Insight August 2014 by Magazines byDesign

AUGUST 2014

THE EYES AND EARS OF THE OPHTHALMIC WORLD – SINCE 1975

Always in Focus

Clarity in a split second. Every time. Everywhere.

The NSW Spectacles Program is in chaos following it being awarded to Vision Australia Instead of VisionCare NSW.

54% of population has eye problems: OA Twelve million Australians (54%) have long-term eye conditions, according to Optometry Australia, in its ‘Line of Sight’ platform.

NSW Spectacles Program in chaos

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SA budget leaves patients In precarious position The recent South Australia state budget has left people needing publichospital eye care in a precarious position.

All the ophthalmic news that matters!

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AUGUST 2014

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Vision Australia attempts re-launch of NSW Spectacles Program, but… T

he dumping of VisionCare NSW in favour of Vision Australia (formerly the Royal Blind Society and a collection of offshoots and associations) for the provision of $4.5 million worth of free spectacles for disadvantaged people in New South Wales has turned what was a well-run service into one of near chaos. And the explanation for how it happened is far from clear or convincing on the part of the NSW government, particularly how it was decided whom would be awarded the contract. In particular, how was Vision Australia selected; was it one of the original tenderers; and if so how was it able to submit a revised tender to the satisfaction of the government when other tenderers were not permitted to do so? Furthermore, did the successful tenderer even submit the same tender as it had before, with just a little tweaking, or was it a completely-brand-new tender; and if so, why were others not invited to submit new tenders? All that has been stated (by a press officer at the Department of Family and Community Affairs) is that “an open tender was conducted by the department to identify a provider for the program and that despite receiving a number of applications, the tender assessment panel was unable to identify a provider meeting the tender assessment criteria. FACS subsequently followed NSW government procurement processes which has led to contracting Vision Australia to commence as a program provider from 1 July 2014.”

At press time, even some providers near or at the top of the tree had not signed up for the new program as they were not willing to participate due to uncertainty about how the program will work or the conditions demanded by Vision Australia. Many long-term previous providers under VisionCare NSW have advised Vision Australia they will not be signing the 20-page agree-

providers, meaning VisionCare NSW itself had to send dispensers to those locations at certain times to provide for local applicants, with the local optometrist being content to pocket the examination fees and not the dispensing fees. VisionCare NSW was given no warning that its contract with the NSW government would end on 30 June, only finding out its contract had not been renewed the

Low prices unattractive to many practices The price schedule for the NSW Spectacles Program lists prices that are very low and unattractive to many practices: For example, the list price (paid to metropolitan practitioners) for supplying a pair of spectacles fitted with single-vision lenses is $55 plus $1.05 GST, including fitting fee and dispensing fee. For bifocals, the list price is $75 plus $1.05. There is a$10 loading for regional and country practices. Under the VisionCare NSW program, providers received a dispensing fee of $34 for single-vision spectacles and $42 for bifocals, with the actual cost of the frames, lenses and case met by VisionCare NSW. One of the few benefits under the new program will most likely be faster delivery of finished spectacles than previously because faster payment will be received by laboratories. However, in addition to as paying for frames, lenses and cases, providers will have to pay the cost of couriers for their jobs under the Vision Australia program.

ment demanded by it, citing the change of administration of applications to providers instead of VisionCare NSW as well as the poor financial returns (if any). There were about 400 providers under the program administered by VisionCare NSW, however in some areas, particularly some of the bigger country towns/cities, there were no optometrist

same day it was announced that the contract had been awarded to Vision Australia – 12 May. VisionCare NSW’s staff will stay on until 31 July. Vision Australia, with no experience in the provision of free spectacles, was supposed to launch its version of the NSW Spectacles Program on 1 July, but so far it has delayed the start date

until 7 July, then 11 July, then 14 July but, according to participants in the scheme, it looked like being lucky to start on 28 July, and that with a much-reduced number of optometrists and optical dispensers as providers. So about, say, 6,00-7,000 people who usually would be expected to have started obtaining the first of about 80,000 free pairs of spectacles over the 2014-15 year from Vision Australia, are having to still wait while it’s all sorted out (if ever) – not the first time under the present NSW government, which has dilly dallied with funding arrangement for the program provided by Vision Care NSW since it (the government) took office in 2011. A major complaint of optometrists and optical dispenses is that they are expected to take on the lion’s share of the administrative work involved in the new program, which used to be handled very efficiently by VisionCare NSW until its contract ended on 30 June. Now, each of the optometrist and dispenser providers (or their staff) will have to go online and fill in details of each applicant and their circumstances. A computer as well as a scanner will be needed to be able to do all of that. At the conclusion of the input of data and, for example copies of bank accounts and the like, a Yes/No decision will be made by a computer at Vision Australia and the outcome of the application will be return emailed to the optometrist or dispenser, who will have to pass on the computer’s verdict to the applicant. Continued on page 4

AUSTRALIA’S LEADING OPHTHALMIC NEWSPAPER – SINCE 1975 www.insightnews.com.au

AUGUST 2014

VISION AUSTRALIA

AUSTRALIA’S LEADING OPHTHALMIC NEWSPAPER – SINCE 1975

Continued from page 3

Method of awarding contract not adequately explained

CONTACT

THE EYES AND

Clarity in a split second.

AUGUST 2014

NSW Spectacles Program in chaos

The NSW Spectacle s Program is in chaos following it being awarded to Vision Australia Instead of VisionCare NSW.

54% of population eye problems: OA has

Twelve million Australian s (54%) have long-term eye conditions, according to Optometry Australia, in its ‘Line of Sight’ platform

SA budget leaves patients In precarious positio n

The recent South

Australia state

budget has left people needing publichospital eye care in a precarious position.

All the ophthalmic

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Always in Focus

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AUGUST 2014

The method used to award the contract to Vision Australia has not been adequately explained by the NSW government. According to the NSW Department of Family and Community Services, an open tender was conducted in 2012 to identify a program provider. Despite receiving a number of applications, the tender assessment panel was unable to identify a provider meeting the tender assessment criteria. Furthermore, FACS says it “subsequently followed NSW government procurement processes which has led to contracting Vision Australia to commence as program provider as from 1 July 2014”. The government via FACS, told Insight that “over the last decades [NSWVisionCare held the contracts for 21 years] the technological and commercial landscape has changed dramatically around the spectacles program. “To ensure the best value for taxpayers’ dollars and the interests of vulnerable people in NSW are prioritised, we need the program to adapt to the challenging landscape,” FACS said. “This means implementing changes to the program and utilising contemporary technology to run the program more efficiently.” Facts said that it and VisionCare NSW had had lengthy and ongoing discussions regarding the future of the program prior to the end of their contract [30 June 2014] and that the appropriate notice was given as stipulated in the contract. Also, that FACS had provided VisionCareNSW with adequate notice regarding the future direction of the program and would work with them to develop their transition strategy. All of that has been denied by VisionCareNSW, which points out it was only advised that its contract would not be renewed on the same day the appointment of Vision Australia was announced and that there had not been ongoing discussions regarding the end of the contract.

Unlike under the previous system, providers (optometrists and dispensers) will be able to provide whatever frames and lenses they want, versus previously being obliged to dispense products stipulated by VisionCare NSW that were checked as meeting quality standards set down by VisionCareNSW. Meanwhile, sitting in warehouses are tens of thousand of frames bought in especially for VisionCare NSW by suppliers who were given no advance warning by the government nor VisionCare that the latter’s contract that had run for 21 years would not be renewed. The suppliers have been told by VisionCare NSW that it cannot take responsibility for their stock holdings as it is a not-forprofit organisation that had a contract with the NSW government to administer the program only. During previous contracts, VisionCare NSW insisted the suppliers maintain at good levels stock of frames supplied under the program. That no longer applies as

there are no requirements for any particular products to be supplied. Under the previous system, eligibility applications would be made by the persons concerned and would be decided upon by staff at VisionCare within 24 hours, with personal contact with the applicant in the event of a query, providing flexibility that is now out of the hands of providers under the new program. The 20-page agreements would-be optometrist and dispenser providers now have to sign with Vision Australia demand quality standards be adhered to, but the question is who will check that they are? As it is the responsibility of providers to dispense and source product from whoever or wherever they prefer, dealing directly with suppliers, realistically Vision Australia plays no oversight role in regard to quality, its major role being to pay providers accounts for services rendered to patients/clients. Continued on page 5

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RURAL PRACTICE

Letter A Letter from a Grad Optometrist: To Researchers, Professors, Teachers, Ophthalmologists and Fellow Optometrists

orry to bother you in your very busy schedule. There is just something I must share with you – to tell you a story. There is a small rural town. The people of this town don’t like to worry too much or talk too much about themselves. Instead most of them like to earn their living through honest labour in a down to earth manner. They have one visiting ophthalmologist coming once every four weeks. Rest of the time they make do of what they have. One day, Mark, a retired farmer, came to see a young grad optometrist to get his driver’s licence filled. He is small and neat, about five feet tall, wearing a shirt that is spotlessly clean and had his hair combed smoothly to the back. Unlike some other elderlies, he smelled nice too, and you knew instantly that he is not a smoker. Later history taking confirmed that. His wife passed away 13 years ago so he lives alone now, in a property that he and his wife built shortly after their marriage.

He has eight children, all of whom have gone away to big cities. One son recently died of cancer, probably due to the “pollution or some other funny stuff”. He was proud when he spoke of his granddaughter, Emily, who has just graduated from optometry school and has gone away too. The small town is not quite big enough for her dreams. In October last year, an incident happened that took away most of his vision. He said he had been seen by an eye specialist but he is not too sure what’s happening. Today he had to ask his neighbour to drive him here because he has been told that he is unsafe on the road. Sure enough, his best corrected visual acuity was 6/40, and if you try hard enough you may be able to squeeze in a sympathetic plus at the end of it. The young optom spent a good forty-five minutes and took some photos and OCT scans. It looked like wet ARMD but not quite so like the pictures in the textbooks

or any of those her lecturers used to put up on the wide screen. Then it was time for the news – the worst thing that had to be done by the young optom. After the news there was a long silence. “Maybe you can get someone to live with you?” He shook his head. “There are some good retirement villages where someone can look after you.” He didn’t like that option either. All his life he had been independent, and besides, he is too used to the companionship of this small town to move away from it at this age. The grad was out of suggestions. She felt powerless and useless. It’s getting a bit sad, a bit upset. You know, it’s the kind of helplessness. She wants to help them, but there is nothing she can do. She doesn’t know why there are so many people so much helpless conditions, or how to make these disappear. It’s nothing like fairytale or parables… no matter how holy the intention is. They trust her, and carefully listen to what she has to say. She tries to sound confident

and reassuring and hopeful, but the truth is, inside she is terrified. I know you are very busy, so I must apologise for taking up so much of your time. I will keep it short now. My point is, that young optom in the story has neither the brains nor the temperament to find a cure for blindness, nor the ability to give any higher-level care to her patients. She can only do what she is doing for the people in the small town. I express my deepest respect and admiration for you. You have the power to research and find cures, to make diagnoses and give treatments, to teach and pass on your knowledge and skills, to inspire, to serve the one community we are all living in. And maybe one day, some of these good works will reach this small town. ■ Catherine (Names have been changed to protect the patient’s privacy)

Drug company in more trouble in Italy

rug manufacturer Novartis is already under scrutiny in Italy after authorities there accused it of colluding to protect sales of eye drug Lucentis. But now the Swiss company’s situation in Italy may be getting more troublesome, with authorities scouring its offices there

for information on flu vaccine pricing. Italian police searched Novartis sites in Siena and Origgio as part of a probe into possible fraud linked to the purchase of two flu vaccines by the country’s health ministry. According to police allegations, Novartis inflated the cost of

an additive to the vaccines, multiplying it six times over and costing the country potentially upward of €16 million ($US22 million). The Basel-based drug maker is co-operating fully with the investigation, saying: “Novartis is committed to high standards of ethical business conduct and regulatory compliance in all

aspects of its work.” Italian authorities have had their eye on Novartis since early this year, when the Italian Competition Authority opened an investigation of the company and its cross-town rival, Roche and their marketing of Lucentis and Avastin for treatment of aged macular degeneration. ■

Continued from page 4

after the supposed start date, VA offered to explain and demonstrate online the program’s portal for the program at 45-minute sessions on 10 and 11 July three and four days ahead of the program’s supposed commencement date of 14 July.

Participants needed a computer with an internet connection and a telephone. They were sent a link that allowed them to view the online portal and were also be provided a dial-in teleconference number to join in the conversation. One of the most unsatisfactory

aspects of the program is that applicants for spectacles under the program must have assets such as bank accounts of no more than $500 for single people and $1,000 for a family – exactly the same as when VisionCare NSW was established 21 years ago! ■

And providers will have to carry the cost of obtaining product direct from suppliers and the delay between that and obtaining payment from Vision Australia. Belatedly, on 8 July (a week

www.insightnews.com.au

AUGUST 2014

ADVOCACY

54% of population has long-term eye conditions: Optometry Australia O ptometry Australia, formerly Optometrists Association Australia, claims in a press release that close to 12 million Australians “have long-term eye conditions” – 54 per cent of the population. The claim was made in a press release issued in Canberra for OA on its behalf on 25 June to coincide with the launch of its new ‘Lines of Sight’ policy platform. OA says the nation’s escalating primary eye-health needs demand greater community awareness with emphasis on early detection and screening checks by qualified optometrists. It says that people living in rural and regional centres have poorer eye health than urban dwellers. Furthermore, that “under its new direction and name it is launching a new action plan for improving primary eye health and vision care.” No mention is made of the role of ophthalmologists in the provision of eye care in Australia. Speaking at an eye-health screening event at Parliament House in Canberra on 25 June, the chairman of Optometry Australia, Mr Andrew Harris, said that close to 12 million Australians have reported long-term eye conditions, but that 80 per cent of all visual impairment is preventable or avoidable. For socially-disadvantaged and remote communities,

‘Long term’ not spelt out

Optometry Australian did not spell out what it regards as “long-term eye conditions”. For example, it did not spell out if it considers presbyopia, myopia, hyperopia and astigmatism are long-term conditions, or rather just conditions such as aged-related macular degeneration, glaucoma and cataract.

eye and vision problems are even more acute, due to health-care costs and lack of access to healthcare professionals. The total economic cost of visual impairment in Australia is $16.6 billion, or approximately $28,000 per person aged 40 and over with vision loss. Timely access to primary eye-care can significantly reduce this health and economic burden, Mr Harris said “Optometrists, in partnership with other primary health-care professionals, play a crucial role in the early detection and management of many eye diseases and vision complaints, including refractive errors, glaucoma and macular degeneration,” Mr Harris said. Currently Australia’s 4,648 optometrists provide care to more than 7.6 million patient visits each year. But, according to Mr Harris, there remains general confusion about what optometry can offer the community, with a recent survey of more than 250 optometrists

finding that the public’s perception of optometry needs to be improved if its quality eye health care needs are to be met. “Optometrists play a vital role in preventing eye-health issues by providing clinical services, patient advice and treatment solutions. Still, many people choose to remain untested, or to be tested infrequently, despite the fact most eye and vision problems are preventable with early detection by an eye-care professional such as an optometrist,” Mr Harris said. “For many people, eye and vision problems affect their ability to perform everyday activities – such as read, drive, study and even work. This has a significant impact on society through reduced productivity.” Optometry Australia released its new ‘Line of Sight’ policy platform and action plan “to ensure all Australians can access primary eye-care in a timely manner, and that the optometry profession remains sustainable into the future.

“‘Line of Sight’ is Optometry Australia’s blueprint for achieving a fair and sustainable system for primary eye care, a well-skilled and distributed optometric workforce and access to primary eye care for all Australians, particularly people who are geographically and socially isolated, and economically disadvantaged.” As part of its plan to better inform people of what optometry can do to improve the eye-health of the nation, OA also announced a range of major new initiatives, including. • Changing its name – at national and state levels – to ‘Optometry Australia’; • Increasing optometry’s representation to government on issues related to protecting and strengthening the profession; • Launching a series of consumer campaigns targeting children and over-45s, who comprise the largest ‘untested’ segments within the community; and • Investing in initiatives designed to support optometrists’ businesses and their service delivery. At the eye-health screening event at Parliament House, MPs, advisory and departmental staff were screened via three tests: LCD vision chart for visual acuity assessment; retinal camera for image of retina/optic nerve; and OTC scan for cross-sectional view of retina/optic nerve. ■

14% of drivers never wear vision correction on road: French Vision Impact Institute

he Vision Impact Institute has published findings of a survey among the French public highlighting the poor use of vision-correction products when driving or performing everyday tasks, Optician reports. Three quarters of those needing glasses were found to have them, the study said. Among those who own vision correction 6

AUGUST 2014

products, such as spectacles and contact lenses, just 69 per cent said they wore them every time they drove a car or rode a motorcycle. A high 14 per cent said they never wore vision correction when on the road. The Vision Impact Institute claimed that many accidents on the road and in the home are caused by poor vision and that

80 per cent of poor vision can be corrected with simple, low-cost options. The study also highlighted the proportion of wearers choosing not to use correction for leisure and tasks around the home. Mr Jean-Felix Biosse Duplan, president of The Vision Impact Institute, said: “I was also alarmed by the number of

people who don’t see the necessity of wearing glasses during leisure time activities (e.g. sport, watching TV, surfing on websites or doing DIY activities, which, by the way, can be extremely dangerous!) “Only 59 per cent of visuallyimpaired people wear vision aids all the time and while 41 per cent reported wearing them only ‘from time to time’.” ■ www.insightnews.com.au

CLINICAL

CONFERENCE Why SCC3-2014 is a must-attend event:

It will be a great day of high quality professional education and networking at incredible value. And remember, there are 10 Golden Tickets waiting to be won, providing free access and one night’s accommodation at the SCC Venue – the Hilton Hotel in George Street.

• One of Australia and New Zealand’s premier professional annual events • Australia and New Zealand’s leading ophthalmic speakers, practitioners and surgeons • 400 optometrists attending • Fantastic professional networking opportunity • 21+ Australian CPD points • 8+ NZ CPD points • Kiosk discussions involving eight fantastic sponsors • Welcome cocktail event the night before SCC – hosted by Specsavers

Acclaimed professionals from Australia and New Zealand will present an exciting clinical program including:

In line with last year, we have allocated 50 SCC seats for nonSpecsavers optometrists. With a packed program of quality CPD and a special welcome cocktail reception at Sydney’s iconic Luna Park the night before, SCC3 promises to be our best event yet.

FCA Established Franchisor of the Year 2013

FCA Excellence in Marketing Award Winner 2013

Australian Retailer of the Year 2013

2014

SPECSAVERS

• Interactive glaucoma session – Jonathan Crowston and Michael Coote • Medical retina – Tony Hall • Indigenous care and telemedicine – Angus Turner • Peripheral retina / Surgical retina – Alex Hunyor • Ocular plastics – Charles Su • One day lenses: Death of the aftercare – Nathan Efron

Australian Retail Employer of the Year 2013

Roy Morgan Research No. 1 for eye tests 2013

Asia-Pacific Best Retail Training Organisation 2013

Saturday 13 September Welcome cocktail reception: 6.30 – 10.30pm at Luna Park Sydney Hosted by Specsavers No cost to attend – be our guest!

Sunday 14 September Specsavers Clinical Conference: 7.30am – 5.30pm Hilton Hotel, George Street, Sydney Standard Rate - $285 + GST Bookings close on Fri 22nd August

Book your seat now! Contact Raj Sundarjee on 0424 135 485 or raj.sundarjee@specsavers.com To include your name in the Golden Ticket draw, email Raj today!

OPINION

Saks on Eyes Patience Alan P Saks MCOptom [UK] Dip.Optom [SA] FCLS [NZ] FAAO [USA]

Overload & Overboard Colleagues increasingly tell me of their frustrations relating to compliance, CPD, bureaucracy, audits and certification. But wait there’s more! Medicare, practice management systems, CRM, email, security, IT systems, backup, privacy, TGA, board registration, banking, accounting, legal, insurance and the IRD all add to the burden. It’s a veritable minefield with a myriad of rules and regulations, forms, fields, files and record keeping that act as barriers to efficiency. They drive overheads and inflation and waste untold hours that could be better spent on patient care, improved service and quality. One is told that it is in the interest of health and safety and sometimes it is. However, if one analyses the situation critically, it seems to be more related to avoiding liability, if not responsibility, while making a nice buck along the way.

