabetic retinopathy, or alternatively, two 45-degree fundus images should be captured, with one centred on the macula, and one on the nasal fundus where the nasal extent of the retina to three disc diameters from the edge of the optic disc is visible. Only 8-15% of patients with DR will have changes outside of this zone alone.

The ZEISS Clarus non-mydriatic camera can capture 133 degrees with one capture, and 200 degrees with two captures, which can be achieved

without dilation, giving adequate visualisation of the area most likely to be affected by DR. Optical coherence tomography (OCT) is another useful adjunct for the detection of diabetic macular oedema, allowing classification as to whether the disease is centre- or non-centre involving, as well as documenting progression or response to treatment.

IMPORTANCE OF COLLABORATION AND EDUCATION The results of DR screenings should be shared with each patient, and their health care providers including their GP and endocrinologist.

The presence or progression of DR is important to convey as it allows for steps to be taken to improve glucose management and other associated risk factors. When hyperglycaemia, hypertension and dyslipidaemia are managed alongside lifestyle modifications in a multidisciplinary setting, patients experience better mortality outcomes as well as improved management of their DR. Regular screening and ongoing patient education at each visit is crucial for the early detection of DR that requires treatment. The timely delivery of any interventions including anti-VEGF injections, laser or vitrectomy can significantly improve patient outcomes.

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CONCLUSION Understanding of clinical risk factors for worsening diabetic retinopathy is essential in determining the appropriate screening periods.

It also helps to identify vision-threatening features of diabetic retinopathy that require urgent referral to an ophthalmologist when assessing a patient.

The optometrist, as a primary care clinician, plays an important role as the first point of contact for patients with diabetes. Regular reviews of asymptomatic patients enable the early identification of diabetic complications and facilitates timely intervention, potentially preventing devastating vision loss.

NOTE: References will appear in the online version of this article and are available upon request.

NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.

DRY EYE

Her Field of Dreams now a reality Images: Dry Eye Solution.

LIZ BARRETT’S bold move to open a standalone dry eye clinic appears to have paid off – she’s set to open No. 8, her first outside NSW. Insight asks how she’s done it and what comes next.

Liz Barrett is set to open her eighth Dry Eye Solution practice, in Melbourne, just a few years after opening the first in Erina, Central Coast.

B

uild it and they will come.

That’s not usually a winning strategy when considering a business venture in relatively little-known territory.

And ignorance is not bliss when the banks are more interested in sound business knowledge and the bottom line.

But just as Kevin Costner’s character in the movie Field of Dreams felt compelled to carve a baseball diamond from a corn field, simply because the ghost of Shoeless Joe Jackson asked him to do it, a businesswoman in Australia has carved out a successful, growing venture from hard work, belief in the cause, and a high-profile mentor who assured her that if she built it, they would come.

Dry Eye Solution founder and CEO Ms Liz Barrett is set to open her eighth dry eye clinic, in Melbourne in the coming months. She has plans for No. 9 and 10 as well, in yet-to-be disclosed locations.

Number eight will be the first foray beyond her NSW base and a long way from where it all began, almost five years ago, when an idea started forming in her head, followed by a nagging, insistent voice.

Barrett, who had a decades-long background in optics and business in Ireland, England and Australia, was helping to prepare the sale of a NSW practice for an optometrist, the late Dr Amanda Ryan.

“She was diagnosed with a malignant brain tumor, and she knew she was dying,” says Barrett. “She asked me to help her get it ready to sell, and I considered buying it.”

But Barrett was struggling with her options. The practice was large, in an unusual area, and the numbers were not great.

She turned to a former colleague who worked with ophthalmologists for advice.

“I said, ‘What do you think? Maybe I could put an eye surgeon in this clinic

– I've got four rooms that are not being used and it's a beautiful practice’.

“She said, ‘No, I think it's too saturated. I think what you need is a dry eye clinic.’ And I said, ‘What’s a dry eye clinic?’. And she said, ‘I don't really know’, but she'd worked in Mudgee, and they were sending patients all the way to the Gold Coast for treatment.”

The idea took hold, the inner voice began its relentless rhythm.

It grew louder, increasingly resistant to scepticism and logic; even the concerns of others in the industry who regarded it as madness: a stand-alone optometry business that focused on one then little-understood ailment? That didn’t sell glasses?

“I felt like the idea was pulling me along, and I just was the willing participant that went along with it.”

It would be another two years before the will would meet the way and, buoyed by the results of a Japanese study that linked dry eye disease with happiness, and the realisation of a significant gap in the Australian ophthalmic sector, Barrett founded Dry Eye Solution and opened her first clinic in Erina, on NSW’s Central Coast, in February 2022.

Ignorance remained, both with Barrett and the industry. But her collaboration with American dry eye expert Dr Rolando Toyos, who convinced the world that intense pulsed light (IPL) had applications in eyecare, helped Barrett fill the gaps, confirm her beliefs, and push on with the business.

“I had been following him on YouTube for quite a while, and I was a huge fan,” she says.

She got in touch after seeing Dr Toyos at a dry eye summit in Sydney.

“I wrote him a text message and said, ‘I've just opened Australia's first independent dry eye clinic; I'm one of your biggest fans’. I told him I knew his protocols were the best in the world and I wanted to offer the best service

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DRY EYE

The management team at Dry Eye Solution – optometrist Dr Daniel Poon (from left), head of optometry Dr Rolando Toyos, medical director Liz Barrett, Dr Allan Bank and Andy McKie.

in the world to Australian patients," she recalls.

“What have I got to lose? So I press send, and I put my phone down, and straight away, it beeped and he says ‘Sure, set up a zoom call’, and it went from there.”

Dr Toyos is heavily involved in the business, helping to upskill the 10 optometrists she employs across the company.

“He comes out two or three times a year,” says Barrett. “He trains our whole team and will spend a whole week supervising appointments in clinic.

“Every Tuesday morning, we have a group call with him, our clinical team, and we will present cases to him that we've never seen before. The knowledge is then shared throughout the group.”

It was Dr Toyos’ advice, early in their connection, to “build it and they will come”. That helped her believe that she was on the right path, despite some early headwinds.

“I thought, oh everyone's going to want to refer their dry eye patients, and the eye surgeons will, and the optometrists will.”

But that didn’t happen.

“I realised, oh my gosh, there's such a lack of knowledge and awareness and understanding with so many eyecare professionals about dry eye, and they didn't refer.”

That has changed over the years, as awareness has grown, along with Barrett’s own knowledge and business.

She has continued to build, and the patients have continued to come.

There are now seven practices in NSW, including Burwood, Chatswood, and Parramatta. She offers a telehealth service as well.

“The demand is there – we have patients reaching out to us asking us, when are you opening up? Which is a beautiful place to be.”

But ignorance remains within the industry. As well as caution towards Barrett.

“This is very controversial,” she says. “They [eyecare professionals] don't want to be seen as not understanding dry eye. And many do not know how to diagnose dry eye disease, which blows my mind.”

In that sense, ignorance is bliss for business – Barrett has been able to carve out a healthy niche for both her patients and her business.

Those customers are offered a 45-minute, partially subsidised consultation that determines the level of any dry eye and a tailored treatment plan.

If it’s needed, people can book a block of four IPL treatments. Dry Eye Solution also offers treatments for rosacea, which is often associated with

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INSIGHT May 2025

DED, as well as other skin issues. But dry eye remains the primary focus, says Barrett.

But it’s not just about IPL, she says.

As part of Dr Toyos’ more holistic view of dry eye and its causes, Barrett and her colleagues look beyond the patient’s eyes to understand what is causing their dry eye.

“I say to patients, we can do IPL on you for the rest of your life, but we don't want to do that, because you're just treating the inflammation in the eye.

“It’s like whack-a-mole; it's inflammation and then you whack it down, and then it'll show up somewhere else.

“We have to address their lifestyle, their skincare regime – what shampoos are they using? Have they've got any allergies? What medications are they on? What about their gut health?”

She believes that with Dr Toyos’ help – “without him we would be flailing about in the dark” – her clinics are now about 25 years ahead of the industry in their knowledge of dry eye.

But like the American specialist, she is doing her bit to help bridge that gap.

“We created a dry eye academy for our interior team . . . and this year we will be launching that academy out to regular optometrists.

“It's not going to have all our secret herbs and spices, but it will be very much around how to diagnose dry eye disease. Patients deserve it.”

That will give parts of the industry, those with a gap in their dry eye knowledge, a chance to catch up.

Until that happens Barrett will continue to build, and DED sufferers will continue to come.

"It’s like whack-a-mole; it's inflammation and then you whack it down, and then it'll show up somewhere else. We have to address their lifestyle, their skincare regime.”

Liz Barrett Dry Eye Solution

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Will Specsavers adopt IPL?

Images: Specsavers.

DRY EYE

The country’s largest eyecare provider is testing whether introducing intense pulsed light therapy is a viable option for its business and dry eye sufferers.

Here are the early results from the pilot phase.

A

t its most recent clinical conference, Specsavers pulled back the curtain on the early work it is doing to potentially bring advanced dry eye treatment into its clinical workflow.

It’s no small feat, given the network is now responsible for five million patient journeys a year, with each step of the patient visit carefully mapped out to ensure an efficient, effective and easily accessible experience – at scale.

The company, Australia’s largest eyecare provider with 393 locations across Australia, revealed it has been expanding a pilot so more patients can receive treatment to reduce their dry eye symptoms at specific Specsavers practices, using intense pulsed light (IPL) technology.

According to Dr Ben Ashby, Specsavers ANZ clinical services director, the project that launched in May 2024 was to grow to nine practices across the country by the end of last year, with early results and feedback from patients and stores being consistently monitored to determine whether it should go further.

Six months on, Specsavers shares with Insight its early learnings and thoughts on the pilot, how patients are responding, and whether this will lead to a nationwide rollout.

WHY ADVANCED DRY EYE TREATMENT? Dry eye disease is reported to be one of the most common eye conditions affecting Australians. In fact, it’s thought around one in five, and one in every three people over the age of 65, suffer in this country, with numbers expected to rise as the population ages and screen time increases.

The condition is often under-diagnosed, with many patients struggling with the discomfort of dryness, irritation, and fluctuating vision. Common causes include prolonged digital device use, hormonal changes (especially in women) and environmental factors like dry climates. There’s also meibomian gland dysfunction (MGD), the leading cause of evaporative dry eye.

While traditional treatments like artificial tears and lifestyle modifications remain optometry staples, advanced dry eye treatments such as IPL therapy are proving an effective solution for these patients.

It is specifically effective in treating MGD as the therapy delivers broad-spectrum light pulses, targeting abnormal blood vessels and stimulating the natural flow of oil.

“My approach to dry eye has become more proactive and comprehensive. I now prioritise early diagnosis and education, emphasising advanced treatments including IPL when appropriate.”

Linda Zhang Specsavers Cranbourne

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IPL being performed in a Specsavers practice.

This process is said to enhance the function of meibomian glands, improving tear film stability and reducing the irritation associated with dry eye.

Dr Ashby says Specsavers has long wanted to offer a wider range of advanced dry eye solutions.

“Dry eye disease can have a profound impact on a person's quality-of-life, extending far beyond the physical discomfort of itchy, burning, or gritty eyes,” he says.

“While the symptoms themselves are disruptive, the condition can affect daily activities, emotional well-being, work productivity, and social interactions. These symptoms can be relentless, often worsening throughout the day, making it difficult to focus on tasks or enjoy activities.

Even simple actions like reading, driving, or watching TV can become challenging, as the eyes may not have the moisture they need to function properly.”

Dr Ashby says Specsavers saw the lack of easily obtained information and “the inaccessible treatment options available for dry eye disease”, prompting the network into action.

“Our ambition for this advanced dry eye treatment pilot is to provide a service that leads to enhanced eye health outcomes for Australians and fits in with our philosophy that the best quality eyecare should be easily accessed by everyone.”

WHAT THE EARLY RESULTS SAY As of January 2025, the nine Specsavers practices offering advanced dry eye treatment services had provided treatment to 319 patients, administering more than 1,000 IPL applications.

As anticipated, the company says early adopters of Specsavers’ advanced dry eye treatment pilot were females aged between 41 and 70 and early trends were indicating “very good compliance with follow-up treatments”. Around 90% of patients reported improvements to their dry eye symptoms after a full course of treatment.

Specsavers ANZ head of professional services Dr Joe Paul says his team have also been monitoring the impact of the treatment – paid for out-of-pocket by patients – by accessing symptom questionnaire responses logged by optometrists when delivering the treatment.

INSIGHT May 2025

Insight h

“At each advanced dry eye treatment appointment, when appropriate. Understanding the transformative Change in SANDE scores - IPL optometrists ask their patients about the frequency impact these treatments can have has made me and severity of their symptoms on that date. The more confident in recommending them as part of the patients then give an answer from zero to five with personalised management plan.” five being very frequent and the worst severity. This Dr Ashby says Zhang’s experience and feedback establishes a Symptom Assessment in Dry Eye has been consistent with most optometrists who are (SANDE) score,” he says. now offering these treatment to patients.

“When we compare the average SANDE scores at “It has been very encouraging to hear the many appointment one versus appointment four, we have stories of patients whose eye health outcomes have observed an obvious change in symptom frequency improved and whose daily lives have been enhanced and severity, showing that the treatment is working thanks to their advanced dry eye treatment at their for the patients. The mean improvement changes local Specsavers practice.

1.7 points for frequency of dry eye symptoms and 1.6 “As optometrists, our purpose is to change lives ABOVE: Specsavers has been measuring impact points for severity of symptoms. This is captured even with a Symptom Assessment in Dry Eye (SANDE) through better sight and this pilot is an opportunity before the patient experiences the impact of their to significantly impact a person’s physical comfort score for each IPL visit, observing an obvious fourth treatment, so we know the treatment is having a change in symptom frequency and severity, and long-term eye health, creating a ripple effect showing the treatment is working. remarkable effect on our patients.” that influences work, relationships and emotional Specsavers Cranbourne optometrist Ms Linda well-being.”

Zhang has been one of the first to pilot advanced dry eye treatment and While Dr Ashby can’t confirm whether advanced dry eye treatment would says seeing patients experience it and the impact on their lives has been be rolling out nationwide, he indicated it was expected to expand further in both encouraging and fulfilling. the months ahead.

“In the past I found managing dry eye patients to be quite challenging as “In this project, we’re working in a fast-moving test and learn situation, many treatments only provided temporary relief instead of addressing the where patient outcomes are being monitored and feedback from root cause. I wanted to help the patient, but I sometimes felt very limited optometrists and patients is being gathered in real time,” he says. in the treatment options available to offer truly effective and long-term “We’re continuing with our focus on making the high-quality service solutions for the patient,” she says. as accessible as possible, especially given the current tough economic “As a result of offering advanced dry eye treatment, my approach to dry climate. In the future, we believe that the harsh symptoms of dry eye eye has become more proactive and comprehensive. I now prioritise early disease will be a thing of the past for Australians and we’re doing all we can diagnosis and education, emphasising advanced treatments including IPL to make that vision a reality.”

