Insight June 2014 by Magazines byDesign

JUNE 2014

THE EYES AND EARS OF THE OPHTHALMIC WORLD – SINCE 1975

$89.6m hit over 4 years for optometry in federal budget ■■ ■■ ■■ ■■

Bulk-billing rebate down from 85% to 80% Schedule fees frozen for 2 years 3-year, not 2, eligibility for benefits for asymptomatic under-65s Fees cap removed from 1 January 2015

he federal government announced a projected $89.6 million hit over four years for optometrists in the 2014-05 budget handed down by treasurer Joe Hockey on 13 May. There will be a decrease in the schedule Medicare bulkbilling fees from 85% to 80%, for most a blowout in length of time from two to three years between consultations by optometrists in order to qualify for a Medicare benefit, and schedule fees for optometrical consultations are to be frozen for two years. The budget papers say: “The

Government will achieve savings of $89.6 million over four years by reducing the Medicare Benefits Schedule rebate for all optometry services from 85 per cent to 80 per cent commencing from 1 January 2015. This measure will also remove the charging cap that currently applies to optometrists accessing the Medicare Benefits Schedule, enabling them, in the future, to set their own fees in a similar manner to other health providers.” The savings from those measures will be invested by the government in a yet-to-be established

Reductions in government expenditure Specific reductions in federal-health-department expenditure on optometrical services are to be $10.8 million in 2014-15, $24.8 million in 2015-16, $26.3 million in 2016-17 and $27.8 million in 2017-18.

medical research future fund. At present there are about 5 million consultations by optometrists each year, with 97 per cent bulk billed. At present, optometrists need to perform consultations outside the Medicare system if they want to set the fees they charge. Optometrists Association Australia has been lobbying politicians to remove the cap on fees optometrists can charge under Medicare, arguing that the cost of providing health services has increased more than the consumer price index over the last 14 years.

The Medicare scheduled fee for a comprehensive eye examination is currently $71.00, but if the health index is applied, it should be $90.94, OAA maintains. Medicare pays $60.35 for a bulkbilled consultation. Furthermore, with 97 per cent of consultations by optometrists bulk-billed, Medicare is paying $60.35 for a consultation that is worth $90.94, OAA says. At the time of going to press, OAA had meetings scheduled with the health department to discuss details and with the Prime Minister’s office. ■

Ophthalmologists’ patients $100 out of pocket

phthlmologists’ patients will be almost $100 out of pocket from 1 July as a result of the federal government’s decision to freeze indexation of the rebate for Medicare item 104 for initial specialist consultations.

The indexation freeze will push the gap between the rebate and the Australian Medical Association’s recommended fee for an item 104 to $97.72 a year. In the budget, the government revealed plans to “simplify” Medicare safety net arrangements

by replacing the Original Medicare Safety Net, the Extended Medicare Safety Net and the Greatest Permissible Gap measure with a single Medicare Safety Net. The new Medicare Safety Net, to come into effect from 2016, will contribute towards

out-of-pocket costs incurred for Medicare-eligible out-of-hospital services. The vice-president of the Australian Medical Association, Professor Geoffrey Dobb, said on budget night that the health budget is full of pain for patients.

Optometrists Association Australia is changing its name to Optometry Australia, as well as its state divisions

EU joins drug collusion check

OAA changing its name to OA

JUNE 2014

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The European Union Union is taking a serious look at how two Swiss drug-makers have marketed their eye drugs

VisionCareNSW loses contract VisionCare NSW has lost the freespectacles contract it held for 22 years to Vision Australia

All the ophthalmic news that matters!

OPINION

Letter

AUSTRALIA’S LEADING OPHTHALMIC NEWSPAPER – SINCE 1975

Aboriginal health

CONTACT

THE EYES AND

EARS OF THE OPHT HALMIC WORL D – SINCE

1975

JUNE 2014

$89.6m hit over 4 years for optometry in federal budget ■ ■ ■ ■

PUBLISHED MONTHLY BY Modern Optics Pty Ltd 68 Blues Point Road McMahons Point NSW 2060 Australia T: (02) 9955 6924 F: (02) 9954 4045

Bulk-billing rebate down from 85% to 80% Schedule fees frozen for 2 years 3-year, not 2, eligibility for benefits for asymptom atic under-65s Fees cap removed from 1 January 2015

Reductions in govern

ment expenditure

Specific reductions in federal-health-depar trical services are tment expenditu re on optometo be $10.8 million in 2014-15, $24.8 $26.3 million in 2016-17 million in 2015-16, and $27.8 million

in 2017-18. he federal governme nt nounced a projected an- Government will achieve sav- medical research $89.6 ings of million hit over $89.6 million over future fund. four years years four The Medicare for optometrists At present there by reducing the scheduled fee in the 2014-05 are about 5 for Medicare million Benefits Schedule a comprehensive budget handed consultations by down by treasurer eye examirebate for all optom- nation etrists each year, optometry services Joe Hockey on 13 is currently $71.00, with 97 per cent May. from 85 per but if the health index bulk billed. cent to 80 per There will be cent commencing is applied, it a decrease in should be $90.94, from 1 January the schedule At present, optometr OAA maintains. 2015. Medicare bulkists need Medicare ure will also remove This meas- to perform consultat billing fees from pays $60.35 for 85% to 80%, for ions outside billed the charging the a bulkcap that currently most a blowout Medicare system consultation. in length of time applies to opif they want to set the fees they tometrists accessing Furthermore, with from two to three charge. 97 years between the Medicare per cent of consultat Benefits Schedule, consultations by Optometrists enabling them, optometrists in Association bulk-bille ions by optometrists Australia has been in the future, order to qualify d, Medicare to lobbying poliset their own for a $60.35 for a consultat is paying ticians to remove benefit, and schedule Medicare fees in a similar manner the cap on fees ion that is fees for op- health to other optometr worth $90.94, OAA tometrical consultat providers.” ists can charge says. ions are to be under Medicare At the time of going frozen for two years. The savings from those meas- providing, arguing that the cost of OAA to press, ures will be invested had meetings The budget papers scheduled by the gov- creased health services has in- with say: “The ernment the health departme more than the consume in a yet-to-be establishe nt to r discuss details d price index over the last 14 years. and with the Prime Minister’s office. ■

Ophthalmologists’ patients $100 out

Optometrists Associatio n Australia is changing its name to Optometry Australia, as well as its state divisions

EU joins drug collusion check

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OAA changing its name to OA

JUNE 2014

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phthlmologists’ patients The indexation freeze will be almost will push by replacing $100 out the gap between the of pocket from the Original rebate and the 1 July Australian Safety Net, the Extended Medicare out-of-pocket costs as a result of Medical Associatio the federal govincurred for Medicare n’s Safety Net recommended fee ernment’s decision and the Greatest Medicare-eligible out-of-hospifor an item 104 to freeze to tal services. Permissible Gap indexation of $97.72 a year. measure with a the rebate for single Medicare The vice-president Medicare item 104 In the budget, Safety Net. for initial spethe governof the Australian Medical ment revealed plans cialist consultat The new Medicare ions. Association, to “simplify” Net, Safety Professor Medicare safety to come into Geoffrey Dobb, net arrangements effect from budget said on 2016, will contribut night that the health e towards et budgis full of pain for patients.

The European Union Union is taking a serious look at how two Swiss drug-make rs have marketed their eye drugs

VisionCareNSW loses contract

VisionCare NSW has lost the freespectacles contract it held for 22 years to Vision Australia

All the ophthalmic

news that matter

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he statement that indigenous people have six times more blindness than other Australians causes concern. Critics say the health department know both the causes and the cures but does nothing about it. The problem seems to have been identified in 2004 when Aerial Missions used a light aeroplane to survey remote areas, finding diabetic cataracts and retinopathy, uncorrected refractive errors and trachoma. Lieutenant-General John Sanderson’s two reports (2008 for Labor and 2009 for Liberal) were discarded, but identified that Aboriginal children are addicted to a sugar-based diet which progresses to obesity and, several years later, to Type 2 diabetes with subsequent secondary diseases. The Visiting Optometrists Scheme (now Outback Optometry) knows that diabetes causes myopia, cataract, retinopathic blindness, low tension glaucoma, impotence, amputations, kidney and heart diseases, unemployment, loss of driver’s licence, extra pensions and premature death. In 2009, the federal government held a parliamentary inquiry known as ‘Everybody’s Business”, costing $1.1 million. It produced

33 ways of preventing Aboriginal diabetes. Inquiries to ministers for health or for Aboriginal affairs during the past five years cannot elicit any evidence that any of the 33 suggestions have been enacted in the states or Canberra; one wonders why they bothered spending money on reports and inqiuiries. The VOS’ Margie O’Neill, Prof Brian Layland and Prof Brien Holden are to be commended for the uncorrected-refractive-error treatments, diabetic cataracts and retinopathy referrals, but the prevention of Aboriginal diabetes itself seems to have Diabetes Australia as its only champion. Ian Trust (Indigenous Person of the Year Award 2014) thinks better education of Aboriginal children would help. Unbeknown to him, three EON Foundation nurses with one car are doing a good job in the Kimberleys schools but don’t get any encouragement. The closing the GAP being discussed today has seven factors to it. Of course health and eyes is only one of the factors. Perhaps we think the other six factors like landrights, social skills and education are more important. ■

Graham Fist Optometrist Perth, WA

Two OAA chiefs resign

hief executives of two division of Optometrists Association Australia have resigned their positions. Ms Terri Smith has resigned as chief executive officer of OAA

INSIGHT:

Circulation of

8,066 copies within Australia

Insight’s circulation for the previous issue (May 2014) has been independently confirmed by Benbow & Pike Chartered Accountants at 8,066 copies.

JUNE 2014

(Victoria Division) after almost seven years in the position and Ms Cristy Ross has resigned as executive officer of OAA (Queensland/ NT Division) after almost three years in the position. ■

James Cook Medal awarded

rofessor Brien Holden, of the Brien Holden Vision Institute, has been awarded the James Cook Medal from The Royal Society of New South Wales.