What me, cynical? No way! J Eye-care practitioners are ultimately responsible for their services and care and there’s usually limited liability by the companies who provide the product. A contact lens is a good example. Top-level practitioners – and indeed the bulk of the profession – were almost always responsible, ethical and stayed up to date through voluntary CPD. Today we are all forced to suffer because of the rules put in place, to force the few who didn’t give a damn, to comply.

AUGUST 2014

Patients are ever more demanding: They’re better informed, albeit sometimes misinformed or misguided through too much time on the Interweb. That’s part of it. Today an ‘old’ granny in their 70s or 80s wants to see their iPad and smart phone. They expect their grandchild in Timbuktu to be razor sharp on Skype on a small screen on their phone. In the old days they’d be knitting a jersey. At most they needed a pair of hobby specs. If they got cataracts they’d while away the hours on the rocking chair while they waited a decade for the cataract to ‘ripen’. After surgery they’d discover the joys of aphakia and +17.00D spectacles. They’d have to get used to the ‘Jack in the Box effect’ and missreaching for objects. I well recall adjusting the aphakic spectacles on the grandmother of a former ‘Miss World’ who had accompanied her gran to see me. A small change in pantoscopic-angle meant enough alteration in spatial perception that she took a tumble down the stairs. I thus got to spend quality time with Miss World and her gran while we tended to a small graze and made her some tea. (I swear I didn’t do it on purpose.) Other aphakes opted for the much better optical solution of contact lenses. I also recall the joys of fitting a 95 year old with contact lenses for the first time. This was all the more challenging because, in some cases, the general anaesthetics needed for cataract surgery in those days led to cognitive problems and some occasional bizarre behaviour. I used to get calls from the staff at ‘old age’ homes, as they called them in those un-PC days. They’d tell me that dear old Betty was again taking her contact lens out at breakfast and spreading jam on it. Many were in RGP lenses but back then some were still PMMA.

They did no worse physiologically, than regular PMMA wearers because when there is no Dk, lens thickness is irrelevant. Those we fitted with extended wear – because of their inability to deal with lens handling and lens care – actually did better than expected because it seems their oxygen requirements were less than in phakic eyes: Holden, Polse, Fonn & Mertz did some work on that, way back then. Check out their paper, Effects of cataract surgery on corneal function. So I for one am ever grateful for the fantastic Sci-Fi results that modern, femto-phaco, foldable IOLs provide. All while the patient is awake. A simple local anaesthetic gel is all that is required along with a Valium and a cup of tea. The patients are usually able to see very well just a day or two after surgery. Full credit to the surgeons, theatre teams, technology providers and the backroom genii that develop much of the fantastic technology, yet rarely get acknowledged.

Corporate Multinationalism While we are ever grateful to the companies that provide us with such amazing instruments and lenses, they also of course have their dark side. The corporate multinationals are among the worst when it comes to overzealous bureaucratic compliance. They are also responsible for other issues that beleaguer many aspects of many industries. This clouds the amazing products and technology they provide. On a grand, local scale, the imminent demise of the Australian manufacture and assembly of Ford and Holden is a good example of what is an emotive and significant issue. In our world of eyecare I have seen SOLA – a major Australian

success story of innovation, manufacture, international supply and world player in optics – get swallowed up by Zeiss, some years ago. Today Zeiss operations in Australasia are very different and SOLA an all-but-forgotten brand. Martin Wells is another that went from an international success to naught. A few years ago Hydron’s ‘Made in Adelaide’ contact lenses were prescribed and fitted around the world with a good reputation for range and reproducibility. After CooperVision acquired Hydron the range was reduced and manufacture was moved to the UK. By the end of 2014 these custom lenses for special cases will cease to exist leaving many needy patients with problems. With much expense, time and frustration we will in many cases find alternatives, sometimes for the best. For some it will be harder to resolve. All these losses have a cumulative impact. In many ways Australia is now a victim of its own success, as workers demand ever-increasing salaries and standards of living. Everything costs a bomb. It is now too expensive to pay Australian workers what they want. As a result many will be unemployed. Small supporting industries will close and the knock-on effect will be significant. The mines will not be able to absorb all this. The mines themselves will leave an unwanted legacy for thousands of years. I watched a documentary on the effect of tailings damns on the Australian environment. It is frightening. This paper, Remediation of Uranium Mill Tailings Wastes in Australia: A Critical Review by G.M. Mudd, gives some idea of the issues. Mining-related pollution is similarly a major concern in South Africa, Russia, USA, China and elsewhere. Continued on page 9

www.insightnews.com.au

ANTI-COMPETITION CONCERNS

French lens companies’ offices searched by Competition Authority A number of ophthalmic lens companies in France have had their offices searched by the French Competition Authority (Autorité de la Concurrence) as part of an investigation into suspected anti-competitive behavior, Reuters reports. The French Competition Authority stressed that the searches are part of an ongoing

investigation and did not imply any formal charges at this stage. An Essilor International spokesperson told VMail on 9 July: “A number of lens manufacturers in France, including Essilor, are in the scope of the investigation into on-line sales of lenses in France. Essilor is fully cooperating in the inquiry.” According to Reuters, Carl Zeiss

Vision confirmed in an emailed statement that its French unit had been searched by the authorities. “We are cooperating with the French authorities, because as a maker of optical lenses we are also interested in having swift and legally valid clarification of the relevant standards for internet sales,” a Zeiss spokesman is reported as saying.

The French Competition Authority did not name other lens companies that are under investigation. The investigation in France follows China’s recent fining of Essilor, Nikon, Zeiss and other lens and contact-lens manufacturers $3 million for allegedly fixing prices and engaging in anti-trust behavior. ■

Inaugural BCLA Industry Award goes to inventor of keratoconus lens

aul Rose, inventor of the Rose K lens for keratoconus, has been named at the firstever recipient of the British Contact Lens Association Industry Award. Launched in 2013 to honour and recognise the entrepreneurial work being carried out by individuals working in contact -ens science, research and technology, the award was made to New Zealander Paul Rose during the BCLA’s annual gala dinner held at Coventry in England on 7 June. Unable to attend the event after an “acrobatic backward flip” off a ladder left him with a ruptured Achilles tendon, Mr Rose thanked the BCLA and the contact-lens industry in general for his award via video message. “I feel very humbled as I can think of many individuals within the

contact-lens industry who certainly also deserve this award,” he said. “In accepting this award, I do so on behalf of the many people who have contributed to make my lenses as universal as they are today.” Mr Rose thanked Japan’s Menicon for its “ongoing support and belief in my designs”, and Dr Jennifer Choo, who heads up Rose K as manager of specialty lens clinical affairs for Menicon Holdings. “Jennifer’s enthusiasm and drive has been a major factor in the brand’s continuing growth around the world, with the lenses now being fitted in nearly 90 countries,” he said. Mr Rosen also thanked David Thomas Contact Lenses UK, which began producing Rose K in 1997, for its ongoing support and the company’s managing director,

Kevin Mitchell, who had nominated him for the award. “I have been asked many times if I had a masterplan for Rose K, when I initially set off on the Rose K journey back in the late 1980s, I can honestly say that I never had such a plan and that the lens designs have evolved out of a desire and passion to make a better lens for those patients, whose lifestyle was often compromised by their condition, and a lens that could be easily used by the majority of prescribers with reasonable success. “Certainly in my wildest dreams, I could have never envisaged my designs being used in as many countries as they are today. I will continue to attempt to add further designs to the Rose K family.” Dr Choo was present on the night to collect the award on Mr

Rose’ behalf from BCLA president, Andy Yorke, who said: “Paul’s outstanding contribution to the field of contact-lens research and development is, without question, extraordinary. That has been clearly recognised by his peers and he is an extremely worthy winner of this new award. I am sure the whole industry will join me in congratulating Paul on his achievement.” Nominations for the 2015 BCLA Industry Award will open in the northern autumn. ■

Continued from page 8

is now an issue. Custom labs can help but good ones are a rare breed. Discontinuations are thus a major problem for needy patients that the investors and bean counters don’t appear to give a rat’s ass about. Is greed and the benefit of shareholders the new standard of care? We do understand some of the reasons but… Of course RGPs can sometimes be the saviour as can piggybacking. When all else fails, corneosclerals, sclerals and hybrids can

be an option. They are however not without their complications. Quite a few referrals I have made for hybrids have been a no go. Those experienced with hybrids tell me that when they work they can be a great option: For how long remains to be seen. When they don’t work, they “suck”, quite literally, as more than one experienced practitioner put it. With many of these ‘newer’ modalities one has to complete online ‘training’ and webinars before being allowed ‘access’ to the

lenses. It never used to be that way. This seems like the companies covering their large, collective butts. Is it for the best? Hopefully it does lead to only skilled, committed practitioners being involved. It should also ensure that the experience of others and the tips and tricks to success are shared, so that there’s less trial and error and better outcomes for the patients. Hopefully patients are the overall winners. ■

Back to lenses: The termination of Custom Air Optix irked many, as did the demise of Miraflow, as did B+L’s ‘deletion’ of sensitive eyes saline. The list goes on and on. Sometimes we find replacements that are equal or better – sometimes not. The XR range of Biofinity and the expected enhancements in the toric version are a step in the right direction. However the limited range of base curves and diameters www.insightnews.com.au

Paul Rose

AUGUST 2014

COMMENT

Editorial Laughable legislation if it wasn’t so serious

t’s difficult to believe that the legislators in Louisiana in the United States knew what they were doing when they voted in favour of granting optometrists the right to perform an impressive range of surgical procedures on or in the eye. After all, in most countries in the western world at least, years of training is regarded as essential before medical practitioners are regarded as adequately trained to perform eye surgery, including the United States, and certainly Australia. But no, the legislators in Louisiana must believe that is all unnecessary and that seven-year trained optometrists can be made competent to perform the range of ocular surgery set out in that state’s legislation, even though those who wish to do so will only be required to undergo 40 hours’ training in order to be regarded as competent. However, according to newspaper reports in Louisiana, that may not be the case – for the sake of the Louisiana community let’s hope it isn’t; let’s hope optometrists there refrain from taking on such potentially dangerous work from a patient well-being aspect and/or that they refrain from trying to convince their colleagues elsewhere, including here, that it is all good for patients. The legislation permits optometrists in the state of Louisiana to perform “ophthalmic surgery … in which in vivo human tissue is injected, cut, burned, frozen, sutured, vaporized, coagulated, or photodisrupted by the use of surgical instrumentation, such as, but not limited to, a scalpel, cryoprobe, laser, electric cautery, or ionizing radiation.” Among the surgeries permitted are “YAG laser capsulotomy, laser peripheral iridotomy, and laser trabeculoplasty.” Ophthalmic surgeries excluded from performance by

AUGUST 2014

optometrists (except for pre-operative and post-operative care), as specifically stated in the law, include “retina laser procedures … and any form of refractive surgery … penetrating keratoplasty, corneal transplant, or lamellar keratoplasty … and the administration of general anesthesia … surgery done with general anesthesia … and laser or non-laser injection into the vitreous chamber of the eye to treat any macular or retinal disease.” A number of other non-laser surgical procedures are also not permitted, including (but not limited to): “Surgery requiring full-thickness incision or excision of the cornea or sclera, other than paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye. Surgery requiring incision of the iris and ciliary body, including iris diathermy or cryotherapy. Surgery requiring incision of the

‘Wide range of surgery permitted by legislation’ vitreous. Surgery requiring incision of the retina. Surgical intraocular implants. Any surgical procedure that does not provide for the correction and relief of ocular abnormalities. Injection or incision into the eyeball.” Louisiana optometrists are now required to “meet the educational and competence criteria established by the board in order to perform expanded therapeutic procedures. Evidence of proof of continuing competency shall be determined by the board.” But who are the board members; what experience and qualifications in ophthalmic surgery do they have? According to Greater New Orleans’ The Times: “Ophthalmologists are physicians who attended four years of

medical school, finished an internship and underwent a threeyear residency in eye surgery. All of that training adds up to about 17,000 hours over eight years or more. “Optometrists, on the other hand, are people to see for glasses, contacts and routine eye care. They get four years of training, but not in surgery and they are not medical doctors. Nonetheless, these well-rested optometrists have persuaded legislators that, after a few days of training, they’ll be qualified to perform all kinds of surgical procedures. Currently, only medical doctors licensed by the Louisiana State Board of Medical Examiners can perform invasive procedures on the eye. “As passed by the House and Senate, however, the legislation HB 1065 will allow optometrists to perform various ophthalmic surgery using scalpels, cryoprobes, lasers, electric cautery or ionizing radiation. Among the specific procedures the bill would permit is YAG laser capsulotomy, an outpatient treatment for cataracts, and laser peripheral iridotomy, a surgical treatment for glaucoma. The bill would wisely prohibit them from performing the sight-correcting LASEK or LASIK procedures, but I suspect that will be next. Optometrists in Oklahoma already can perform LASIK. “It’s all part of a movement by optometrists to expand their practices to include lucrative eye surgeries. So far, only Kentucky and Oklahoma have opened the surgical suite to optometrists. “In Louisiana, the state requires you to train for 1,500 hours to get a barber’s license. However, if you examine people’s eyes for glasses and contact lenses and wish to perform certain types of eye surgery, legislators believe that about 40 hours of training should suffice.”

The key to what will now happen in Louisiana largely rests with the Louisiana State Board of Optometry Examiners, created within the Department of Health and Hospitals. Would it not be reasonable to expect that such a board, given the new legislation, would have at least one medical practitioner (preferably an ophthalmologist) sitting on it? But no, that board consists of five members who are licensed optometrists and have practised optometry in that state for seven years! So who was behind the legislation? The Governor of Louisiana who signed it into law? The Louisiana State Senate? The Louis House of Representatives? Technically all of them. However the bill’s author was ostensibly Representative Rogers Pope, Republican of Denham Springs, but everyone around the Capital understands the real force behind it was New Orleans Senator David Heitmeir, chairman of the Senate Health and Welfare Committee, which overwhelmingly approved the bill. And guess what Senator Heitmeir is? A Doctor of Optometry and owner and manager of a most-successful clinical optometry practice in Algiers, Louisiana! As the chief executive officer of The Royal Australian and New Zealand College of Ophthalmologist, Dr David Andrews s said in a statement to Insight: “This new legislation to come out of Louisiana is absurd, although the American system is different from the Australian system, optometrists are not medical doctors, and certainly don’t have the necessary training to perform surgery. It would appear to be purely a revenue-raising exercise, and one which directly puts patients safety at risk.” That surely sums up the whole fiasco. ■

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BUDGET INSIGHT

AMA conference calls for overhaul of $7 co-payment for GP visit D elegates to the Australian Medical Association National Conference in Canberra on 23-25 May passed a resolution calling on the AMA federal council to hold urgent talks with the federal government to overhaul the $7 GP visit copayment announced in the May budget. The conference resolution reads as follows: “That National Conference calls on the AMA Federal Council to urge the Federal Government to hold urgent talks with the AMA regarding a model of co-payments that: • recognises that general practice, pathology and diagnostic imaging are delivering high quality and efficient health services for patients and the need

•

for strong investment in these areas; provides adequate support for vulnerable patients so that they are not discouraged from accessing primary care services, which would otherwise increase the burden of chronic and preventable diseases and health care costs into the future; allows for exceptional circumstances arrangements where the co-payment can be waived without any financial penalty being incurred by the doctor; recognises the right of doctors to establish a fair fee based on the costs of providing a service; ensures practices are properly funded to cover the initial and ongoing costs of collecting copayments; and minimises the costs of compl-

iance for practices by providing an efficient means to confirm patient eligibility for safety net arrangements and adopting simplified billing arrangements.” Outgoing AMA president, Dr Steve Hambleton, said the AMA is not opposed to co-payments in principle where they are appropriate and equitable. Also, that the AMA accepts it is reasonable for people with appropriate means to make a contribution towards the costs of seeing a doctor, but the co-payments announced in the budget could hurt the most needy and vulnerable. “The AMA National Conference today called for an overhaul of the model being proposed by the Government because of its potential effects on the most vulnerable

patients in the community,” Dr Hambleton said. “Overseas evidence shows that better health outcomes are delivered when barriers to primary care are low. “Front line primary care services are very efficient and are a low cost part of the Australian health system. “Encouraging patients to access this part of the health system reduces pressure on the hospital sector and can avoid the need for more expensive medical interventions. “Co-payments can hit vulnerable groups hard. “The Government’s model will also add red tape and require practices to put in place extra infrastructure and staffing to implement this proposed model. ■

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FUNDING

SA’s state budget leaves public eye patients in a precarious position T he recent South Australia state budget has left members of the public there needing eye treatment in a public hospital in a precarious position, and the situation will only get worse, according to the Macular Disease Foundation Australia. “The situation developing in South Australia is dire. Many patients are already waiting up to 24 months for appointments for sight-threatening eye conditions such as macular degeneration and diabetic macular edema and now two hospitals in Adelaide are no longer taking new patients for treatment for those conditions. Without urgent attention it will lead to people unnecessarily losing their sight,” Ms Julie Heraghty, chief executive officer of the foundation, said. “Furthermore, the situation will only deteriorate without decisive action. The old Royal Adelaide Hospital currently has 24 outpatient treatment rooms. The move to the new RAH will result in this number being slashed to 11,” Ms Heraghty said. “The decision by government to earmark the old RAH site for the

Royal Adelaide Hospital building of a new school has appeared to close the door on a proposal to establish a much-needed SA Eye Hospital in the McEwin Building on the site. This facility would have had sufficient capacity for the foreseeable future. The foundation recognises and respects the needs of public education but is highly concerned at the

inability of government to meet the present and future eye health needs of South Australians. “Given the government’s decision for the old site, there is now an even greater need for the minister for health to work with stakeholders to provide adequate capacity at the new RAH. One must question why South Australian taxpayers

are funding a superb new facility where current plans do not provide sufficient capacity to cater for future needs. Moreover, given that the Queen Elizabeth and Lyell McEwin hospitals cannot cope with existing demand, it is simply impractical to shift substantial additional load onto them. “The foundation calls on the minister to urgently address the existing and future inadequacies in eye health in the state. The eyehealth clinicians and staff in South Australia are some of the best in the world. Those people and their patients deserve to have the facilities, services and patient focused care that ensures the best chance of saving sight.” “Changes in federal funding cannot be used as an excuse. The eye-health capacity crisis in South Australia has existed for several years – long before the federal government proposed cuts to the state’s health budget. The South Australian government must accept the responsibility to ensure that its citizens have timely access and affordability to sight saving treatment.” ■

Essilor Australia signs licensing and endorsement agreement with Cancer Council

ssilor Australia on 3 July announced it has signed a licensing and endorsement agreement with Cancer Council Australia for its Crizal UV product. The agreement came into effect immediately and will see Essilor Australia able to promote

its Crizal UV lens as the only prescription lens endorsed by Cancer Council for providing wearers with protection against the damaging effects of UV radiation. Cancer Council’s endorsement of Crizal UV is based on the product’s patented technology.

Cancer Council is a not-forprofit organisation, and is the peak independent cancer body in Australia, providing education, research and support services across the country. The organisation boasts a brand-awareness level of 98%

amongst Austalian consumers, and works with ‘best in class’ manufacturers to produce, distribute and promote a range of high quality, affordable sun protection products, including sunscreen, hats, clothing, sunglasses, shade structures and car-window tinting. ■

the week before the budget was handed down and 5.3% in the week after, according to the Australian Retail Index.