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11/04/2025 11:07:44 AM

Blink Intensive Tears Preservative Free.

A blinking success

Every second counts in DR LOURENS VAN ZYL’S busy Perth clinic, motivating him to switch to a new lubricating eye drop that’s helping his practice find new and unexpected efficiencies.

D

r Lourens van Zyl can see as many as 50 cataract and refractive laser patients a day. There’s hardly a second to spare in his appointment book, so when people complaining of ocular discomfort syndrome need to be squeezed in, the day can quickly turn on its head.

The Perth ophthalmologist is a one-man-band at Crystal Eye & Laser Centre, performing a 50/50 split of cataract and refractive laser surgery – at high volume.

But a recent switch to a brand of lubricating eye drops, now available through Bausch + Lomb (B+L), has significantly cut the number of unscheduled follow-up appointments with patients experiencing post-operative discomfort.

“Regardless of how successful your surgery is, ocular surface problems can cause patients severe pain and distress, and it makes their experience negative,” he says. “We want to leave a positive impression, and by changing to Blink eye drops, we found callback rates and patients reporting ocular discomfort syndrome is significantly less. It makes my job much easier.”

Time is the main remedy for these patients, but still, their complaints can’t be dismissed.

“You have a duty of care towards these people, and we always need to see them to rule out anything more sinister. With a fully-booked clinic, if there's three or four of these extra patients it can really ruin your day.”

Blink Intensive Tears Preservative Free is the eye drop that’s made the difference in Dr van Zyl’s clinic.

For mild-moderate dry eye, this advanced lubricating eye drop is specially formulated to provide protection and comfort for the eyes that are dry, irritated or uncomfortable. It contains 0.20% sodium hyaluronate, and comes at a lower price point than other over-the-counter drops also with this ingredient.

It’s one of five Blink eye drop and contact lens rewetting products available through B+L, which acquired the range from Johnson &

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1.1 Images: B+L.

DRY EYE

Dr Lourens van Zyl recently switched to Blink eye drops in his clinic.

Johnson Vision in 2023 for US$106 million (AU$155m), expanding its over-the-counter dry eye portfolio.

Others in the range include: •B link Intensive Tears – a non-preservative-free drop available in a multidose bottle for mild-moderate dry eye.

•B link Intensive Tears PLUS – a thicker, more viscous lubricating eye drop for moderate-to-severe dry eye, containing high dose 0.38% hyaluronate.

For ophthalmologists like Dr van Zyl, Blink Intensive Tears Preservative Free has become the go-to because it’s well tolerated by patients. Also, it’s a preservative-free formulation.

“In my days as a corneal trainee and subspecialist, we always worked to avoid any toxins on the ocular surface. Even though I’m not convinced there’s evidence showing which one is ultimately better, I feel the less chemicals you expose the ocular surface to, the healthier it's going to be.

“You never know when someone is going to be sensitive to a preservative, so I'd rather just prevent that altogether.”

His protocol is to prescribe the lubricant one month pre-operatively if patients have signs or symptoms of dry eye, diagnosed via a tear break-up time test on his corneal topographer.

Post-operatively, all patients are advised to use Blink Intensive Tears Preservative Free for six months, especially during the hot Perth summer.

Beyond the performance on the ocular surface, there are other reasons Dr van Zyl likes the eye drop.

Because it comes in single-use ampoules, it’s easy for patients to take in their bag and there’s no need to keep them refrigerated.

For the ophthalmologist, it’s reassuring to work with a company with a vested interest in the entire patient journey.

“Bausch + Lomb is a company that I’m familiar with, I know their reps like Albert Yau, who was instrumental in us making this change to Blink eye drops,” Dr van Zyl says.

“It’s reassuring to know the people supplying us with intraocular lenses are also supplying us with the drops; they know us, our patient and practice profiles.”

For his ophthalmology colleagues, Dr van Zyl has a clear message: Blink Intensive Tears Preservative Free eye drops are saving him and his patients valuable time and money.

“It’s the most well-tolerated lubricant I’ve come across to date,” he adds.

“If ophthalmologists add this to their cataract regime or their pre-op regime, there’s a high chance it will reduce post-operative ocular discomfort syndrome significantly, which has been great for my practice.”

INSIGHT May 2025

S1219_E

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FEELS EXCELLENT Working with the best

Feeling proud to have been accredited as a Great Place to Work® in Australia and New Zealand for the past five years and named one of Australia’s Best Workplaces for two years running.

In 2024, we were recognised as one of the Best Workplaces in the World!

Find your best at Specsavers? spectrum-anz.com/ careers-at-specsavers S1219_EVP_Feels Like_Insight_Apr_PRESS_235x297mm.indd 1

20/2/2025 8:34 PM

CPD – DRY EYE

Dr Ngozi Chidi-Egboka

FNCO, FAAO Postdoctoral Research Associate, clinical trial coordinator, sub-investigator, The University of Sydney Corneal Research Group, Sydney Medical School, Faculty of Medicine and Health, Sydney Eye Hospital, Central Sydney (Patyegarang) Precinct

Professor Chameen Samarawickrama

BSc(Med) MBBS, PhD, FRANZCO Professor of Cornea and Cataract, Sydney University Head of Cornea Unit, Westmead Hospital Director, Translational Ocular Research and Immunology Consortium (TORIC) Faculty of Medicine and Health Clinical Ophthalmology and Eye Health Westmead Institute for Medical Research, Save Sight Institute University of Sydney, Westmead and Central Clinical Schools

Professor Stephanie Watson

OAM FARVO Head of the speciality of ophthalmology and head of the Corneal Research Group, The University of Sydney Sydney Medical School, Faculty of Medicine and Health, Central Sydney (Patyegarang) Precinct Head of Corneal Unit, Sydney Eye Hospital Chair, Australian Vision Research (formerly Ophthalmic Research Institute of Australia)

CLINICAL CPD HOURS This activity meets the OBA registration standards for CPD

LEARNING OBJECTIVES:

Best-practice management of topical ciclosporin in dry eye Ciclosporin is transforming ocular surface disease by addressing underlying inflammation rather than just symptom relief. With ciclosporin use expanding, optometrists are influential in prescribing, monitoring and optimising treatment outcomes, as the authors explain.

P

atients with ocular surface disease, particularly dry eye disease (DED), may benefit from topical ciclosporin.1 Increased apoptosis or programmed cell death in the ocular surface epithelium, particularly the conjunctiva, has been found in ocular surface diseases including dry eye. Topical ciclosporin A (CsA) exerts immunomodulatory effect by reducing T-cell activation and the release of pro-inflammatory cytokines that can trigger or exacerbate apoptosis. 2 By inhibiting apoptosis (programmed cell death) of the ocular surface epithelium, topical CsA reduces inflammatory cell infiltration of the lacrimal gland.3 The efficacy and safety of CsA has been shown in multiple studies, including randomised controlled clinical trials1 and Cochrane systematic reviews,4,5 which have reported on the use of CsA for treating ocular surface disease. Use of topical CsA in varying concentrations, and in combination with other topical treatments, has been investigated more commonly for DED – the most common ocular surface disease.4,5 Most studies have found reduced ocular surface symptoms and improved clinical signs including tear production and ocular surface staining with CsA treatment over the course of four to 12 weeks treatment duration. Studies have also shown that patients may benefit from up to 12 months of treatment during which follow-up is required at the least every six months to monitor improvement and patient compliance, but the efficacy is unclear for longer term treatments.1 The treatment regimen consists of the instillation

of an eyedrop of CsA once daily (Ikervis (CsA 0.1%)), twice daily (Cequa (CsA 0.09%)), Restasis (CsA 0.05%)), or four times daily (Restasis (CsA 0.05%)) to achieve a sustained immunomodulatory effect. Although the cost of treatment with a commercial formulation of CsA for DED may be higher than lubricants alone (0.05% CsA (Restasis, Allergan) has a calculated annual cost of US $1,276 per patient compared to treatment with preservative-free artificial tears (for example, Refresh Lubricant Eye Drops, Allergan, Inc., Irvine, CA) costing US $96 per patient annually)),6 the benefit from improved treatment outcomes with CsA may out-weigh the costs.

WHAT ARE THE CLINICAL INDICATIONS FOR PRESCRIBING? Topical CsA at concentrations ranging from 0.05% to 2% have been useful in treating ocular surface diseases. For DED, topical CsA has been indicated for the management of symptoms and/or signs of DED not adequately controlled by preservativefree artificial tear monotherapy. Topical CsA may be considered for moderate severity of DED – that is, in patients with dry eye symptoms (typically OSDI score ≥ 23 or an equivalent depending on the questionnaire scale) and at least one deficient ocular surface sign based on recommendation by the TFOS DEWS II management and therapy report.7 In Australia, the Therapeutic Goods Administration (TGA) approved product information and pharmaceutical benefits scheme (PBS) guidelines for initiating treatment with topical Image: CSL Seqirus.

ABOUT THE AUTHORS:

At the completion of this article, the reader should be able to…

• Understand the immunomodulatory role of ciclosporin in managing ocular surface disease.

• Have the information needed to educate patients on dosing and expected treatment timelines.

• Advise patients on strategies to reduce instillation discomfort and improve adherence.

• Understand how topical CsA combined with artificial tears can be more effective at improving DED symptoms and signs than artificial tears alone.

PBS eligibility criteria for prescribing Ikervis (0.1% CsA). Please refer to PBS Schedule for full information.

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INSIGHT May 2025

THE OPTOMETRIST’S ROLE IN CICLOSPORIN THERAPY In Australia, the Therapeutic Goods Administration approved topical CsA products (Ikervis and Cequa) are prescription-only medicine, for prescription by ophthalmologists and therapeutically-qualified optometrists.

Ikervis and Cequa may be prescribed under the PBS subsidy scheme or as a private prescription.

Restasis is available in Australia via the authorised prescriber or special access schemes (SAS) of the TGA.11 Eligible patients for PBS subsidy must meet the criteria for moderate to severe DED symptoms and signs criteria for initial treatment, and an improvement in corneal fluorescein staining by ≥ 3 grades and OSDI score by ≥ 30% for continuing treatment with no more than five scripts repeats at a time. Patients do not need to meet the PBS criteria for a private prescription.

The prescription of Restasis requires a government special authority approval after prior consideration of other appropriate treatment options by the clinician. Such that the optometrists have a key role in assessing which patients may be eligible for CsA and if therapeutically-qualified prescribing CsA and then reviewing the response to treatment. Optometrists are also able to work closely with a prescribing ophthalmologist to manage patients on topical CsA. Available compounded formulations in Australia are typically prepared in varying concentrations (0.02%, 0.05%, 0.2%, 0.5%, and occasionally 1% or 2%) by only a handful of pharmacies, with ophthalmologists exclusively eligible to prescribe.

Compounded CsA can be considered if a higher concentration (0.5%, 1% or 2%) is needed, if there is no response to a low dose, or if there is intolerance/sensitivity to excipients or adverse reactions to commercially available products. Use of compounded topical CsA with preservative-free artificial tears, allowing five 15 minutes interval between drops is still recommended.

PATIENT EDUCATION It is important for clinicians to explain the mechanism of action of topical CsA, treatment timelines and possible side effects of use to patients. Topical CsA is an anti-inflammatory agent used to treat inflammatory ocular surface diseases including mostly DED. DED is a common inflammatory ocular surface condition associated with disruption in the tear film function and may

develop due to an underlying health problem, eye treatment, after eye surgery, environmental exposure, lifestyles or for no apparent reason.

Treatment with topical CsA is aimed to improve tear production by treating the ocular inflammation.

Patients should understand the dosing in accordance with the relevant product information (Ikervis once daily as final medication at bedtime, Cequa twice daily, Restasis twice daily), the concomitant use with preservative-free artificial tears, and timeline to improvement usually up to 12 weeks which may inform the follow-up schedule.

Currently available CsA products are preservative-free where each ampoule is intended for single use; patients should be advised to discard the ampoule immediately after a single dose.

Topical ciclosporin drops may be prescribed in varying concentrations and combinations with other topical treatments such as corticosteroids in the presence of moderate to severe inflammation.

Lower potency topical corticosteroids (for example, fluorometholone 0.1%, loteprednol etabonate 0.5%) may be considered and commenced concurrently with topical CsA for short term (two to four weeks).

Topical corticosteroid eyedrops provide fast relief of ocular inflammation signs and symptoms.

However, long-term use of topical steroids is known to be associated with adverse effects such as cataracts, high intraocular pressure and delayed corneal wound healing which may increase the risk of developing an infectious keratitis.12 Close monitoring is required to mitigate the risks if topical corticosteroids are used concurrently.

Patients should be educated on a risk of ocular side effects with topical CsA such as stinging, irritation or transient blurring of vision on instillation.

Adverse effects are mostly mild and primarily relate to local reactions upon eye drop instillation and do not usually require treatment discontinuation.

Adverse effects may be more frequent with topical CsA in oil formulation (Restasis, Compounded CsA) or higher concentrations of CsA e.g., 1%, 2%.4

MANAGING INSTILLATION DISCOMFORT DUE TO TOPICAL CICLOSPORIN A Managing topical CsA instillation discomfort is vital to improve patient adherence to treatment.

Evidence from randomised clinical trials showed the proportion of participant reporting instillation discomfort with topical CsA ranged from 7.6% to 38%1 indicating a significant proportion of patients at risk for treatment discontinuation.

A recent study13 found that refrigerating topical CsA reduced instillation discomfort in up to 60% of patients with DED, lasting up to nine minutes, compared with instillation of warm CsA. Thus, refrigerating CsA prior to instillation may improve patient experience. Although there may be concern that refrigeration could potentially impact the stability of the product, given the

Currently available CsA products are preservative-free where each ampoule is intended for single use.

Image: tawanroong/Shutterstock.com.

CsA (example, Ikervis (CsA 0.1%) and Cequa (CsA 0.09%) indicate that patients must have corneal fluorescein staining (CFS) at grade 4 at treatment initiation using the Oxford scale8 (or equivalent9) and an Ocular Surface Disease Index (OSDI) score of ≥ 23 (out of 100).10 If outside this guideline, CsA can still be prescribed using a private prescription.

recommended CsA storage at room temperature of 20 to 25°C, though this study found that 30 days of storage at 4°C did not significantly alter its pH or nanoparticle size.13 The results were consistent with previous investigations that reported stability in CsA encapsulated in lipid nanoparticles over three to six months of refrigeration at 4°C,14 5°C,15 or −20°C.16 These studies suggest that refrigeration for a duration under six months may have minimal effect on the physical properties of CsA products.