The medal was last presented 20 years ago. It is presented for “outstanding contributions to science and human welfare in and for the Southern Hemisphere”. ■ www.insightnews.com.au

3 LOSSES 1 WIN

Ophthalmologists’ patients $100 out of pocket; federal budget decision Continued from cover... “Patients – especially vulnerable patients such as the chronically ill, the elderly, Aboriginal and Torres Strait Islanders, and low-income families – will pay more for their health care,” Professor Dobb said. “Many Australians already pay a co-payment, and there is a place for co-payments for patients with the right model – but this is not the right model. It does not have the right protections. “Patients will now face higher out-of-pocket costs at their GP, the emergency department, pathology, radiology, and at the pharmacy through new or higher co-payments.

“Access to quality primary care will be more difficult for many Australians. “The revised safety nets do not provide sufficient support. “There will also be a greater red tape burden on general practice, without adequate compensation.” Professor Dobb said the AMA is concerned that too many costs are being shifted to patients through: • co-payments for GP services; • co-payments for emergency departments; • higher co-payments for medicines; • cuts to Medicare rebates; and • frozen rebates for specialist

services. Changes to the National Health Reform Funding Agreement will create uncertainty in the states and territories about public hospital funding, he said. “State budgets will be in danger of being overrun by public hospital cuts. “Patient will have longer waits for public hospital services. “Put together, the cuts and copayments threaten fairness and equity in the health system. “The AMA recognises the government’s priority is to achieve a budget surplus, but it should not be achieved by costing health

services out of the reach of ordinary Australians.” Professor Dodd said the AMA welcomes: • more GP training places, but is concerned they are funded by abolition of the successful Prevocational GP Training Place programs; • strong investment in medical research; • preservation of prevention and health workforce functions despite the abolition of agencies; and • reform to Medicare Locals and creation of primary health networks. ■

Three-year review of AHPRA and its national registration boards

he Australian Health Ministers’ Advisory Council on 29 April published the terms of reference for the three-year review of the National Registration and Accreditation Scheme (National Scheme). Former director of Western Australia Health Kim Snowball has been appointed to independently lead the review. He has held a variety of senior leadership roles in both the public and private health sectors, was previously director-general of WA Health and has also served as chair of the Australian Health and Medical Advisory Committee. The three-year review will examine: • the extent to which AHPRA is meeting the objectives and guiding principles of the National Scheme; • operational performance of the National Scheme; • the National Law, including mandatory reporting, the Australian Health Workforce Advisory Council and new professions entering the scheme; www.insightnews.com.au

• governance effectiveness, including within the National Scheme and with key stakeholders; and • sustainability of the National Scheme, with a specific focus on new professions in the scheme and funding for smaller professions. AHPRA will be actively participating in the review process and making submissions in the months ahead. The National Registration and Accreditation Scheme for the health professions (the National Scheme) was established under the Health Practitioner Regulation National Law Act (the National Law) as in force in each state and territory, and commenced operation on 1 July 2010, and 18 October 2010 in Western Australia. An intergovernmental agreement signed by Council of Australian Governments members in March 2008 underpins the National Scheme and identifies its objectives as: • protection of public safety;

Scope of the Review and Objectives The scope of the NRAS Review is to be focussed on matters relevant to: • identifying the achievements of the National Scheme against its objectives and guiding principles; • the future sustainability of the National Scheme, any recommended changes and the specific matters articulated below; • the administration of the National Scheme; • the interface between the National Scheme and jurisdictional practices; and • an assessment of the extent to which the National Scheme meets is aims and objectives. The NRAS Review will examine to the extent to which the implementation of the National Scheme and the regulation of the professions under the National Scheme is meeting the objectives and guiding principles as set out in the IGA and Section 3 of the National Law. The objectives of the National Scheme are to: • provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered;

• facilitation of workforce mobility and high quality education and training; • promotion of access to health services; and • development of a flexible

responsive and sustainable workforce. The objectives and guiding principles of the National Scheme are set out in section 3 of the National Law. ■ JUNE 2014

ASSOCIATIONS INSIGHT

Optometrists Association Australia to become Optometry Australia O ptometrists Association Australia is to become Optometry Australia, so that, as the association says, “it will play a much more visible and high profile role than it previously has in areas such as government lobbying and advocacy, highlighting eye-health issues and promoting optometry to consumers and the health care sector”. According to OAA, the peak membership body for more than 90 per cent of Australian optometrists, the name change will “refocus its direction in response to a major review completed last month”. The association intends to change its name to Optometry Australia at national level, and the six state divisions intend to change

their names to Optometry Victoria, Optometry New South Wales/ACT, Optometry Queensland/Northern Territory, Optometry Western Australia, Optometry South Australia and Optometry Tasmania. In line with the proposed name changes, the association’s national and state boards are committed to refocusing their resources “to strengthen and protect the profession”. To support these changes, the association says it will play a much more visible and high-profile role than it previously has in areas such as government lobbying and advocacy, highlighting eye-health issues and promoting optometry to consumers and the health care sector. OAA national board president/ chairman, Mr Andrew Harris, said:

“Our goal is to put eye health front and centre of Australian health care and to significantly raise the standing of optometrists as eyehealth experts”. Mr Harris said the intended changes were in response to a comprehensive sector and membership review undertaken by the Association. “To help us shape our future, we asked our members how we can better support them. They told us exactly what they needed from us and we are responding accordingly,” Mr Harris said. “They want us to support them throughout their careers and help protect, enhance and promote the optometry sector and their professional standing

as eye-health experts. “We firmly believe that the interests of individual optometrists are best served by a strong and progressive profession, with a representative body that actively leads, engages and promotes on behalf of all members. A stronger profession means a more rewarding and secure future for all of us.” Mr Harris said that all boards had unanimously agreed on the new name and collaborated on the new strategic direction. “The association has made some very positive changes in the past six months in line with our goal to become more efficient and effective,” Mr Harris said. A new logo for Optometrists Australia is yet to be revealed. ■

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European Union joins probes into eye-drug collusion allegations F

irst it was Italy, then it was France, and now the European Union is taking a serious look at how Swiss drug-makers Roche and Novartis have handled the marketing of their eye drugs Lucentis and Avastin, used to treat age-related macular degeneration.   The EU’s antitrust chief, Joaquin Almunia, said regulators are “gathering information” on whether the two companies colluded to prevent the use of Avastin – the much cheaper drug that’s similar to Lucentis – for treating age-related macular degeneration.  In early March, Italy’s antitrust authority levied more than $US250 million in fines against

Roche and Novartis, on charges that the companies catalysed sales of Lucentis and Avastin by pushing ophthalmologists toward the much-higher-priced option. The companies continue to deny the charges, but soon after the fines were imposed, Italian prosecutors began investigating whether they engaged in market manipulation and fraud.   By mid-March, France was also probing, going public with the revelation that it actually has been investigating the Lucentis-Avastin controversy since 2012, when French health minister Marisol Touraine first expressed concerns about possible collusion.   On 10 April, the French

Competition Authority raided local offices of Roche and Novartis looking for evidence of collusion.  Mr Almunia isn’t saying much yet about the EU’s investigation beyond acknowledging that it involves close collaboration with French and other European authorities. A spokesman for Roche said there is no agreement between it and Novartis to restrict competition.  Avastin, which is approved to treat some cancers, and Lucentis have the same mechanism of action – they both choke off blood vessels – but Roche’s California unit, Genentech, developed Lucentis specifically for

ophthalmic use.   Lucentis costs about $2,000 per dose, while Avastin sells for just $100 per dose, prompting ophthalmologists all over the world to repackage the cheaper drug for use in patients with AMD.  The EU’s case was partly prompted by an advocacy group called European Consumer Organisation (known as BEUC), which has been lobbying heavily for an investigation. “This case undoubtedly requires an EU-wide investigation as both medicines have been approved in the EU,” a senior health policy officer at BEUC said.   “Consumers have the right to access cheaper medicines.” ■

Hoya wins lens product of the year in London

oya Lens United Kingdom won the ‘Optician Lens Product of the Year’ with its Hoyalux iD MyStyle V+ at an award ceremony at the Hilton Hotel, Park Lane in London in April. The progressive-power lens was launched in September 2013, during Silmo in Paris and is the world’s first progressive lens that balances the difference in prescription for the left and the right eye, which has been proven to lead to a visual imbalance, with its binocular harmonization technology. Hoya’s patented binocular performance measurement program verifies the design under real-life circumstances before production. Using Hoya’s visuReal portable and the new Hoya iDentifier, the lens offers a high degree of individualisation, providing clarity and instant focus for the wearer. Hoya’s BlueControl was also a finalist for the award. It is a coating that neutralises the blue light emitted by digital screens, preventing eye fatigue and eye strain. Additional benefits are the reduction of glare and enhanced contrast. ■ 6

JUNE 2014

(L-R): Martin Batho and Michelle Batho (Hoya Lens UK), Sir Anthony Garrett (board of trustees general secretary, ABDO College) and Chris Bennett (Optician) www.insightnews.com.au

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OPINION

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

Overload I attend a lot of conferences in various parts of the world. I know many readers are also forced into compulsory CPD in order to maintain their ‘right’ to practice. Some are involved in the provision or such CPD and yet others in the exhibition of frames, lenses and the amazing hardware we have these days. This year it was nice to finally attend a conference in Melbourne in summer! Hats off to the Southern Regional Conference for making this move. As the report in the April edition of Insight mentioned, numbers were hardly affected. 924 visitors is massive for any Australasian meeting. I don’t think any others even get close. As mentioned before the MECC rates as the best conference venue in the world that I’ve ever presented at, or attended. The venue is ideal, the spaces massive, the AV world class, the food very good and the exhibition spaces too. Not to mention the myriad choices for handy accommodation. The amazing array of après conference dining and pubs is also worthy of mention.