By comparison, overall retail sales rose 1.8% in the week after the 2013 budget and 5% after the 2012 budget, according to the index. ■

Budget news bad for retail

etail sales slumped following the 2014 federal budget handed down by Treasurer Joe Hockey on 13 May, confirming 12

AUGUST 2014

that a hit to consumer spending would cause many people to cut back spending. Overall retail sales fell 4.6% in

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AUGUST 12-13 3rd Annual Launch Event

Healy Optical wish to invite you to our exclusive event for 2014. e The event will showcase the latest releases from our world leading optical and sunglass brands. Including Tom Ford, Swarovski, Superdry, Lafont, Esprit, Elle Roberto Cavalli & more! p This prestigious event is taking place on 12th August 3pm to 9pm & 13th August 9am to 9pm. Located at the stunning Blue Hotel on Woolloomooloo wharf, the 2 day event is sure to turn heads. For more information and to RSVP, contact Clare on 02 9420 3200 or cconnolly@healyoptical.com.au

AMD TREATMENT

Italy moves to fund off-label use of drug; follow-on to $1.72bn damages T he Italian government will pay for patients to be treated for age-related macular degeneration with Roche’s Avastin, a drug not approved for that use, and has taken legal action against the Swiss manufacturer and marketing partner Novartis for steering physicians toward the more expensive Lucentis drug. – about $200 versus $2,000 per injection, usually monthly, before benefits for Lucentis. The legal action follows the Italian government’s decision to seek an extra $1.72 billion in damages from Rocher and Novartis on top of the $251 million in fines already imposed on them by the government, with investigations in France and the European Union in train at present. Italy’s approach, which may look appealing to other European

countries, drew a sharp rebuke from both companies as well as ‘Big Pharma’ in general. “Novartis strongly rejects the Italian law allowing reimbursement of Avastin to be used off-label in the eye for economic reason as it is against European law,” a spokesman for Novartis, Mr Eric Althoff, said. Novartis markets Lucentis in Europe. “Patient safety is of the highest importance for Novartis, and we urge the Italian Medicines Agency to promptly implement clear protocols and procedures around the use of Avastin including monitoring.” The Italian government will cover Avastin, used to treat AMD, instead of Lucentis, which is approved for that condition. Ophthalmologists have long used Avastin off-label for treating

the eye disease. Both companies deny wrongdoing saying they have an obligation to let ophthalmologists know the perils of substituting one drug for another. The economics of the situation are compelling. A recent study found that the United States Medicare system could save $3 billion a year if Avastin was substituted for the $2,000-plus-per-dose Lucentis. They are compelling for Roche as well. Avastin, first approved for colon cancer, is approved for multiple indications and generated $6.751 billion last year for the company, up 13%, but Lucentis, used only for eye conditions, generated nearly $1.9 billion with 15% growth last year. It is even more important for Novartis, which markets it outside the US. Novartis

reported Lucentis sales of $2.38 billion last year. The pharmaceutical industry, which stands to lose more revenue if drug substitution becomes a trend, has spoken out against Italy’s decision as well. The industry has seen little growth in the European Union in recent years as governments have already been cutting reimbursements and been slow to approve new drugs. “We are concerned about efforts by European Union member states creating secondary, national marketing authorizations for economic reasons that undermine the EU regulatory framework and could potentially put patients at risk,” Mr Richard Bergstroem, directorgeneral of the European Federation of Pharmaceutical Industries and Associations, a trade group that represents ‘Big Pharma’, said. ■

Sleight of hand is at work on Medical Benefits Scheme, claims AMA

s flagged in the federal budget in May, the federal government has announced a two per cent indexation increase in fees for a number of general practitioner services, which took effect from 1 July 2014. The increase has been posted on MBS Online. The president of the Australian Medical Association, Assoc Prof Brian Owler, said \the AMA notes the modest increase for GP services, but warned it is inadequate and would be swallowed up by a range of cuts next year. Assoc Prof Owler said that the costs of providing general practice services – including wages for practice staff, rent,

electricity, computers, continuing professional development, practice accreditation and professional insurance – are rising. “The government must recognise that the cost of providing medical services increases each year, as practice costs increase, and that the single fee charged by the doctor has to cover practice costs,” A/Prof Owler said. “But there is sleight of hand at work here – the increase is small and will be short-lived. “Patients are going to be slugged with a number of new health-care costs next year as a result of the budget measures. “GP rebates will be slashed by $5.

“The government will also take $5 off Medicare rebates for pathology and diagnostic imaging services, which haven’t been indexed for 14 years. “The indexation of rebates for other medical services – specialist, consultant physician and psychiatry consultations, and operations and anaesthesia – last occurred on 1 November 2013 and the government has no plans to index them again until July 2016. “That’s an almost fouryear freeze of the rebate the Government will pay towards the cost of specialist medical treatment. “The private health insurers may decide not to carry the

Government’s savings by indexing their schedules of medical benefits – they may decide to freeze indexation too. “If that happens, there will be a drop in the current high rate of 89 per cent of privately insured services having no out-of-pocket costs. “The government may have offered a sweetener to the Australian public this year for GP services, but things will turn very sour with hard hitting cuts to health care next year. “Those arrangements are going to hit the most vulnerable patients in the community – elderly, poor, chronically ill and indigenous Australians.” ■

EVERYBODY READS INSIGHT! 14

AUGUST 2014

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P: 02 9420 3200 F: 02 9420 3222 E: sales@healyoptical.com.au www.healyoptical.com.au

03/03/14 08.27

EARLY DIAGNOSIS

Victoria Lions fund promising keratoconus research at CERA V

ictorian Lions are funding promising new research at the Melbourne-based Centre for Eye Research Australia to enable the early diagnosis and treatment of the eye disease keratoconus. Keratoconus, a common condition affecting the cornea, often developed in childhood, is characterised by progressive corneal thinning resulting in an abnormally steep cornea and considerable vision loss. In the early stages of keratoconus, vision can be corrected by glasses or contact lenses, but as the disease progresses, corneal transplantation is often required. A significant number of keratoconus patients require multiple

transplants. Almost half of all eye transplants performed in Victoria are due to keratoconus. According to Associate Professor Paul Baird, principal investigator ocular genetics, recent advances in imaging techniques, particularly using a Pentacam corneal imaging system, now allows the detection of corneal changes in individuals who would normally not be diagnosed until their disease is more advanced. “The key focus of the new study funded by the Victorian Lions will be to identify any characteristics or risk factors that might exist in parents and may impact on the age of onset and severity of keratoconus in their children,” Professor Baird said.

Coming Up

Lectures on ocular damage from UV exposure The Cornea and Contact Lens Society of Australia is presenting a series of events featuring international speaker Professor James Wolffsohn. With the support of the society’s gold sponsor, Johnson & Johnson and its silver sponsor, Abbott Medical Optics, the tour will include Brisbane, Melbourne and Sydney. Professor Wolffsohn, who is past-president of the British Contact Lens Association, will present on practical management of dry eye for contact-lens wearers that has emerged from new ‘Tear Film and Ocular Surface Guidelines’ and ‘New Emerging Evidence on the Effect of UV on the Eyes’. He will examine the level and type of evidence in the peer-reviewed literature on the effects of ocular damage from UV exposure, with the role of UV-blocking contact lenses in context and to examine the latest studies on their use. The need to raise awareness of UV exposure on the eye and the subsequent issues with patients and help for them to protect their 16

AUGUST 2014

eyes will be discussed. Currently marketed contact lenses range in the amount of ultraviolet (UV) A and B that they block. However, most patients don’t appreciate that contact lenses can protect the eyes from UV damage. Hence a better way to communicate this health message to patients is required. Sun-protection factors have been used for identifying the relative protection of sun lotions since the 1960’s and more recently for clothing. That is calculated by multiplying the percentage transmission at each wavelength by the erythema damage profile which is mainly in the UVB spectrum. Applying that to modern soft contact lenses, those with minimal ultraviolet blocking properties were calculated as having an SPF between 1 and 2 whereas lenses classed as having Class 1 or 2 ultraviolet (UV) blocking according to International Standard Organisation (ISO) standards had a significantly higher SPF with values greater than 50. All three events have had 4.5 CPD points applied for.

“We will also identify the presence of any corneal changes in siblings of children to allow us to better assess whether those children are at risk of keratoconus. “If the study is successful and the Pentacam becomes the tool for early keratoconus diagnosis, corneal collagen cross-linking (CXL) could become the standard treatment option at the early stage of keratoconus within a couple of years.” In March this year, CERA reported conclusive evidence that corneal collagen cross-linking slows or even halts the progression of keratoconus. CXL is a relativelysimple process involving the application of riboflavin (vitamin B2) solution to the cornea. The

riboflavin is then activated with ultra-violet light. Associate Professor Baird said that early diagnosis and treatment with CXL will allow the majority of keratoconus patients to be managed with glasses or contact lenses throughout their lives, and avoid the need for corneal transplantation. “It is a promising time for families with keratoconus – only a few years ago there were limited treatment options and the prospect of multiple surgeries and transplantations,” he said. “Now there is hope and the real promise of a better, healthier future. We can’t thank Victorian Lions enough for their generous support.” ■

Varilux progressive lens inventor honoured in US

he American Optometric Association has awarded its most prestigious prize – the Apollo Award- to Mr Bernard Maitenaz, French inventor of progressive lenses. Mr Maitenaz, inventor of the progressive lens and chairman and chief executive officer of Essilor International in 19801991, was presented with the Apollo Award at this year’s 117th Annual American Optometric Association Congress. The AOA

represents some 36,000 optometrists. The Apollo Award honours persons or organisations for distinguished service to the visual welfare of the public. In 1959, following eight years of research, Mr Maitenaz, a young mechanical engineer at Essilor, created Varilux, the world’s first progressive lens A total of 300 million people around the world wear or have worn Varilux lenses, with a new wearer every three seconds. ■

$500,000 donated to MDF ayer donated $500,000 to the Macular Disease Foundation Australia in 2013, part of the

company’s $1.1million-plus in donations to support health-care organisations here. ■

The three events are: • Brisbane, 4 August, The Greek Club, 29 Edmondstone St, South Brisbane. Registration: <https:// tas.currinda.com/register/ event/1088> • Melbourne, 18 August, GG150, Shop 1, 150 Clarendon St.

East Melbourne. Registration: <https://tas.currinda.com/register/event/1089> ? • Sydney, 19 August, Georges Mediterranean Bar & Grill, 17 Lime Street, King Street Wharf, Sydney. Registration: <https://tas.currinda.com/register/event/1090> ■ www.insightnews.com.au

CONTACT LENSES

Cooper Companies buying Sauflon in transaction worth $1.2 billion T

he Cooper Companies Inc on 30 June announced it has entered into definitive agreements to acquire Sauflon Pharmaceuticals Ltd, a European manufacturer and distributor of soft contact lenses and solutions, in a transaction valued at approximately $US1.2 billion. Sauflon forecasts revenue of approximately $210 million for its fiscal year ending 31 October, up approximately 22% year-over-year. The transaction is subject to regulatory approval and is expected to close prior to fiscal year end, 31 October 2014. Excluding

one-time charges and deal-related amortisation, the transaction is expected to be accretive to earnings per share in fiscal 2015. The acquisition will be financed with off-shore cash and credit facilities. Commenting on the transaction, Mr Robert Weiss, Cooper’s president and chief executive officer, said: “We are extremely pleased to announce this acquisition which gives CooperVision the world’s most comprehensive portfolio of daily-disposable lenses. CooperVision will now be able to offer a multi-tier daily strategy that includes a full suite

of silicone hydrogel and hydrogel lenses, including options within all categories – spheres, torics and multifocals. The daily segment is the fastest growing segment of the soft-contact-lens market and this transaction positions CooperVision as the premier company in this space.” The Cooper Companies is a global medical device company publicly traded on the New York Stock Exchange. It operates through two business units, CooperVision and CooperSurgical. CooperVision produces a wide range of highquality products for contact-lens

wearers. CooperSurgical focuses on supplying women’s health products and treatment. Headquartered in Pleasanton, California, Cooper has approximately 8,000 employees with products sold in over 100 countries. Established in 1985, Sauflon is a privately-owned British company and a global manufacturer of contact lenses and after-care solutions. It has three state-of-the-art manufacturing plants, sales offices in 10 countries, and products sold in over 50 countries. Sauflon is recognized as a high-quality, award-winning global manufacturer of contact lenses and after-care products. ■

Daily-disposables the future of contact lenses: professor

auflon’s full suite of daily disposables represent the future model of contact lens provision, according to a presentation by Professor Nathan Efron, reported by Optician. Its full ‘family’ of Clariti daily lenses, including sphere, toric and multifocal options, provided a template for the contact lens market over the coming decade, Professor Nathan told practitioners at an event hosted by Sauflon in England in early July. “Daily disposables really are a

miracle of modern-day ophthalmic science,” Professor Efron said, also crediting United Kingdom wearers for embracing the daily disposable trend. While Denmark was leading the charge with 57 per cent daily penetration, the UK is “sitting very proudly in the top echelons of countries”, he said. Sauflon now has offices in 13 countries and earlier in the year launched its Clariti 1day range in the United States market, where it will be hoping to convert more

wearers to daily-disposable routines. Sauflon joint managing director Mr Bradley Wells also addressed the140 practitioners who attended the talk at London’s science museum. He said: “We are a privatelyowned British company and we are proud of that fact. We are also a family run business.” Mr Wells agreed daily disposable and silicone hydrogel represent the future market in contact lenses, and said Sauflon

remained dedicated to high street practices despite the surge of non-optical online contact lens retailers. “They’ve all [non-optical sellers] come along to us and we’ve turned every one of them down,” he said “There is not a practice in the country today that is immune to the threat of the non-optical sector so we take this seriously. This is very important to the history, culture and legacy of Sauflon as a company.” ■

Student goes blind after keeping her contact lenses in for 6 months

student in Taiwan who kept a pair of disposable contact lenses in her eyes for six months has been left blinded after

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a microscopic bug devoured her eyeballs. The tiny single-cell amoeba ate away at undergraduate Lian Kao’s

sight because she didn’t take out and clean the lenses once during that time. The case was a particularly severe example of a young person

under pressure who did not take the time to carry out basic hygiene on their contact lenses, according to practitioners. ■

AUGUST 2014

EDUCATION

Optical dispensers 33rd graduation T

he 33rd Optical Dispensing Celebration Dinner was held, as has become established practice, at Dockside, Darling Harbour in Sydney in late May 2014. The graduating classes were from the TAFE NSW Certificate IV courses at the Sydney Institute and the Open Training and Education Network (OTEN) in Australia and New Zealand.

112 graduate A total of 108 dispensers received their Certificate IVs in Optical Dispensing. The SI accounted for 55, OTEN’s Australian arm 45, and OTEN’s NZ course 8. The Australian Dispensing Opticians Association also presented four individuals with its Diploma in Ophthalmic Practice Management. An extensive number of academic prizes was also delivered on the night, the pinnacle of which was yet another TAFE NSW State Medal to an optical dispensing student. The worthy recipient from the 2013 graduating class was Ms Carly Toms from the OTEN course. Other notable prize-winners were Ms Donna Wright, Course Prize – OTEN and Ms Xiao Lan Li, Course Prize – SI. The evening’s MC was Mr James Gibbins from Randwick College’s course and the welcome to the celebration was delivered by Mr Martin Kocbek, president of ADOA. The graduating students were introduced by their respective head teachers, Ms Jeanette Ramos (SI) and Mr Rogers Kumar (OTEN). The actual certificates were presented by senior staff of their respective institutions, Ms Carmel Ellis-Gulli, Randwick College director (SI graduates) and Ms Carolyn Rosier, manager of educational programs OTEN (OTEN graduates). Industry-contributed prizes were presented by Mr Richard Grills, chairman of the Optical Distributors and Manufacturers Association. ADOA diplomas were presented by Mr Kocbek.

AUGUST 2014

Graduates of 2013 courses

Guest of Honour The evening’s guest of honour was Mr David Riordan, director of the Sydney Institute. Mr Riordan gave a brief overview of the history of the optical mechanics’ course (much longer than the dispensing course) and the optical dispensing course including the course run previously by the Guild of Dispensing Opticians. He acknowledged the rôles of Mr Grills, Mr Malcolm Syme, and Dr David Wilson in that course. Dr Wilson went on to become a senior teacher in the OTEN course and eventually its head teacher, ultimately with responsibilities beyond just the dispensing course within OTEN. He is now at the University of NSW. In his address, Mr Riordan spoke of the positive reaction to the revamped SI course that has resulted in a quadrupling of enrolments and an increase in partnerships between industry and the institute. To facilitate the quality and relevance of the education delivered, modern facilities, equipment, laboratories, and classrooms have been made available in Randwick College. The contribution from ODMA members to that facility was acknowledged.

Carly Toms and David Riordan State Medal

Donna Wright and Richard Grills

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EDUCATION

dinner in Sydney

James Gibbins

Xiao Lan Li and Richard Grills

Mr Riordan detailed the fasttrack, one-year, face-to-face/ on-line hybrid program now offered. He amused the presbyopes, especially the advanced

presbyopes, in the audience by relating the common vision experience he and they have of being in the shower and attempting to read labels on hair-care products

that have packages of identical colour and size – is it shampoo or conditioner? His vision for all SI courses is to change the futures, and therefore the lives, of graduates by offering relevant courses delivered by highly-qualified teachers (both vocationally and educationally) so that the ‘products’ are job-ready. He asked the new graduates and continuing students present to spread the word about their courses. He closed by thanking the various supporters (ODMA, ADOA, ADONZ, UNSW School of Optometry and Vision Science, Insight, Mivision, and Eye Talk). He also asked that all the teaching staff be recognized for their contributions to the education of the graduating classes.

Students reply As a representative of the graduating classes, Ms Randa Trott from the SI course gave a brief address thanking Mr Riordan for his address. Graduate representatives from each course, Ms Allison Robinson (OTEN) and Mr Vivek Sehdev (SI) gave appreciations of, and thanks to, their course lecturers and other staff.

Closing Mr Grant Hannaford (a Diploma in Ophthalmic Practice Mangement recipient and ADOA executive member) gave the ADOA appreciation address. It is probable that next year’s graduation will be held at the same venue on a date to be fixed. ■

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COMBATING BLINDNESS

Fred Hollows Foundation provided 449,000 eye procedures last year “The 2010 Global Burden of Disease Study has shown that because of the efforts of organisations such as ours, in 2010 18.5 million fewer people were blind than would have been expected given population growth and ageing since 1990. “Fred would now want us to get

on with the job to reach the four out of five people still blind in the world today.” The results top off a year when the foundation was named The Australian Charity of the Year 2013 in the inaugural Australian Charity Awards. ■

‘Disappointed’ at cap on aid spending in federal budget: chief executive officer

n the last financial year (2013), 449,768 eye operations, procedures and treatments were performed by The Fred Hollows Foundation with their partners, which was up from 404,915 in 2012. The foundation also trained 42,189 eye-health workers, giving them what the late Professor Hollows called “the tools of their trade” and building or upgrading 48 medical facilities. The foundation also continued to lead Australia’s contribution to eliminating trachoma in the worst-affected countries, providing over 4.1 million people with antibiotics to combat the disease. Professor Hollows believed that no one should be needlessly blind, the foundation’s chief executive officer, Mr Brian Doolan, said. “Fred hated double standards,” Mr Doolan said. “To him it was unacceptable that people in

AUGUST 2014

the developing world were going blind from diseases that were commonly treated elsewhere. “Tackling that inequality was his lifetime goal. Fred would be proud to see the foundation has grown so dramatically since he started it 21 years ago. Every aspect of our work – from the number of operations, to the donations, the people we train, revenue raised, employees, and government support – has steadily increased. “The results are further evidence of the progress being made towards eliminating avoidable blindness. “More than 20 years after we lost Fred, the Australia public continues to support his foundation, saving the sight of millions every year. “And the exciting thing is that the prevalence of global blindness is declining, thanks in part to our supporters.

The Fred Hollows Foundation says it is “disappointed” at the federal government’s decision to cap aid spending at $5 billion annually for the next two financial years and abandon its commitment to CPI increases. “It’s a real cut that affects real people who would have had their sight and their dignity restored,” the foundation’s chief executive officer Mr Brian Doolan said. The federal government expects to save $7.6 billion over five years as a result of the freeze and subsequent peg on consumer price index payments from 2016/17. Two billion dollars alone will come from abandoning bipartisan support to lift aid levels to 0.5% of the gross national income and tying rises to inflation instead. The cut to aid spending is the biggest single savings measure in the 2014-15 budget. Mr Doolan said the money had been earmarked for work with some of the world’s most vulnerable people. He is urging Canberra to channel more funds through non-government organisations. “We have actually seen a minor increase in funding to NGOs despite the larger cuts to the aid budget. But funding to Australian NGOs is currently less than 3% of the total Australian aid budget. It should be no less than 10%. The treasurer has failed to live up to his commitment to channel greater funding through Australian NGOs.” The foundation’s comments echo those of the Australian Council for International Development – the peak body for humanitarian and overseas development organisations. “When you’re talking about people living on $2 a day, every dollar counts and we’re incredibly disappointed to see the government fail to honour its election commitment,” ACFID executive director Mr Marc Purcell said. However, Mr Purcell has welcomed an increase in humanitarian funding and the government’s ongoing partnership with non-government organisations and volunteers.

www.insightnews.com.au

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2014-02-024

STEM CELLS INSIGHT

Stem-cell derived retinas: a few steps forward and fewer steps back – By Lewis Williams, PhD

In the beginning Insight published an article (June 2012), about the world’s first successful creation of early-stage retinal structures in vitro by United States scientists at the University of Wisconsin-Madison. Lead author and paediatric ophthalmologist Dr David Gamm described their advance at the time as a ‘solid step forward’. They used a method based on induced pluripotent stem cells derived from human blood and to date, iPSC methodology has dominated stem cell research thinking.