ROLE OF ARTIFICIAL TEARS AS ADJUNCT THERAPY Topical CsA combined with artificial tears can be more effective at improving DED symptoms and signs than artificial tears alone and/or vehicle eye drops.1 Topical CsA has been mostly trialled in patients with the aqueous-deficient DED subtype of which typical treatment involves primarily using artificial tears as the first-line therapy.

Monotherapy with artificial tears can be sufficient to treat symptoms in milder cases of DED that may not require CsA.1 However, in moderate-tosevere DED, topical anti-inflammatory medications such as CsA or corticosteroids may be added to manage ocular surface inflammation.

SAFETY INDICATIONS Ocular side effects with topical CsA such as stinging and irritation on instillation have been reported in some high evidence trials with no risk of

INSIGHT May 2025

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CPD – DRY EYE

Image: Save Sight Institute.

GAPS IN KNOWLEDGE

serious adverse events. Evidence is limited on CsA use in individuals <18 years however, some topical CsA eyedrops are used as steroid sparing agent for non-infective severe conjunctivitis for children >3 years in the in-house medication resource called Meds4Kids under the Sydney Children’s Hospital Network.

The use of topical CsA has not satisfied the TGA categories A, B, C, D and X system for prescribing in pregnancy therefore the potential risk of prescribing CsA during pregnancy or planning pregnancy or lactating, based primarily on preclinical evidence should be carefully weighed against the expected benefit.

Topical CsA should not be used while wearing contact lenses; patients should be advised to remove contact lenses prior to administering topical CsA and have contact lenses re-inserted at least 15 minutes following administration. Topical CsA should not be prescribed for patients with active or suspected ocular or peri-ocular infection, peri-ocular malignancies or premalignant conditions; and should not be prescribed for patients with known hypersensitivity to the active substance or to any of the excipients. Patients should be advised not to touch the ampoule tip to the eye during instillation to avoid potential for eye injury.

There is a need for evidence-based recommendations for prescribing topical CsA in various ocular surface diseases to inform clinicians and support improvements in care and research. To meet this need, a systematic review with meta-analysis involving 48 randomised controlled clinical trials1 and a review of Australian CsA prescribing guidelines, formulations, TGA-approved product information, TFOS DEWS II Diagnostic Methodology and Management and Therapy reports,17,18 was used to inform an expert-led consensus of ophthalmologists and optometrists from across Australia.

The consensus aligned with the TGA approved product information that topical CsA can be used for patients with moderate to severe DED symptoms (OSDI score ≥ 23)10 and at least grade 4 corneal fluorescein staining (using the Oxford scale 8 or equivalent9), where artificial tears monotherapy was not providing adequate disease control, at treatment initiation.

Concomitant treatment with preservative-free artificial tears substitute allowing at least five minutes interval between drops was also recommended. The clinical response to treatment was recommended to be reassessed at least every six months to determine further prescription.

Overall, it was noted that topical CsA can be used for treatment of a variety of ocular surface diseases with most evidence for aqueousdeficient DED and may lead to improvements in symptoms and signs.

A knowledge gap remains on the coherency of benefits and the magnitude of treatment effect of the various CsA treatment options. Translation of the clinical studies into guidelines and then clinical practice for ocular surface disease is lacking.

Currently, translating results from research to routine clinical practice is an important challenge in medicine. The framework of guidelines developed will support the translation of clinical evidence into practice on the use of topical CsA in ocular surface disease that will ultimately improve patient

REFERENCES 1. Chidi-Egboka NC, Fan L, Qureshi M, et al. Evidence on the use of topical ciclosporin for ocular surface disease: A systematic review and meta-analysis. Clin Experiment Ophthalmol. 2025;0(0):1-23.

2. Periman LM, Mah FS, Karpecki PM. A Review of the Mechanism of Action of Cyclosporine A: The Role of Cyclosporine A in Dry Eye Disease and Recent Formulation Developments. Clin Ophthalmol.

2020;14:4187-4200.

3. Donnenfeld E, Pflugfelder SC. Topical Ophthalmic Cyclosporine: Pharmacology and Clinical Uses. Surv Ophthalmol.

2009;54(3):321-338.

4. González-López JJ, López-Alcalde J, Morcillo Laiz R, Fernández Buenaga R, Rebolleda Fernández G. Topical cyclosporine for atopic keratoconjunctivitis. Cochrane Database Syst Rev. 2012(9):Cd009078.

5. De Paiva CS, Pflugfelder SC, Ng SM, Akpek EK. Topical cyclosporine A therapy for dry eye syndrome. Cochrane Database Syst Rev. 2019(9).

6. Brown GC, Brown MM, Brown HC, Peet J, Roth Z. Topical cyclosporine (Restasis) cost-utility analysis. Evidence-based ophthalmology. 2009;10(3):166-171.

7. Jones L, Downie LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017;15(3):575-628.

8. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea.

2003;22(7):640-650.

9. Sall K, Foulks GN, Pucker AD, Ice KL, Zink RC, Magrath G. Validation of a modified National eye Institute grading scale for

corneal fluorescein staining. Clin Ophthalmol. 2023:757-767.

10. Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the ocular surface disease index. Arch Ophthalmol. 2000;118(5):615-621.

11. Australian Government. Department of Health and Aged Care.

Prescription medicines registrations. Therapeutic Goods Administration. In:https://www.tga.gov.au/resources/prescription-medicines-registrations.Accessed 14 May 2024.

12. Bonini S, Bonini S, Lambiase A, et al. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term followup.

Ophthalmology. 2000;107(6):1157-1163.

13. Ngo W, Nagaarudkumaran N, Huynh CB. Refrigeration reduces instillation discomfort of a 0.09% cyclosporine A solution. Optom Vis Sci. 2025;102(1):14-19.

14. Guada M, Sebastián V, Irusta S, Feijoó E, Dios-Viéitez MdC, Blanco-Prieto MJ. Lipid nanoparticles for cyclosporine A administration: development, characterization, and in vitro evaluation of their immunosuppression activity. International journal of nanomedicine. 2015:6541-6553.

15. Chennell P, Delaborde L, Wasiak M, et al. Stability of an ophthalmic micellar formulation of cyclosporine A in unopened multidose eyedroppers and in simulated use conditions. Eur J Pharm Sci. 2017;100:230-237.

16. Fiscella RG, Le H, Lam TT, Labib S. Stability of cyclosporine 1% in artificial tears. J Ocul Pharmacol Ther. 1996;12(1):1-4.

17. Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15(3):539-574.

Inferior corneal erosions in a patient with severe dry eye disease (grade 4 staining based on Lexitas Modified NEI scale).

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safety and care. The framework developed by our consensus approach will provide insight to some clinical questions including evidence of superiority of CsA in clinical effectiveness of ocular surface disease treatment compared to other conventional treatments, dosage, concentration and duration of treatment effect, the best clinical outcome and patient reported outcome effect, and the safety of use.

There is also a need for robust clinical real word data to provide evidence-based patient reported outcomes data and long-term follow-up data. Ophthalmic registries yield knowledge that complements randomised clinical trials which may have generalisability and applicability issues due to their controlled testing conditions and strict participant selection criteria.19 The real world data collected by clinicians in routine clinical practice and entered into the Save Sight Dry Eye Registry (SSDER) (Fight Corneal Blindness! – Save Sight Registries) is a valuable means of tracking patient reported outcomes from the use of topical CsA in DED and can be used to monitor patients’ disease status by tracking their DED symptoms and signs. 20,21

CONCLUSION Therapeutically-endorsed optometrists are now able to prescribe ciclosporin in Australia, but its integration into routine clinical practice will require enhanced patient assessment, long-term follow-up, and a deeper understanding of treatment efficacy.

While ciclosporin has shown significant benefits, factors such as cost, patient adherence and potential side effects must be carefully managed.

Future advancements, including improved formulations and real-world data collection through registries, will further refine prescribing guidelines for ciclosporin and strengthen the role of optometry in delivering targeted, evidence-based care for ocular surface disease.

NOTE: This article has been supported by CSL Seqirus.

18. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.

19. Kandel H, Gillies MC, Watson SL. Opportunities and challenges for clinical registries. Clin Experiment Ophthalmol. 2023;51(6):651652.

20. Watson SL, Chidi-Egboka NC, Khoo P, et al. Efficient capture of dry eye data from the real world: The Save Sight Dry Eye Registry. AJO International. 2024;1(3):100065.

21. Kandel H, Ao FS, Downie LE, et al. The impact of dry eye disease on patient-reported quality of life: a Save Sight Dry Eye Registry study.

Ocul Surf. 2025;35:11-23.

NOTE: Insight readers can scan the QR code or visit insightnews.com.au/cpd/ to access a link to this article to include in their own CPD log book.

TH E POW E R O F 3

The Beginning of the Interventional Glaucoma Revolution

infinite possibilities Brought to you by the founder of MIGS, iStent infinite® is built on the #1 MIGS platform worldwide and is designed to provide

powerful technology that delivers foundational, 24/7, long-term IOP control in glaucoma patients on ocular hypertensive

medications, including those who have failed prior medical and surgical intervention1. iStent infinite® can be performed in combination with cataract surgery or as a standalone procedure.

REFERENCE 1. Glaukos Data on File.

IMPORTANT SAFETY INFORMATION INDICATION FOR USE. The iStent infinite® Trabecular Micro-Bypass System Model iS3 is intended to reduce intraocular pressure in adult patients diagnosed with primary open-angle glaucoma (POAG) currently treated with ocular hypertensive medication. The device can be implanted with or without cataract surgery. CONTRAINDICATIONS. The iStent infinite System is contraindicated under the following circumstances or conditions: In eyes with primary angle closure glaucoma, or secondary angle-closure glaucoma, including neovascular glaucoma, because the device would not be expected to work in such situations; In patients with retrobulbar tumor, thyroid eye disease, Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS. Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualisation that could lead to improper placement of the stent and pose a hazard. MRI INFORMATION. The iStent infinite is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details. PRECAUTIONS. The surgeon should monitor the patient postoperatively for proper maintenance of IOP. Three out of 61 participants (4.9%) in the pivotal clinical trial were phakic. Therefore, there is insufficient evidence to determine whether the clinical performance of the device may be different in those who are phakic versus in those who are pseudophakic. ADVERSE EVENTS. The most common postoperative adverse events reported in the iStent infinite pivotal trial included IOP increase ≥ 10 mmHg vs. baseline IOP (8.2%), loss of BSCVA ≥ 2 lines (11.5%), ocular surface disease (11.5%), perioperative inflammation (6.6%) and visual field loss ≥ 2.5 dB (6.6%). CAUTION. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events. © 2024 Glaukos Corporation. Glaukos® and iStent infinite® are registered trademarks of Glaukos Corporation. All rights reserved. PM-AU-0262

EQUIPMENT

LEFT: Jillian Campbell, performing as many as 20 contact lens fits a day, relies on the Medmont Merdia Pro for most of her work.

The workhorse of this contact lens practice The next-generation Meridia Pro boasts all the advantages Medmont corneal topography is famous for, plus more. Independents like JILLIAN CAMPBELL are extracting all they can from the device that’s proving a sound investment.

B

y the time many patients reach Ms Jillian Campbell’s practice, they’re frustrated. They're unable to continue dealing with fogging, discomfort, poor vision – or all the above – created by a vision correction solution poorly matched to their highly irregular corneas.

While many eyecare professionals may feel ill-equipped to manage such challenging conditions, Campbell’s in her element working through the intricacies of advanced contact lens fitting for these patients.

Patients with conditions like corneal ectasia, pathologically high myopia, recurrent herpes simplex keratitis (HSK), extreme dry eye caused by graftversus-host disease and post-corneal transplant recipients.

For nearly three decades, her practice, Richard Lindsay & Associates, has cultivated a reputation for delivering bespoke solutions that transform these patients’ lives, even in the most demanding clinical presentations.

“We treat an incredibly diverse range of patients, from those newly diagnosed with keratoconus with little understanding of contact lenses or glasses, right through to those who have tried contact lenses elsewhere and feel they’ve exhausted every option, or infants with congenital cataracts,” says Campbell, who took ownership of the practice in 2023.

“Often, it’s about carefully explaining why they’re experiencing issues, helping them understand the root of the problem. When you can swoop in with thoughtful solutions that truly make a difference, they’re incredibly

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appreciative – and that’s such a satisfying feeling.”

Campbell can do as many as 20 contact lens fits a day. To flourish, she needs gold standard equipment behind her. When a contact lens interest spawned during her early days at the Australian College of Optometry, the Medmont E300 was the first corneal topographer she used.

The same device – Australian-made, world-renowned and ubiquitous in advanced contact lens practices – was also the workhorse at Richard Lindsay & Associates when she landed her dream job there in 2016.

Then, in 2020 Medmont launched its next generation corneal topographer, the Medmont Meridia.

It was a big milestone for the Melbourne-based manufacturer, and Richard Lindsay & Associates was one of the first to have it installed.

“I’m fortunate that I didn’t have to purchase the Meridia Pro myself, as it was already part of the practice’s toolkit before I took over. However, if you asked whether I’d buy it again, I absolutely would,” Campbell says.

“A considerable portion of our revenue is generated by advanced contact lens services – particularly rigid lenses where patients are willing to invest in effective solutions to address complex vision challenges.

“Beyond these direct financial returns, the superior imaging and topography data mean we achieve more accurate initial fits, with fewer refits overall. Our high success rate leads to happier patients, valuable word-of-mouth referrals, and more comprehensive ongoing care – collectively growing our patient base.

“Furthermore, new services such as dry eye evaluations using meibography provide an additional income stream, alongside enhanced patient engagement and retention.”

SIMULATING FOR A BETTER FIT The Medmont Meridia is available in two models – Classic and Professional.

The Classic offers the same gold-standard topography as Medmont’s E300, enhanced by a larger colour field-of-view and ergonomic quick keys for navigating the software.

The Professional (Meridia Pro) has the same functions as the Classic, but with more features like anterior imaging and video, fluorescein capture, and meibography. It also offers dry eye grading scales and reports for patient communication and engagement.

Richard Lindsay & Associates opted for the top-of-the-line Meridia Pro. For Campbell, the device proves its worth in all the essential aspects of anterior eyecare, supported by a high-definition colour camera and three light sources for assessing dry eye, contact lens fits and anterior pathologies.

“Due to the nature of our practice, almost every patient receives corneal topography. I’m using it to track whether they've progressed over time in combination with corneal tomography, fitting custom contact lenses, tracking how my orthok treatments are going before and after, and to measure the HVID (horizontal visible iris diameter),” she says.

“One of the very important reasons we stayed with Medmont when upgrading was that we had 20 years of data on the E300, so it was important to maintain that for future comparison, especially for our keratoconus patients who make up the majority of our patient-base.

“The functionality is also an advantage. Our front-of-house staff obtain all the scans, it's very intuitive. Medmont have also made it easy to swap between different maps; it’s effortless to use, allowing me to focus on the patient in front of me.”