That’s Edutainment. I’ve been fortunate to present at a number of SRC meetings over the past few years, with some well received Industry presentations on

the opening mornings, as well as a rare contact lens keynote. The SRC presenters I’ve heard are generally top class. I really enjoyed Marc Bloomenstein’s presentations. He was hilarious and educational to boot. That’s what we want: Edutainment. As they say, a spoon full of sugar helps the medicine go down. Glaucoma, diabetes, the ocular surface, AMD and the rest are dry subjects; anything that makes it easier to absorb or enjoy is worthwhile. I wish more presenters and organisers would appreciate these finer points. In Australia we are spoiled for choice when it comes to CPD. If meetings want to attract delegates they need to appeal to a wide range of punters. I still feel the SRC is a little over the top on some aspects – a bit too much on TPAs and path and not quite enough on clinical, instrumentation and things that are 80% of what we do – like spectacle prescribing and CLs. Overall however delegates vote with their feet and SRC attracts the numbers. That said 61% of delegates were from VIC, 16% from NSW while NZ and QLD tied at 6%. Queenslanders can of course hardly be missed. The rest of Australia was barely represented.

Trade Up? Then of course there are the trade displays. I for one find that being able to view the fantastic instruments, test and discuss them with suppliers and colleagues, is a key draw card. At the same time things like frames, sunglasses and lenses are probably better covered

Pharma benefits slumped $800m in 2013 Pharmaceutical Benefits Scheme spending slumped by over $800 million in the 12 months to 31 8

JUNE 2014

December 31 last year, mainly driven by a $600 million collapse in the cost of cardiovascular drugs. ■

at conferences like ODMA. I note that there’s been some debate as to the merits of offering CPD lectures at ODMA. My feeling is that it’s a good thing to have a meeting that’s free of the restraints imposed by compulsory CPD. In the good old days of voluntary CPD, exhibition halls would be quite busy during lecture sessions. Nowadays the delegates are so busy chasing points that the exhibition is like a morgue while lectures are in session. It is of course a double-edged sword. At least now the lecturers feel appreciated. I thus reckon that ODMAfair (or something similar?) should offer a pure wholesalers conference and if any CPD is offered it should be sparse and not attract points. It would ensure that those who attend are those who want to see as many frames, lenses and instruments as possible in their time at the meeting. This would also allow for more commercial presentations to be offered. CPD is now big business – it’s no longer provided by passionate volunteers. There are vested interests and conflicts galore. It’s still evolving but in time I think we’ll see a clearer distinction between CPD events and trade shows with only the bigger meetings being able to offer both in a satisfactory manner. Exhibitors quite simply don’t have the resources to be at dozens of meetings a year. We will also probably see more boutique style conferences appearing and less of the ‘all in one’ big state events that compete for delegates and exhibitor dollars. It also surprises me to see that

at some presentations, workshops and launches that require instruments – like OCTs and slit lamps – the wholesalers are expected to supply, transport and install all this gear ‘free’. This is different to a supplier paying for space at an exhibition hall and being provided with a captive audience, where the intention is to sell such instruments. Such launches are often big budget events designed to sell a new contact lens – not slit lamps – and one would think the instrument supplier should receive a fair price for their time and effort. A new contact lens launch will likely make the supplier tens of thousands of dollars in sales. Fair’s fair eh? I for one rarely notice what instrument I just viewed a contact lens with or did a BIO or VOLK workshop with. The organisers of such workshops are also usually making a fair wedge from delegate registrations. Hence I don’t see why equipment providers should have all the hassle and not get paid. I also don’t think it is fair to judge a slit lamp in such an environment and rarely judge an instrument on that basis. The ambient illumination is often not ideal (especially for an OCT or fundus camera) and eyepiece alignment is usually not ideal. I have however purchased a slit lamp (and other gear) after spending some time setting it up and testing, at an exhibitors stand. That said I usually have had said instrument installed in my office for a further evaluation, before signing the contract to purchase. There’s a time and place for everything. ■

$320,000 donations to political parties Pharmaceutical companies and Medicines Australia gave just over $320,000 in political donations in the 2012-13 financial year, close

to 13 per cent above last year’s total of $284,000, according to data released by the Australian Electoral Commission. ■ www.insightnews.com.au

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DISADVANTAGED SCHEME

VisionCare NSW loses free spectacles supply contract to Vision Australia V

isionCare NSW has lost the NSW Spectacles Program contract to supply free spectacles to disadvantaged people, which it has held for 22 years. The contract has been awarded to Vision Australia by the New South Wales Department of Family and Community Services, effective 1 July. The first thing the management of VisionCare NSW knew of the decision was when it was told its contract would not be renewed and that it had been awarded to Vision Australia. The news was delivered on the same day FACS wrote to practitioners advising them of the change. VisionCare NSW has experienced difficulties in recent years, with funding shortages and complete cut-offs at various times during 2012-13 causing delivery delays of finished spectacles for thousands of its clients. During its 22 years’ existence, VisionCare NSW has provided about 1.8 million pairs of glasses to its clientele at no charge. Its budget has been about $4.5 million a year, with topups provided in the event of the budget being exceeded. That works out at about $64 average for a complete pair of spectacles, which are provided at no charge to applicants who meet certain criteria. Vision Australia (initially the former Royal Blind Society of NSW and now a national body) is a provider of blindness and low-vision services, and, according to a letter of 12 May sent to practitioners and signed by Ms Eleri Morgan-Thomas, executive director of services system delivery at FACS, the spectacles program complements its current suite of services. Also, according to Ms Morgan-Thomas, there are strong synergies between the /program and Vision Australia’s aim to reduce preventable blindness and low vision through early identification and intervention. All nine staff at NSW VisionCare have been given notice that their employment will come to an end on 30 June.

Vision Australia has not … In her letter, Ms Morgan-Thomas said eligibility criteria for the program have been simplified and application decisions will be made immediately, with the time for delivery of spectacles after application approval expected to be reduced “significantly”. Changes were developed in consultation with a cohort of optometrists [at present]

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participating in the program, Optometrists Association Australia and the Optical Distributors and Manufacturers Association, Ms Morgan-Thomas said. Furthermore, that FACS will be working with VCNSW to ensure a smooth transition process and that continuity of service to clients and support for optometrists is “paramount”. And, finally, that Vision Australia would be in touch with practitioners over coming months to discuss their participation in the program, explain the changes in detail and answer questions. With only six weeks to go before commencement of the new contract, Vision Australia was advertising for a temporary full-time administration support officer for the spectacles program at the Enfield, Sydney, location of Vision Australia to “ensure the smooth running of the NSW Spectacles Program by Vision Australia, which provides free spectacles and other optical aids to vulnerable and disadvantaged residents of NSW”. According to Vision Australia, the program enters a new phase from 1 July whereby optical providers such as optometrists [will] use an online application process on behalf of eligible clients. Once they supply the spectacles they [will be] reimbursed the cost by Vision Australia. Vision Australia’s website says the role of the administration support assistant will be to ensure claims and payments stay on track and information in the database is kept accurate and up to date and that it is looking for a person with: • Qualifications or experience in office administration; • Clear written and oral communication skills; • Well developed organisational and planning skills; • Strong attention to detail; • High level customer service skills; • Advanced computer skills in Microsoft Office suite and internet (minimum typing speed of 50 words per minute at 95% accuracy); and • Ability to work autonomously and within a team environment. Duties will include: • Monitoring payment of claims for reimbursement by participating optical providers;

Questions unanswered Insight asked the following questions of FACS, but had not received answers by press time (extended twice to try to accommodate the department): 1. Were tenders called for conduct of the NSW Spectacles Program, until 30 June 2014 in the hands of VisionCare NSW (VCNSW)? 2. When were tenders called? 3. Why was the contract between FACS and VCNSW not renewed to take effect from 1 July 2014? 4. What notice was given to VCNSW that its contract with FACS would not be renewed. 5. Did that comply with the contract between FACS and VCNSW? 6. Will Vision Australia (VA) be fully prepared to take over the contract from 1 July 2014, including having adequate numbers of practitioners signed up to carry on from where VisionCare NSW’s involvement ceases, particularly as it is now only six weeks to go until 1 July? 7. How many staff at VA will be replacing the nine staff at VCNSW? 8. Will quality-controls insisted upon by VCNSW for goods supplied to beneficiaries be maintained by VA?

• Checking information and documents against eligibility criteria; • Surveying customers to gauge their satisfaction with the program; • Maintaining records in the online database; • Running reports from online database and finance system; • Issuing notifications about the program to providers; and • Handling queries about the program and claims from optical providers; Vision Australia welcomes applications from candidates who are blind or have low vision. ■

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RELATIONSHIPS

Luxottica calls for loyalty to OAA T

he president of Luxottica Asia Pacific, Mr Chris Beer, has called for Luxottica Australia’s optometrists to show loyalty to Optometrists Association Australia. In a letter to the optometrists last month, Mr Beer said: “You may recall me writing to you around this time last year, where I shared the steps we have taken over the last seven years to deliver on our purpose of `Creating World’s Best Customer Experiences and highlighting some of what you could expect going forward, particularly in relation to eye care. “As I reflect on what I would like to share and connect with you this year, I feel compelled to shift our focus and message for a moment, and talk with you more about our optometry profession and greater community as a whole, beyond Luxottica. “In my 20 years-plus of experience in the industry, I have seen more change in the last five than in the previous 15. Like any change, there have been many good things come from progress and some not so good. The one thing that I am certain about, that has stood the test of time

and all the changes, is hightrust relationships and trusting partnerships. “Without trust, nothing else matters. Trust is made up of many elements including Integrity and Intent. “One of those high-trust relationships that I would like to particularly call out is with Optometrists Association Australia. OAA has represented and supported the optometry profession, the optometry community and its members in a range of initiatives over time. “Through its connections, relationships and partnerships across the board, it has helped set and maintain quality standards of eye care for all Australians. It has helped the optometry community grow, develop and prosper in the services and payments they receive through Medicare. It has been a valuable provider of resources, skills, expertise and comprehensive indemnity insurance to its members. I could go on with the legacy that the OAA has created. What has impressed me most by the association is its commitment and resolve to looking after the eye-care needs of Australians and the quality and health of the profession.