First ever iPSC trial approved In July 2013 the Japanese government approved a study of human stem cell therapy to treat vision loss due to AMD using the patients’ own cells, reprogrammed to be stem cells, i.e. the iPSC approach. The contracted institutions, the RIKEN Center for Developmental Biology in Kobe and the Institute of Biomedical Research and Innovation Hospital, were to take adult skin cells from six AMD patients and reprogram them to into a stem cell-like state, before injecting them back into the subjects’ retinas to treat their AMD.

Institutional problems surface However, the use of iPSC cells is not limited to the creation of ocular structures and a group based at the RCDB announced the creation of a mouse foetus using iPSCs and a technique they developed also in mid-2013. Essentially, their technique applied an external stressor, such as a low pH environment or mechanical squeeze pressure, that can, they claimed, send differentiated mouse cells back to a pluripotent state, a very valuable 22

AUGUST 2014

resource in stem-cell research. Unfortunately for the RCDB group and especially its key researcher, Dr Haruko Obokata, but fortunately for ‘the scientific method’ whose central plank is ‘repeatability’, several other groups heavily involved in advanced stem cell research could not repeat the Japanese team’s results. That led some key stem cell researchers to question (in February 2014) the veracity of the RCDB claims. The technique, called stimulus-triggered acquisition of pluripotency or STAP, that failed in the hands of others, resulted in a RCDB investigation that revealed evidence of image manipulation and reuse. Almost appropriately, the first investigation’s outcomes were announced in Japan on 1 April 2014. That was followed by further controversies including accusations of image manipulation in papers published by the chairman of the investigating committee. He resigned subsequently (April 2014) as his position was no longer tenable. Later still, additional imagerelated questions were raised in regard to papers published by three more members of the original investigating committee suggesting a far wider problem.

Final straw for STAP? Independent analysis of the STAP papers uncovered a suspected mouse cell mix-up. That analysis concluded that the cells at the centre of the controversy were most likely obtained by combining two kinds of different cells The Japan Times reported (June 4). Critically, neither of those cell types were claimed to have been used in the January 2014 Nature articles. In fact, the analysis suggested that the mix-up was deliberate because such an eventuality was ‘unlikely’ to occur by accident or mistake. Further to her being found guilty of research misconduct by the RCDB in May 2014, Dr Obakata agreed to retract a second paper (in June 2014) after earlier agreeing to retract the first (that was in the form of a letter, not an article, the article was considered to be the more flawed). A co-author (of the original Letter), Dr Charles Vacanti from Harvard Medical School who was Obakata’s post-doctoral mentor, also expressed a desire to have the initial publication retracted. However, Nature itself prefers to retract articles only after all authors have agreed to such a step and as of June 4, Nature stated that discussions were still in progress and would not discuss such matters further until they were finalized.

Review of up to 20,000 papers

Others weigh in

In a May 2014 edition of The Scientist, an on-line science journal/magazine, quoting The Yomiuri Shimbun, it was announced that in the wake of allegations of research misconduct, the president of the RCDB, Prof Ryoji Noyori, had asked all institute labs to review their publications for evidence of manipulated and/or doctored images, or plagiarism. Apparently, that request could mean that up to 20,000 publications need reviewing.

Another iPSC researcher, Dr Paul Knoepfler (UC Davis), left no doubt as to where he stood as at 28 May 2014 on the page: http:// www.iPSCCcell.com/tag/charlesvacanti/. He stated: “If I was a Nature senior editor…, I’d figure this is the end of the road for STAP and we should editorially retract the STAP article at this point since the authors will clearly not do so [Editor: They reversed that decision subsequently]. The fact that the STAP letter is now likely to be dead only further supports the

idea that the whole STAP story is fundamentally flawed and the STAP article cannot survive much longer either” he concluded.

A glimmer of hope for STAP At about the same time, Chinese University of Hong Kong stemcell researcher Dr Kenneth Lee reported that he had been able to reproduce the results using the ‘refined’ protocol posted by Dr Vacanti after the original articles were published. Significantly, his earlier attempts using the original methodology failed.

Stem cell debacle could bring down entire centre Because investigations pointed strongly to a culture problem at the RCDB, many consider that closing the research centre at the heart of the unfolding scientific scandal may be necessary to prevent a recurrence of research misconduct on such a scale. Yet another investigating committee found lax oversight and a failure on the part of senior authors of the two papers in Nature. The committee concluded that enormous pressures to announce and/ or publish novel results resulted in the premature publication of ‘work in progress’. The committee is quoted as saying: “It seems that RIKEN CDB had a strong desire to produce major breakthrough results that would surpass iPSC research”, i.e. they were keen for STAP technology to surpass better-established iPSC-based technology. Central to the long-term viability of the RCDB was the statement by the committee chair, Prof Teruo Kishi Kishi, that: “One of our conclusions is that the CDB organization is part of the problem”. They recommended a complete Continued on page 24 www.insightnews.com.au

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MEDICATIONS INSIGHT

RANZCO warns patients taking T

he Royal Australian and New Zealand College of Ophthalmologists with the support of the Urological Society of Australia and New Zealand, is urging patients and prescribers to be aware that some medications containing alpha-1 adrenergic receptor antagonists can potentially increase the likelihood of serious complications during cataract, glaucoma or some forms of refractive surgery in susceptible patients. RANZCO is concerned that the product information for these medicines does not adequately address those potential complications. The most commonly prescribed, tamsulosin (Duodart, Flomaxtra), typically used for the treatment of benign prostatic

hyperplasia in men and kidney stones in men and women, is of particular concern. The warning has come through local ophthalmologists’ experiences, and also from some recent studies. Most members of the American Society of Cataract and Refractive Surgery believe that tamsulosin makes cataract surgery more difficult (95%) and increases the risks of surgery (77%).* Ophthalmologist Dr Mark Renehan explains his concerns: “If you’re having that kind of surgery and are already taking, or have taken medication containing a selective alpha-1 adrenergic receptor antagonist such as tamsulosin, the pupil may dilate poorly and the iris may become floppy during the procedure. That could lead to damage to the iris increasing the

risk of post-operative blurred vision, sensitivity to light and difficulty driving at night. “Having a floppy iris also significantly increases the risk of damage to the lens capsule, a delicate membrane in the eye the integrity of which is important in the outcome of cataract surgery. If that is damaged, there is a high risk of further surgery being required and a poor outcome, potentially even loss of vision. It also applies in different ways to glaucoma and some refractive surgery procedures.” The two colleges said: “This side effect is referred to as Intraoperative Floppy Iris Syndrome (IFIS) and is best approached by prescribers, patients and the operating ophthalmologist being aware of alpha-1-adrenergic receptor antagonist usage

in the patient. That is important as permanent structural changes to the iris have been observed in patients who have taken treatment for even a short time, and also in patients years after ceasing medication. “Other related medications available in Australia and/or New Zealand with the potential to cause IFIS include alfuzosin (Xatral), terazosin (Hytrin) and doxazosin (Carduran) also used to treat BPH; prazosin (MiniPress) and labetolol (Presolol, Trandate) used to treat hypertension; and risperidone (Risperdal), ropinirole (Repreve), and mianserin (Tolvon, Lumin) used for treatment of some psychiatric conditions. There are accounts of a herbal preparation called ‘saw palmetto’ having similar effects.

Continued from page 22

the laboratory using human iPSCs (The Scientist, 10 June 2014, actual article published in Nature Communications). Dr Maria Valeria CantoSoler, Director of the Retinal Degeneration Research Center at Johns Hopkins, and her colleagues demonstrated their ability to grow the most mature retinal tissue so far from iPSCs. Their ‘retina’ was able to demonstrate it had functional photoreceptor cells whose properties parallelled those of a similarly-aged embryological retina. The cells exhibited an innate ability to organize themselves into a complex structure that mimicked the real thing. The tissue contained all seven retinal cell types. Tellingly, Dr Gamm (lead author of the original 2012 paper) was a co-author of the latest paper. The Scientist reports him as saying: “Outer segments, which are the business end of photoreceptors, have not been previously shown to form from scratch in culture. That study is important as it demonstrated the extent to which we can study the retina in a culture dish”. Usefully, the tissue could be maintained for more than 200 days which may have therapeutic

implications much later on. Lead author Zhong is a postdoctoral fellow at Johns Hopkins. The electrophysiological confirmation of light-sensing function was carried out at the equivalent of 28 weeks gestation. The authors were surprised by the ability of the progenitor cells to self-assemble and they believe that having that innate ability should make therapeutic applications more feasible. The team are now pressing on with a technique that will emulate even more mature stages of development. The team’s interests are threefold, therapeutic/transplant, retinal disease modelling (pathology and treatments), and therapeutic drug testing. To curb the obvious enthusiasm for, and the high hopes raised by, their results and those of others, Dr Canto-Soler said: “But there is still a long way to go before we can directly apply this to patients”.

‘directed differentiation’ of human iPSCs into retinal pigmented epithelia. They claimed an 80% conversion rate of iPSCs into RPE phenotype cells in just 14 days. Their goal is also AMD treatment. While STAP technology remains in limbo the research using iPSCs is promising and the small, steady but significant advances in ocular tissue generation bodes well for sufferers of the many retinal conditions those developments might assist, if not eliminate. The challenge would appear to be the lead time in perfecting the techniques followed by the usual, but necessary, delays is getting approval for human use. It is almost certainly not in our immediate future. ■

overhaul of RCDB and voiced the possibility of restructuring it into a new institute, not just a change of name. Where that leaves the 2013 government-sponsored AMD iPSC trial is unknown but it is probable that it has had/will have an impact. Fortunately, similar US-based studies are also underway so that area of eye research is still active. The main attraction of the iPSC path is its avoidance of the use of human embryonic stem cells and all the tissue rejection and ethical issues that involves.

To balance the equation somewhat Despite the controversies surrounding the STAP approach, other research groups using iPSCs have built on the original Gamm team’s work published in 2012. For example, a group at The Wilmer Eye Institute at Johns Hopkins University School Of Medicine (Zhong et al., 2014) have demonstrated, in vitro, that a functioning light-sensing rudimentary human retina can be ‘grown’ in 24

AUGUST 2014

More hope: RPE Buchholz et al. (2013) of UC Santa Barbara (Dr Gamm is a collaborator with the group but not a co-author) published a paper describing a rapid and efficient method of

Buchholz DE et al., 2013. Rapid and Efficient Directed Differentiation of Human Pluripotent Stem Cells Into Retinal Pigmented Epithelium. Stem Cells Translat Med. 2: 384 – 393 or: biosbcc.net/bio291/dox/buchholz.pdf. Zhong X et al., 2014. Generation of three-dimensional retinal tissue with functional photoreceptors from human iPSCs. Nature Communications, doi:10.1038/ncomms5047.

www.insightnews.com.au

MEDICATIONS INSIGHT

prostate and kidney-stone drugs “USANZ supports RANZCO in calling for more prominent warnings in the product information from drug companies manufacturing alpha-1-receptor antagonists about the increased risk of IFIS in patients taking their products. Prescribers of those medications should be aware of this complication and warn their patients to inform their ophthalmologist about their usage if contemplating cataract or other eye surgery. In some selected cases where patients are about to have at risk surgery, the commencement of these medications may be delayed in consultation with an ophthalmologist. Any patient requiring such surgery should have a history of alpha1-receptor antagonist usage

elucidated to attempt to mitigate the risk of IFIS. “Alpha-1 adrenergic receptor antagonists are effective in the treatment of a variety of conditions. While it is not something patients and prescribers may think of at this time, the key is for all parties to be aware of the potential for those drugs to cause IFIS before starting on the medication. Further information for ophthalmologists on IFIS management is available on the American Academy of Ophthalmology website: www.aao.org. ■ Chang DF, Braga-mele R, Mamalis N, et al. Clinical experience with intraoperative floppy-iris syndrome. Results of the 2008 ASCRS member survey. J Cataract Refract Surg 2008; 34:1201-9.

About RANZCO RANZCO is the professional body for ophthalmologists and, as such, is the body responsible for creating and maintaining standards in ophthalmologist training and practice. It organises the examination system and sets the curriculum. It maintains a continuing professional development (CPD) system. It organises a scientific congress, produces clinical guidelines and the scientific journal Clinical and Experimental Ophthalmology. It promotes study and research in ophthalmology. RANZCO also exists to educate the general public in all matters relating to vision and the health of the human eye.

About USANZ The Urological Society of Australia and New Zealand is the peak professional body for urological surgeons in Australia and New Zealand. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. Those conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.

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AUGUST 2014

Revisit all the moments that have defined the ophthalmic professions and industry in the past 38 years!

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Over 38 years we’ve seen many changes in the ophthalmic professions and industry; ophthalmic professionals’ stars rise and fade, restructuring of the industry, clinical studies that have led to revolutionised eye-care, the struggles and triumphs of eye-care practitioners, new companies emerge as leaders, existing companies merge, established companies fold, and old technologies made redundant by new technologies.

INSIGHTâ&#x20AC;&#x2122;S 400th Issue Online Special After a record 38 years and 400 issues, weâ&#x20AC;&#x2122;re proud that INSIGHT is the highest circulated ophthalmic publication in Australia. To mark this milestone, INSIGHT has produced a special online 400th issue that revisits all the significant and industry changing news over the past 38 years. Take a journey down memory lane by reliving all the industry-altering moments that have defined our professions and industry and makes it what it is today by visiting the INSIGHT website to read this special online edition.

Visit www.insightnews.com.au INSIGHT statistics Published for 38 years, readers rely on INSIGHT for hard-hitting news supplying the facts that are reliable, accurate, independent and unbiased. Ophthalmic professionals respect INSIGHT because we identify the issues that need to be covered and challenge our readers through intelligent reporting and analysis.

88%

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INSIGHT is the most-read ophthalmic publication with 88% of practitioners regularly reading it.

If ophthalmic practitioners were to read only one publication, 74% would choose to read INSIGHT only.

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78% of ophthalmic practitioners rely on INSIGHT to keep up-to-date with the ophthalmic professions.

85% of practitioners believe INSIGHT provides balanced and independent reporting.

Research conducted at ODMA2013 in Brisbane.

CCLSA INSIGHT

Ortho-K: an update T

he Sydney branch of the Cornea and Contact Lens Society of Australia held a dinner meeting in late May featuring guest speaker Prof Helen Swarbrick of the Research in Orthokeratology group within the School of Optometry and Vision Science at the University of New South Wales. Prof Swarbrick is the ‘lead singer’ of the ROK group and is an acknowledged world authority on Ortho-K. Her presentation was titled The Science Behind Ortho-K. She described Ortho-K or OK as non-surgical and non-invasive corneal reshaping to correct refractive error. The process uses special reverse geometry contact lenses customized to the individual wearer. Importantly, the contact lenses are only worn over night and, in the ideal scenario, the wearer sees perfectly throughout the following day without the need for any vision correction of any sort. Once the situation stabilises, lens wear can often revert to every second night rather than every night. However, with the current lens designs only low to moderate amounts of myopia can be altered although there are designs with more ambitious claims. There are also designs emerging to tackle hyperopia, astigmatism, and presbyopia although the results for hyperopia to date have been mixed and the other errors could be an even greater challenge.

Reverse geometry While the shape of most contact lenses bears some resemblance to the shape of the anterior eye they are to fit, reverse geometry lenses are a deliberate mismatch. The central zone of the lens, sometimes referred to as the treatment zone because of the positive pressure it exerts on the corneal apex, is somewhat flatter than that of a true alignment fit while the lens periphery of the lens is basically an alignment fit. A normal rigid lens edge lift is also used. The ‘reverse’

AUGUST 2014

Helen Swarbrick

Mark Koszek

Margaret Lam

curve is located between the centre and the periphery and basically joins those two curves and, regardless of actual shape, stands clear of the cornea. The space under the reverse curve acts as a tear reservoir. The Rx change is modulated by the central corneal flattening to effect a simple myopic correction.

OK lens or the epithelial thinning it induces. In the mid-periphery there is slight stromal thickening at the edge of the treatment zone. The essentially epithelium-only thinning has been confirmed in numerous studies of humans, primates, cats, and rabbits over almost two decades of research. Is the epithelium compromised by OK-induced thinning? Research by ROK group member Ms Kathleen Watt into 129 welldocumented cases (2001-2008) of microbial keratitis in OK wearers found that more young patients (8-15) were affected than the older group (16-25) especially in China, Taiwan, Hong Kong, and, disappointingly, Australia. The usual suspect Pseudomonas aeruginosa was detected in more than a third of cases (49), Acanthamoeba sp. in almost as many (42), while 22 cases did not grew any organism in culture. Other bacteria accounted for just 13 cases and fungal species just 3 cases. Compliance is obviously an issue (always is) in that the Acanthamoeba cases are mostly due to the involvement of tap water, especially of poor quality, in lens care procedures. As such it is almost completely preventable. The question that arises from those figures is: Are younger OK patients more susceptible to eye infections? Further investigation showed that many (>50%) of the cases occurred early in the study’s time

band (circa 2001/2002) and nearly all were in China, Taiwan, and Hong Kong during a time when inexperience in OK may have been a factor. Since 2008 there has been a significant reduction in MK reported in OK to such an extent that most professional journals and OK practitioners have ceased reporting them. That may reflect fewer cases as well as a change in behaviour of those concerned. While there is no strong evidence that the young are more susceptible, the issue of MK in OK remains unanswered although recent figures suggest it is no longer an issue. In a study undertaken at the request of the US FDA of experienced wearers (1435 children, 1164 adults) in the hands of experienced OK practitioners and spanning the period 2005 to 2007, just 8 cases of corneal infiltrates and/or painful red eyes, and 2 confirmed cases of MK were identified. Fortunately, no vision loss was reported in any case. An analysis of the study’s data gave the Relative Risk as 7.7 per 10,000 patient-years or 1 case per 1,500 wearers per annum (95% confidence level). That risk is just slightly greater than daily-wear, conventional, rigid contact lenses and about the same as SiHy soft lenses worn on a daily-wear basis and slightly less than any form of overnight lens wear of conventional lenses.

How effective In the early stages of OK therapy there is a measurable ‘regression’ of the refractive state over the course of a day but by about 10 days of treatment the daily regression has usually decreased to a manageable 0.25D at day’s end. By 90 days there is very little regression. The other side of that coin is that about 75% of the full effect of OK is apparent after the first night of over-night OK lens wear. The effect is stable by 7-14 days but the actual time is Rx-dependent. According to Prof Swarbrick OK is reliable up to about –4D of myopia, less reliable from 4 to 6D and >6D needs a careful risk assessment. OK will generally halve any astigmatism present but daily regression can be as high as 0.50D and a small over-correction can be made in anticipation.