Wide corneal topography coverage is considered key to custom contact lens fitting, helping remove the guesswork. It’s something Medmont has achieved with up to 11 mm of real corneal data in a single automatic capture, plus, for even more data, it has a Composite

Images: Richard Lindsay & Associates.

Mapping feature for “gold standard” limbus-to-limbus coverage.

In Campbell’s clinic, that baseline data is the key to high quality orthok and rigid contact lens fitting. It also supports an enviable first-time fit rate, helping to avoid unnecessary chair time and unsatisfied patients.

A big part of that is Meridia’s contact lens simulator, which can integrate with custom lens design software or export files straight to contact lens labs.

“The contact lens module is excellent for simulating the fit of various lens designs. This speeds up the process by reducing the number of lenses applied to the eye. Additionally, the lens fitting simulation software enables us to make adjustments to the lens design while comprehending the effects of individual modifications on other parameters,” she says.

“As long as you've got high quality initial scans, which Medmont instruments offer, and you’ve well trained staff to take them, it gives great insight into how the contact lens is going to sit.”

Detailed fluorescein images, using cobalt blue light with a built-in wratten filter, also ensure efficient and effective orthok fits. The practice’s support staff are trained to acquire these images that are “easy to take and come out focused and clear”, saving Campbell time to attend to higher patient needs.

The fluorescein images are also useful for documenting pathology like loose sutures, graft bullae/oedema, and dimple veiling to name a few.

With the device, she’s found new ways to encourage greater patient buy-in too, thanks to new video capability. It doubles as an excellent educational tool when she lectures optometry students at the University of Melbourne.

“For patients struggling with blurry vision I can demonstrate, for example, dimple veiling – bubbles underneath the lens – helping to explain why they’re having these issues. Another great example is a patient that had chronic wettability issues with scleral lenses and was a religious user of kohl liner – using Medmont Pro’s meibography, I could demonstrate the root cause of her issues and put in place management strategies to create better habits around contact lens wear.

“For educational purposes, the videos allow you to sit back and think more about how the lens is moving on the eye, not just in a photo in one position.

You can look at how the lids interact with the lens while the patient blinks."

And it's good for problem-solving when the patient's left the clinic.

“Many times, we’ve been huddled around a Medmont fluorescein video after work, problem-solving a complex reverse geometry fit.”

Epithelial Bullae on a corneal transplant, captured on Meridia Pro.

Surface of lens poor wettability caused by significant meibomian gland dysfunction.

A patient with significant dry eye issues and meibomian gland drop out.

ASSESSING THE ROI Given its broad-base functionality, it’s easy to see how the Medmont Meridia does much of the heavy lifting in Campbell’s clinic.

From a business perspective, it becomes much easier to justify the return on investment (ROI). Looking at orthok alone, which can cost patients around $2,000 for a pair of lenses in a treatment plan, Medmont notes it would require as few as 15 patients to recoup the investment.

That’s before the more intangible returns, such as patient satisfaction, retention and the best marketing tool there is – word-of-mouth referrals.

Using the Meridia Pro has also enabled Campbell to focus more on dry eye management, while enabling her to effectively demonstrate and document patient outcomes. Her management strategies include ciclosporin eye drops, BlephEx, and Zocular eyelid and skin hygiene products, as well as topical steroids, lid margin debridement, a comprehensive range of ocular lubricants, warm compress therapy, and manual lid expression.

Campbell can be confident in her clinical diagnosis and recommendations because of the device’s advanced features. The Meridia Pro offers a robust set of dry eye analysis tools, including meibomian gland imaging, Meiboscale meibography grading, tear meniscus height measurements, and visual dry eye reports.

“This is something I’ve under-utilised in the last five years, but I’ve cottoned on to it during the past 12 months, and patients love it,” Campbell says.

“It's helped me put more of a focus on managing dry eyes and we’re seeing more patients come back because they want those scans to see if their treatment has been working.

“I love using meibography to take photos of the glands and then the machine generates these excellent grading reports that you can show to the patient. It’s great for educational purposes, showing what type of dry eye they have and the reason for their symptoms.

“I then print the dry eye report, give it to the patient, and it includes their diagnosis, management and review schedule and their instructions for management. When they come back in, I can compare it to their baseline scan.”

For Richard Lindsay & Associates, Meridia Pro has allowed the practice to raise the bar in advanced contact lens fitting and disease management, while creating new differentiation opportunities for the business. It’s been a worthwhile investment.

INSIGHT May 2025

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Rodenstock’s new B.I.G. Exact Sensitive lenses are now available in Australia.

Image: Rodenstock.

LENSES

Try before you buy – an exacting trial

Rodenstock has made some significant statements about its new B.I.G Exact Sensitive lenses. The director of a Melbourne optometry practice thought he’d try them himself, to see if the marketing married up with the science. Here’s what he discovered.

A

ssociate Professor Richard Vojlay doesn’t do ‘spin’.

During his many decades in the ophthalmic industry, the director of Collin & Kirk Optometrists in Thornbury, Melbourne, and university lecturer has seen his fair share of marketing.

But integrity is important, as well as the scientific rigour to back up what he sells to his patients in his practice.

So it’s a little ironic, and certainly insightful, that A/Prof Vojlay is so enthusiastic about the new Rodenstock lenses he now has in his practice.

That enthusiasm, however, is not based on marketing spin; it’s based on his personal use of the product.

When Insight speaks with A/Prof Vojlay he is reflecting on his first impressions from wearing B.I.G. Exact Sensitive lenses he received 12 hours earlier, the latest extension to Rodenstock’s premium lens tier.

And he’s more than a little surprised at how good they are.

“One of the things I realised today is that my reading is better than with my extended focus lenses, which shouldn’t happen,” he says. “That wasn’t in the PR campaign.

“If I don’t have my normal extended focus ones at work, I’m going to have a very grumpy day, and these are actually better. It’s amazing.”

The glasses were delivered at 7pm the previous day, so A/Prof put them on, grabbed his dog and headed out into the Melbourne night.

“The night vision was better,” he says. “I’m out there and the first thing I notice is that it just feels more seamless, less intrusive and I am looking around without thinking about my vision.”

It’s something he often talks about with his patients.

“It’s cognitive load, it’s how you process information.”

That processing can lead to some blurring and a disruption of a person’s visual flow, the significance of which is down to an individual’s visual sensitivity.

German lens manufacturer Rodenstock has established that this sensitivity is highly personalised and linked to the eyes’ biometry, which is why it established a Visual Sensitivity Index.

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Using data from an extensive database of eyes scanned and analysed as part of its on-going research, plus AI and information about an individual’s eye taken using its DNEye Scanner, Rodenstock is able to produce an optical lens custom-designed to work for that person.

The latest advances in that technology are available in its B.I.G. EXACT Sensitive lens, which became available in Australia earlier in 2025 and can be offered in practices installed with Rodenstock’s DNEye device.

It builds on the company’s B.I.G. EXACT lens that incorporates more than 7,000 data points, allowing a biometric model of the eye to be ‘built’ and used to calculate the final lens. The new B.I.G. EXACT Sensitive goes further and is based on more than five years of research, the analysis of more than 500,000 eyescans, three complex wearer trials and a scientific eye-tracking study.

That’s a lot of science.

For A/Prof Vojlay and his many patients, what that means in practice is less blur and a more seamless, natural transition as they move between tasks near to them and at a distance.

He understands the impacts of that transition and the sometimes jarring disruption to visual flow.

“I get motion sickness and I had a pair of glasses for three years, and I’d move my head and feel a little bit of nausea.

“I can’t even find the swim effect on these Rodenstock lenses. So that was pretty impressive.”

The science and innovation behind the glasses are impressive as well.

A/Prof Vojlay has seen for himself the work that has gone on behind the scenes. He believes it’s something that optometrists and dispensers don’t always appreciate.

“I think with respect to all the companies, they're all busting their boilers to give us good lenses,” he says.

“You look at some of the intellectual property behind this, the patents, what they're doing and what they're developing . . . they’re working hard to give us better quality products.”

That knowledge, plus his own experience with the lenses, gives him the confidence to offer a premium product to his patients.

Part of that will come down to a level of trust he has built up in the Thornbury community he works in.

“I need to be able to convince patients, in a short amount of time, to be able to say, look, this is useful, because I know it works.

“I know these guys and girls have done the hard work. They've done the hard yards to give you a quality product.”

He says some clients might be keen to understand the science, but most will be more focused on the benefits. Benefits that he can demonstrate personally.

“It’s about ‘look, these will make it easier for you to look around, it’ll be more natural, and you'll feel more comfortable’.”

He believes the lenses are appropriate for all of his clients, and the small increase in price for what is a premium product is justified by their quality, the science behind them, and the benefits they bring.

For A/Prof Vojlay it’s a no-brainer.

“If it's available to us to give patients better quality vision, why shouldn't we?”

“You look at some of the intellectual property behind this, the patents, what they're doing and what they're developing . . . they’re working hard to give us better quality products.”

A/Prof Richard Vojlay Collin & Kirk Optometrists (wearing his new Rodenstock lenses)

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OPHTHALMOLOGY

Phaco’s new phase A novel modality dubbed 4D phaco is one of the standout features of Alcon’s new Unity Cataract System and, as DR RAHUL CHAKRABARTI explains, is setting a new benchmark in surgical safety and efficiency.

M

elbourne ophthalmologist Dr Rahul Chakrabarti is one of those people with a growth mindset. Every day, he’s trying to get better, even if it’s by 1%.

But sometimes there are quantum leaps. They don’t come around often, and for professionals like Dr Chakrabarti it’s a pivotal moment to be part of, potentially reshaping the way he and his colleagues go about their work for the next decade.

He’s not the first to marvel at Alcon’s new Unity Vitreoretinal Cataract System (VCS) and Unity Cataract System (CS).

The technology received regulatory approval in October 2024 and was introduced to selected surgeons during the RANZCO 2024 Congress in Adelaide, making ANZ the first market to receive approval outside of US. Some of Australia’s top vitreoretinal surgeons have told Insight it’s like nothing they have experienced before, and now, from the cataract

Image: Rahul Chakrabarti.

Dr Rahul Chakrabarti during a wetlab session with Unity VCS.

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surgeon’s perspective, Dr Chakrabarti is echoing these sentiments.

“This innovation is an opportunity for all surgeons to achieve even better outcomes+, and more efficient surgery for their patients,”+1,2 he says.

“And to teach and have our next generation of surgeons exposed to this technology, for them to learn a new and more efficient way of doing surgery, is exciting.1” Unity VCS integrates vitreoretinal and cataract surgical capabilities in one device, making it a great space and cost-saving proposition for public and teaching hospitals. Meanwhile, on the same system, surgeons can opt for Unity CS as a standalone system for phacoemulsification cataract surgery.

In cataract surgery, the technology will supersede Alcon's Centurion Vision System, something Dr Chakrabarti describes as a “workhorse” that’s “trustworthy and reliable, particularly for dense cataracts” and ubiquitous in private and public theatres around the country.

He’s also been a proponent of the Active Sentry handpiece, available on the Centurion Vision System, that has allowed him to drop his intraocular pressure (IOP) during surgery from 55mmHg to near-physiological 30mmHg3, thanks to sensors in the handpiece allowing automatic, real-time surge reduction support.

But all of that, plus a lot more, is available on the Unity CS and VCS systems.

Dr Chakrabarti, a director at Essendon Eye Clinic, got his hands on the technology in an intensive wetlab session at the RANZCO Congress and was immediately blown away. Its performance stands out in the key areas of efficiency, enhanced stability of the anterior chamber, and improved functionality such as an improved user-friendly interface.1,2 “But probably the thing that brings it all together is this what Alcon calls 4D phaco,” he says.

It’s one of the reasons Alcon can now claim to possess, with Unity, a phacoemulsification modality delivering up to two times faster nucleus removal^ with 40% less energy* into the eye.4 “Alcon has programmed the phaco tip to oscillate in a certain way. It’s a mathematical algorithm that they've got – and this unique 4D movement allows the tip to basically mitigate surge as well as efficiently break down the lens,” Dr Chakrabarti says.

“That’s exciting, because what I felt when using it, albeit in a simulated environment, is it was able to fragment and remove the lens particle very efficiently. Alcon talks about a 41% improvement in energy efficiency, but I would go even beyond that to say it may change the way we actually do and teach cataract surgery.”

Elaborating on this, he says most surgeons adopt a divide and conquer or chop technique, but these could become obsolete in many cases with Unity CS. “You could potentially almost vacuum the entire lens, or use very little phaco to segregate the fragments and remove it,” he says, expanding on this later.

“It'll improve the surgical efficiency and it might even reduce the traditional steps of cataract surgery.”

And it achieves this while maintaining anterior chamber stability. 5 Dr Chakrabarti is passionate about low-IOP cataract surgery, and with the Unity CS this functionality – lower infusion pressure – comes as a standard feature, rather than an optional module and separate handpiece as was the case with the Centurion system.

“It reduces post-operative inflammation, reduces intraocular

“You could potentially almost vacuum the entire lens, or use very little phaco… it'll improve surgical efficiency and it might even reduce the traditional steps of cataract surgery.”

inflammation, and is another evolution of how we do cataract surgery.”6,7 But during surgery itself, this capability ultimately means less fluid is being driven around the eye, reducing “turbulence” in the anterior chamber.

“That improves your efficiency of movement. As a surgeon, you want everything to be stable so that you can be precise at the moment you engage the phaco energy."

Secondly, it helps with surge mitigation. 5,8 “Once you've engaged that fragment, and you initiate the ultrasonic energy, it's so efficient. At the same time, there's reduced post-occlusion surge. That could happen in other machines or previous technology; you're always worried after the fragment is removed, will there be that surge effect? But it’s almost non-existent with Unity CS.” Once the surgeon engages the fragment, Dr Chakrabarti says only a small burst of ultrasound energy allows them to efficiently remove that fragment, with the next fragment almost immediately arriving at the tip.

“There's no trampolining of the posterior capsule and the anterior chamber. It's completely stable and you don't have to use as much ultrasound, because the vacuum is largely doing the work.”

BEING ‘OPEN MINDED’ TO A NEW ERA Beyond phaco, Dr Chakrabarti is an early adopter in other areas of cataract surgery.

He’s made, for example, extended depth of focus (EDOF) intraocular lenses (IOLs) his default lens option, implanted now in almost 80% of his cases. Trifocals are implanted 22% of the time, according to his latest audit, with monofocals now a rarity.

Microscopy is another area he’s fascinated in. Heads-up displays with 3D visualisation are the future of ophthalmic surgery and he’s made Alcon’s Ngenunity his 3D visualisation system of choice in all surgeries, including cataract, minimally invasive glaucoma surgery, pterygium, squint surgery and even oculoplastics.