Chris Beer Unfortunately, as I look at other markets and geographies in the world, for example the United Kingdom, the associations and partnerships have not shown that same resolve and commitment. “It is for this reason that we continue to endorse OAA, and actively encourage all of our optometrists to be members, even though we provide the same, if not more, services, benefits and insurance. We believe together with OAA and our other hightrust relationships we can make a greater difference and leave a

brighter legacy in the Australian optometry community. “So I call on you to continue to support your association as it has supported you over the many years and help build an even stronger future for our profession and industry. I would also encourage each of you to reach out to your colleagues in other organisations to continue their association as some other organisations today don’t have the same value or ambitions for the health of Australians as we do at Luxottica.” ■

New Zealand appoints six retail groups as preferred suppliers of optical goods

he Ministry of Social Development in New Zealand has appointed six retail groups consisting of 196 preferred suppliers representing about 56 per cent of optical outlets to provide optical goods and services to beneficiaries, pensioners and low-income earners. Under the preferred-supplier agreements between the MSD and 12

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the six groups, $8.7 million will be lent each year to people who qualify for hardship grants to buy optical goods and services, which has to be repaid. New Zealand Optics reports that until the scheme was launched, the average amount lent was more than $500, but no information was available on the average price expected under the

new scheme. The preferred suppliers are Barrington Eye Care (independent), Eye Pro Marketing (consortium covering 46 locations), John O’Connor Optometrists (independent, 3 locations), Specsavers (53 locations), University of Auckland (independent, 2 locations) and Visique (consortium covering 91 locations).

They will offer a discounted price for eligible people, including fixed-price eye examinations and lens type – single vision, bifocal, progressives and ‘specials’. All new eyewear will be covered by a two-year warranty. New Zealand does not have a Medicare health-care system as such as far as optometry is concerned. ■ www.insightnews.com.au

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SUN CARE

Cancer Council endorses lens coating

Part of the 1400-strong audience at Dubai

he Cancer Council has endorsed Essilor’s Crizal UV as the best lens coating for providing maximum protection against damaging UV rays that may lead to eye-related cancers. The endorsement was announced at the Essilor AMERA ‘Navigate Through Change’ convention for eye-care practitioners from Asia-Pacific, Middle-East, Russia and Africa in Dubai on 11-14 May. The partnership and resulting endorsement of Crizal UV is the first non-Cancer Council-branded product endorsed by the organisation. Typically the only products

endorsed by the Cancer Council are its own branded products, such as sunscreens and sunglasses. The partnership will also see a large public awareness campaign hit TV screens and online across Australia commencing in August. The campaign will communicate the dangers of UV to eyes and discuss the need to protect eyes. Crizal Forte UV lenses virtually eliminate back surface reflections, intergrating a new AR stack on the back surface that extends the transmission to visible light and UV, providing wearers with E-SPF of 25, - i.e. they are 25 times better protected

against UV than without lenses. Fourteen-hundred eye-care practitioners from 30 countries went to Dubai to hear from international speakers addressing a broad spectrum of topics to help practitioners navigate through change. The convention was segmented into three streams: shift, adapt and engage. The shift stream identified paradigm shifts occurring in retail markets in consumer purchase behaviours, technological trends and wearer needs that can shape the future of the optical business. The adapt stream coached

delegates to ride the waves of change by being adaptive and leveraging the opportunities change brings with it to improve business. The third stream was engage, in which delegates heard about creating unique retail experiences designed to engage consumers while building long-term relationships. In the coming months, Essilor will advise eye-care practitioners of how they can become involved in the Cancer Council campaign and leverage within their stores. Detailed reports on papers presented at the meeting will be included in future issues of Insight. ■

Optometrist receives UNSW Alumni Award

ural and remote optometrist, Ms Margaret O’Neill, received the University of New South Wales 2013 Community-atLarge Alumni Award at a ceremony held at the future location of the university’s Alumni Park on 8 May. Seven Alumni Awards were given on the night spanning the categories: Arts & Design, Science, Business, Communityat-Large, International Alumni, and Young Alumni. The awards recognize the success and leadership of seven of its most outstanding graduates. The winners were announced by UNSW vice-president, advancement, Ms Jennie Lang, who said the university was “very proud of the

extraordinary achievements of our 250,000-plus alumni, who are making an impact in so many areas in Australia and around the world”. Alumni Park is a planned twohectare development located in the north-west of the UNSW main campus behind the recent residential developments lining its High St. border. It is designed to celebrate the achievements of its graduates. Citation “MARGARET O’NEILL is an optometrist, who 12 years ago was responsible for establishing the North West Eye Program. The program aims to provide access to remote eye care in Western Australia. It started with her travelling alone in a four-wheel drive 12 years ago

to a program that now encompasses more than 50 optometrists and ophthalmologists from all over Australia. Her determination to see the program succeed was evident when she slept in her car for the first two years as there was no funding and accommodation was not always available in very remote communities. Margie’s dedication and enthusiasm is infectious; not only is she providing services, she is building friendships. Returning year after year, she has earned the respect and trust of the remote communities through her professionalism, vivacious personality and caring nature. She single-handedly tore down long-standing cultural boundaries

to ensure Aboriginal cultural values are still respected while providing the highest standard of care possible. Her goal was to ensure all sides came to the realisation that saving sight and increasing a person’s quality of live is what counts most. More importantly, Margie’s work facilities sustainability; she Margaret O’Neill is actively involved in training local health-care providers and medical personal to operate diagnostic equipment for the early detection of vision threatening eye conditions. She was pivotal in establishing a direct communication channel between medical centres and ophthalmologists via Continued on page 16...

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OPINION

Editorial Time for a change of regime?

reat negotiators Optometrists Association Australia’s hierarchy are not; in fact their performance versus their selfclaimed talents in their Medicare and other negotiations is unimpressive, as shown by recent results. It really looks more and more as though they couldn’t negotiate/ lobby/advocate their way out of a wet paper bag! In short, they have been well and truly done over by the federal government, health minister Peter Dutton in particular, as the federal budget clearly shows. What is desperately needed is convincing argument of optometry’s case instead of what was obviously unconvincing argument in the lead-up to the budget as far as the government was concerned.

Rushing off to frantic, hastily-called meetings with public servants is too little too late. Does OAA really believe the budget will be undone to accommodate its wishes? At first glance, the lifting of the fees cap under Medicare looked like a victory for OAA, however market reality is that the Big 2 (Specsavers most certainly and OPSM still making up its mind) are not going to touch their consultation fees, leaving out in the cold those brave independent practitioners who decide to charge higher fees; most won’t do so. And there’s also the matter of the time allowed between consultations blowing out from two to three years, as well as a freeze on Medicare fees and benefits for optometrists and

their patients. The costs of the latter far outweigh the monetary benefits for those who are game to take the commercial risk of increasing their fees above the schedule-fees level. It’s going to cost optometry $89.6 million in lost income over four years! Per capita that may be chicken feed, but it’s a lot to be lost overall. Perhaps it’s time for a new regime at national OAA, complete with competent negotiators/lobbyists/advocates. (There are a number of people who could do it.) Some OAA members have been jumping up and down about it all, but to no avail. The problem is the structure of national OAA and the six OAA state divisions (which collectively

own the national body) means it is difficult for floor members to make their feelings known; they can only do that by taking it up with their respective state-division council, each of which has a member on the national body, and hoping the latter will bring up the concern(s) when they put on their national-body hats. A few years back, OAA had a look at changing to a different system, but ended up consigning it to the too-hard basket, so the difficult road to complaining to the decision-making hierarchy remains in place. And that is causing much angst among disgruntled floor members, who one day will do something about it; maybe this time even a new regime. ■

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RETAILING

Essilor moves quickly with its newly-acquired online business H

aving just completed its acquisition of online vision care retailer Coastal.com on 28 April, Essilor International moved quickly to begin the process of integrating the retailer into its global network of eyewear companies. On 29 April, Essilor of America president John Carrier welcomed the 350 employees at Coastal.com’s Vancouver headquarters into the Essilor group. Here, with the agreement of Essilor Australia and Jobson Medical Information LLC, publisher of VMail, Insight publishes Mr Carrier’s overview of Essilor’s plans for the company, which will now be headed by newly named Coastal.com chief executive officer Mr Roy Hessel, who also serves as president of online initiatives for Essilor of America. Mr Hessel takes over from Coastal’s founder and former CEO, Mr Roger Hardy, who will remain an advisor to Essilor for the next three years. In the exclusive interview with VMail, which we republish here, Mr Carrier discussed why Coastal is a good fit for Essilor and how the acquisition will enable Essilor, which already owns two other e-tailers, EyeBuyDirect. com and FramesDirect.com, to significantly expand its online presence and the company’s multichannel capabilities. Mr Carrier said: “The internet complements traditional distribution channels, which remains the one able to provide added value in taking measurements and supporting wearers. We are vigilant that the development of online sales in the

optical industry does not come at the expense of wearer’s safety and the quality of the correction or product performance. “What’s unique about Coastal is the combination of the size of the company, the multiple countries it operates in and the multiple products it sells: eyeglasses, sunglasses, contact lenses. “That’s why we think it’s a good platform for more global expansion. The other online properties we own are much smaller. Most of their business is in the United States. They certainly did not have the scale and multinational aspect of this one.” According to Mr Carrier, Coastal does business in about a dozen countries around the world, including Canada, the US, Sweden, Norway, Brazil, Australia, New Zealand and Japan. Mr Carrier said Essilor has no plans to combine the three online businesses, each of which has a distinct identity. “The three brands will remain the same,” he said, adding that Essilor’s brand name won’t be visible to consumers. “It’s the same as with our other businesses,” he noted.Private-label frames will remain Coastal’s core business. “We don’t expect to see this change significantly,” Mr Carrier said. Although Coastal also sells spectacle lenses, Carrier emphasised that Essilor will not add Varilux, its premium brand of progressive lenses, to Coastal’s product mix or to any of the company’s other online sites. “We believe the internet is good for simple prescriptions at this point.