OK’s mechanism Primarily, OK works by central cornea epithelial compression, often by around 20 microns. The corneal stroma is little affected by the

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CCLSA INSIGHT

Ortho-K: an update Myopia control Myopia control, ever a hot topic in ophthalmic practice, was defined as the reduction or elimination of myopia/myopia progression. The sub-discipline still lacks clarity however and no claims for achieving control have been proved. One of the many unanswered questions relates to what happens to the eye’s refractive state when a designated treatment ceases for a time. OK per se has been shown to be effective in reducing myopia by between 30 and 50% although one study showed 63% (the CHARM study in Hong Kong involving high myopes). Regardless, the use of atropine (1%, 0.5%, 0.1%, 0.01%) is still

more effective (up to a 74% decrease) over a 2-year period. Myopes tend to show a hyperopic refractive state in the mid-periphery/periphery of their field of view and studies have shown that manipulation of the peripheral refraction can decrease the amount of myopia although probably to a lesser level than OK or atropine. The optics resulting from reverse geometry lenses also modulates the peripheral refraction and that might result in the decrease in myopia/myopia progression found. Spectacle lenses with modified peripheral optics are the least effective at reducing myopia. In a 2010 ROK group study of myopes of East Asian origin (mixed ethnicity is unacceptable

scientifically in relation to myopia given apparent different susceptibilities of different races) aged from 8-16 years. A contralateral cross-over study design was used in that only one eye was ‘treated’ with OK while the other eye wore a conventional GP lens (OK, night-only, GP dayonly wear). After 6 months of the study the wear modalities were swapped over with a 2-week ‘washout’ period between) (i.e. the Ok-treated eye started wearing GP lenses and the GP eye was subjected to OK treatment). The results were then reviewed at 12 months. OK lens wear reduced the change in axial length whereas the GP lens wear did not slow

myopia (axial length growth) at all. All GP wearing eyes grew but most OK eyes did not. However, some OK wearers had a good result while some had a negligible outcome. Predicting which wearer would benefit proved difficult and confounding factors included genetics, race, level of parental myopia, environment, exposure to near work, and amount of outdoor activity. The superiority of atropine (see later) suggests strongly that peripheral hyperopic defocus is not the whole story although it does point to some local, in-retina factor(s) influencing the outcome. What rôle atropine might have in local retinal influence of the refractive state remains unknown.

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CCLSA INSIGHT

Ortho-K: an update A study to investigate what influence OK lens design might have on myopia drew a complete blank. Three major OK lens types (BE, CRT, Contex) were used, a wide-field, auto-refractor assessed central and peripheral refractive states (Shin Nippon N Vision), and various core lens parameters such as BOZD, BPRs, and peripheral curve tangent cone angles were tried. The results suggested that OK effects/effects on myopia were almost generic to the OK treatment regardless of how the lenses varied or their parameters altered. The follow-up study will focus purely on peripheral lens design. Prof Swarbrick gave the following as issues deserving more attention. Does OK continue to control myopia (most studies are only of about 2 years duration)? Already a Japanese study done over 5 years suggests that OK effectiveness declines over time and produced no further benefit after about 3 years. Maybe the OK process has a 3-year benefit window but at the end of 5 years the study’s subjects still had less myopia than did its controls. What about rebound? How long does a wearer have to be in OK lenses for them to be effective? Atropine studies also show a rebound effect. Following cessation of atropine treatment, faster axial growth is observed and that is considered dangerous by some due to the stretching of the posterior poles anatomy. Counter-intuitively, the users of the 1% treatment showed the greatest rebound, the 0.01% users the least suggesting that a light-handed approach might achieve better results, i.e. a lesser rebound effect. Unfortunately, too much anecdotal evidence surrounds the studies for sound conclusions to be drawn and more works needs to be done. Wearing OK lenses and then stopping lens wear gives the same results as having worn GP lenses all along, therefore starting and stopping was concluded to be a waste of time. Is 100% control of myopia achievable? According to Prof

AUGUST 2014

Swarbrick: Probably not! She concluded her presentation with a summary: OK has about the same risk to wearers as over-night wear of any other lens type. On average, over a 3-year period, OK decreases myopia by about 45% (3263%). Atropine is still more effective but atropine and OK methods still have an issue with a rebound effect, the magnitude of which concerns some researchers.

An OK practitioner The second speaker at the meeting was Mr Mark Koszek an optometrist and Ortho-K practitioner from Sydney. After a brief rundown of the adverse and potentially-adverse effects of myopia on the human eye, he posed the question: What are a practitioner’s legal obligations to a patient when confronted with ample evidence of their myopia and a strong likelihood of myopic progression? The problem such a question poses is just what is ‘best practice’ when it comes to myopia and its control. Unfortunately, at the moment, an adequate defence is probably taking an evidencebased approach to the topic – the simple answer is we don’t know with any great certainty. Mr Koszek supports the rational idea that an OK exponent must have a corneal topographer available to be able to ascertain key characteristics of the cornea before treatment and the changes wrought as a result of it. Prolate elliptical corneas (prolate = ‘pointy’) that can be ‘sphericalised’ by an OK contact lens are ideal but that can only be determined by competent and well-centred corneal topography. A trial lens set for a rational number of OK designs rather than a trial-set ‘library’ was advised and trial lens fitting should be done without anaesthetic was his recommendation. He also advised that a practicewide refund policy be put in place to cover the possibility of unsuitability to, or failure of, OK treatment. His approach is to divide the professional fees into non-refundable and refundable components and

to discuss the possibilities with the patient before the process is commenced rather than if and when something goes awry. On the subject of astigmatism, he has used new designs that can cope with corneal astigmatism up to about 1.50D (ideally with the spherical component 2x or more the cylindrical one). For corneal astigmatism greater than 1.00D cylinder, consideration should be given to using a toric OK lens. An assessment of the extent of the astigmatism was also advised, i.e. is it central only or does it extend near or to the limbus? An alternative method of deciding on a toric lens is to compare vertical and horizontal meridian elevations in the elevations map of a topographer. Differences greater than 40 microns suggest a toric lens, in his opinion. He also warned about the deleterious effect a large pupil has on night vision (the noncontributory optics from the reverse curve zone entering the visual field decrease vision quality). As a user of the Australian-made Medmont instrument, MrKoszek recommended the use of its Composite feature provided the component measurements are of suitable quality. A complication, he also noted in passing, was the disparate data requirements required by each supplying lens laboratory, perhaps another reason for sticking with a few designs and becoming very familiar with the products selected. To reduce the possibility of air bubbles being trapped under the lens following lens insertion he advised filling the concavity of the lens with saline beforehand. After describing an ideal fit he then moved to the delivery and after-care aspects of the OK process. He advised that a booklet with written and illustrated instructions be given to the patient and special emphasis given to the prohibition of using tap water at any stage of the lens care process (initial hand washing in running potable tap water before hand drying is acceptable).

He raised the issue of lens adherence which is not the sole preserve of OK lenses, virtually all rigid lens wearers experience such episodes at some stage, and generally he advised against taking OK lenses to school camps, on camping expeditions, etc. because of the difficulties with compliance under such makeshift circumstances. Then he then moved on to problem solving and dealt systematically with islands (lens too steep), smiley face (lens too flat), frowney face (lens also too steep), lens decentration (lens too flat, too steep, too small), ring jam (local corneal topographical irregularities), and corneal staining (sign of an unhealthy eye). Mr Koszek expects at least 2 years from a pair of OK lenses and he regards anything beyond that as a bonus. Lens warpage (lens and corneal shapes are quite different leading to lens distortion) is often the lens-life limiter. However, before changing a lens (unless the cause is unambiguous) his advice was to delay a change until a fit assessment on 2 or 3 different occasions suggest the same alteration be made. He also cautioned that bound protein on a lens can falsify the apparent fit of a lens (more traction between lens and lid giving erroneous [exaggerated] amounts of oneye lens movement). His parting advice to those just starting out in OK was to tackle simple, relatively low refractive errors first until some experience was gained. The night was wrapped up by a brief address from the night’s sponsor, Innovative Contacts (Adelaide) given by its managing director, Mr Kendrew Smith, who detailed the range of lenses (OK, scleral, conventional) and services available, including hands-on workshops and contact lenses whose quadrants can be ordered individually to create an asymmetric lens for abnormal corneas. He also detailed the company’s Eyespace software and its on-line services. ■

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RESEARCH & TEACHING

Save Sight Institute’s Glaucoma

Geoff Pollard

he Save Sight Institute (SSI), the ophthalmic research and teaching centre for the University of Sydney, held a glaucoma information morning for the general community in the Claffy Lecture Theatre within Sydney Hospital on 11 April. A near capacity audience was informed and entertained by the line-up of speakers. At the end of the formal presentations a questions and answer session was held and all presenters and organization representatives were available. Such was the interest that they were almost overwhelmed by the response from the intensely interested audience, many of whom were glaucoma sufferers, and that session lasted the best part of an hour after which some presenters were approached one-on-one thereby extending the session even further. Small displays by Glaucoma Australia and Guide Dogs NSW/ ACT (who also announced a new website: www.visionloss.com.au at the gathering) rounded out the resources made available.

An overview of glaucoma Ms Renee O’Kane, SSI’s communications manager, introduced

AUGUST 2014

Ivan Goldberg

John Grigg

Renee O’Kane

Assoc Prof Ivan Goldberg, president of the Australia and New Zealand Glaucoma Interest Group as well as being president of Glaucoma Australia. He described glaucoma as being a problem related to pressure within the eye (although it can also be normal) and fluid [aqueous] circulation, the fluid being a blood derivative responsible for the carriage of oxygen and other necessary nutrients. Data analysis shows that about a third of glaucoma patients have an intraocular pressure (IOP) within normal limits (see later) and about two-thirds have IOPs greater than normal. Regardless, lowering the IOP in all cases was described as being beneficial.

difference between eyes will draw attention. In advanced cases, globe stretching and, ultimately, rupture can occur. Treatment is almost invariably a surgical alteration of the drainage angle, especially if the anterior angle has not formed fully. Angle-closure glaucoma (ACG), which is more common in Chinese and least common in Africans (and therefore so-called African-Americans), usually occurs in older individuals and is more common in females possibly because their eyes are smaller leading to a narrower anterior angle. ACG symptoms include sudden pain, headaches, nausea, vomiting, ocular redness, blurred vision, and haloes around light sources caused by the resultant corneal oedema. Despite the reputation surrounding ACG, Prof Goldberg does not see it as a crisis, rather it is a condition that can become an emergency and generally should be investigated/ treated within 24 hours. If a ballooning iris (iris bombé) is found, a laser peripheral iridotomy (PI, current thinking is to locate a PI in the horizontal meridian rather than the more traditional location under the upper lid) is performed.

The situation surrounding primary open-angle glaucoma (OAG or POAG) is more complex and our understanding of it is still probably a work in progress. In POAG the angle is open but the pressure still rises due to other factors such as reduced drainage from the eye. Lifestyle factors were mentioned as having some involvement and factors mentioned included the wearing of tight-fitting swimming goggles, excessive water ingestion (increased production of aqueous), and the extensive and forceful use of wind instruments, and sleeping positions that entail an eye ‘buried’ in a pillow applying pressure to the globe via the closed lids. To counter the effects, lowering IOP was seen as a way to increase the margin of safety, blood pressure should be normalized (neither too high nor too low) and blood cholesterol should also be normalized. Research into products that might offer neuroprotection or encourage neuroregeneration is in progress. Prof Goldberg thought that the promise of stem cell therapy for retinal regeneration was at ‘long odds’. Because pressure is not the whole story and normal tension glaucoma is relatively common, the rate of ongoing damage is usually

Types of glaucoma The primary glaucomas were given as childhood, angle-closure, and open-angle while the secondary variety can be the result of trauma, use of steroids, cataract, inflammation, pigment dispersion, and most commonly of all, pseudoexfoliative (PXF) glaucoma which has a strong genetic association. Childhood glaucoma is characterised by big, beautiful, watery, photophobic eyes and the disease is more likely to be detected if it is unilateral as the

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RESEARCH & TEACHING

Community Information Session slowed by a lowering of IOP to subnormal levels. He gave the statistical normal rate of retinal cell loss as one cell every 90 minutes but that figure can rise to every 9 minutes in glaucoma. Lost cells are irreplaceable with our current knowledge. While admitting that glaucoma is incurable currently, all therapy is aimed at stopping the ongoing destructive process. Retinal nerve fibre destruction at the optic disc is responsible for the characteristic thinning of the disc rim and disc cupping. Drance haemorrhages at the disc margin are also a tell-tale sign of a disc abnormality secondary to the glaucoma disease process especially nerve fibre loss. Visual field determination was described as assessing the ‘island of vision’ who’s peak (central vision) is attributable to the fovea. Glaucoma therapy requires an appraisal of the risks (side-effects) and benefits involved. Medical therapy was the most common and lowering the IOP either by increasing the outflow or decreasing the inflow (aqueous production) is the goal. The art of minimizing the treatment (frequency of drops, type of drops) needed to be practised. Selective laser trabeculoplasty (SLT) is a form of surgical intervention but a surgical trabeculectomy (surgery on the drainage system of the anterior eye) is a more common approach. Drainage devices that bypass the anterior drainage system are already in use and their latest incarnations constitute an evolving field using minimally-invasive glaucoma surgery (MIGS) and very small drainage devices.

Compliance Compliance issues are an evergreen problem in medical and paramedical circles. About 73% of glaucoma patients are noncompliant in some way and few instil their medication correctly, i.e. block the tear ducts by the application of finger pressure to the corner of the eye after initial

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instillation to reduce (by about two-thirds) the systemic absorption of the active ingredients. However, given that more serious life and death matters like AIDS only have a 66% compliance rate, it seems highly unlikely that compliance in non-acute diseases like glaucoma (ACG cases aside) is likely to improve significantly. Prof Goldberg introduced the term dyscompliance, non-compliance due to real issues such as complexity of steps. the number of steps, and compounding issues such as arthritis making correct instillation less likely. Overall, only about 45% of glaucoma patients applied their medications well, some 15% held the dropper bottle too high and about 5% were head-rollers, i.e. the drops were applied the skin adjacent to the eye and then the head ‘rolled’ until the drops drained over the skin and then into the eye (what they collect along the way would be an interesting research project). Some 15% of patients could not squeeze the bottle adequately because of inappropriate physical properties of the drug container suggesting a serious lack investigation of obvious issues by the manufacturers and/or their package suppliers. Worryingly, some 25% of patients had no success instilling their drops and half of those are unaware of their failure meaning medication was attempted but not achieved. An impregnated polymer ring device as an alternative was mentioned as something that might be brought to market eventually although Prof Goldberg did mention that in his eye, the discomfort of a prototype took some time to recede. Changing hats to that of Glaucoma Australia (GA) president he described that organization as an advocacy group offering advice to patients that was complementary to that given by their practitioner. He saw GA as a bridge between patient and practitioner.

A glaucoma research update Assoc Prof John Grigg, Head, Discipline of Ophthalmology, USyd gave an update on the research into glaucoma at the SSI titled See the Future. His subspecialty is glaucoma but ostensibly he is a cataract and paediatric ophthalmologist. He is also the chair of RANZCO’s scientific committee for paediatric eye disease and genetics. In his overview he divided the whole glaucoma scene into: basic or laboratory research and clinical research into the aetiology of glaucoma, early diagnosis, and treatment (medical, laser, surgical).

Genetics A genetic basis to glaucoma can be related to the iris, crystalline lens, or cornea (think: ACG) and anatomical factors can give clues to the mechanism(s) of glaucoma. Just because a particular patient is the first in their family line to get glaucoma does not mean that their disease is not genetic in origin. Confounding attempts to pinpoint a genetic origin is the fact that multiple genes can cause similar eye conditions and glaucoma is no exception. Factors that may be involved include: signalling molecules, transcription factors, structural proteins, and enzyme metabolism. The human genome has about 3 billion base pairs (building blocks of double-helixed DNA – the bases are adenine which always pairs with thymine and guanine that always pairs with cytosine) of which about 1.5% (45 million) are exons (an exon is a nucleotide sequence encoded by a gene that remains as part of a mature RNA product) of protein coding genes. The remainder are non-coding RNAs, regulator sequences, introns (an intron involves removal of a nucleotide sequence from a gene by gene splicing, the remaining material once spliced together becomes an exon), or repeats of exons.

Early detection Multifocal visually-evoked potentials (MVEP) is one technique used to detect early changes objectively that was the subject of an 5-year NH&MRC study. The study concluded that MVEP did correlate with other methods and clinical techniques. Early detection remains a goal of much research and various techniques have been deployed to investigate glaucoma onset. The key benefit sought is to prevent glaucoma-induced losses in the visual system before they are established and irreversible damage is done.

Collaboration Prof Grigg sees glaucoma care as a health care team issue requiring collaboration between ophthalmology, optometry, and other stake holders such as Glaucoma Australia. The magnitude of the need for care can be gauged from his figures that show about 1% of 50 year old Australians have glaucoma, a figure that rises to about 10% by 80 years of age. Issues that warrant consideration include who and how glaucoma screening is to be done, the initiation (a clinical decision) of glaucoma therapy, and the monitoring of the disease’s progression.

Other issues Although a common problem, ocular surface disease in glaucoma including dry eye and dryness symptoms is not a common conference topic. If for no other reason, ocular surface issues are important to patients’ well-being and comfort and very important to quality-of-life overall. Prof Grigg recommended strongly the use of preservative-free glaucoma medications as a way of reducing irritation and redness but he was unconvinced about the effects of such drops on compliance levels. On the efficacy of a trabeculectomy he noted that wound healing is a major determinant of surgical success, a factor that can be related to the patient’s age which in

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RESEARCH & TEACHING

Save Sight Institute’s Glaucoma Community Information Session glaucoma tends to be older. Poor wound healing and/or scar tissue formation can defeat the effect of the surgery leading to an unsuccessful outcome.

Glaucoma Australia GA, which started as a not-for-profit organization in 1988, was detailed by Mr Geoff Pollard its national executive officer. Among its main aims are the minimization of glaucoma-induced sight disability and the support of those with glaucoma and their families regardless of whether it is a recent diagnosis or a well established one. GA also funds glaucoma-related activities of the Ophthalmic Research Institute Australia (ORIA) and plays an advocacy rôle on behalf of those affected.. GA’s community messages encompass the idea that glaucoma is an invisible disease and it is now using the BIG campaign – Beat Invisible Glaucoma. GA also fosters drop instillation technique training both face-to-face and over the phone. They also foster the use of special drop applicators to make the instillation process more successful. . According to Mr Pollard about 50% of Australian glaucoma patients have stopped using their eye drops just 12 months after their commencement.

Q&A Session From the fast-and-furious question-andanswer session that followed the formal programme, it was learned that: Unilateral glaucoma was more likely to be asymptomatic. PXF can be unilateral for a long time. The interval between routine eye examinations (no glaucoma involved) can be 2-3 years unless family history suggests otherwise, in which case more frequent examinations are prudent. If a first-degree family member has glaucoma then the other family members have a 23% lifetime risk of also getting the disease, i.e. approximately a one in four chance. Dry eye associated with glaucoma affects women more than men. Dry eye is more likely in glaucoma patients taking medications for their disease but it is unclear if the medication is the cause of the dryness or whether the dryness is secondary to the disease itself. Neither tea nor coffee have much effect on IOP (about 1 mm elevation) but there is now some suggestion that caffeine (in coffee, not tea, or so-called energy drinks) may have some neuroprotective effects. The caffeine in tea is not available biologically. Tight-fitting ties are not recommended. Cataract surgery does not cure glaucoma but it can help, especially in ACG. There may be some slight benefit in POAG. Cataract surgery some time after a trabeculectomy can cause inflammation that can cause further trouble. Glaucoma patients should keep themselves well hydrated. Alcohol consumption can reduce IOP. Wine containing resveratrol may be the more desirable form of alcoholic drink.