“My view as a surgeon is much better using Ngenuity, and the recent upgrade, called Ngenunity 1.5, has excellent responsiveness and detail, there’s no lag and you can selectively implement filters for different stages of cataract surgery. It’s a major upgrade from Alcon," he says.

“Ergonomics is one of the huge benefits.9 I'm much more relaxed. I'm not confined to looking down the oculars of a microscope.”

Increasingly, ophthalmologists are demanding surgical technology that seamlessly integrates from the clinic and into the theatre.

It’s one of the advantages of the Alcon Vision Suite, and Dr Chakrabarti is looking forward to combining Unity CS with other technologies like Ngenuity, the Alcon Verion image guidance system for toric alignment with reference image import from the Argos biometer.

With all new technology, he acknowledges there is a natural learning curve, but is encouraging his peers to approach this new cataract surgery era with an open mind.

“We’re heading towards even safer and more efficient cataract surgery,

Image: Alcon

Dr Rahul Chakrabarti Essendon Eye Clinic

Unity VCS integrates Alcon’s best vitreoretinal and cataract surgical capabilities.

and for trainees it’s going to fast-track their development so they can do more complex cases sooner.

“Ultimately, we’re trying to preserve the highest outcomes, while performing more surgery. Post-pandemic, there’s a huge lag both in the public and private systems, and so if this improves your surgical turnaround by a couple of minutes per case, then you could potentially add another four or five cases to your list a day. That translates to a big difference over the long-term," he says.

“Ophthalmology is one of the few specialties in Australia where we’re exposed to these new advancements early relative to the rest of the world.

It positions us well, and it’s an exciting time that we need to embrace.” ^ 2x faster nucleus removal than OZIL Torsional phaco * Based on N=10 HPs, Artificial cataract lens IOP 55mmhg vacuum of 450 mmHg #Compared to Constellation HYPERVIT 20k vitrectomy probe + Compared with Centurion with Active Sentry REFERENCES: 1. Alcon Data on File, 2024. (REF-25562) 2. Alcon Data on File, 2024. (REF-25374) 3. M iller KM, Dyk DW, Yalamanchili S. Experimental study of occlusion break surge volume in 3 different phacoemulsification systems. Journal of Cataract and Refractive Surgery.

2021;47(11):1466-1472.

4. A lcon Data on File, 2024. (REF-24379) 5. U nity Phaco Handpiece. Directions for Use. 6. Vasavada V, et al. Realtime dynamic intraocular pressure fluctuations during microcoaxial phacoemulsification using different aspiration flow rates and their impact on early postoperative outcomes: a randomized clinical trial. Journal of refractive surgery.

2014:30(8);534-540.

7. Vasavada AR, et al. Impact of high and low aspiration parameters on postoperative outcomes of phacoemulsification: randomized clinical trial. Journal of Cataract & Refractive Surgery.

2010:36(4);588-593.

8. U NITY VCS and CS User Manual 9. C heng TC, et al. Evaluation of three-dimensional heads up ophthalmic surgery demonstration from the perspective of surgeons and postgraduate trainees. The Journal of Craniofacial Surgery. 2021;32(7):2285–2291.

INSIGHT May 2025

49

OPHTHALMOLOGY

Images: Rayner.

LEFT: Rayner, based in Worthing, UK, has grown its presence and staff numbers in Australia.

Rayner – a not-so-little disrupter In just a few years, British company Rayner has grown its presence Down Under significantly.

The company’s leaders outline the opportunities in Australian cataract surgery and why, sometimes, less is more.

A

ussies like to back the underdog.

And just as David had a few tricks up his sleeve in his contest with Goliath, British ophthalmic company and intraocular lens (IOL) manufacturer Rayner has discovered there are advantages in being the smaller, more nimble player in a tough, competitive market.

And it is using those advantages to tackle those bigger players and grow.

In reality, Rayner is not a little guy. It’s a leading ophthalmology company and manufacturer of IOLs based in Worthing, the UK, where, just as this article went to print, it has doubled its production capacity to produce four million IOLs a year.

Its products and reputation are well known in the Northern Hemisphere.

But up until a few years ago it was more of a peripheral figure in Australia, its products distributed for 18 years in this part of the world, against big players like Alcon, Zeiss, Johnson & Johnson and Bausch + Lomb.

That began to change in January 2022 when the company decided it needed a greater presence in Australia and a way to establish long-term, meaningful relationships with the country’s ophthalmic community.

It looked to Ms Lisa Farquhar, a long-time leader in the medical device industry with plenty of experience working with those bigger players in ophthalmology, including leadership roles at Alcon and Australian medical device company Ellex.

“I like to build businesses that provide an alternative,” she says. “I had an opportunity to do that here at Rayner; they were a blank canvas in Australia, so I thought, well, why not, let's do it.”

In early 2022 Rayner in Australia was just two people: Farquhar and Ms Sue Ford, an Australian ex-pat working for just under a decade with Rayner UK, who was returning home.

Three years on, the Australian arm of Rayner is pushing 20 staff, with salespeople in practically every state, backed up by leading figures in its global business, including Mr Kuntal Joshi, vice president of international sales, as well as the heads of international marketing and finance, and the director of Rayner's APAC business. They live in Australia, with a focus beyond its shores, but also contribute to local decision-making.

Because of that, Rayner has a great story to tell and a pipeline of innovative

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new products to share, but it remains a small, nimble player steadily nibbling at the big guys’ market share.

Farquhar says she and her team have relished growing surgeon choice within those three years. “Flying under the radar of our opposition for the first few years let us grow Rayner’s brand unhindered.

“It doesn't sound like a lot, but when you've got big players with established substantial market share, going slow and steady” was just the way Farquhar liked it.

It’s reflected in how she has built the national team.

Many of her colleagues also have extensive ophthalmic backgrounds and experience with the bigger companies, in ophthalmic clinics and focused on patient outcomes.

“We continue to find people that really liked our philosophy,” she says.

They discovered that surgeons like the philosophy as well.

“The surgeons know that we're the new kid on the block, but we've got this British calm,” says Farquhar.

“And we're really transparent – surgeons can come and visit, we walk them through our factory, we talk them through our processes.”

Making that conversation easier was a key early collaboration with Western Australian ophthalmologist Professor Graham Barrett, just as Rayner was taking its first steps in the Aussie market.

Rayner worked with Prof Barrett, a well-respected voice in Australia and around the world, to develop the RayOne EMV, an Increased Range of Focus lens. It adopts an optical concept he had been working on for years, based on positive spherical aberration, and Rayner turned out to be the ideal partner.

“That brought us some notoriety and established credibility in Australia,” Farquhar says.

Prof Barrett’s EMV IOL and the backing of others, including Dr Ben LaHood, helped lay a bridge over another stretch of troubled water – Aussie surgeons’ lack of familiarity with IOLs using hydrophilic, rather than hydrophobic, material.

When Farquhar resurfaced after some time away from the ophthalmic sector, and at the head of Rayner’s push into Australia, former colleagues questioned her judgement.

“They said, ‘what are you doing? You know how hard it's going to be to sell a new lens and material in this market. Well, you're either going to crash and burn Rayner began in Australia in 2022 with just two staff members. Three years later the number is pushing 20.

It s

A fe a h in t

R a s

“We listen to surgeons, we act fast and surgeons like that about us. The RayOne EMV lens was an example of that. We started to work with Professor Barrett and were pretty fast at taking that concept and developing it and commercialising it.”

Kuntal Joshi Rayner or you're actually going to take it head on.”

Rayner found Australian surgeons to be sceptical but “open-minded”.

“Our surgeons have always been very curious,” says Farquhar. “Our surgeons travel the world and have the ability to have new technology on their doorstep pretty readily, they embrace that; they like being pioneers, forward-thinking.”

“We were one of the first countries in the world to embrace toric and astigmatic correction with IOLs. “Australian surgeons provide honest commentary, which can be a good thing and a bad thing – calling a spade a shovel,” she says.

It was important that they deal with people at Rayner steeped in the ophthalmic industry. Of the company's seven sales reps in Australia, six are either orthoptists or optometrists.

“And Rayner listens, which is especially important when many of those surgeons are contributing to Rayner’s science and product development,” says Joshi. “We listen to surgeons, we act fast and surgeons like that about

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us,” he says. “The RayOne EMV lens was an example of that. We started to work with Professor Barrett and were pretty fast at taking that concept and developing it and commercialising it.”

Another aspect of Rayner’s growth in Australia has been the way that has aligned with its roll-out of new products and innovation.

Aussie surgeons were some of the first implanters of Rayner’s RayOne Galaxy IOLs that – with a novel spiral design – have been well received by the global ophthalmic community. They are now available in Australia but waiting to gain Prostheses List approval.

The company is already moving beyond IOLs and shaking it up elsewhere.

Rayner has recently extended its footprint to other aspects of surgery and eyecare. wWith the acquisition of Sophi, Swiss Ophthalmology Innovation, in 2024, Rayner’s eco-conscious phacoemulsification platform allows multiple procedures from a single cassette, which it says will reduce surgical costs and impacts on the environment.

Being wireless and with a small footprint provides a versatile choice for cataract surgeons.

Rayner also now manufactures its own ophthalmic viscosurgical devices (OVD) Ophtesis, which are bio-fermented, enabling unrefrigerated use in the OR with a larger volume for versatility.

Joshi and Farquhar believe that reliable pipeline of product and innovation, coupled with a great narrative and talented, knowledgeable story-telling experts, will help Rayner grow further in Australia.

“Our large competitors have some fantastic products and some great people, and are obviously steeped in a legacy, with great processes,” she says.

“But being open to change, nimble and agile, and seeking continual improvement in patient outcomes makes surgeons interested to work with us.”

Sometimes it’s good to be David rather than Goliath.

OPHTHALMOLOGY

Image: VEI.

Surgeons using Vision Hospital Group facilities get access to the best equipment and staff.

Benefits of working with the best Two eye surgeons who regularly perform surgery within Vision Hospital Group day surgeries, designed with ophthalmologists in mind, discuss why they go back time and time again, and why they would be happy to recommend the facilities to their peers.

“O

ften, young nurses want to work in the public hospital because it's busy and chaotic, and they probably thrive on that. But actually, what you want for a routine operation is to have someone who’s done it 1,000 times before and knows it inside out.”

When Queensland ophthalmologist Dr Nick Toalster considers the advantages of operating at a Vision Hospital Group (VHG) day surgery in Brisbane, working with people who have done it all before, and many times, is high on his list.

Calm vs chaos. Quiet efficiency vs noisy, frenetic energy.

Dr Toalster’s cases can be complex. As well as the more straight-forward cataracts and pterygium procedures, there are more complicated corneal transplants and glaucoma operations.

So the last thing he wants is complexity in his workplace. For the sake of his own practice and his patients’ outcomes, nothing beats a simple, orderly space populated by state-of-the-art operating suites and staff. Doing something they have done time and again. Successfully – and all geared towards optimal ophthalmic surgery.

That’s what he gets at RiverCity Private Hospital in Brisbane, operating under the VHG banner. With 11 day hospitals across Queensland, New South Wales, Victoria, and South Australia, the group is a subsidiary of Vision Eye Institute (VEI), but operates independently.

This means VHG is agnostic when it comes to which ophthalmologists perform surgery in its facilities. As such, VHG facilities are becoming preferred locations for ophthalmologists not generally associated with VEI, like Dr Toalster.

It’s a similar experience for Dr Michael Wei.

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He’s a general ophthalmologist at VEI who subspecialises in retinal work, dividing his time between various clinics and day surgeries in and around Sydney, whereas Dr Toalster is a consultant who spreads his work between public and private patients and facilities.

But both have a similar high regard for the quality of VHG’s staff and care, and what that does to bolster their own reputations and practices.

For Dr Toalster it means not only elevated safety and efficiency but also a smoother, more streamlined workflow.

“I probably get three or four cases done in an afternoon at the public hospital, whereas I can probably get between 14 and 15 done at RiverCity,” he says.

Dr Wei gets compliments.

“Many of my patients have commented on how well they were looked after and that they look forward to their surgery for their fellow eye,” he says. “That experience helps to relieve any anxiety they have.”

And then they tell others.

“They’ll tell other patients about what a great, positive experience they have had, they’ll tell their friends."

Dr Toalster agrees.

“You know, the last thing that patients remember is always the last person that they spoke to and how caring they were,” he says.

“I think what drives patients is the referrers, so the people out in the community, the GPs and the optometrists and their friends and family that they talk to, coming back with positive stories and saying I went to such and such, and I had a good experience.”

That experience in the surgical suite is matched by efficient and

Image: Nick Toalster.

“What drives patients is the referrers, so the people out in the community, the GPs and the optometrists and their friends and family that they talk to, coming back with positive stories and saying I went to such and such, and I had a good experience.”

Dr Nick Toalser OKKO Eye Specialist Centre

Image: VEI.

streamlined service elsewhere, reducing the burden on surgeons.

“Staff at VEI clinics and the VHG day surgeries are very experienced and efficient,” Dr Wei says.

“Booking a patient into surgery is very easy and fast; I just have to tell my clinical staff and director of nursing that this patient needs surgery and they'll take care of everything from then on.

"This includes billing, ordering lenses and any special equipment, liaising with the anaesthetist and answering any questions the patients may have about admission and discharge process, such as when they should eat and have their regular medications. The whole process is being taken care of.

“The staff also remind me to select the intraocular lenses for my patients ahead of the time.”

That leaves the ophthalmologist to focus on the surgery and ensuring the patient’s best outcome.

Another thing that helps with that, for both patient and practitioner, is the size and scale of VHG and the distribution of its facilities around the country.

Dr Wei is based in NSW. He does a lot of his consulting at VEI’s Hurstville clinic, with surgeries performed at Forest Road Day Surgery. But VEI also has clinics in Drummoyne, Tuggerah Lakes and Chatswood, located next to Chatswood Day Surgery, another VHG facility.

That means he can meet patients in locations that suit them, whether it’s for consulting or surgery itself.

“For a lot of us, we travel around in various clinics or locations, and we have different day surgeries to work in, depending on where the patients are based,” he says.

That’s particularly important for many of Dr Toalster’s older patients too.

“Part of the advantage of the group, which is obviously pretty big, is that you're likely to have a facility that's reasonably close to where the patient is,” he says.

His own consulting clinic is in the same building as VHG’s RiverCity Day Surgery in Brisbane.

“We are on one floor, and then I can say to them, when you come back on your days for surgery, you only need to go up to level one. And I think, particularly elderly patients, they find that very reassuring, because they don't like the stress of having to find a new place and where to park and all of the rest.

“It's nice to know that they can come and get surgery in a timely fashion with the surgeon that they choose in a location that they're familiar with.”

Knowing that they will have access to the best, most modern ophthalmology equipment and technology gives peace of mind as well.

Dr Toalster says VEI day surgeries are equipped with all of the “big, expensive bits of equipment – things like the microscope, the cataract machine, the phacoemulsification machine”.