We are not going to promote progressives. They’re available but we see it as a channel that’s much better suited to single vision lenses, he said. “We want to make sure everyone benefits, whether it’s eye-care practitioners, consumers or the brand itself. So there will be no Varilux. That brand requires the professionalism of ECPs.” However, Essilor does plan to offer Transitions lenses through Coastal. “Transitions has always been sold in all channels. That’s the case today and will remain so,” he said. Mr Carrier said Coastal, which operates its own prescription laboratory, will benefit from access to Essilor’s global supply chain, including lens manufacturing facilities and, possibly its laboratory network. “From a supply-chain standpoint, we can bring synergies that can make Coastal more efficient. It’s a little preliminary to discuss it now. But considering that most products sold through this form of distribution are single vision, stock lenses. So when we’re talking about laboratories, it’s mostly edging and mounting,” he said. “Certainly we have capabilities when it comes to distribution of

lenses, and we have laboratoriess in those countries that serve those global markets. It’s a complex question. We think there will certainly be important benefits for Coastal to rely on Essilor’s entire supply chain.” One major strategic change Essilor does plan to make is to immediately halt the international expansion of Coastal’s brick-andmortar stores, an initiative that the company began last year. According to Mr Carrier, Coastal operates two stores in Vancouver, one in Toronto, one in New Zealand, one in Australia and a handful in Sweden. “Coastal had a large plan for retail expansion in multiple countries. Today, we’re making the decision to stop this expansion. Our intention is to look for a divestiture of those stores.” Essilor will also stop Coastal’s program of giving away free pairs of eyeglasses with a purchase. “For us, as the leader in industry, we do not find it’s the proper way to reflect the proper value of our services. So we’ve taken the decision to immediately de-emphasise the free-pair program and shut it down in the next weeks and months.” ■

in the Pilbara and Kimberley regions of Western Australia. Due to the numerous geographic, socioeconomic and technological challenges inherent in the provision of adequate health care, Margie’s achievements cannot be underestimated. Her passion and commitment to her work is unparalleled;

travelling to remote communities to conduct vision-screening programs, liaising with local health-care providers to establish a network of patient management and triaging high-risk patients for further assessment by visiting eye doctors. When Margie is not travelling in remote communities in

Australia, she lends her services to eye-care programs overseas in both East Timor and Papua New Guinea, which she of course helped establish. Margie reinforces the value of an individual’s resolution and proactivity in making a difference to the community.” ■

The bricks-and-mortar Clearly.com store in Sydney’s George Street is to be disposed of soon.

Continued from page 14... via tele-medicine to determine patient management remotely. Margie was also involved in the coordination of the Judy Glover Memorial Scholarship, which aims to provide final-year optometry students with an opportunity to be involved in remote eye care and multi-disciplinary patient management 16

JUNE 2014

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EDUCATION

RANZCO’s NSW branch holds annual scientific meeting in Hunter Valley – By Lewis Williams, PhD

he New South Wales branch of The Royal Australian and New Zealand College of Ophthalmologists held its annual meeting at the Crowne Plaza, Cessnock, in the Hunter Valley on 21-22 March, attracting an attendance of 250 ophthalmologists.

Glaucoma: treat the patient as a partner Associate Professor Ivan Goldberg’s (Sydney) very long association with glaucoma sufferers (as an ophthalmologist and as president of Glaucoma Australia) was on display to great advantage in Cessnock. His opening line was to treat the glaucoma patient as a partner in the relevant processes that follow. Research also confirms that the quality of life (QofL) of the glaucoma patient is lower than matched controls and that the QofL declines at a faster rate once the disease is diagnosed for the first time. As usual, compliance issues have proved to be a major problem, especially in view of the ‘subtle’ nature of the disease to the ‘uninitiated’ (new patient). However, in light of the shocking figures related to non-compliance in HIV/AIDS patients where compliance can be the difference between life and death, it would seem that diseases like

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glaucoma have little hope of achieving a very high level of compliance regardless of what steps are taken to promote it (the best laid plans of mice and [wo]men). Compounding the problem is the known tendency for clinicians to overestimate patient compliance levels (wishful thinking or an over-inflated belief in one’s own influence/power?). Factors working against good compliance include: being young, especially if of AfricanAmerican extraction, being in poor general health, actually reporting lower adherence to directions, being willing to admit non-compliance, being ignorant of the medication’s name, and having a negative family history of glaucoma. Using Pharmaceutical Benefits Scheme data to derive Australian compliance figures, it has been demonstrated that up to 50% of glaucoma sufferers are not fully compliant just 4-5 months after treatment was instigated. By the 4-year stage just 25% of patients are compliant. Only a little surprising in an Australian context, medication costs make little difference to compliance figures. However, if Australians were to lose their PBSsupplied cost-shield exposing them to the full/real cost of their medications, it is reasonable to assume that compliance levels would plummet.

Compliance levels were slightly higher when a medical specialist is the instigator of pharmacological treatment compared with a GP. Regardless, it has been shown that most patients are more comfortable talking with a practice’s staff that to the practice medical practitioner(s). Prof Goldberg proffered that if the IOP increases and the visual fields decrease while a glaucoma sufferer is under ‘treatment’, the practitioner should think ‘noncompliance’. Even the basic issue of eye-drop instillation is a serious non-compliance issue with some startling figures that showed up to 25% of instillers do not actually get the drops into their eyes and, worse still, half of that group were unaware of their failure. Many patients also failed to understand the desirability of compressing the naso-lacrimal ducts to reduce systemic absorption of the drug’s actives. Prof Goldberg mentioned a medicated ring insert, the Helios (ForSight VISION5), that fits under both lids much as a scleral contact lens edge would fit, as being a multi-day solution to glaucoma medication (dry eye and allergy variants are also under investigation – no Helios ring product is available anywhere as yet). Glaucoma Australia’s advice to practitioners is: be honest, do not

raise any false hopes, take care in phraseology when communicating with patients (the example given was the statement that ‘the disease had progressed’ – to the practitioner - it’s gotten worse, to the patient – progress has been made so the situation has improved), refer for rehabilitation as necessary, and overall, imagine yourself as being the patient and treat accordingly. Prof Goldberg made the point that VA was related to the RGC population and the normal healthy person lost on average one RGC every 90 minutes. Glaucoma increases that rate of cell loss significantly.

The brain and glaucoma Professor Stewart Graham (Sydney) elaborated on the intimate association between glaucoma (a neuropathy) and the brain. In a case of trans-synaptic degeneration, atrophy of the RGCs has been shown to follow removal of the primate striate cortex (first reported by Cowey, 1974). Similarly, an optic nerve axotomy (severing) results in a shrinkage of related neurons, a decreased retinal dendritic tree, and lateral geniculate nucleus shrinkage. Detectable molecular changes precede the cellular changes and apoptosis in trans-synaptic degeneration. Continued on page 20...

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EDUCATION Continued from page 18... Detecting some of those microstructural or neuropathological changes requires diffusion tensor imaging (DTI) a specialised form of magnetic resonance imaging (MRI) (sometimes simply referred to as diffusion MRI). Diffusion MRI measures axial and radial water diffusion in tissues of interest. Cortical changes in glaucoma include decreases in the optic radiations detected by DTI and secondary degeneration in the retinal nerve fibre layer (RNFL). While RNFL changes can result in scotomata, stimulation of the affected area is not always without response, suggesting some brain plasticity. Furthermore, stimulation of the analogous (concomitant) area in the fellow eye tends to increase the response in the ‘bad’ (affected) eye suggesting both brain plasticity and brain remodelling. The latter is also supported by the increased response measured when the stimulus is applied to the areas just outside a scotoma area.

Angle-closure glaucoma Dr Ridia Lim (Parramatta) delivered a presentation on angle-closure glaucoma (ACG) involving an anatomically-narrow anterior chamber angle, rendering it occludable. ACG may be intermittent

or acute although the former may precede the latter giving all concerned adequate warning of what might happen eventually. ACG can also be secondary. In narrow angle situations, Becker-Shaffer’s criterion for imminent angle closure risk is 20 ° or more of irido-trabecular contact whereas Prof Ravi Thomas (Brisbane) views contact in two quadrants as indicative of impending problems. A peripheral iridotomy (PI) is a fairly standard response to angle-closure threat or reality and to study the utility of a PI, a large study, the Zhongshan Angle Clasure Prevention Trial (the ZAP Trial, a China, UK, US collaboration carried out in Guangzhou) involving 11,000 subjects aged 50 to 70 was undertaken. Some 890 (8.1%) subjects met suspect criteria for primary ACG (PACG) and were given a Laser PI in one eye only and are being followed closely for 36 months. The study is still in progress but results from the testing of subjects has already shown that: a 15 minute dark-room provocative test has more effect in subjects with open angles (counter-intuitive); eyes with shallower anterior chambers and those requiring more laser energy to complete a PI have a higher risk of developing an acute increase

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in IOP immediately after their PI. The China location is appropriate as East Asian eyes are more prone to PACG than other races. Ultimately, the ZAP Trial hopes to elucidate what anatomical and IOP changes can be attributed to a Laser PI, the magnitude of the risk of leaving suspected primary angle-closure candidates untreated (an interesting ethics question), and who are the angle-closure candidates at greatest risk who might benefit from a prophylactic PI. Another study (EAGLE, UK) is examining the effects of early cataract surgery in PACG. Imaging techniques useful in PACG cases and suspects include UBM (ultrasound biomicroscopy, a lengthy [30 minute] procedure requiring two medical practitioners to administer), anterior segment OCT (takes just seconds and requires only one medical practitioner), Swept-Source OCT (e.g. Tomey’s Casia instrument) which Dr Lim described as a ‘leap forward’ probably because of its virtual 3D representation of the anterior ocular anatomy. Mechanisms responsible for angle closure include: irido-trabecular contact, plateau iris (deep anterior chamber but no ciliary sulcus), and irido-lenticular contact that might include the volcano sign (seen in gonioscopy, iris is relocated forward by a large lens narrowing angle but pupil margin and adjacent iris is curled ‘inwards’ forming a depression that looks like a volcano’s crater). Provocative tests such as extended stays in a dark room (guaranteeing maximum pupil dilation and therefore an enhanced chance of angle-closure) have not been replaced by the latest instrumentation including the various ‘flavours’ of OCTs. Angle-closure risk factors include being female especially if of East Asian origin. Lens vault is usually defined as the ‘protrusion’ of the lens profile beyond an imaginary line joining diametrically opposed scleral spurs. Dr Lim quoted Dr Harry Quigley (Wilmer Eye Institute, Baltimore) who said: “The iris is a sponge”. She then added that the iris volume increases with age (due to an increase in its area) resulting in more crowding of the anterior chamber.