The lifting of excessive weights in the gym should be avoided. Peripheral iridotomies can become less effect with increasing age due to increasing crystalline lens thickness. In such cases further PIs or cataract surgery may be pursued as an answer. Head-down (upside-down) yoga postures can increase IOP significantly and are not recommended. Although the same glaucoma treatment may have been effective for a long time there is no guarantee that it will always remain so – the medication can become less effective, there may be some adaptation to the medication rendering it less effective, or the disease may progress. Photophobia may be related to glaucoma, cataract, or both. Average IOP is 16 mm. Two standard deviations gives a high-side reading of 21 mm and figures above that should be viewed with suspicion. The presenters were agreed on the fact that screening for glaucoma using just IOP was unsafe, it is a neuropathy not simply ocular hypertension. No special dietary advice was given, rather follow dietary advice related to a healthy heart, brain, and body. While fatty meats should be avoided generally, some fat is still required. Salads, vegetables, and fruits should become the food focus supplemented by light meats. Flying is not dangerous to the glaucoma patient. Except for overly tight-fitting goggles, SCUBA diving is not a danger. Dryness and ocular surface disease/dry eye symptoms when flying are simply the result of the very low (often <10% RH) relative humidity of the aircraft’s cabin. The SSI would have been well pleased with the attendance, intensity of interest, and the popularity of the Q&A session that wrapped-up the event. ■

Homeopathy is quackery: NHMRC finding

omeopathy has been shown up as quackery by Australia’s peak medical research body, putting pressure on pharmacists to stop stocking homeopathic products.  After three years of research costing at least $140,000, the National Health and Medical Research Council has issued a draft

AUGUST 2014

position statement on that concludes there is no reliable evidence that homeopathy is effective for treating health conditions.  The NHMRC scrutinised 57 systematic reviews of homeopathy from across the globe, where the treatment was studied for 61 health conditions, including diarrhoea in children and even heroin addiction.  ■

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EDUCATION

First online anatomy laboratory uses virtual patients and clinics C entral Queensland University is the first to adopt the Smart Sparrow commercial, adaptive (to the individual student), eLearning platform (www.smartsparrow.com), an on-line technology first created by a research group (Intelligent Tutoring Systems and Educational Data Mining) at the School of Physics, University of New South Wales in Sydney. CQU’s first application for the platform is on-line study of the human body using online virtual patients, clinics, dissecting rooms, and diagnostic tools. While it is counter-intuitive that anatomy in particular could lend itself to on-line study, it needs to be recognised that doing so ‘in the flesh’ is not as straight forward as one might think either, e.g. preserved material has a largely undifferentiated, almost monochromatic aspect to it making differentiation of anatomical features and functions difficult. Graphical presentation of anatomical material can be based on real dissections (e.g. high-resolution, serial sectioning of a cadaver with post-production intelligent colouring, computerised removal of distractions to show on-demand just the nerves for example or the arterial and/or venous blood systems, etc) and can be more useful to all except those who might be charged with actually operating on a real surgical case. Even they would benefit from the rendered form as it would help their visualisation of the in vivo reality while still in training.

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Dror Ben-Naim CQU will use the platform to create, deliver and assess a series of new on-line learning modules in the course Human Body Systems. That component is an integral part of Medical Science, Exercise Science, Paramedic Science, Chiropractic, and Sonography and Imaging courses offered by the School of Medical and Applied Sciences. About 70 per cent of CQU’s students doing those courses do so via distance learning. The SMAS is replacing a number of its existing ‘wet labs’ with the new on-line technology to provide an interactive and immersive experience. Students using the technology as a self-paced learning experience have demonstrated consistently-improved outcomes, it is claimed. Professor Fiona Coulson, dean of the School of Medical and Applied Sciences said: “Smart Sparrow works for us in two ways – to replace the lab, which relieves

our distance learners of the great burden of having to come to campus, and also to provide a pedagogical advantage as it enables students to self-pace, repeat activities, and apply complex ideas and concepts in engaging ways”. However, anatomy of the human body is not the only aspect offered by the technology: “Smart Sparrow offers several advantages over a face-to-face class. For example, we can give students the opportunity to explore complex concepts in human reproductive systems, like changing levels of hormones, and to understand those ideas in a hands-on way that we wouldn’t be able to do in a wet lab”. Feedback from both staff and students has been very favourable and the university is exploring other opportunities to use the technology. “Virtual laboratories are one example where the on-line learning

experience can exceed the off-line. They enable more opportunities to ‘learn by doing’, especially in the case of distance learners,” Smart Sparrow CEO and founder, Dr Dror Ben-Naim who led the original UNSW research group, said. In 2005 Dr Ben-Naim was charged with building virtual laboratories for the School of Physics, a pursuit that morphed into a PhD and, with assistance from other graduate students, the eLearning platform that became Smart Sparrow (2011). The company has attracted venture capital from a company in the United Kingdom and from an Australian company as well as from the commercial arms of the University of Queensland and the University of Melbourne. From the company’s website: “There is so much more that software can do for teaching than all those multiple-choice quizzes – it’s not even funny”. While no specific mention was made of ophthalmic applications, the use for the latter offers almost unlimited possibilities, e.g. anatomy, physiology (normal and abnormal), pathology, optics, clinical procedures including refraction, binocular vision, and therapeutics. Presumably universities welcome such advances because, ultimately, the costs are probably lower and their real-estate requirements smaller. Given the proposed upheaval in tertiary education funding and fees, a competitive advantage may be gained by early adopters to hold their fees while offering a superior educational experience using the latest technology. ■

AUGUST 2014

DUBAI MEETING

The opportunities of disruptive technology for eye-care practitioners T he Essilor AMERA convention held in Dubai on 12-14 May featured a selection of international speakers to help eyecare practitioner navigate through change. Mike Walsh delivered a keynote presentation on how technology is changing human behaviour patterns and affecting business. He outlined how eyecare practitioners not only keep up with change but how to face the real opportunities. Mr Walsh opened his keynote presentation with the notion that technological innovation is changing how consumers live, communicate, entertain and inform themselves. In fact, there is a new global generation growing up today that has never known a world without smartphones and high-speed digital connections. Therefore the challenge for eyecare practitioners is to rethink the way they do business with the next generation of customers and staff.

The next generation The next generation of customers will have a radically-different approach to shopping and purchase decisions empowered by mobile devices and shaped by a childhood of disruptive technology. In 2007, Steve Jobs introduced the iPhone and as a result the next generation does not think of their smartphones as phones. Instead

they are devices that are windows to the world, provide for all communications and entertainment. However, technology is of course already impacting how customers and patients are making purchase decisions today. Consumers read online reviews, read emails from retailers, explore You Tube clips, and engage in social media. The Holy Grail in business is closing the loop between the online and offline world. Traditionally marketers thought of each of these channels in isolation and may have had different people managing each of these channels. But for 21st century marketers, they realise that all of these consumer activities are part of the same channel. As such, marketers now design an engagement strategy that works across all possible interaction channels.

Innovation Innovation not only refers to the way businesses interact with consumers, nor to the technology itself, but more importantly being able to see the world through customers’ eyes. Mr Walsh believes that successful businesses do not think only about technology, they also think about anthropology. They observe what their customers do and allow the customers to lead the journey. Innovation can come from simply asking yourself

what is one of the most frustrating things customers do today that could actually be turned into a new opportunity.

Data driven With technology affecting consumer behaviour, business decisions can now be more data driven than ever. In fact, the world’s most valuable asset in the near future will be data. Smart companies use data to re-invent customer experiences, automate engagement and achieve better business results. Mr Walsh stressed that eyecare professionals shouldn’t evolve their business in one big change. Instead it should be lots of small changes, monitoring what has the greatest effect. For example, if eyecare practitioners send an eNewsletter to patients, experiment with different subject headings and monitor which one works best to maximise the results for future eNewsletters. Data can also be gathered from eye-care practitioners’ websites and social media pages. Data should be regularly monitored and shared with the team. Mr Walsh recommends practice staff whiteboard all practice data which can come from reports, where leads come from, what social networks are used and what content is clicked on. He then challenged eye-care practitioners to think like

anthropologists looking for clues in practice data that could indicate future growth opportunities.

Platforms

The digital revolution has not only changed how consumers make purchase decisions and how eye-care practitioners engage with patients, it also means businesses need to re-think business design and the platforms that enable it. Mr Walsh challenged the audience to consider how changing their back-office operations may change the way they interact with customers on the shop floor. Eye-care practitioners should think about what part of their business can be automated – such as accounting, transactions and supply chain – so that more time can be spent on customers. Mr Walsh concluded his keynote presentation reminding eye-care practitioners that the shifts resulting from disruptive technology are not in the distant future, but are happening right now. He challenged all eye-care practitioners to not just keep up with change, but be proactive agents of change themselves. ■ Mike Walsh is CEO of Research Lab and a global keynote speaker on future trends, innovation and how to build companies for the 21st century. Mr Walsh’s clients include BBC Worldwide, Bentley Motors, Philips, HSBC and LinkedIn.

A sit down with Eric Bernard

t Essilor’s AMERA region convention in Dubai in May, Essilor’s AMERA chief operating officer, Mr Eric Bernard, sat down with Insight to exclusively discuss the Australian marketplace. Having been Essilor chief executive officer in Australia from 2000 to 2005 during his twenty year tenure at Essilor, Eric Bernard has a unique view of the global, regional and Australian market.

“There have been dramatic changes in the Australian retail landscape since I left Australia, but I believe there is still plenty of opportunity for growth. I often hear the Australian market is regarded as soft and not going as well as it used to. I tell those people to wake up. There are still multiple opportunities driven by consumer needs that are real and genuine,” Mr Bernard said. As an industry, Mr Bernard does not think retailers and

manufacturers are truly competing against each other. Instead, he believes they are collectively competing for consumers’ minds and wallets against non-optical competitors. “We are not competing against each other. We are competing against non-competitors. Consumers often wonder why they should spend so much on eyewear when they also want to spend money on other items such as clothing and shoes. The

Eric Bernard Continued on page 37

AUGUST 2014

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DUBAI MEETING

Duplicating Disney success in-store T

he Essilor AMERA convention held in Dubai on 12-14 May featured a selection of international speakers to help eye-care practitioners navigate through change. Doug Lipp delivered a keynote presentation on duplicating Disney customer service magic as a key strategy for business success. As former head of Disney University’s training department and being on the start-up team of Tokyo Disneyland, Mr Lipp took delegates on an entertaining and informative behind-the-scenes tour of the Walt Disney Company, sharing both its successes and how it overcame challenges. During the presentation Mr Lipp shared the operating philosophies of creating a world-class customer service environment that could be adopted by eye-care practitioners. Despite the perceived magic of Disney’s success, Mr Lipp said there is no real magic to it. Instead it is simply doing the ordinary extraordinarily well. He believes Disney never had the best rides nor was it the cheapest theme park, but Disney ‘magic’ was engaged customers as a result of excellence in customer service. This was best captured when he stated: “Snow White never has a bad day.” That is, how customers are treated and engaged in every interaction must be consistent and

of a high standard. Staff should never have a bad day, no matter what. Additionally, Disney management led by example: staff are viewed as Disney’s most important customers. As a result, Disney staff are treated in a way that Disney wants staff to treat customers. Staff are also empowered to make decisions and encouraged to take risks and innovate. Despite obvious success, Disney almost folded twice in twenty years. The first time was when Walt Disney died in 1966 and the second time was in 1983. Mr Lipp shared four of the obstacles the company faced during those times. The first obstacle was letting the old ways rule and not evolving. Typically the response to change was asking what Walt Disney would say about a particular change and often the answer was: “Walt wouldn’t like it.” There was also a constant yearning for the ‘good ole days’. The second obstacle was pride that had evolved into arrogance. In Mr Lipp’s words: “We thought we were so good.” That then promoted complacency and a ‘one-trick pony’ mentality. Typical thinking was the belief there is only one way of doing business, that one way being what has been successful in the past. Obstacle three was blaming others for challenges and adopting

a victim mentality. Commonly competition is blamed for challenging circumstances. The last obstacle was forgetting about the customers, which is a major flaw when selling a commodity product. Mr Lipp likened this to the optical industry whereby he believes few have a large technological advantage over competitors, which means customer focus is of the greatest importance. Disney forgot about customers by being inwardly focused instead of focusing outwardly to customer experience. To overcome obstacles, Mr Lipp says there is no excuse not to regularly recognise and minimise obstacles. He suggests practices focus on one obstacle a week to be addressed in staff meetings. Team balance was also explored during the presentation with Mr Lipp sharing his belief there are two different types of people – dreamers and doers – with the most-effective teams being made up of both. ‘Dreamers’, such as Walt Disney, are visionary, they are risk takers and creative. ‘Doers’ ask ‘what if’, they know the science and implement. When Walt Disney died, the company lost its only dreamer which contributed to the company’s woes. Walt Disney’s death also reinforced the critical importance of having a succession plan. Additionally, Mr Lipp said the Disney experience highlighted

the need to have people on your team that look at legacy and leveraging that, and people that look to the future to help evolve and break new barriers. A balanced team fosters collaboration and creativity to help create opportunities and overcome obstacles. Mr Lipp challenged delegates to consider their practice culture. That is, what is their practice culture and what are core practice values. Additionally, practice owners and managers must be equally comfortable in the testing room as they are with staff and customers. Delegates were also challenged to ask themselves if staff are aware of practice culture and if they are participating in and living this culture. Mr Lipp concluded that budgets may be tight but creativity, customer-service excellence and flawless execution are free. And that is the Disney magic. ■

Continued from page 36

walk into, even when they are not looking to buy glasses.” Simplicity is also key to industry success. Mr Bernard thinks the optical industry overcomplicates messages to consumers by focusing too much on technology. “I think we spend too much time explaining how the complexity of eyewear. Instead, we should focus on simplified benefits. At Essilor we’re striving to keep messaging simple: we want to provide eye-care professionals with a message that is easy to deliver and easy for patients to understand.”

Mr Bernard believes they are in a service industry, offering a service to eye-care practitioners. “I believe you are only as good as the last job. This principle spans oceans, crosses borders. It is universal. I often liken it to being a chef; if you mess up a meal once, you will lose ten customers. It’s the same for us, it is one job at time.” Hubert Sagnieres, chairman and chief executive officer of Essilor International, addressed the acquisition of Coastal Contacts during his convention presentation.

Mr Sagnieres said there was a risk that Coastal Contacts would be acquired by a company outside of the optical industry. Regarding that, Mr Bernard said: “I know there has been some emotion about changes in Australia. But what if Coastal Contacts had been acquired by a player outside the industry? Imagine if that outside player didn’t care about the eyehealth segment and the notion of protection that we have collectively built and continue to build?” ■

first enemy of our industry is our collective inability to reach out to consumers. Instead we need to collectively ensure consumers understand we are making people’s lives better by providing quality vision and protecting eye health. “I believe optical stores should become a destination, not just somewhere consumers go when they have a problem. Eye-care professionals should ask themselves how they can make their store a place consumers want to

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Doug Lipp was head of Disney University’s training department at Disney’s headquarters and on the start-up team of Tokyo Disneyland. After Disney, Mr Lipp became a sought-after consultant, speaker and trainer teaching Disney’s success secrets to clients including MercedesBenz, Prudential, Cisco, Starbucks, McDonalds and Coca-Cola.

AUGUST 2014

KIDS EYE HEALTH

Seeking the ‘buried treasure’ of

Sophie Falkiner

PSM launched a nationwide initiative to raise awareness of children’s eye health with the aim of improving the vision of children across Australia. It is hoped to achieve that by screening distance vision, colour vision, and depth perception of children ‘surreptitiously’. The target age group is 3 to 10 years. The initiative was launched at a well-attended event at the Australian National Maritime Museum in Sydney’s Darling Harbour on 30 June. Most of the audience were children and their parents and several chests of glittering treasures were around the venue as were some pirate-themed games. The children needed no invitation to get involved.

Penny the Pirate The guest speaker, chief storyteller, and ambassador for the campaign was Australian television personality Ms Sophie Falkiner, a mother of two children (9 and 5) in the target age group. The Trojan Horse of the subterfuge is a children’s book called Penny the Pirate written by Mr Kevin Waldron. The ‘book’ has the screening tests buried inconspicuously within. The actual screening tests are delivered in either of two ways, as a tablet/smartphone application or in printed form. Both are available to interested parents at no charge nation-wide.

AUGUST 2014

The app is downloadable from the Google Play, the App store, or directly from OPSM (www.opsm. com.au/penny) after completing a brief registration process. Because of screen-resolution issues (central to letter size at presentation), versions for Android devices (phones and tablets) and iPads are available but an iPhone version of the test is not. The printed book version is available directly from any of OPSM’s 400 Australian stores.

The science The science behind the tests was provided by the Department of Optometry and Vision Sciences at the University of Melbourne, especially Assoc Prof Darryl Guest, working with optometrists from OPSM. The comprehensive test kit supplied by OPSM is for use with either the electronic or printed version and includes: • An eye patch (naturally, and it is suitably printed with a skull and cross-bones) – for monocular distance vision testing; • A symbol key, a licensed version of Patti Pics acuity symbols (house, apple, square, circle, and star) for demonstration and pointing purposes (the app or book has the test symbols presented at suitable test sizes); • A spy glass (a truncated, cardboard pyramid [a pop-up creation that is delivered flat] into which is fitted the included round, +2 D meniscus, clear

polymer lens – for latent hyperopia detection; • 3D glasses, a pair of cardboard anaglyphic spectacles (with red and green filters) for detection of suppression and determination of the presence of stereopsis; and • A three-page fold-out set of instructions. The Ishihara-like pseudoisochromatic plates are included in the app or book. Naturally, with reduced control over the illumination characteristics (ambient and/or screen), subtle colour vision deficiencies, e.g. anomalous trichromacy, are not targeted by the tests. Given that most deficiencies are genetic in nature there is less urgency to detecting or quantifying subtle defects and many of the more significant defects will often declare themselves in due course. The written instructions include space for recording the responses of multiple children and a unique numerical code that is required when entering the responses on the OPSM/Penny website. The website delivers the results once the responses are entered. If significant problems are identified as a result of the screening, the parents are advised to have their

child/children examined fully by their eye-care practitioner.

The problem OPSM’s research has revealed that Australian parents place a relatively low priority on the vision of their children when compared with other health matters such as dental care and immunisation that are seen as more pressing apparently. Their figures suggest that about 36% of children in the target group have not had their eyes examined within the previous 2 years and about 21% have never had their eyes examined at all. The ‘Penny the Pirate’ campaign is an attempt to address those issues, especially in rural and remote areas. According to Mr Grant Fisher, OPSM’s director of eye care: “This year alone, the book is on track to help parents book half a million eye tests, helping an estimated 125,000 children with a previously undiagnosed vision problem”. Other data from OPSM’s research includes: • 17% of children (3-10) have experienced eye problems; • 14% of people know that an eye test is recommended at least every 2 years; • 57% of all Australian children have had an eye test in the past

Penny the Pirate kit www.insightnews.com.au

KIDS EYE HEALTH

good eyesight for kids symptom of eye problems; and • 49% were unaware that consistent underperforming at school can be a symptom of eye problems.