All the right things in one place, says Dr Wei. “Some day surgeries may not have, for example, a Femtosecond laser which has many useful advantages, especially in cases like a dense cataract and Fuch’s Endothelial Dystrophies. So you have to send the

Dr Michael Wei says VHG having a number of day surgeries around Sydney means patients can access eyecare closer to them.

patient to another location to perform the procedure.”

This can affect the outcome for the patient and their appreciation of the experience.

“But we have access to the latest technology and equipment all in one place in VHG day surgeries. For example, the Forest Road Day Surgery in Hurstville has Femtosecond laser for laser-assisted cataract surgery, Alcon Centurion Phaco machine with Verion Toric marking system and celling-mounted Zeiss Lumera 700 microscope which has excellent optics and red flexes.

Both believe that VHG is one of a number of networks offering very good equipment and facilities for patients and eyecare professionals.

But both also think that the group offers even more in a couple of unappreciated areas.

Dr Wei says that the group’s size can help it cater to a wider, more diverse group of patients.

“VHG has staff from many different backgrounds, and that means it can accommodate and actually reach out to patients from various racial or ethnic groups.

“For example, at Forest Road Day Surgery, the theatre and support staff can communicate in Mandarin and Vietnamese, which helps me give post-surgical instructions to many of my patients, sometimes without having to rely on their friends or family members to interpret.”

Dr Toalster appreciates another form of diversity.

He likes that VHG in particular is flexible enough to allow him to change plans, when needed.

“So if I want to do something a certain way, or if I want a particular bit of equipment, or I want to use a particular theatre, then they've always been super accommodating,” he says.

“They listen to what I want and look at how they can fit that in and say, ‘we'll try and make that work’.”

Both are happy to recommend VHG facilities to other surgeons.

For Dr Toalster, it goes beyond the top-of-the-line equipment, experienced staff and other advantages you would expect from economies of scale.

It’s more than the research that VHG and VEI is often involved in, and the access to the latest technology being trialled.

“They're willing to accommodate and they're keen to have young, enthusiastic people that work and want to achieve good things together; it’s a collaborative approach.

“Ultimately, that’s what makes healthcare work.”

INSIGHT May 2025

53

A vision for someone’s future A diagnosis of permanent vision loss is not the end.

At Vision Australia it’s the start of a new journey for someone living with vision loss. And as Insight finds out, helping that person find employment is a big part of getting them on the right path.

“Y

ou can work.”

Three little words. Delivered by an ophthalmologist to a young woman contemplating the loss of her vision, but also her confidence, her way of life, her future.

“Life-changing”. The impact of those words on that same woman.

A little more than a decade after those words were delivered, Ms Vildana Praljack manages the employment services at Vision Australia, which helps others with low vision and blindness find work and careers.

She got there by working her way up in the organisation, gaining experience in practically every facet of its operation – from administration to government services and advocacy, client services to data analysis and insights.

Praljack even made cups of tea when she began as a volunteer.

But it all started with a diagnosis of cone-rod dystrophy, thoughts of life with a disease that would progressively rob her of sight, and a chair in front of ophthalmologist Dr Jonathan Ruddle. And all just a year or two before her 30th birthday.

“I thought, I'm never going to work again,” says Praljack. “And that's the sort of societal expectations that you internalise and hold as your own.

“He told me you should be working, right? ‘You can work’.

“That sentence was something that reverberated, it really challenged some of the thinking that I had at the time.

“The idea of someone having that sort of conversation with the patient can be really life changing; it can be so transformative.”

It was not long after that she began pouring those cups of tea as a volunteer, then went one step further and applied for a job with Vision Australia.

For the past 18 months she has been leading the organisation’s employment team, helping people like herself to find that all-important job and career.

She knows the transformative power of employment.

“Everyone wants to have a few things, like obviously a safe place and a lovely home, beautiful relationships, and a job,” she says.

“It’s no different for anyone who has a disability, who's blind or has low vision; it’s incredible the independence that they gain, the financial freedom, the choice and control, confidence, self-determination – all of it just changes a person, big time.”

Vision Australia helps between 80 and 100 people a year experience that change.

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LEFT: Each year, Vision Australia helps between 80 and 100 people with blindness and low vision into employment.

Many of those people are referred to them by optometrists, ophthalmologists and others in the ophthalmic sector. Vision Australia would love to see many more.

Because there are plenty of people in Australia who, like Praljack and so many others, are ready and able to contribute. Who remain on the bench, waiting for the call-up.

A LARGE, UNTAPPED RESOURCE Figures may show that national unemployment is at 4.1% but Vision Australia says that 53% of people with low vision or blindness are jobless. And one in five Australians have some form of disability.

That means, in a country so reliant on bringing in overseas labour to fill so many roles in a tight labour market, there remains a significant untapped resource within its own borders.

A resource that brings very particular skills.

“As a blind or low-vision person, you have to think outside of the box,” says Praljack.

“You’re problem-solving constantly, because the world is full of physical, societal, attitudinal barriers; it's always there, and you have to always navigate those relationships, you have to always navigate spaces, you have to navigate the technology.

“So there's always that sort of innovation, that ‘can-do’ attitude.”

She says those who are referred to Vision Australia get a lot more than merely the tools and support to find work.

“We have a chat to see where they're at. It really depends on where the person's at in their vision-loss journey.”

The end destination might be a career but the journey has many other meaningful waypoints.

“Do they have a safe place to live, how is their independence in the kitchen?

Are they getting around safely in their community? Can they catch public transport? Are they using a computer?”

To help answer those questions, the person will work alongside occupation and mobility therapists, technology and accessibility specialists, and others.

They’ll also talk with vocational counsellors about what they might have done previously in a job, what they are looking for in work, and what they might need to do to get there. That includes help with CVs and cover letters.

Vision Australia also works with employers to make the recruitment and transition into a job as seamless as possible on both sides.

Both employers and prospective employees will have access to a number of federal and state government disability employment funds to support the person in the new role.

Praljack says the support from Vision Australia continues beyond the employee’s first day.

Vildana Praljack started as a volunteer at Vision Australia and now runs its employment services team.

Image: Vision Australia.

Image: Sam Biddle.

LOW VISION

“We maintain an ongoing relationship with the employee and the employer because we want to make sure the candidate is settling in.”

Daniel Leighton helps many people like him find work.

Image: Daniel Leighton.

GIVING PEOPLE A ‘FAIR GO’ Vision Australia is normally associated with the start of a new job, but for Mr Daniel Leighton its involvement heralded the end of one.

Leighton was working in an orthopaedic rehab facility. It was a job he loved but a change in management, coupled with growing vision problems put a lot of stress on the working relationship.

Looking for support he contacted Vision Australia, which recognised two things: firstly, that the relationship with his employer was broken and beyond repair.

“We walked out of a meeting [with the employer] and Jenny the Vision Australia employment consultant said, ‘No, we can't repair this, this is not going to work, we're finding you another job’.”

And secondly, that Leighton had significant eye problems that needed to be diagnosed.

Sadly, the outcome of his many visits to various eyecare specialists was the same as Praljack’s: another young person with a devastating and debilitating eye condition. In this case, Usher Syndrome, which has left him legally blind, with just a five-degree field of vision.

That hasn’t stopped him from finding work, though.

Vision Australia asked Leighton if he’d like to contribute to a lived experience workshop. He handled himself so well, communicating effectively with people from all walks of life, that the organisation realised he was a keeper.

Jenny, the employment consultant who helped him earlier, is now his colleague at Vision Australia. Praljack is his manager.

But Leighton still needed to walk before he could run.

“If you saw my shins, they were just bruised and battered,” he says.

“I had the shins of an 80-year-old.”

He worked with an occupational therapist and orientation and mobility specialist. There were adaptations he needed to make so he could continue to be involved in the active lives of his three children – aged between nine and 14.

But he’s running now. Just maybe not as quickly as before.

He started at Vision Australia a couple of years ago as a support worker; now he’s an employment consultant.

He works with many people like himself – young, keen to start their adult lives but dealing with vision loss.

“They want a job, they want money, they want something, right?”

Praljack says it’s “about uplifting people, uplifting communities. And I think it really comes down to the idea that Australia is a country of having a fair go”.

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09:59 PM

EVENTS

Taking stock Independent optometry practice owners discuss why it’s so important for their teams to break the daily practice cycle and attend live industry events like ODMAFair, a show that’s returning bigger than ever in June 2025.

W

ABOVE: ODMA events are a key part of the commercial strategy for independents.

In saying that, the practice will have objectives.

While it’s a nice opportunity to trawl the aisles for new frames, Gibbons is on the hunt for equipment offering corneal topography and axial length measurement after a device she recently purchased was discontinued.

“We’re a full-scope practice, and part of that is scleral lenses and orthokeratology, so it’ll be a good chance to get a feel for what’s out there and suitable for our practice.

“Having all the suppliers under the one roof and being able to receive advice and compare instruments on the same day saves a lot of hassle. We are a country practice, reps don’t come by as much, so it’s good to be able to go to them.”

Adding to the convenience factor is ODMA’s new agreement with Optometry NSW/ACT. The latter’s Super Sunday conference on 29 June will grant Gibbons and her fellow optometrist access to up to nine CPD hours.

“Being at the same venue makes it very convenient, it’s a great initiative.”

PUTTING A FACE TO THE NAME Tamworth-based independent Paul Harvey Optometry is another regional practice that enjoys the ‘one-stop-shop’ nature of ODMA events.

The three practices, two in Tamworth and one in nearby Quirindi, employ six qualified optical dispensers, four optical assistants and five optometrists. This includes Mr Paul Harvey himself, who founded the business 26 years ago.

Four of them will be heading 4.5 hours southeast to ODMAFair, including a newly qualified optical dispenser and another who inputs stock into the system but hasn’t been as involved in sourcing eyewear.

The chance to network with peers is a highlight for attendees.

INSIGHT May 2025

57

Images: ODMA.

odonga Eyecare, an independent optometry practice located on the upper edge of Victoria, fights hard to ward off the problem many other small businesses face.

When the team works so hard in the business, that can leave little capacity to work on the business.

It’s something principal optometrist Ms Kelly Gibbons treats with hyper-vigilance. Often, time is ringfenced for after-work dinners and even camping trips, providing a chance to stop, breath, consider the big picture and galvanise the practice culture.

For Wodonga Eyecare, independent-focused events run by the Optical Distributors and Manufacturers Association (ODMA) are another opportunity to take stock – and from Friday 27 June to Sunday 29 June 2025 the seven-strong team will pack up the practice and drive 5.5 hours north to Sydney check out the latest frames, lenses and equipment.

Although Gibbons and her team, including husband Kurt (co-owner and lab manager), regularly attend ODMA events in Melbourne, it’s been some time since they’ve trekked to the Harbour City.

It’ll be worthwhile considering ODMAFair in 2025 marks the revival of ODMA’s flagship event.

Maybe it’ll be its biggest yet, bolstered by new collaborations with the Australasian College of Behavioural Optometry and Optometry NSW/ ACT running their clinical conferences concurrently at the International Convention Centre Sydney (ICC Sydney).

“There’s seven of us – three optical dispensers, two assistants and two optometrists including myself – that’ll head up. We treat it like a team-building exercise: the roadtrip up there, the event itself and then other activities like going out for dinner or heading to Luna Park,” Gibbons says.

“Even though there’s the loss of income from reduced practice hours, plus hotels and dinners, it’s a worthwhile investment.”

Perhaps this mindset is the secret behind such great staff retention at the practice. All have been with Wodonga Eyecare eight years or more, some up to 18 years.

“It’s easy to forget how important activities like this are for your business, and then in hindsight you look back and think we should be doing these things more often. It's just lovely for everyone to get together and not be so serious all the time.”

Image: iOptical.

EVENTS

WOMEN IN OPTICS BREAKFAST

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INSIGHT May 2025

Alisha Shastri (left) and Ebru Efem, owners of iOptical in Melbourne, will be attending the Women in Optics Breakfast.

“It’ll be a great experience for them,” says Ms Courtney Priestley, one of four principal optometrists whose remit covers stock control.

“One of the important things about independent optometry is that we have control over what we buy and stock, so it's nice to take a couple of dispensers, demonstrate this and involve them in these decisions. And if there are frames they like, we can buy them into the practice.

“It’s also ideal to meet face-to-face with reps, especially some of the companies we use for more sundry items (eye drops, consumables, etc) that we don't ever see reps for. It’s good to put a face to the name and then it builds those relationships.”

Fellow optometrist Mr Clifford Chong concurs, but also notes the networking benefits. These often happen informally with old university mates or colleagues on the trade floor.

ODMAFair will also feature networking drinks on Friday 27 June from 5-7pm while the trade fair is still open and is free for all to attend.

“I regularly attend the ODMA events whenever they’re in Sydney, often bringing my team along. These events provide a valuable opportunity for team bonding and facilitate networking with others in the industry,” he says.

“I look forward to seeing a diverse range of new products and innovations in frames, lenses, and equipment, as well as checking out devices that highlight advancements in technology. I also hope to reconnect with colleagues, fostering camaraderie and mutual encouragement.”

Kelly Gibbons (bottom right) will be taking her Wodonga Eyecare team north for ODMAFair25.

Image: Wodonga Eyecare.

The spirit of collegiality will be felt in all corners of ODMAFair, but especially during a new Women in Optics Breakfast taking place on the morning of Saturday 28 June.

Sponsored by ProVision, it will be headlined by Ms Carli Phillips, CEO of Corporate Wellbeing Hub. It’s hoped the initiative will resonate with all women’s optical support groups, bringing them together to talk about issues relevant to them.

For Ms Ebru Efem, a dual-qualified optometrist-orthoptist who founded Melbourne greenfield iOptical with Ms Alisha Shastri in 2021 (pictured right), that includes working in an industry that still feels male-dominated despite almost 60% female representation in optometry.

“Some of the challenges women in optics face include being under-represented in a male-dominated workplace. This at times can create self-doubt or imposter syndrome. In addition, limited training and the opportunity to move to management roles are amongst some of the other challenges,” says Efem, who has also been working at the Royal Children’s Hospital as a paediatric orthoptist since 2017.

Shastri feels there aren’t a lot of young women in practice ownership, and it can be difficult to break through.

“I believe work-life balance can be difficult for women as there is a stigma around this being an owner and balancing family and other responsibilities. I believe that it is hard for the younger generation to see this is something they can do because there is a small amount of role models within the industry that have done this.”

Vision on Koornang principal optometrist Ms Clare Campitelli, in Melbourne, says wage stagnation has been an issue in her career after having children, despite developing her clinical skills.

“And on a part-time wage I was paying for all of my work expenses – insurance, registration, education – there wasn’t a lot left over. I could see that the only way to fix this was to own the business and not be employed.”