Turning to the location of a PI she stated that current thinking is to locate it temporally (or nasally) rather than the more traditional superior position as that reduces dysphotopsias experienced commonly. The latter are due to the prismatic effect of the upper-lid tear prism refracting irregularly and randomly through the PI’s aperture.

Retinal ganglion cell layer analysis Dr David Wechsler (Burwood) questioned whether or not OCT retinal ganglion cell layer (RGCL) analysis was useful to investigations of glaucoma. The human retina contains more than 1 million RGCs but approximately 50% of those cells are located within 4.5 mm of the fovea (figures originally from Curcio and Allen, 1990). With much interest directed towards detecting glaucomatous changes before the visual fields are affected, the so-called pre-perimetric phase, retinal nerve fibre layer (RNFL) and RGCL analyses were considered prime candidates for investigation. Early detection is particularly relevant when the IOP is normal, fields remain unaffected, but Drance haemorrhages are noted at the optic disc. In the young, it is even more important given the bulk of their life has yet to be lived and good vision and full or at least large visual fields are their expectation. Dr Wechsler concluded that RGCL analysis adds significant extra information to normal (RNFL) OCT results. However, he noted that RGC analysis can yield false positives (up to 20%) and as always, good clinical judgement is still required on the part of the consulting practitioner. He also noted that the inner plexiform layer of the RGCL can be measured now using the latest instrumentation. Possible downsides/problems include: the confounding effect of an atrophic macula, axial myopia, and importantly, more difficult/less useful analyses in the elderly. His conclusion was that RGCL analysis was good for pre-perimetric glaucoma detection especially when other methods, including complex visual field assessments, prove to be unreliable. ■

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SOUTHERN REGIONAL CONGRESS

What optometrists need to know about cranial nerves – By Lewis Williams, PhD

he Sunday programme at the Southern Regional Congress on 2nd March included a well-attended public health symposium that flowed smoothly under the skilled chairmanship of Mr Mitchell Anjou, senior research fellow in the Indigenous Eye Health Unit of the Melbourne School of Population and Global Health and a former long-term director of clinics at the Australian College of Optometry. The inimitable Prof Erica Fletcher delivered her usual entertaining and erudite presentation focusing on what optometrists need to know about the cranial nerves. Her skill is delivering the core of information in a focused and informative way without getting too bogged down in excessive

and counter-productive detail. That was the perfect approach for her SRC topic. The only other presenter of such a lecture would have been neurologist and one time optometrist Dr Neil Shuey but he was absent from the lecturer line-up of SRC 2014. Using an analysis of the problems experienced by two patients with radically different symptoms and signs to illustrate the approach, Prof Fletcher analysed the neurology related to the functional loses detected to deduce the location of the lesions at the seat of their problems. One patient had ‘locked-in’ syndrome that exhibited only vertical eye movement and not much else whereas the second patient only had decreased vision in one eye. After a brief overview of the

gross anatomy of the brain she revealed that the only really important brain structures were the long fibre tracts, the reticular formation (located in the brainstem responsible for vertical and horizontal gaze co-ordination, regulating the sleep-wake cycle and discerning important incoming stimuli such as touch, pain, and temperature), the nuclei of the cranial nerves, and the cerebellar circuitry (paths within the cerebellum thought to be responsible for movement planning, sensory input evaluation, and some cognitive functions). Most cranial nerves originate in the brainstem, four above (9, 10, 11, 12), four within (5, 6, 7, 8), and four below (1, 2, 3, 4) the pons. Dividing the cranial nerves into three basic functional groups the following

Erica Fletcher emerged: 1 (olfactory), 2 (optic), and 8 (vestibulocochlear) are sensory, 3 (oculomotor), 4 (trochlear), 6 (abducent), 11 (accessory), and 12 (hypoglossal) have motor functions, while 5 (trigeminal), 7 (facial), 9 (glossopharyngeal), 10 (vagus) are mixed nerves. Each of the cranial nerves relevant to the eye were then detailed by function, how their integrity could be assessed, and the effects (pathology) of their loss of function/ disease/compression/severance. Overall, a fascinating, important, but intricate topic handled well. ■

‘Racism is alive and well in health care’

he second presenter was Research Prof Yin Paradies who is the deputy director of the Centre for Citizenship and Globalisation at Deakin University’s Burwood campus in Melbourne. From his online university profile: he conducts interdisciplinary research on the health, social, and economic effects of racism as well as anti-racism theory, policy, and practice. He defined racism as unfair and avoidable disparities in opportunity, benefits, and resources that can be based on ethnic, racial, or cultural group affiliations. Nobody is immune from racism or its practice. He defined three sub-groups of racism: internalised, e.g. attitudes suggesting whites are more intelligent than blacks, interpersonal: e.g being abused by another on the street, and systemic, e.g. young indigenous people, especially males, are 2x to 3x more likely to be arrested. Prof Paradies confirmed that there are significant disparities

in the quality of health care delivered to minority groups and others. If a healthcare provider or the health system in general is racist in approach, the care delivered is likely to be of lower quality, result in an underutilisation of health services, and delay the seeking of care, all of which produce poorer care and outcomes. In some instances, implicit association of racism with certain diseases or health conditions, e.g. obesity, drug use, etc. can prejudice the chances of good outcomes among those identified as being ‘associated’. Racism need not be overt and the subtle problem of unconscious bias can have the same deleterious sequelae.

Indigenous sector The health issues surrounding indigenous Australians is well know and understood in ophthalmic circles largely because of the known ocular effects of the trilogy of diabetes,

hypertension, and glaucoma. Of course the eyes are not the only focus of health care and other issues such as kidney disease results in indigenous transplant rates 3x that of other Australians compounded by the fact that they are also likely to receive about a third of the health care considered appropriate. Apportioning blame for the former on the latter has not been attempted but a relationship almost certainly exists. In a 2008 survey, 4.3% of indigenous people reported discrimination by medical practitioners, nurses, and other healthcare practitioners, a figure that probably underestimates the reality. An examination of the media often shows it to be overly ‘whitish’ as judged by non-verbal cues, e.g. actor race/ethnicity not mirroring the population reality. Prof Paradies perused the material from Optometrists Association Australia before his presentation and noted that it too did not reflect accurately the population mix of the

Yin Paradies patient base. He noted that the situation was probably more an advertising agency issue than a brief from OAA, especially in light of the work undertaken by many in the eye-care professions (the four Os).

‘Colour blindness’ ‘Colour blindness’ was the description used by Prof Paradies to Continued on page 24...

JUNE 2014

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SOUTHERN REGIONAL CONGRESS

Differential corneal staining

r Marc Bloomenstein’s presentation on differentiating corneal staining started with a refresher on the anatomy of the anterior eye and its tear film. Vital stain uses were given as: the fit of contact lenses (rigid and soft), tear film visualisation, foreign-body localisation, assessment of the palpebral conjunctiva, and detecting ocular abnormalities including dry eye, mechanical trauma, and inflammatory and infiltrative conditions. For many years now the standard vital stains have been sodium fluorescein (NaFl), rose bengal (RB), and the ‘youngest’, lissamine green (LG). The latter has replaced RB usage in many practices as both detect dead and degenerated epithelial cells and mucous and RB (a fluorescein derivative) has a tendency to sting on instillation. However, in the relatively new pursuit of examining the so-called lid wiper on the inner surface of the upper eyelids and the lid wiper epitheliopathy (LWE) that can result from insufficient tears and the loss of lubricity of lid on anterior eye afforded normally by the tears, Dr Bloomenstein believes RB is better. Interestingly, many journal articles on LWE typically show LG staining in their colour paltes. A contributing factor to that situation may have been the lower availability of RB in recent years. Dr Bloomenstein’s recommendation for LG usage was to put more than enough stain on the anterior eye and wait about

60 seconds before commencing the examination without further delay. Little staining can be indicative of goblet cell drop-out (no goblet cell-produced mucus to stain). For NaFl staining a 3-5 minute delay was recommended however excessive amounts of stain or too high a concentration are undesirable as the resulting absorption of incident light and self-absorption of fluoresced light leads to self-quenching and a dim slit-lamp image of staining areas. Fluorescent intensity is also pH-dependent. Although NaFl staining was traditionally thought to be indicative of dead or damage cells, more recent research stimulated by the staining-grid ‘wars’ to some extent, suggest that NaFl can enter an intact, healthy cells resulting in false but transient ‘staining’.

Inferior staining

inflexible positions. However, the very low relative humidity (often <10%) of their work environment at operational altitudes makes finding a solution more pressing.