The launch

Giuliana Baggoley 2 years (and 64% of the target group), 77% have had a dental check-up, and 73% have had

Melinda Spencer their feet sized for shoes; • 50% of parents are unaware that disruptive behaviour can be a

The campaign launch was opened by Ms Melinda Spencer, OPSM’s vice-president of marketing, who promptly handed the floor to Ms Giuliana Buggoley, an OPSM optometrist with professional responsibilities in Canberra (mainly) and Sydney. Ms Buggoley provided a clinical introduction and gave some of the technical background to the project and then handed the floor to Ms Falkiner who explained that her own involvement began with the suspected eye problems of the

child of a close friend. The suspicion was confirmed by a full eye examination subsequently. Like Ms Falkiner, one of her own children is also a spectacle wearer. She reinforced the take-home message of eye examinations being recommended every 2 years. In true TV presenter style she then proceeded to read the Penny the Pirate book to the attentive young audience. Judging by the reception of the programme by all those in attendance, success of the campaign seems all but assured. Given the sound foundations of the screening tests there is every reason to believe that the campaign will be effective and that can only be a good thing. ■

AU 1800 637 654

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AUGUST 2014

DIARY DATES

Diary Dates 2014

10th International Symposium of Ophthalmology Location: Hong Kong Contact: Email: venuscheung@ iso-hk.org Website: http://apgc-isohk-2014.org/

17 - 19

The 11th Congress of Orthokeratology Society of Oceania Location: Sheraton Mirage Resort, Gold Coast QLD Contact: www.osa.net.au

16-17

26-28

18-21

Western Australia Vision Education (WAVE) Location: Pan Pacific, Perth Contact: Ph +61 08 9321 2300 Email: admin@optometrywa.org.au

Asia Pacific society of Ophthlamic Plactic & Reconstructive Surgery AND Silver Jubilee Meeting Oculoplastics Assoc. of India Location: India Habitat Centre New Delhi, India Contact: Website: http://www.apsoprs2014delhi.com E: conference@apsoprs2014delhi.com

AAO Annual Meeting 2014 Location: McCormick Place Chicago, Illinois, United States Web site: www.aao.org

MCLOSA (British Ocular Surface Society) – 21st Annual Scientific Meeting Location: London Contact: MCLOSA Secretary, Ms. Kate Martin Ph:+44-0-121-507-6849 Fax: +44-0-121-507-6853 Email: secretary@mclosa.org.uk www.mclosa.org.uk

AUGUST

22-24 Tasmanian Lifestyle Congress Location: Hobart, Tasmania Contact: www.optometrists.asn.au/ tasmania or Email: optometristsasn. tas@bigpond.com

OCTOBER

ESCRS 2014 Location: London, United Kingdom Contact: www.escrs.org Email: escrs@escrs.org Ph: +353-1-209-1100 Fax: +353-1-209-1112

GET YOUR EYES TESTED

17-21

Please email your details to: insightnews@bigpond.com

9TH OCTOBER

2014

www.vision2020australia.org.au /events/world-sight-day

1-4 EVER 2014 Congress Location: Acropolis Convention Ctre Contact: www.ever.be/c_page. php?id=277

112th DOG Congress of Ophthalmology Contact: www.dog-kongress.org

15 International White Cane Day Contact: www.visionaustralia.org

AUGUST 2014

JANUARY Hawaiian Eye 2015 Location Maui, Hawaii, U.S.A. Contact: Meeting Registration at SLACK Incorporated Ph:+1-856-848-1000, ext. 219 or 476; Fax: +1-856-251-0278

18-21

24-30

American Academy of Ophthalmology Annual Meeting Location: Chicago, U.S.A. Contact: AAO Ph:+1-415-561-8500 Fax: +1-415-561-8533 Email: meetings@aao.org www.aao.org

Ski Conferences for Eyecare Professionals Rusutsu Ski Resort,Hokkaido, Japan Contact: www.skiconf.com

22-26

25-27

2nd Asia-Pacific Glaucoma Congress held in conjunction with The

2015 18-23

Location: Dubrovnik, Croatia Contact: www.eclso.eu/

26-28

International Strabismological Association Meeting Location: Kyoto International Conference Center, Kyoto, Japan

Annual Congress of Japan Clinical Ophthalmology, Location: Kobe, Japan Contact: Congress Corporation Ph: +81-3-5216-5318; Fax: +81-3-5216-5552 www.68ringan.jtbcom.co.jp

(European Contact Lens Society of Ophthalmologists)

The 44th ECLSO

1-4

13-16

46th Annual RANZCO Scientific Congress Location: Brisbane Convention and Exhibition Centre Contact: www.ranzco2014.com.au

10-11 25–28

2014 Italian Society of Ophthalmology Annual Meeting Location: Rome, Italy Contact: www.soiweb.com

Academy 2014 Denver Location: Colorado Contact: www.aaopt.org.

13-17

DO YOU HAVE AN EVENT FOR OUR CALENDER?

12-15

SEPTEMBER

Afro-Asian Congress of Ophthalmology Location: Xian, China Contact: AACO2014 Secretariat Email: AACO2014@hotmail.com Website: www.aaco2014china.org

NOVEMBER

DECEMBER

Vision-X Optometry Conference Location: Dubai World Trade Centre Contact: www.vision-x.ae/ optometry-conference

28 February March 2

International Optics, Optometry and Ophthalmology Exhibition Location: Milano, Italy Contact: +39 02 3267 3673 Email: informido@mido.it Website: www.mido.com

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An online web-based programme for eye health professionals. Approved by the Optometry Board of Australia (OBA) for a maximum 28 CPD points with Therapeutic content.

Seven cases each comprising a series of seminars based on clinical case studies, linking academic knowledge with practice. • All cases have been produced by qualified glaucoma specialists. • Participation is available to any eye health professional. CPD points awarded are for optometrists.

Case 1 - Pigment Dispersion Syndrome. This case covers the initial diagnosis, management and long term follow up in a patient with pigment dispersion syndrome. Case 2 -IIn this case we discuss the presentation, appearance and clinical features in a patient with optic nerve hypoplasia.

• The programme consists of 7 cases, each with a case history, questions and answers for self-directed learning, followed by an associated web-based assessment.

Case 3 - We look at a patient who presents with vague visual field loss, and discuss the diagnosis and follow up in patients with primary open angle glaucoma.

• The assessment associated with each case is made up of multiple choice and true/false questions.

Case 4 - We discuss a patient presenting with unusually high intraocular pressure, as well as the diagnosis, management and features of Posner Schlossman syndrome.

• Two attempts are available to achieve the 70% pass required by the OBA. • Each successfully passed course attracts 4 CPD points as approved by the OBA. • Successfully passing all 7 courses awards the maximum 28 CPD points. • The annual cost for the programme is $150 i.e. for up to 7 cases. • CPD points are only allocated to each case(s) completed prior to 30th November 2014.

Case 5 – Patients often present with vague symptoms. This case looks at a patient with unusual symptoms who is found to have glaucoma. Unfortunately the patient then develops a central retinal vein occlusion. Features and long term management of this condition are discussed. Case 6 – Patients can have multiple things that occur concurrently. We look at a patient with suspected glaucomatous changes, who has an associated intracranial tumour. Features differentiating these two entities are reviewed. Case 7 - Conditions don’t always present as you may expect. We review a case of bilaterally painful red eyes, found to be due to bilateral acute angle closure. Features of this condition are reviewed.

www.glaucomaeducation.com

SELLING

50 Shades of Reps Point/counterpoint: Two sides to every story By Karen Michaelson and Tim Slapnicher*

ep after rep, meeting after meeting, I was seeing a pattern of what reps do. They come in, schmooze with me, tell me how great we are, and how much money I will make selling their amazing product. They may promise me exclusivity if I do enough business or tell me how our business will suffer if I don’t carry their product. They may offer some sort of rewards if we sell their stuff or maybe a 20 percent discount if I act today. If I don’t, they will have to go to my competitor down the street because they need some presence in our market. They’d like to have it be with me, but they have to make a living too, you know. They make sure to let me know how their competition is struggling and lost another frame line or how the competition’s product is just not holding up like it used to. They promise me training and coming in regularly, and being available any time there’s a question or problem. I like what I hear. I go for it. I get a great discount, buy a bunch of product and wait for it to turn my business into a profit machine because I’m the only place around that has this product. Reality sets in. The frames don’t look as sexy when they arrive in plastic bags eight days later. I also see some interesting styles I don’t recall purchasing. Could they have padded (four frames too many) our order? The provided counter card doesn’t seem all that inspiring. I’m left to make them look spectacular in our display case. We wait. I figure we’ll sell these like hotcakes right them. We are now THE hot spot. Tick-tock…

AUGUST 2014

Waiting. Any day now. After a week or so, I contact our rep to let her (or is it him?) know it’s not going well. She returns my email three days later and tells me I flipped the wrong product, and our optical team just doesn’t know how to sell her special frames. We are not seeing eye-to-eye. I ask for her to come in to do brand training. Her calendar is booked for a few months. I tell her that I found all of these frames online for an average of $75 less than what we’re selling it for. She dances around the issue and tells me that hardly anyone actually buys frames online, and her company can’t control it anyway. Ugh. How did I get myself in this mess? Foiled again! Typical rep. Months later, I find this exclusive frame line in an optical shop down the road. It’s explained to me that we are not getting a healthy turn on these frames, and she’s losing money because we can’t sell the product. She has to make money too. She did, however, bring in a new line that she will definitely keep out of any stores near us. Are you kidding me? I take her exclusive line and discount it at our store and tell her we’ve decided on a new direction. I meet with a new rep with a new line the following week. He tells me how special we are and how his frame line fits our brand and will make us a ton of money. He will give us a 15-kilometre exclusive and a 15 percent discount if we bring in the 24-piece minimum order. I hate him already. Now I feel paralyzed with what direction to go next. I don’t trust any reps anymore. They are hurting their colleagues. When one rep drops the ball, they all do. Help me like you.

‘Not so fast,’ says the rep: I arrive at the clinic a few minutes before my scheduled appointment. Apparently, I’m a surprise because no one knows why I’m here. I somehow need to make them understand they need to value my time as I do theirs. I wait for about 20 minutes before an available dispenser finally brings me into the lunchroom. There are plenty of patients in today so our first meeting feels a bit choppy. We get started on my frame trays, then she gets pulled away to dispense. Then she gets a phone call. Then she comes back frustrated… today’s not the best day. Well, that’s good to know, as I scheduled this over three weeks ago. Hmmm, how do I help them schedule their time more efficiently? I have great ideas but until I earn some respect, it will seem self-serving.

We finally get a break. She leads me to an empty (and quiet) exam room to go over things. I tell her a bit about my frame lines in our dimly lit space. She then spends the next 45 minutes trying every… single… one… on. Yes, they do look amazing on you. She complains that some are just not her style. OK, so now we’re stocking inventory that looks good on one person? At this point, I would love to take her to the frameboards to see what might be missing from styles, colours and materials as well as talk about their patient base. However, today she doesn’t have time. I want my product to shine! My first visit has turned into a marathon event. Every available staff member tries on every frame. Cute! Oh, fun! I want a pair! I do

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SELLING

how efficient I am as well as the sell-through on the product. This is a partnership. The dispenser flips 45 frames. Nice. These frames all look good on her and are starting to resemble the rest of the inventory here… I see a pattern. I’m excited to get a big sale, but have a funny feeling I’ll be exchanging most of them. There is no accountability here. I will close this call by making an appointment to review the initial sell through on the order and request time looking at inventory to be sure the best product is there for them. The optometrist does not want to be involved. I have a feeling there will be some headaches down the road with this one. Shoot. I’m running way behind with one of my favorite accounts. That was an experience. Kind of reminds me of yesterday. And the day before. I need an organised store that can knock this product out of the ballpark. This story is getting old.

An account on the perfect rep:

my best to continue to smile. I love my job, but it’s been over two hours of complimenting the entire staff. I am concerned I will be late for my next appointment, and I am struggling to stay composed through the fashion show. The skeptical optometrist comes in. He wonders sarcastically what big deal we have going on, and how he “got screwed by a frame rep four years ago… they’re never coming back here again!” He mumbles something else and carries on his way. Ah, the welcome team! Get me outta here! Here is where I gain some ground by introducing myself and creating a relationship with him. I give him my card and let him know if there is ANYTHING he is not satisfied with to contact me. I am determined to be a rep he remembers for

Give me a rep I can trust. I feel like I get the same “speech” with almost all my reps (frame, lens, pharmaceutical etc.). This predictable formula has run its course. I am craving a partnership where I can trust my rep, we have common goals and they can help me be the best optical around. I’ve been burned many times before. Yes, other reps have ruined it for you. They’ve padded my orders, done deals with my dispensers under the table, not followed through, been jerks when I needed help with exchanges, and unreachable when I needed them most. I’ve been played many times, so it is hard for me to trust you. How will you be any different? I’d love it if instead of gift cards and spiffs, you gave us more support through brand training, continuing education credits, tips on selling, sending us to conferences and giving us the tools to differentiate our optical. You’ve seen a thousand opticals—what can we do different? Who is doing something extraordinary? What are the best practices out there? If you invest in our growth, we will be loyal with you. I’m looking for a long-term partner/relationship, not an optical one-night stand.

A rep on the perfect account: I am taking cues from your “flow.” I can’t come in and tell you how to run your business. I’ve had to bite my tongue more than once… this week. I play by your rules even if I know things should be run very differently. The infrastructure should be established so a rep

understands who is responsible for certain decisions. Your dispensers are running the business here. That can work, but it’s not in your case. Your optometrists need to be involved. It is easy for me to work with the frame buyer, but the owner needs to know more about this side of the business. A frame selection team is an approach to be sure that all demographics are covered. Be honest, focused, goal-oriented and strive to create partnerships based on business first. Establish what your needs are. What are your goals? Where are you headed? I have tools and resources that I’d love to share with you. You’re not utilising me. Share your needs and desires, and let me know when something needs attention. If we can establish better communication lines, and we’re all on the same page, there’s no wiggle room for surprises. It works great when there is accountability on both ends. I too crave more trust. I apologise what’s happened to you in the past, but I’ll do my best to exceed your expectations so we can move forward together.

Getting on the same page: Both sides agree: expectations and guidelines need to be established. We need to be on the same page. If we are to become a true partnership, things need to be laid out clearly so there are no surprises. The rep should ask questions of new accounts. This will help organise your account and make them think about their policies and expectations if they seem a bit unorganised.

Make it last These questions (and ones you come up with) will help get you on the same page. They take the guesswork out of it all. If either side is not holding up their side of the agreement, then it’s easy to go back to these expectations. It takes two to tango. Be honest, trustworthy and hold your end of the bargain. Support this partnership and develop a long-lasting partnership. ■

‘50 Shades of Rep. Point/counterpoint: Two sides to every story’ was originally published in 20/20, a publication of Jobson Medical Information LLC. *Tim Slapnicher, ABOC, CPO, is currently the practice coordinator at Rivertown Eye Care in Hastings, Minnesota. Karen Michaelson, ABOC, is a certified optician and practice management consultant, staff and professional trainer for private and wholesale practice applications.

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AUGUST 2014

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MANAGEMENT

Practice Dollars – By Karen Crouch*

Succession Planning “A single point of success is also a potential single point of failure”

isk Management is often overlooked or downplayed in health practices. After all, major catastrophes are rare e.g. loss of entire premises. However, an important element of Risk Management that is likely to occur more frequently relates to your most valued resource – staff of various categories, clinical or administrative. The most effective solution is meaningful and effective Succession Planning. In most practices, particularly those with relatively small staff numbers, each person is a ‘specialist’. For example, the Practice Manager has specific knowledge, experience and skills applicable to his/her position. Likewise, clinicians are often single units on which much reliance is placed for patient care. So what happens when one of the key personnel is absent for planned or unplanned reasons

e.g. vacation, extended sickness or even resignation? Of course, there are agency temps and locums who may be called upon but that invariably results in temporary reductions in efficiency and effectiveness, not due to lack of personal ability but simply the requirement to familiarise themselves with clinical or administrative practice protocols including compliance with cultural and behavioural expectations of the owners. Recently, one of my clients had expanded her practice very impressively in a short period of time to the point where she required advice on how to manage the sudden growth. Among other things, she could not even consider a relaxing holiday for 3-4 weeks because some of her vital tasks required daily attention – absence of a trained successor! We commonly assume another staff member will simply absorb the extra workload of an

absent colleague but the aforementioned reduction in efficiency/effectiveness, not to mention increase in stress level, is the invariable result. So, how do you mitigate or at least minimise the impact of these exposures? The following points are useful in developing a meaningful Succession Plan: • ensure each staff member has a comprehensive Position Description listing roles and responsibilities including key deliverables; • identify main tasks that must be performed to ensure proper job performance or at least to avoid errors or omissions, particularly if they relate to patient service; • staff numbers permitting, identify a current staff member who could ‘understudy’ each person (more difficult for clinicians but equally important to try) during a period of absence; • implement an ‘upskilling’ prog-

ram e.g. receptionist periodically performs key tasks undertaken by the Practice Manager. Apart from mitigating impacts of planned or unforeseen absences, staff generally appreciate the opportunity of performing different tasks and, where applicable, acquiring new skills. Job rotation, whenever possible, also results in greater job satisfaction and wider cover for absences. These measures should render a practice more self sufficient and also reduce hiccups when employing agency temps or locums. ■

Karen Crouch is managing director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal and financial management of practices. Contact Karen on 0433 233 478, email kcrouch@hpcnsw.com.au or www.hpcgroup.com.au.

Allergan takeover battle drags on: attempt to sack directors at special meeting

he latest move in the takeover battle for Allergan has now seen an attempt to sack directors of the company at a special meeting called by the wouldbe buyer Valeant Pharmaceuticals for 7 August. In a solicitation statement filed with the United States Securities and Exchange Commission, hedge fund Pershing Square Capital Management, which owns 9.7% or Allergan, wants to call the special meeting of Allergan shareholders to remove current member of the board and request that it promptly engage in good faith discussions with Valeant in regard to the latter’s offer to merge. www.insightnews.com.au

In response, Allergan is urging shareholders to refrain from any action, including returning any proxy card sent by co-holders Pershing Square and Valeant and waiting until the matter is reviewed by Allergan’s directors and until proxy solicitation materials are provided. The takeover offer has been increased to $US72 per share plus 0,83 shares of Valeant stock per Allergan share. If Pershing Square gets its way, a special meeting could be held on 7 August. In the midst of the hostile bid for Allergan, activist investor Mr Bill Ackman said shareholders are

willing to hand over the company for $180 per share, just about in line with the latest offer from Valeant and Mr Ackman’s Pershing Square. On 16 June, Allergan reiterated its concerns about Valeant’s “unsustainable” business model, that time invoking analysts, media and the like to underscore its point. Valeant CEO Michael Pearson’s operation is a “house of cards”, Morgan Stanley says and it “depends on people continuing to drink this Kool Aid” Gimme Credit analyst Vicki Bryan said. “Something from the Wizard of Oz,” Bronte Capital said. Valeant has already faced criticism from Allergan about its “significant

management turnover”, and now the Botox-maker has more ammunition. EVP and company group chairman Ryan Weldon is on his way out, Valeant confirmed Friday; the company says Weldon’s departure was planned and will take effect after Valeant closes the $1.4 billion sale of several injectable treatments to Nestlé. Valeant isn’t about to let Allergan get the last word on its latest $53 billion offer and refutes “recent misleading assertions” made by Allergan and others, as well as answer questions investors may have about its play for the specialty pharma. Continued on page 48 AUGUST 2014

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ACO’s Visiting Business Briefs Optometrists Scheme extended in Vic and SA T Essilor’s ‘robust’ 1Q, but net debt almost quintupled

USPTO also ruled that 15 additional claims submitted by Zeiss were patentable. The request for a re-examination of Essilor International has reported a “robust” the ‘713 patent was filed by Ocuco Inc on October 2013. The Patent rejected first quarter ended 31 March, withThe revenue The ACO Office provides care new 4 sites are: he Australian College Ocuco’s challenges to the validity of the up 8.4% million ($A1,915.0 milof communities experiencAboriginal Health Services of to €1,322.6 Optometry’s ‘713 patent, so doing confirmed its lion),Visiting expansion in fast-growing markets, Morwell ingin disadvantage through at Kerang, and and Optometrists strength. The panel of three patent examtwo successful product and comthe provision of comprein Victoria and at Mt Scheme contract with launches the Bendigo iners found allhensive of Zeiss’public arguments distinpletion health of two major acquisitions. health eye Gambier and the Riverland federal department guishing the prior art to be persuasive. Essilorto International’s net Australia. care. has However, been extended in- region in South Thewere ‘713 patentACO covers certain types of debt more quintupled milstaff also contribAdditional sites clude some than additional sites from €389 back-surface progressive lenses lion ($A564 million) ute as locum optometrists added to2103 increase the focus free-form through to June 2014.as of 31 December and processes by which they are made. to Some €1,878of million ($A2,726 million) as of 31 the new sites on residential aged care cli- in the Brien Holden Vision Those include types of progressive March 2014. program inlenses the and cli- Institute were identified by the de- ents, elderly clients whoseThose front surfaces areTerritory. rotationally symObservers say netwhere debt is likely to grow Northern ents with diabetes. partment as areas with the back-surface progressive to about €2.3were billion ($A3.34 billion) by Boort the metric Further information: sites are: and Birchip more services required design determined by the individual preend of the June 2014 quarter following the for Aboriginal communities. in central Victoria and Dr Genevieve Napper, lead scriptions or in combination with acquisition ofACO Coastal.com the payoptometrist at Aboriginal Minyip, Jeparit, Rainbowalone As a result the applied and options. ment of dividends to Essilor’s (03) 9349 7476 or and Edenhopeother incustomisation the Services for, and was granted addi- shareholders. the Patent Office Essilor bought from PPG the 51% it did gnapper@aco.org.au. ■ Horsham region. “We are pleased tional funding. not own in Transitions (and all of Invercast) has found all of the original ‘713 patent for €1.73 billion ($A2.51 billion) immedi- claims patentable and also granted 15 ately and €125 million ($A181 million) over new claims,” Ms Karen Roberts, Zeiss’ vice president of customer enablement, said. a five-year period. The Paris-based Essilor International “These new claims provide specificity rebought Clearly.com for $C430 million garding the optimisation of lenses for ver($A430.7 million) in a deal completed in tex distance, binocular vision, frame form and frame fit. This increases the protection May. In Australia, Essilor’s business benefited for our business and for the businesses of from “solid gains with independent optom- our many licensees.” On 19 February, the US Patent Office, in etrists, buying groups and optical chains”. Revenue in the Asia/Pacific/Middle a similar move, terminated a re-examinaEast/Africa region rose by 9.1% like-for-like tion of Seiko Epson’s patent 6,019,470 that (of which + 5.0% in developed countries was requested by Ocuco. It confirmed all and + 10.6% in fast-growing markets), lifted of the patent’s 20 original claims, and ruled by the ongoing solid domestic performance that six additional claims submitted by in the region’s main fast-growing markets, Seiko are confirmed and patentable. Seiko as well as by a recovery in export sales and a Epson’s ‘470 patent, issued on 1 February 2000, covers the invention of back-surface rebound in the developed markets. Since buying Clearly.com, Essilor has progressive lenses. In 2012, Zeiss prevailed over rival lens announced it will close or sell the handful of bricks-and-mortar stores that were includ- manufacturer Signet Armorlite in a lengthy ed in the deal, and has defended its pur- lawsuit concerning the ‘713 patent. chase of the mainly on-line retailer as being better to have it in the industry’s hands than The Melbourne Exhibition and Convention Centre Transitions Optical may lay in what it describes as “the wrong hands”.