She says momentum behind women in optics had been growing thanks to the efforts of a ProVision business coach. A What’sApp group has formed where people seek advice and support. Handling maternity leave is a topic that stands out.

“I had nobody to ask when I went through this – I thought how wonderful it is to now have a resource for women in this group.

We have had multiple dinners, and a breakfast at our most recent ProVision conference in 2023. Our gatherings have been very positive so far and I look forward to this next one in Sydney at ODMAFair.”

In her keynote, Phillips will merge her expertise in wellbeing research, nutrition and mental health first-aid with her own five-year career in the Australian optical industry as a contact lens rep.

“I am also a mother, business owner and carer for my elderly parents. Since recovering from burnout 10 years ago, I have found wellbeing workarounds that work for super busy days,” she says.

“I now share these with other women to protect them from the everyday stressors and life juggle.”

She will present her wellbeing research from the optical industry and compare it with Australian benchmarks. This will include physical wellbeing, such as nutrition, exercise, sleep and smoking.

Mental wellbeing – causes of struggles and where to go for help – will also feature.

“Industry-specific workplace wants and needs will also be shared from my research. I will inspire with wellbeing workarounds for busy working women. I will then facilitate a panel to discuss how women in various stages of life prioritise their wellbeing.”

The breakfast is a “fantastic initiative”, says Efem, who hopes to connect with her female counterparts, all at various stages of their careers.

“Raising awareness of the impact that women make in the field increases recognition of great female leaders and clinicians,” she says.

Campitelli loves connecting with people who share stories, converse, thrash out ideas and listen, regardless of their gender.

“I think getting a group of women together is great though if it provides a chance to be understood, heard, to give or receive support,” she says. “It’s events like this that can lead to unexpected opportunities; you never know.”

OPTICAL DISPENSING

SHARPENING YOUR MANUAL DISPENSING TOOLS When did you last use your PD ruler and felt tip pen? With so much tech available at the optical dispenser’s fingertips, it’s vital to brush up on your manual skills, as NICOLE GRASSO recently discovered.

A NICOLE GRASSO “IN OUR DISPENSING TOOL KIT, WE HAD A TRUSTY PUPILOMETER, LENS INSERTS, PD RULERS, PEN TORCHES, FELT TIP MARKERS AND A FEW HANDHELD MIRRORS SO OUR PATIENTS COULD SEE THEIR NEW SPECTACLES.”

Images: Nicole Grasso.

BELOW: Nicole Grasso fitting a frame to a patient during an outreach trip to Fiji in 2024.

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lot of work as an optical dispenser requires making quick decisions and relying on prior knowledge to ensure the best outcomes for patients.

As technology develops, the number of resources we have access to at our fingertips multiplies such as automatic centration systems and digital consulting tools. Some dispensers have only ever used these systems, and they achieve excellent results.

But what happens if your systems go down? Or if you have aspirations to step outside your comfort zone and volunteer your dispensing services to remote Australian communities?

Or an overseas country with limited resources, often running on power generators during harsh weather?

This severely impacts not only the use of digital measuring tools but devices such as an auto-lensmeter and your approach to dispensing.

When dispensing overseas, like Optical Dispensers Australia did in 2024 for its inaugural international outreach project in Fiji, we were faced with many challenges such as using children’s classroom tables as dispensing stations, books for an N4 reading chart, matching best fit frames and best fit prescriptions and, most importantly, relying on our training to take accurate manual pupillary distance (PD) and height measurements.

DISPENSING SKILLS AND ADAPTIONS We relied heavily on donated frames and lenses from generous sponsors, learning how to adjust them as needed.

With this in mind, it varied from our usual day-to-day dispensing where you can contact your frame suppliers with any questions regarding material composition and heating requirements or even Google your questions.

Having the skills at our disposal to recognise the difference between cellulose acetate, polyamide, metal alloy, cellulose propionate, and other materials meant we could confidently make adjustments to the final fit – regardless of whether the patient needed petite spectacles or broader fitting spectacles.

Some of the frames dispensed were an inflexible polyamide, so our team needed to have a keen eye to recognise what frame shapes and sizes would be suitable for the patient before us.

Some were receiving their first pair of spectacles, so sharp vision and a comfortable fit were critical. Especially in some of the villages where the closest optometrist is hours away so the chance to pop by for a quick adjustment is severely unlikely.

Once our patients made it through the dispensing journey, screening distance and near visual acuity, they were tested by one of our two optometrists.

Then, they were handed over to another dispensing team member for glasses selection and fitting with a recommended prescription. Most of the glasses we dispensed were pre-made, so they were sphere-only.

We know that not every prescription is sphere-only with a matching right and left eye, and that astigmatisms are very prevalent. We were lucky to have a range of sphero-cylindrical lenses that we could cut into frames customised for the patient.

IMPORTANCE OF MANUAL SKILLS IN THE FIELD Making these tailored lenses, we needed to take some measurements,

INSIGHT May 2025

including monocular distance PDs, monocular near centration distances and monocular heights to be able to edge and fit these lenses.

In our dispensing tool kit, we had a trusty pupilometer, lens inserts, PD rulers, pen torches, felt tip markers and a few handheld mirrors so our patients could see their new spectacles that were easy to transport from village-to-village on our outreach program journey.

While the digital tools we often rely on streamline modern dispensing, adapting to manual methods in Fiji highlighted the value of foundational skills.

For some of us, it had been years since we took a measurement with manual tools rather than a digital device that captures both PDs and heights simultaneously. We did not have the luxury of spending 30 minutes or more with our patients.

There was always another person ready to be fitted with their brand-new spectacles, so we needed to confidently measure a PD and take an appropriate height to start the process of edging and fitting these spherocylindrical lenses to deliver same-day glasses.

Some of the classrooms that we were dispensing from were dimly lit with the blinds closed as to not let the hot Fijian sun warm up the rooms.

This means that having a pen torch to accurately attain the pupil centre was an essential part of dispensing.

The experience of working in remote communities in Fiji taught us the importance of adaptability, teamwork, and the profound difference that access to clear vision can make.

Despite the challenges, the rewards of helping patients, especially children seeing clearly for the first time, far outweighed any logistical obstacles.

ABOUT THE AUTHOR: Nicole Grasso is a qualified optical dispenser and a regional compliance officer and optical trainer at the Australasian College of Optical Dispensing. She also dispenses at The Optical Co and provides volunteer dispensing services internationally.

ORTHOPTISTS – AT THE FOREFRONT OF HOLISTIC LOW VISION CARE

NADINE MCARTHUR "THE EMOTIONAL WEIGHT OF VISION LOSS OFTEN UNFOLDS OVER TIME, MAKING EACH FOLLOW-UP APPOINTMENT A NEW OPPORTUNITY FOR SUPPORT."

“WHAT HAPPENS NEXT?”

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t’s a question many patients don’t ask outright but one that lingers long after a diagnosis of permanent vision loss. While ophthalmologists focus on disease management, and orthoptists provide critical interventions to enhance functional vision, the journey towards adapting to daily life with low vision is often deeply personal, non-linear, and filled with uncertainty.

Patients leave appointments with their clinical information, yet many still struggle to understand how to maintain their independence, continue working, or stay connected in an increasingly digital world.

The emotional weight of vision loss often unfolds over time, making each follow-up appointment a new opportunity for support.

Orthoptists are specialists who engage with patients throught their vision loss journey and are uniquely positioned to identify when a patient could benefit from additional help.

Now, with one simple referral, orthoptists can extend their impact beyond the appointment setting, connecting patients to SeeWay. SeeWay is an initiative of Guide Dogs, a comprehensive low vision support service offering practical guidance, no-gap psychology services, and digital skills training, all delivered in a way that meets patients where they are in their low vision journey.

Patients can maximise their functional vision and feel emotionally supported – right from the point of diagnosis.

Examples like the one below are common.

“My patient, Jan, had been managing well since her diagnosis of macular degeneration. I had made a referral to a low vision service and some suggestions around simple home adaptations. She was following her treatment plan closely but at her last follow-up appointment she was very teary. She didn't feel ready to accept a full low vision service and she was sad and unsure of her future. She said she felt a bit isolated because her community transport options were limited and she is mostly

The journey into daily life with low vision is often very personal and uncertain.

Image: Orthoptics Australia.

Image: Nadine McArthur.

NADINE McARTHUR writes that when a patient is contemplating a future without vision, there are still things that an eyecare professional can do to help with those next steps into the unknown.

at home managing by herself. She was struggling with more than just the physical aspects of her condition."

- Orthoptist, NSW. Previously, there were few options beyond offering reassurance.

Many patients turn to Google after a diagnosis, only to be met with fear-inducing clinical information that emphasises worst-case scenarios rather than practical solutions.

SeeWay offers a safe, supportive space, shifting the focus from loss to ability, adaptation, and confidence.

This kind of holistic approach, where clinical care is supported by emotional and practical adaptation, ensures that patients like Jan are not just adjusting to vision loss but actively rebuilding their confidence and independence.

ONE REFERRAL TO SEEWAY PROVIDES: • The first truly patient responsive digital platform with easy to read or listen-to practical strategies for adapting daily routines while maximising functional vision.

•N o-gap counselling and group therapy to process the emotional impact of vision changes. Telehealth or in-person for easy accessibility.

•D igital literacy training to maintain connection, employment, and independence.

•P athways to one-to-one services when wanted.

Some patients will engage immediately, while others may take time. SeeWay provides a gentle, safe space allowing patients to access support in their own home, at their own pace – without pressure, but with the reassurance that help is there when they need it.

SeeWay will have a presence at the upcoming International Orthoptic Congress in Brisbane, where it will present the results of its low vision pilot program - demonstrating how the holistic approach to low vision care has already strengthened patient outcomes for our client focus group.

SeeWay is designed to complement and enhance existing care, providing a direct pathway to resources that expand the scope of low vision support.

You can reach the organisation at seeway.com.au. It welcomes collaboration that ensures every patient has access to the tools, knowledge and confidence they need to adapt and thrive.

ABOUT THE AUTHOR: Nadine McArthur is a highly experienced orthoptist and vision care specialist with expertise in low vision, medical device innovation, and public health. As marketing manager at SeeWay, she is dedicated to advancing low vision services and improving support for people with low vision.

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

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MANAGEMENT

CAN I HAVE A FULL COPY OF MY MEDICAL RECORDS?

GEORGIE HAYSOM “YOU CAN CHARGE THE PATIENT FOR THE COST OF PROVIDING ACCESS, FOR EXAMPLE, THE COST OF MAKING COPIES, BUT YOU CANNOT CHARGE THE PATIENT FOR MAKING THE REQUEST.”

H

elena, the receptionist of an ophthalmology practice, has just got off the phone with Steve, a long-time patient of the practice, who made an unexpected request: a full copy of his medical records.

“I heard that, legally, the records belong to me, not the practice,” he said. Helena is uncertain. What should she do?

Steve is not correct – legally the records do not belong to him. However patients generally do have the right to access their medical records, except in limited circumstances.

A patient’s right to access may include being provided with a copy of their records, inspecting them, and providing a copy to an authorised third party (for example, a solicitor or insurer).

REFUSING ACCESS You can refuse to give patients access to their records where there is: • Serious threat – you have grounds to believe that if a patient accessed their health information, it would pose a serious threat to the life, health or safety of the patient, another person, or the public.

• U nreasonable impact on the privacy of other individuals – the patient’s health information contains another individual’s information, which would impact that individual’s privacy.

If you refuse a patient’s request, you must still take reasonable steps to provide access to the requested information in another way.

CAN YOU CHARGE THE PATIENT? You can charge the patient for the cost of providing access, for example, the cost of making copies, but you cannot charge the patient for making the request.

The amount must reflect the way that access is provided. There should not be any costs for obtaining legal advice about the request. You should advise the patient of the cost before providing access to the records to ensure that they agree. You may negotiate the patient’s request (for example,

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Image: pandpstock001/Shutterstock.com.

Image: Xxxx.

Image: Xxx

Blanket requests to obtain medical records can blindside and overwhelm an unsuspecting practice, so how should they be handled? GEORGIE HAYSOM outlines the rights of the clinic and patient.

ABOVE: A patient’s right to access may include being provided with a copy of their records, inspecting them, and providing a copy to an authorised third party.

the volume of records) to minimise the charge.

In Victoria and the ACT, the cost of providing medical records is capped by regulations that are updated periodically.

HOW TO PROVIDE ACCESS TO MEDICAL RECORDS Aim to provide access to records in the form that the patient requests it, where possible. Health information can be provided in several ways, such as: • sharing a copy of the information (electronic or hard copy) • providing a summary of the information • providing information over the phone (for example, test results) • allowing the patient to view or listen to an audio or video recording of the information and take notes.

HANDLING REQUESTS FROM THIRD PARTIES While this request came from Steve, in other situations, patient records may be requested by third parties (for example, from a solicitor for legal proceedings or an insurer in relation to a patient’s workers’ compensation or life insurance claim). In that situation, your response depends on whether you have ‘authority’ (the patient’s consent) to release the information.

Often, requests are accompanied by a document signed and dated by the patient. To ensure the authority is valid, check the patient’s full name, date of birth, and address and ensure it is signed and dated by the patient. While the authority doesn’t necessarily expire, if the document is more than 12 months old, we recommend you contact the patient to confirm that they still authorise the release.

To avoid breaching the patient’s confidentiality or releasing records inappropriately, only provide the documents that are captured by the scope of the authority.

For more information, refer to Avant’s 'Providing medical records to a third party' factsheet, available online.

WHAT SHOULD HELENA DO? For Steve’s request, Helena should document the conversation in the record, discuss the request with the ophthalmologist and, unless an exception applies, she can arrange to provide him with a copy of his records after determining a reasonable fee.

ABOUT THE AUTHOR: Georgie Haysom, BSc, LLB (Hons) LLM (Bioethics), GAICD, is general manager of advocacy, education and research at Avant.

SOAPBOX

BY SHIH SHIH TA Refractive surgery, while a life-changing procedure for many, can be a significant source of anxiety for patients.

Anecdotally, we observed that highly anxious patients exhibit increased restlessness during surgery, potentially leading to a higher risk of complications.

This underscores the importance of addressing anxiety before the procedure to enhance patient safety and surgical precision. Understanding the nature of this anxiety, its potential impact, and developing strategies to mitigate it are crucial for optimising patient experience and safety.

A recent pilot review funded by the Future Vision Foundation – Vision Eye Institute’s not-for-profit organisation supporting ophthalmic research – focused on exploring these aspects, providing valuable insights for our laser refractive clinics. The review aimed to understand patient anxiety and its impact on surgical procedures, with the further goal of integrating a range of further potential strategies.