Other staining Superior staining may be due to superior limbic keratitis or a limbal cell or limbal stem cell deficiency. Other causes of staining include chemical burns, trauma, Thygeson’s superficial punctate keratitis, epidemic keratoconjunctivitis, herpetic diseases, and dry eye. In dry eye cases, the assessment of staining intensity suffers the same problem that symptom severity does – a lack of a reliable proportional relationship with dry eye severity determined objectively, i.e. a severe dry eye can have little staining or symptoms and mild cases of dry eye can have significant staining or symptoms.

Staining in the inferior cornea might be an indication of an incomplete blinker, blepharitis secondary to MGD, corneal exposure, or environmental factors. If exposure is confirmed and computer monitor use is involved, a change of vertical screen position may result in less cornea and bulbar conjunctival exposure by allowing the lids to cover more of the anterior eye. The case of pilots and the positioning of overhead instruments and controls in an aircraft’s cockpit is more difficult because all, including the pilot, are in relatively

Miscelaneous conditions

dealing with superstitions, etc. that had to be addressed if they were to be viewed as more than just spectacle suppliers. To overcome racism an optometrist must come to understand stereotyping, prejudice, bias, etc. and learn how to respond to racism, including that sometimes demonstrated by patients towards their ‘different’ practitioners. An understanding and/or a tolerance of affirmative action, race, ethnic,

cultural, sexual preference, and religious diversity was necessary to treat people equitably. To defuse racial bias Prof Paradies suggested: getting motivated to overcome personal biases, develop an understanding of the difficulties confronted by the racially diverse, develop more confidence in regulating ones own emotional responses to ‘different’ others, and enhance ones ability to take a patient perspective and

Using epithelial basement membrane dystrophy (EBMD), recurrent corneal erosions (RCE), and corneal degenerations as examples that can need differentiation, Dr Bloomenstein took the audience through methods of a differential diagnosis based on staining and other factors such as age of onset. He then gave an overview of the controversy surrounding contact lens care solution-induced corneal staining (SICS), an issue now a decade old relating to corneal staining

Marc Bloomenstein apparent some 2 hours after lens insertion after the lenses were cared for in a multipurpose solution. Further investigation has suggested that products incorporating the most popular antimicrobial (a polihexanide) show a staining peak at 2 hours whereas the alternative chemistry (PQ1) shows a similar peak at 30 minutes. The approach recommended is to assess the staining 2 hours after lens insertion and again 8 hours after insertion and if staining is still present than a real problem exists. His conclusion was that it was Shakespearian in nature – much ado about nothing. The consensus would appear to be that SICS is related to contact-lens-care product preservative/antimicrobial uptake and subsequent release by various lens materials and has not been linked to any significant pathological effect. Dr Bloomenstein finished his lecture on that note. ■ Next year’s SRC is scheduled for the same venue from 21-23 February

Continued from page 22... describe the attitude to a comfortable status quo typified by the attitude that ‘it’s good/OK now, let’s keep it that way’. He then raised a term, ‘cultural competence’ which he defined as a set of congruent behaviours, attitudes, or policies that become a ‘system’. On the issue of the cultural competence of optometry/optometrists he noted possible issues with language, personal space (e.g. female Muslims),

JUNE 2014

develop empathy accordingly. He went as far as suggesting that practitioners build partnerships with the groups that make them less comfortable as a way of overcoming their discomfort. He summarised his presentation by saying that racism is alive and well in Australia’s health-care system and optometry is no exception. He suggested the development of racial and cultural competencies as a solution. ■

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CURRENT RESEARCH

Harvard Medical School lectures at UNSW’s School of Optometry – By Lewis Williams, PhD

he University of NSW School of Optometry and Vision Science was visited separately by two leading vision researchers from the Schepens Eye Research Institute (SERI) at the Massachusetts Eye and Ear (affiliated with the Harvard Medical School). Both gave presentations on their current research, some of which overlapped. The first visitor was Dr Russell Woods who holds assistant professor and assistant scientist positions at the SERI. The second visitor was Prof Eli Peli, professor of ophthalmology and currently the Moakley Scholar in Aging Eye Research at the SERI. Dr Woods is a UNSW SOVS alumnus who also holds a PhD in visual science from the City University, London. At SERI his primary area of research is vision rehabilitation focused on novel aids for the vision impaired, especially those with central-vision loss typically due to AMD. Prof Peli is a collaborator in much of his research. Prof Peli is a senior scientist at SERI, professor of ophthalmology at Harvard Medical School and an adjunct professor of ophthalmology at Tufts University School of Medicine, adjunct professor of optometry, New England College of Optometry, and director of the Vision Rehabilitation Service, New England Eye Center (Boston). He also holds a DSc (HC) from the State University of New York (SUNY, 2006). He is an optometry alumnus of New England College of Optometry. Dr Woods’ presentation dealt with viewing television and videos with impaired vision especially by those with a central scotoma caused by aged macular degeneration. The importance of that pursuit can be gauged from data he presented regarding viewing habits: in the United State, about 60 hours of TV and/or videos are watched every week; in Australia a more modest 89 hours a month is watched but that is likely to 26

JUNE 2014

increase towards the US figures as advances in digital technology encourage more viewing activities. Data relevant to those with vision impairment suggest that the amount of screen viewing attempted differs little from those with normal vision. To compensate for their loss most sit closer to the screen to benefit from proximity magnification. The obvious adaptation of acquiring a device with a larger screen and optimizing the seating position is mostly limited to the young vision impaired which means many others can benefit from such a simple change.

Eli Peli One of the greatest difficulties faced by vision researchers is assessing the impairment accurately and, if possible, objectively. Commonly, they resort to ‘relative preference’ techniques in which a user’s preference is gleaned by a series of A-B comparisons. Because many of the vision impaired view screens alone, the researchers have pursued in detail, methods of image enhancement that the viewer can invoke to suit their own needs without having to consider the needs of others who might be normally-sighted or suffer a different vision impairment. Objective methods include facial recognition, facial expression determination, and ‘odd image

out’ detection. Visual search in which a target is shown and the subject is asked to find the same in a complex image is another method in which correct responses and/or times to respond correctly, can be determined. Unfortunately, the latter two factors tend to be confounding or mutually exclusive andare also probably somewhat personality-dependent. One rehabilitation method trialled is contour enhancement in which the edges of image components, e.g. a face, are enhanced to make them more obvious and/ or more detectable. While that feature tends to worsen search speed/ accuracy it is often preferred by the vision impaired. In another related technique, edges only are extracted electronically from an image and the extracted detail (not much more than an incomplete set of outlines) are overlaid onto the original before presentation. Now that embedded controllers and small computers are fast and affordable, such processing can be done in real-time affordably, i.e. enhancement ‘on-the-fly’. Electronic magnification has only a small rôle to play in central vision loss because of the attendant reduction in the field-of-view. A derivative of that technique that addresses that issue partially is ‘bubble magnification’ is which only the local area defined by a pointer or mouse cursor is magnified selectively and the modified image is blended smoothly into the surrounding image by a progressive reduction in magnification near the edge of the ‘bubble’ (some Apple computer operating systems have had that feature for viewing small icons on their home screen for some time). People with central vision loss have reduced eye movement control through the loss of their fovea and that leads to reduced coherence of gaze, i.e. they tend to look all over the place. People suffering from a

hemianopia rather than a central vision defect have different difficulties even when their central vision may be quite normal and their gaze control adequate. Sometimes the cause of their hemianopia, whether it is divided vertically or horizontally, and whether it is homonymous or heteronymous in nature, influence the outcome.

Russell Woods Dr Woods’ research is ongoing and a universal solution has yet to be found. One thing is certain, technological advances within the last 10 years have opened up many more possibilities of useful image modification than ever before. Prof Peli arrived at the Rupert Myers Theatre, UNSW for his presentation wearing a Google Glass attached to his normal spectacles. The audience should not have been surprised because it turns out that Prof Peli is a consultant to the Glass project. Like Dr Woods, he too is in the vision enhancement and vision rehabilitation business. Band-pass filtering was one method he detailed. Given that high-frequency image components are beyond most vision-impaired subjects they are selectively and deliberately ignored because nothing is likely to make them resolvable. Conversely, low-frequency components are probably visible without enhancement so Continued on page 29... www.insightnews.com.au

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CURRENT RESEARCH Continued from page 26... that means image enhancement only needs to focus on the midrange components in the hope of making then visible/detectable. Theoretically, that makes the enhancement task simpler meaning that more resources can be focused on a narrower task. However, as mentioned above, the presence of the normally-sighted or others people with different vision deficits means that the task of those in vision rehabilitation is made more complex or even impossible as not all needs can be met simultaneously on a single screen. One obvious solution that meets with significant social resistance is to deploy a head-mounted display unit that only caters for a single individual, albeit while preventing normal social interaction. Subjectively, facial recognition of known, famous people is used but a more objective method uses a subject’s response (detection or failure to detect) to pulsing noise in a background field-of-noise presentation. Such tests do not require any prior knowledge, rather they just need an understanding of what they are being asked to do. Using enhanced and normal screen presentations, it is possible to explore the visual performance of individuals and to compare performances of different enhancement techniques. Analysis of the graphical data produced is often based on an ‘area under the curve’ determination. The large individual variations in response to seemingly similar vision

losses mean that some respond well, some only benefit a little, while others show no improvement at all. Generally, the researchers seek to determine the maximum possible improvement as well as the level of improvement preferred and the enhancement responsible for it. It is noteworthy that not all subjects select the maximum enhancement achievable. Edge-detection enhancements based on a model of normal human vision is another enhancement but like many image modifications it is possible to ‘overdo’ changes to such an extent that the alterations are sometimes rejected by subjects. Often, a moderate rather than an extreme version of an enhancement trialled is preferred and it is not unknown for the original image (no enhancement) to be selected suggesting that the techniques ‘are not there yet’. Although wide-band (most frequencies altered) enhancement worked well, only 20% showed a statistically significant improvement although more expressed a subjective preference for it. The simplest method is to provide the subject with the controls affecting image properties and request they adjust the image to their liking. To enhance the assessment and to speed the process, their setting is altered every 15 seconds and a request to repeat the process is made. The repeatability of their responses can be assessed and most but not all differ little in their choice. A stable choice usually indicates that the enhancement on

trial has a real and beneficial effect. Other tests seek to ascertain justnoticeable image differences in settings while others use side-byside comparisons. Some viewers prefer a smoother or a sharper enhanced image but those preferring a smoother presentation generally reject extreme enhancements. One influential factor in choice is the presence or absence of faces in the material presented. In Prof Peli’s opinion the creation of valid tests for evaluating impairment and enhancements has proved to be as difficult as the development of suitable enhancements.