Focus Conference: Melbourne in May

off 60 in Ireland

he Melbourne Focus distance from a range of of the discounted rate of Transitions $295will for significantly a King Room.reduce Book is being confirms hotels to suit any budget.Optical US Conference Patents Office manufacturing volumes at its manufacturwww.focusheld in the Victoria Focus Conference’s accom- directly through Zeiss’ free-form lens ing plant in Tuam, Ireland, and that the melbourne.com.au capital on 25 May, which pro- modation partner, Hilton cutback may result in approximately 60 repatent; finds 15 newMelbourne claims South Wharf, is vides an opportunity for deldundancies a totalto workforce What do? of 173. egates to explore the delights ideally placed with direct ac-from patentable “We have looked at this way we cess to MCEC. This modern Melbourne is every of that city in mid-Autumn. renowned for can and we have little option,” Mr Kevin The United States Patent and Trademark and stylish hotel in located on fine dining establishments director of theofTransitions Office has a notice in the Where toissued stay? the re-examibanks of theMinton, Yarra River – many which are Optical located plant city in Tuam, nation of Zeiss’ 6,089,713 patent onoffering with rooms or said. within Melbourne’s CBD. Melbourne Exhibition and(‘713) “Manufacturing willyourself be moved June 10, 2014 confirming theviews. patent’s Focus Conference Why volume not treat on Convention Centre (MCEC)thatbay to Asia to look after our clients there, while eight original claims were patentable. The is located within walking delegates can take advantage Continued on page 28 www.insightnews.com.au

INDUSTRY

Business Briefs the remaining manufacturing done here will be for our European customers. The customer support and administration functions will remain here as well.” Employees whose positions are ultimately made redundant will receive “a generous severance package, which will include outplacement services,” Transitions Optical said in a statement. The exact number of redundancies cannot be confirmed until a consultation period has been completed, according to Transitions Optical. It is expected that redundancies will be completed by the end of the year, the company said.

Specsavers appoints new advertising agency Specsavers has appointed Cummins & Partners to handle its creative account following a competitive pitch. Cummins beat four other agencies for the Specsavers’ business, including incumbent McCann Melbourne. McCann worked on the ‘Should’ve gone to Specsavers’ campaign.

3-D virtual try-on app wins awards At the 2014 Cannes Lions Festival in June, the Glasses.com 3-D virtual try-on app won a bronze award for ‘Creative Use of Technology’ and made the shortlist in the ‘User Experience’ category. In addition, the Glasses.com app won a Webby Award for ‘Best Use of Device Camera’ at the 18th Annual Webby Awards presented by the International Academy of Digital Arts and Sciences in New York. The app was also recognized at the Appy Awards at Internet Week New York in May, winning in the ‘Retail’ category and also taking home the highest honor of ‘Best in Show’. The Glasses.com app lets shoppers virtually try on frames,

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using facial mapping to allow users to see a 180-degree view of how the frames will look on their face. Since its release in July 2013, the app has been downloaded over 1.3 million times, according to a statement from the company. “We believe that everyone should have glasses that they truly love,” Glasses.com president, Mr Carlo Privitera, said. “Fuelled by that belief, we embraced the latest in technology and pushed the envelope in creating the Glasses. com app, ultimately empowering our customers to find their perfect pair through a fun and easy shopping experience.” Luxottica Group SpA acquired Glasses.com from WellPoint Inc in January 2014.

European Innovation and Technology Centre inaugurated Essilor International has inaugurated the European Innovation and Technology Center in Créteil, France, the world’s largest private campus dedicated to research and innovation in the ophthalmic optics sector. As a pioneer in products for the ophthalmic field – multifocal lenses, organic lenses, anti-reflection and scratch-resistant treatments, and organic photochromic lenses – at the new research centre, Essilor says it intends to accelerate innovation and guarantee excellent vision for all wearers of glasses. The aim of the centre is to overcome the physical limitations of ophthalmic lenses in order to anticipate people’s needs and respond to them more effectively. Uniting research and a team of engineers and experts in a single location will foster more fruitful collaboration, accelerate projects and the launch of new products and technologies in support of Essilor’s aim: ito mprove life by improving vision. Together with Essilor’s other two Innovation and Technology

Centers – one in the United States (Dallas) and the other in Asia (Singapore) – this new campus, which integrates the group’s global research organisation, will bring Essilor closer to its goal of making innovation the cornerstone of its development strategy. The group has united the best of its innovative activities in every region with the aim of creating synergies, stimulating interdisciplinary cooperation and more effectively meeting the expectations of customers and the specific needs of local markets. At the Europe centre, about 900 people in the R&D, worldwide operations, global engineering, purchasing, quality and supply chain divisions are working together on researching and developing innovative solutions that meet consumers’ vision needs. “Eyesight is the most important of our senses and plays a fundamental role in our lives. The newlyopened centre is an extraordinary platform for developing lenses, materials, and the treatments of tomorrow that will open up new prospects for correcting and protecting vision and for dealing with the challenge of prevention and eye health,” Essilor chairman chief executive officer, Mr Hubert Sagnières, said. “Innovation in the ophthalmic optics sector is particularly important today because increased life expectancy has led to an increase in age-related ailments like cataract and age-related macular degeneration. In addition to correcting and protecting eyesight (from UV rays and violet-blue light, for example), the real challenge facing the sector is the development of preventive solutions that can contribute to maintaining eye health for as long as possible in the future.”

German market worth €5.5 billion in 2013 The German optical market was worth €5.5 billion ($A7.98 billion) in 2013, according to the opticians association there, the ZVA.

However, the rise was partly due to increased online sales, the ZVA said. The online market is estimated to have grown to €165 million in 2013, from €130 million the year before. Unit sales of complete glasses were 11.3 million pairs, while a further 6.5 million existing frames were fitted with 35 million new lenses. Bricks-and mortar stores increased their sales by 2.1% to €5.5 billion, but retail chains continued to raise their market shares. Independent stores had flat sales, with the biggest increases recorded by stores generating annual sales between €5 and €10 million. ZVA says it considers the independents need to promote their services more widely and adapt to new market conditions. The number of ophthalmic businesses in Germany continued to decline slightly in 2013, from 8,591 to 8,4891, compared to 8,791 in 2010. The decline was mainly in businesses with annual sales of less than €100,000.

Fielmann continues to grow Part of the explanation for the above is the continued rise in domestic sales of Germany’s biggest optical retail group Fielmann, which increased such sales by 9% on a same-store basis during the March quarter. The company’s sales increased to €256.9 million for the quarter compared to €231.1 million same quarter previous, with pre-tax profit increasing from €35.6 million to €49.1 million. Son of founder Gunther Fielmann and chief executive, Marc Fielmann, said the company plans to double its revenue from contact lenses and accessories in the coming years. However, the company has no plans [at present] to sell spectacles over the internet. ■

AUGUST 2014

DISPENSING

Building a case… For cases. A must-have in any eye-care practitioner’s arsenal of products, cases, like the true fashion accessories they are, constantly change in mode, perhaps even faster than their eyewear counterparts. And just as with other accessories, consumers are drawn to the new and unusual. To keep you updated on the latest in cases, check out these Insight Basics.

Case history Take special note of those wonderful cases now designed for specific brands – so fashionable consumers have been known to use them as a clutch or makeup case, sans eyewear. They also make perfect merchandising tools and help foster brand recognition.

Multi-tasking

Promote cases as gifts, particularly around Christmas, Father’s Day and Mother’s Day. Show your appreciation for a substantial purchase by including an additional special case.

Don’t expect a case to only hold a pair of eyewear. The new, stylish women’s cases mimic handbags, complete with a handle, interior mirror and space for lip gloss, a credit card and maybe even a cell phone. Many cases have a compartment for the everpopular clip; still others hold multiple pairs of eyewear.

Multiple choices

The best of both worlds

Gifting

Keep a varied inventory, ranging from oversized, sporty zip cases, floatable cases for water sport enthusiasts and fun cases in animal shapes or with sporty motifs for kids to

Continued from page 45 Allergan has reiterated its concern regarding Valeant Pharmaceuticals International’s “unsustainable business model”, which relies on serial acquisitions and cost reductions, as opposed to top-line revenue growth and operational excellence. A number of different third parties have also publicly expressed similar views. On 10 June, Allergan’s board of directors, after consulting with its independent financial and legal advisors, unanimously determined that the re-revised unsolicited proposal dated 30mMay by Pershing Square 48

ultra-slim designs for small frames and readers, and elegant clutch styles in fine leathers or lavish silks for special occasions and evening wear. And carry multiple colours, not just neutrals. Multiple choices encourage multiple sales.

AUGUST 2014

For protection, hard cases are ideal, especially for kids who might easily put their eyewear in a pocket and sit on it, but they can be bulky so many sunglass manufacturers

Capital Management, LP and Valeant substantially undervalues the company, creates significant risks and uncertainties for the stockholders of Allergan, and is not in the best interests of the company and its stockholders. On 22 June, Allergan said it had unanimously deemed Valeant’s unsolicited exchange offer “grossly inadequate”, adding once again that it substantially undervalues Allergan and creates “significant” risks for its shareholders. The board cautioned investors against tendering Allergan shares to Valeant, which is trying to acquire them at a price of $72 in cash plus 0.83 shares of Valeant stock per

especially are offering a hard case and a pouch, which serves as a spare case and also performs double duty as a cleaning cloth

On display

Display cases in the windows, on the counters, at the point of sale. Incorporate appropriate cases into all product category displays: men’s, women’s, kids, sun, sport, luxury.

Simply perfect

Don’t overlook the simple slip-ins in basic black or brown. Men love them, especially if they have a holder for a pen and a pocket clip.

‘Building a case’ by Gloria Nicola was originally published in 20/20, a publication of Jobson Medical Information LLC.

Allergan share. “The board strongly recommends that Allergan stockholders reject Valeant’s exchange offer and prevent Valeant from taking control of Allergan at a price that does not appropriately reflect the underlying value of Allergan’s assets, operations and prospects, including our industry-leading position and projected growth opportunities,” CEO David Pyott said in a statement. But Valeant says Allergan – and its investors – might feel differently if it had its facts straight. The Botox-maker’s rejection of Valeant’s offer is based on assumptions about its business that don’t add up,

a company representative told The Wall Street Journal. To dispel those assumptions, Valeant released “fact-based answers to refute misleading assertions made by Allergan” in an investor presentation. The Canadian pharma Valeant needs shareholders on its side if it wants to clear the hurdles in the way of the merger. Right now, Allergan has a poisonpill defence in place, meaning Valeant can’t acquire more than 10% of shares. Instead, it’s hoping to spark investors into supporting its call for a special meeting, at which it hopes to overturn the board and strike the anti-takeover measure. ■ www.insightnews.com.au

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AUGUST 2014

HAT brave souls (or is it greedy?) are the various vice-chancellors of the Group of Eight universities (the so-called ‘sandstone universities’) in Australia, as shown by their response to the federal government’s 2014-15 budget attacks on university students via deregulation of the fees they (the universities) may charge. While proclaiming their commitment to the ‘true and the good,’ their mission to ‘support the development of national unity … and to contribute to economic development and social cohesion’ or to ‘truth and knowledge as universal values’, the nation’s most influential VCs have added their genteel, toffy accents to the chorus of cries for fee-deregulation being shouted by such out-to-lunch bodies as the Institute of Public Affairs, The Australian newspaper and the Liberal-National parliamentary front and back bench. Collectively, the Go8 blathers that it “commends the government for progressing structural reform of higher education in its first budget” … and that the reforms “reconcile access and quality, and make growth affordable” (whatever that all means). The increased graduate debt from deregulation will weigh heaviest on lower-income students and families, disproportionately target women and disadvantage anyone employed in lower-paying but essential occupations like nursing or teaching. That is what supporting the ‘universality of truth and knowledge’ and ‘contributing to social cohesion’ amounts to.

Bravo VCs of the Go8, paid up to $990,000 a year plus perks of course; you really are an appalling lot who will stand by as the government guts higher education for so many. Your declarations are perfidious; even worse than the nonsense coming from the mouth of federal education minister ‘Poodles’ Pyne. You are accessories to the forthcoming vandalism. You should all be ashamed of yourselves.

VERY so often, there’s a burst of activity on Ausoptom, the chat-line for optometrists, that includes the tiresome claim that Insight is in league with Specsavers. The tirade usually lasts about a day and a half, then moves on to moans about something else. The usual suspects take part in the occasional attempts at bagging us, but they never back up their usually-ridiculous claims with any facts, seemingly content to just hurl what they consider to be devastating insults, in the process making themselves look quite like galahs in the process. And of course they don’t take it up with us direct, relying instead on the supposed anonymity of the chat-line for their mutually-assuring nonsenses. For the umpteenth time, let me inform them that they are wrong, wrong, wrong. Insight has no connection with Specsavers, direct, indirect or otherwise. Yes, we publish advertisements for Specsavers, as does Optometry Australia’s Australian Optometry, but that’s where it ends.

Can they understand that? Or is it beyond them that a simple commercial deal is possible – as has always been the case in this instance? Yes, we do publish news of Specsavers from time to time, because they actually do things rather than just live in fairyland. In any case, isn’t it best to know what your opposition is up to so that you can take appropriate action? And isn’t it best to do that rather than just stamping on the ants while the elephants rush by?

OU must be a member of a political party, judging from your column, a reader suggested to your humble scribe recently. Not so, I’ve never been in one, I replied. But I hasten to now correct that: I was in fact a member of the Young Liberals decades ago; in fact I met Mrs Pluvius there. So what happened? Well we held branch meetings and meetings and meetings, deciding how to save the world from itself (none of the results of our earnest deliberations were ever acted upon). But it all came to an end when the honorary treasurer of our Young Liberals branch shot through with the funds, never to be seen again! And that was the end of any involvement by me with any political party.

UST a final one on federal pollies: the treasurer looks after treasury, the defence minister defence, the education minister education, the health minister health, and so on.

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So could someone think up a new handle for the current environment minister; he seems to do everything except look after the environment – witness his Abbott Point/Great Barrier Reef decision that will lead to untold damage to the Reef and its environs.

O you reckon five optometry schools in Australia producing optometrists as against the long-time three are too many? Consider pharmacy, which used to have six schools back in 2002 but by 2012 had 19! And just to make matters interesting, there’s a strong rumour that New South Wales is to soon have a second school of optometry – at the University of Technology Sydney (UTS) – just around the corner from where the first diploma course in optometry was conducted by Sydney Technical College until the degree course commenced at the University of New South Wales in 1961. It’s only a rumour at present, but rumours have a habit of coming to be facts.

NE of the names behind the giant Chemist Warehouse retail chain is Gance, with brothers Jack and Sam, who established Le Tan sunglass cream, Le Specs sunglasses and, later, Le Specs frames. At one stage they owned wholesaler Optical Manufacturers, later on-selling it to Melbourne’s Smorgon family, which in turn sold it to Device Technology. The $2.5-billion Chemist Warehouse chain of 300-plus stores sells $2.5 billion of pharmaceutical and allied products a year, making it market leader in the $12-billion retail pharmacy game. At one stage, there was an attempt by Woolworths and Coles to have pharmacies within their supermarkets, which was rejected by the then Howard federal government. Chemist Warehouse took a different tack, instead having its own operations look like supermarkets but without the expensive fit-outs. It’s been a huge success, beating other pharmacies hands down, and no doubt irking Woolies and Coles when they see what they’re missing, in the process showing them how to go about pharmacy retailing. ’Onya Jack and Sam.

HAD an interesting conversation recently with an optical dispenser who originally trained as an optical mechanic at Fuller Optical Supplies in Sydney. Headed by one of the most liked people in optics, the late Jack Fuller, the company was

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one of those rarities that seemed to put people above profit. But, as the optical dispenser reminded me, that in reality was why the company ended up in the hands of a groups of suits – one of whom was (as revealed so incisively by the late Ralph Lewis in his Optical World newspaper) a self-promoting fraudster, the other two being would-be-if-they-could-be big shots but really just trumped-up nobodies. So what happened? “Ah, Jack, sorry I can’t pay my account this month as I have to pay for some work on my yacht and Matilda wants us to go to Paris for the fashion shows this year …” or “Jack, old boy, I’ve just taken delivery of a new Mercedes and the kids’ private school fees are due for payment, so I’ll have to pay your account the month after next.” Click would go the phone. And so it went on. Sadly, Fuller Optical Supplies is no more. It was driven to the wall by debtors who did not pay their bills on time and by the aforementioned suits, almost breaking Jack Fuller’s heart in the process. Shameful behavior on the part of the debtors and suits concerned.

HERE’S an outfit in Europe that goes under the name Euromcontact, the short name for the (get a load of this) ‘European Federation of National Associations and International Companies of Contact Lenses and Lens Care Manufacturers’. What a mouthful; little wonder they adopted a shortened version!

NE of the biggest annoyances publishers have to face is the attempts to obtain free publicity for a new or existing product. The usual ploy is for someone to send a laudatory piece on their latest and greatest product, asking for a write-up, with the comment that advertising is to follow. After time and effort is spent re-working the piece to make it readable and it is published, then followed-up for the promised advertising, out comes the news that, guess what, ‘the budget’ has been cut, meaning advertising is now not possible. A fabrication, of course; there was never to be any advertising expenditure. We don’t fall for that line any more; haven’t for years. And the sad part is they expect you to believe their attempted con!

HE above brings to mind the question of fees paid for ‘co-management’ by optometrists of patients who undergo cataract surgery. Many regard the so-called co-management fees as nothing more than spotters’ fees and nothing to do with co-management – certainly not worth some of the fees paid. After all, post-cataract checks take only a small amount of time, and many optometrists have plenty of time on their hands, with the national average of full-blown consultations provided by them averaging about 25-30 a week. The fees are a handy addition to their incomes. So how can the ‘co-management fees’ of, say, $600 an eye be justified? For example, on a time-spent basis? It hardly can. But the real question to be asked is this: if a fee is payable for co-management (which many say is really a spotter’s fee), why doesn’t the same apply to referrals and post-procedure checks for all referrals from optometrists to ophthalmologists? If that is considered unethical, then why is it ethical to be paid a substantial fee for referral and post-cataract checks, but not for a referral for a more serious condition, say a detached retina? If it’s regarded as all to do with the costs of the equipment used to perform cataract surgery, then that opens a can of worms for the ophthalmological and optometrical professions, with commercial and financial considerations being brought into the eye-care equation. There are anecdotes galore of demands being placed on cataract surgeons for substantial ‘co-management fees’ – and for other types of surgery too from time to time. Those making the demands have usually found themselves being shown the door. However it seems to be something that nobody wants to know about, blind eyes being turned away from the potential ‘outing’ ahead. Two, perhaps three, organisations could do something about it all, should they wish to do so. They are The Royal Australian and New Zealand College of Ophthalmologists, perhaps the Australian Society of Ophthalmologists and, most importantly, Optometry Australia. Will anyone do anything? Given that comanagement fees for referrals and post-cataract checks have been around for 20 years-plus, it seems most unlikely. There have always been denials that the co-management fees are for referrals, however that just deserves hoots of derision. It’s a murky part of the ophthalmic world; one that needs bringing out into the light. ■

AUGUST 2014

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