A total of 209 consecutive patients undergoing laser refractive surgery at a single clinic were provided with the State Trait Anxiety Inventory (STAI) questionnaire before surgery and prior to pre-operative medication being administered. Patients were asked to rate feelings of being upset, frightened, nervous, jittery and confused. The data showed that nervousness was the most common emotion. Multiple studies have indicated that anxiety is often rooted in the fear of the unknown, concerns about potential complications, and the apprehension associated with surgical procedures,

all of which are normal and expected.

To provide an understanding of how pre-operative anxiety matched the subjective operative experience, we then provided a Likert scale for patients to rate their discomfort levels immediately following their laser procedure. The results revealed a strong correlation between pre-operative feelings of fear, nervousness, and jitteriness, and post-operative discomfort scores. This suggests that anxiety affects not only the patient's emotional state but also their physical perception of discomfort. It could also mean that anxious patients were not compliant with instructions during surgery, which could cause increased technical challenges for the surgeon, which may lead to more discomfort for the patient. This highlights the importance of addressing anxiety before surgery to improve patient comfort and satisfaction.

Further, post-operative scores showed that subjective discomfort was significantly correlated with patient age and surgeon. Younger patients reported more discomfort, and the surgeon choice played a role, though these factors are less modifiable. Of note, our findings indicated that overall, patients were generally not upset following surgery, suggesting that pre-surgery information provided by the clinic was likely effective in addressing initial concerns. However, there remains room for continued review and improvement.

Recognising the impact of anxiety, non-pharmacological interventions, such as music therapy, have been explored to reduce anxiety through surgery. As part of the extended project, our team is looking to introduce personalised music playlists through the use of headphones to the refractive suite and investigate if this may help further. This project is ongoing, and findings are anticipated to contribute to developing effective anxiety management strategies.

Our review, which was also recently presented as a RANZCO Congress poster, has yielded several key findings. STAI scores effectively identify pre-operative patient state and their potential impact on post-operative perceptions. However, the pilot review confirmed that no single pre-operative metric was ideal at predicting perceived discomfort, suggesting that

Image: Vision Eye Institute.

Images: Shih Shih Ta.

TAMING THE TREMORS IN REFRACTIVE SURGERY

subjective evaluation represents a part of the broader experience. Pre-operative preparation should be tailored to individual patient anxiety levels and age. The use of a short pre-operative questionnaire may assist in the identification of patients who appear comfortable yet may have higher internal anxiety.

Ideally, clinics should foster a culture of open communication where patients feel comfortable discussing their concerns and provide comprehensive pre-operative education. Surgeons should be aware of the potential impact of patient anxiety on surgical outcomes and take steps to create a calm and reassuring environment. Ongoing support and follow-up should be provided to address any post-operative concerns and ensure patient comfort.

By implementing these strategies, ophthalmology clinics can create a more positive and supportive environment for patients undergoing laser refractive surgery, ultimately leading to improved surgical outcomes and patient satisfaction.

The integration of data from tools like STAI, alongside an understanding of patient demographics, allows for a more tailored and effective approach to patient care. We look forward to providing a further update on the impact of music in the refractive suite.

ABOUT THE AUTHOR: Name: Shih Shih Ta Qualifications: BAppSc (Orthoptics) Affiliations: National manager of patient experience & projects, Vision Eye Institute.

Location: Sydney Years in industry: 23

ABOVE: Anxious patients can be more restless during surgery, risking complications.

RECOGNISING THE IMPACT OF ANXIETY, NON-PHARMACOLOGICAL INTERVENTIONS, SUCH AS MUSIC THERAPY, HAVE BEEN EXPLORED TO REDUCE ANXIETY THROUGH SURGERY.

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EVENTS CALENDAR Image: Photoholgic/Shutterstock.com.

Image: Silmo.

To l i s t a n e v e n t i n o u r c a l e n d a r e m a i l : m y l e s . h u m e @ p r i m e c r e a t i v e . c o m . a u

Silmo Paris is where the world’s latest eyewear collections and trends are often revealed.

SEPTEMBER 2025 ICC Sydney, in the Darling Harbour precinct, will host ODMAFair25, Optometry NSW/ACT’s Super Sunday clinical conference, and ACBO's annual meeting, over the same weekend.

MAY 2025

JULY 2025

TASMANIA'S LIFESTYLE CONGRESS Tasmania, Australia 20 – 21 September tlc.optometry.org.au

ARVO 2025

AUSCRS 2025

SILMO PARIS

Utah, US 4 – 8 May arvo.org/annual-meeting

Darwin, Australia 16 – 19 July auscrs.org.au/2025-conference

Paris, France 26 – 29 September silmoparis.com/en

AUGUST 2025

NOVEMBER 2025

OPTOMETRY VIRTUALLY CONNECTED Online, Australia 17 May ovc.optometry.org.au

JUNE 2025

OPTOMETRY CLINICAL CONFERENCE

RANZCO CONGRESS

Melbourne, Australia 17 – 18 August occ.optometry.org.au

Melbourne, Australia 14 – 17 November ranzco2025.com

ORTHOPTICS AWARENESS WEEK Australia 2 – 6 June orthoptics.org.au

INTERNATIONAL ORTHOPTIC CONGRESS Brisbane, Australia 27 – 29 June

ODMAFAIR25 Sydney, Australia 27 – 29 June odmafair.com.au

ASIA-PACIFIC STRABISMUS AND PAEDIATRIC OPHTHALMOLOGY SOCIETY CONGRESS Brisbane, Australia 29 June – 1 July apspos.org/apspos-congress-2025

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Image: Drazen Zigic/Shutterstock.com.

ioc2025.com.au

Optometry Australia’s August event, Optometry Clinical Conference, is being heralded as a premier in-person event bringing together the latest innovations in eyecare.

SP E C S AV E R S S T O R IE S: J E S S I C A H I C K E Y HOW DID YOU COME TO WORK AT SPECSAVERS?

CHANGING LIVES THROUGH BE T TER SIGHT AND HE ARING

After completing a university degree, I was looking for a change. Feeling unfulfilled, I wanted a job that helped people.

A close friend worked for Specsavers for many years and had amazing experiences. That, combined with the catch phrase ‘Should have gone to Specsavers’, made me excited to work for a company that not only helped people but also had fun while doing so.

WHAT WAS YOUR FIRST ROLE WITHIN THE BUSINESS? I was hired at the Specsavers Dapto store as an optical assistant, and this is where I started my training towards optical dispensing. I had sales experience but learning the technical aspects around frame fit and the importance of lifestyle recommendations was completely new and intriguing to me.

WHAT GROWTH OPPORTUNITIES HAVE PRESENTED THEMSELVES?

SPECSAVERS STATS Name: Jessica Hickey Current position: Regional training manager NSW/ACT Location: NSW/ACT Years within the business: 4

I was fortunate to be in a store with two fantastic partners who demonstrated many opportunities in store and offered unconditional support. They encouraged me to take on the in-store trainer role and then supported me through completing the Cert IV in Optical Dispensing. When I expressed an interest in moving to into the support team, they not only advocated for me but continued to strengthen my dispensing and leadership skills.

WHY DID YOU PURSUE A DISPENSING CAREER? I was immediately hooked. I loved all aspects of dispensing, the behind-the-scenes technical skills, as well as the professionalism that comes with getting to know patients and making recommendations you know will improve their quality-of-life.

Specsavers YOUR CAREER, NO LIMITS Optometrist Partnership Opportunity in Karratha Specsavers Karratha is offering an exciting opportunity for an experienced Optometrist to join the brand as a Partner. Karratha is a seaside gem capturing the essence of coastal charm and natural beauty. Specsavers Karratha will be a new site offering the latest store features including optical test rooms, pre-test rooms, dispensing desks, and state-of-the-art equipment including OCT. The store will also showcase the latest Specsavers design, with digital displays and illuminated shelving. Successful applicants will receive Specsavers’ awardwinning support in building up their business, including team recruitment support and end-to-end financing on new stores.

Optometrist opportunity – Specsavers Blenheim, NZ Join Specsavers Blenheim for a rewarding career in a vibrant community! Enjoy Blenheim’s sunny climate, stunning vineyards, and outdoor activities like hiking and cycling. With career progression and support in our Pathway to Partnership program, this is the perfect opportunity for Optometrists seeking career growth and a relaxed lifestyle.

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: Carly Parkinson on +61 (0) 478 201 057 or E carly.parkinson@specsavers.com Optometrist employment enquiries: Specsavers Recruitment Services – anz.srsdepartment@specsavers.com Locum employment enquiries: ANZ.locumteam@specsavers.com Graduate employment enquiries: apac.graduateteam@specsavers.com

WHAT IS YOUR MOST INTERESTING DISPENSING CASE? A mother brought her son with ADHD who struggled to stay still. She had been told by the school they believed her son had vision problems. After a challenging sight test, it was confirmed he needed glasses. The mum was overwhelmed and struggling to process this information. Having just completed my Cert IV in Optical Dispensing, caring for this boy was a great experience, putting much of my knowledge into practice. It was important to make dispensing fun for him while ensuring he picked frames that fitted him and were durable for an active lifestyle. The dispense itself was another challenge but I used some new techniques to keep it fun and lively while also obtaining the accurate facial measurements and frame fit.

The most rewarding part was at collection, when the young boy went very still and started to point out, to everyone in-store, all the new details he could see. This dispense will stay with me for a very long time as it highlighted to me the power of sight.

WHAT ADVICE WOULD YOU OFFER TO SOMEONE CONSIDERING A CAREER AS AN OPTICAL DISPENSER? I would say go for it! It is not a job you hear about at school, but it is a job that has endless possibilities, not only locally, but all around the world. You will meet some amazing individuals and continue to help people along the way. It is extremely rewarding.

WHAT EXCITES YOU MOST ABOUT TURNING UP FOR WORK EACH DAY? In my role as regional training manager, no day is ever the same. It is exciting to always face something new, challenging myself and keeping me on my toes. I am always learning and that’s what makes every day exciting.

$20k bonus to refer a friend to join Specsavers in regional QLD! Specsavers are expanding our Optometry team in Australia’s Sunshine State. Home to rainforests, beaches and an array of great cafes, bars and restaurants along with access to the Great Barrier Reef, there is something for everyone. Accredited as one of Australia’s top 10 places to work for the last 2 years running, Specsavers offers the opportunity for our Optometrists to provide outstanding patient care through our market leading technology - including OCT free for every patient, experienced dispensing teams to support and quality product. Earn up to $20k by referring an interested Optom to the Specsavers Recruitment Services team. You can also refer yourself!

Graduate Opportunities Specsavers are looking for final year students to join one of our stores and be part of our industry leading Graduate Program. With strong career development paths for optometrists, great graduate packages and a diverse range of patients in locations all across Australia and New Zealand, Specsavers is the perfect place to start your optometry career.

Visit spectrum-anz.com

CAREER

People

on the move

Image: EssilorLuxottica.

Ms Bonnie Lee has joined 1001 Optometry Hurstville. With more than 30 years of industry experience, she brings a deep understanding of eye health, a passion for patient care, and a dedication to delivering exceptional vision solutions, the company said. “Her expertise spans across children’s vision, dry eye management, and preventative eyecare, allowing us to further strengthen our commitment to providing comprehensive and personalised eyecare for our community. At 1001 Optometry, we believe that great vision starts with expert guidance, and Bonnie’s wealth of knowledge will ensure our patients receive the highest standard of care.”

PROFESSIONAL AFFAIRS MANAGER FOR ESSILOR ANNOUNCED

Ms Amy Pillay has held multiple leadership roles, including professional services manager and engagement manager at EssilorLuxottica, where she focused on building relationships with optometrists, driving clinical education, and supporting talent engagement through networking events. Now, as a professional affairs manager for Essilor, she is responsible for driving clinical education, supporting eyecare professionals with training, and advancing the company’s professional engagement strategy.

In her role, she collaborates with industry partners and develops and delivers educational programs.

PROMOTION FOR PROF STEPHANIE WATSON

Professor Stephanie Watson was appointed head of ophthalmology at The University of Sydney, a role she assumed in February 2025. She is grateful to be taking on the role after Professor John Grigg’s “outstanding contributions in the position” and thanked him for all his efforts. “Since starting in the role I have been working with Sydney Medical School academics and professional staff to review the educational programs across the current three streams; medical student education, post-graduate degrees and Sydney Health Executive Education short courses,” she said. “I am also looking forward to working with Professor Peter McCluskey AM at the Save Sight Institute to support innovative research and community engagement.”

Image: Fred Hollows Foundation.

FRED HOLLOWS FOUNDATION FINDS IAN WISHART’S REPLACEMENT

Mr Ross Piper has joined The Fred Hollows Foundation as CEO, taking over from Mr Ian Wishart.

Previously, he was chief executive, superannuation, at Australian Ethical Investment. He’s also been CEO at Christian Super, and worked at World Vision Australia and World Vision International for over 10 years in several roles, including COO and senior director of operations for the Middle East and Eastern Europe region.

Image: CPMC.

1001 OPTOMETRY SECURES EXPERIENCED OPTOMETRIST FOR HURSTVILLE

Image: Opticare.

Image: 1001 Optometry.

Image: Save Sight Institute.

INSIGHT'S MONTHLY BULLETIN TO KEEP THE AUSTRALIAN OPHTHALMIC SECTOR UPDATED ON NEW APPOINTMENTS AND PERSONNEL CHANGES, NATIONALLY AND GLOBALLY.

NEW CPMC BOSS HAS EXTENSIVE LEADERSHIP EXPERIENCE IN HEALTHCARE

The Council of Presidents of Medical Colleges, the peak industry body for Australia’s medical colleges – of which RANZCO is a member – has appointed Ms Jodie Long as its new CEO. Long has extensive leadership experience in the healthcare sector and brings a strong strategic vision and commitment to strengthening Australia’s medical colleges and the broader healthcare system.

She has served as CEO of the Australasian Sonographers Association for several years and, most recently, Speech Pathology Australia.

DO YOU HAVE CAREER NEWS TO SHARE?

OPTICARE APPOINTS TECHNICAL SUPPORT & SALES SPECIALIST

Mr Nima Nayebi has been appointed as technical support & sales specialist in South Australia. With experience at ZEISS in Iran and a passion for optical technology, Nayebi is excited to support Opticare’s independent customers.

Email editor Myles Hume at myles.hume@primecreative.com.au to be featured 66

INSIGHT May 2025

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ICC SYDNEY ODMAFAIR.COM.AU

MAY 2025

Capture the power of

FOCUSED LIGHT. Experience the IC-8™ IOL, the small aperture extended depth of focus IOL, designed to help patients achieve their best personal vision.

For more information please contact your Bausch + Lomb Territory Manager, Customer Service at Customer.Service@bausch.com or scan the code to receive a call back.

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Level 2, 12 Help Street, Chatswood NSW 2067 Australia. (Ph 1800 251 150) New Zealand Distributor: Toomac Ophthalmic. 32D Poland Road, Glenfield 0627 Auckland New Zealand (Ph 0508 443 5347) IC8.0020.AU.23