MPEG The relatively common compression algorithm for videos based on JPEG images (one of several MPEG standards) lends itself to real-time sharpening of images. A possible downside is the number of artefacts that normal MPEG compression creates. During enhancement those artefacts can contribute to the creation of more and unwanted ‘additions’. What Prof Peli and SERI have been researching is the insertion of an enhancement algorithm into the decompression electronics and/or software before final decompression occurs, i.e. early in the whole process and before the usual artefacts are created. That is done by inserting enhancement processes that generate altered quantization tables for the decompression process. Some artefacts are still created

but they are much less intrusive than would otherwise be the case. The most complex method under investigation currently utilizes a see-through, head-mounted display in which a cartoon of enhanced edges-only data generated by fast image analysis software, is positioned accurately over, and aligned perfectly with, the straightthrough, real-world image seen through the device. While the speed of processing is adequate, the accurate alignment of the processed data with the real-world images is a challenge. Although a device of that type was released commercially the light loss in its systems led to a dim image. Weight, complexity, and cost of that approach remain a challenge. To provide distance information stereo set-ups have been developed using two video cameras mounted on opposite sides of a spectacle frame. Image processing is done by a small external computing device residing in a pocket or on a belt. A simplification of such a theme is Google’s Glass device that uses a single camera that only caters for a single distance. However, that distance is user-adjustable. Prof Peli is a consultant to the Glass project and he has also been a consultant to several other commercial vision aids projects over the years. His presentation created considerable interest among the large audience that included staff and students from other universities and other disciplines, especially psychology/vision perception. ■

JUNE 2014

DIARY DATES

Diary Dates 2014 JUNE

19 - 20

NACBO Vision Conference 2014 Location: Coogee, Sydney Contact: www.acbo.org.au or Email: info@acbo.org.au

World Sight Day Contact: www.vision2020australia. org.au/events/world-sight-day

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

6-9 BCLA Clinical Conference & Exhibition Location: ICC, Birmingham Contact: www.bcla.org.uk

22-24 Association of Regulatory Boards of Optometry Inc. (ARBO) 2014 Annual Meeting Location: Philadelphia, Pennsylvania Contact: http://www.arbo.org/2014_ meet.php

24-27 Manchester Royal Eye Hospital Conference Location: Manchester Conference Centre Manchester, United Kingdom Contact: www.mreh200.org.uk

27-29 Retina International 2014 World Conference Location: Paris, France Contact: www.retina2014.com

18-21

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

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

SEPTEMBER 13-17 ESCRS 2014 Location: London, United Kingdom Contact: www.escrs.org Email: escrs@escrs.org Ph: +353-1-209-1100 Fax: +353-1-209-1112

17-21 Afro-Asian Congress of Ophthalmology Location: Xian, China Contact: AACO2014 Secretariat Email: AACO2014@hotmail.com Website: www.aaco2014china.org

25–28

JULY

GET YOUR EYES TESTED THIS JulEYE

26-28 2nd Asia-Pacific Glaucoma Congress held in conjunction with the 10th International Symposium of Ophthalmology Location: Hong Kong Contact: Email: venuscheung@ iso-hk.org Website http://apgc-isohk-2014.org/

OCTOBER

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JUNE 2014

International White Cane Day Contact: www.visionaustralia.org

16-17

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

1-31 JULY

NOVEMBER 12-15 2014 Italian Society of Ophthalmology Annual Meeting Location: Rome, Italy Contact: www.soiweb.com

13-16 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

18-21 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

DECEMBER 1-4 International Strabismological Association Meeting Location: Kyoto International Conference Center, Kyoto, Japan

2015 JANUARY 18-23 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

24-30 Ski Conferences for Eyecare Professionals Rusutsu Ski Resort,Hokkaido, Japan Contact: www.skiconf.com

FEBRUARY

22-26

28 - March 2

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

MIDO International Optics, Optometry and Ophthalmology Exhibition Location: Milano, Italy Contact: +39 02 3267 3673

1-4

25-27

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

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

DO YOU HAVE AN EVENT FOR OUR CALENDER? Please email your details to: insightnews@bigpond.com

www.insightnews.com.au

MODES OF PRACTICE

New US optometrists’ group targets vision-care plans in member alert T

he American Association of Doctors of Optometry formed in mid-2013 and headquartered in Agoura Hills, California, has sent an alert to its members questioning the behaviour and business ethics of some of the United States’ largest vision care plan companies. With evocative goals such as ‘Defending eye care providers from unfair and illegal vision care plan business practices’, ‘A national association of eye care providers working together to improve eye care in America’, and more tellingly ‘A national union of eye care providers working together to improve eye care in America’ the targets of the AADO are obvious – third-party vision care providers

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that are trying to get more deeply involved with the patient (plan holder) directly thereby cutting out some of the interactions between practitioner and patient.

AADO The AADO is run by a small board of trustees, with the only member having an international profile, especially here in Australia having visited several times, is Dr Art Epstein, OD, he of the chief medical editor of the Optometric Physician ‘fame’. Initially, it was developed and run by one Dr Craig Steinberg OD. Importantly, the AADO is pursuing a path of independence from all other organisations, even those with overlapping goals, so as to

avoid any anti-trust implications that can result from two or more organizations pursuing openly the same apparent objectives. From its website: “The AADO is an organisation created for the sole purpose of improving access to, and the quality of, eye care in the United States. It will achieve that purpose by removing barriers to care imposed by 3rd party payers, removing the barriers to free competition among eye care providers, and by advancing and protecting the interests of optometrists during times of significant changes in American health care delivery so that they can continue to take care of the needs of the American public.” While laudable, the freeenterprise and self-serving aspects

of that description are only disguised thinly. The most recent alert centres on an attempt by one plan (Superior Vision/Block Vision, a recent merger of two separate plans) to bar all contact-lens purchases by patients from their own service providers (optometrists) so that they, the plan, can be the sole provider of contact lenses to plan holders (patients). As a result of resistance from practitioners Superior/Block have announced that their plan is ‘on hold’ pending further deliberations. To rub salt in those fresh wounds, they were intending to apply their supply ruling only to independent practices and not corporate practices signed up as providers. ■

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Deakin Optometry 11/04/2014 9:34 am

JUNE 2014

SUSTAINING VISION

UV and high-energy visible light: effects on an ageing eye (part 2) – By Mark Mattison-Shupnick and John Lahr*

Trusted Eye-Care Expert We didn’t mean to get you discouraged about ageing in Part One of the story on the effects of UV and highenergy visible light on the eye, particularly the ageing eye. However, being prepared and being able to tell patients/customers what to do is the key to minimising the effects of UV and HEV as we age. It also maintains your position as a trusted eye-care expert. First, recommend to all patients that they get a comprehensive, dilated eye examination annually, especially if over the age of 50. The early detection of agerelated eye diseases can ensure treatment when it is most important. A dilated examination also lets the eye-care practitioner see the effects of systemic diseases like diabetes and high blood pressure or aged macular degeneration that only a refraction would miss. Next, attenuate the most UV and HEV radiation possible, indoors and outdoors. In order to do this, knowledge of lens attributes as it relates to radiation attenuation is required. Modern lenses should block UV and HEV using all the properties of the lens, that is, coatings on the front, lens material, polarising films, photochromics and the coating applied to the back. The frame should fit well and provide good coverage, and minimise the UV and HEV getting to the eye from the top and sides. Usually in outdoor eyewear that means that the closer the fit and the more wrapped the frame, the better the coverage.

UV/HEV Absorbing Materials: Start with the right lens material since it is the platform to which you’ll add the design and then the lens treatments. However, UV and 32

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HEV blocking is the result of the total lens and how it’s constructed. The materials that are inherently 100 percent UV absorptive are Trivex material, polycarbonate, 1.60, 1.67, 1.70 and 1.74 high index. Standard hard resin plastic (about 90 percent UV absorptive) requires additional UV treatment that might adversely affect AR adhesion. No clear lens materials by themselves are blue light absorbing (at least not yet).

UV/HEV Blocking Treatments: Lens treatments like photochromics and polarisation, or combinations of the two (for example, Transitions Drivewear) are 100 per cent UV blocking. For blue light, lenses with colour treatments provide selective absorption using either polarising films or tints. Therefore, knowing the transmission characteristics of lenses before and after coating allows you to deliver the best outdoor lenses that block UV and HEV. Request transmission curve charts from your laboratory or lens manufacturers (total lens = lens material + coating and/or treatment) to know the best lenses to block short wavelength, high-energy blue light outdoors. Also ask for the laboratory’s recommendations. You know that all outdoor lenses should be anti-reflective AR, on the back surface. This reduces the brighter-appearing back-surface reflections especially because of their very large size (the concave mirror acts like a convex lens and magnifies the reflection). Consider switching to a UV-blocking back surface AR since there is significant back-reflected UV from lenses that can enter the pupil. The same surface reflectance is also true of blue light outdoors. On the lens front, consider coatings that increase reflectance of the

LIGHTING FOR OLDER ADULTS Good-lighting advice makes you more of an expert to those with small pupil, cloudy media, cataracts, AMD, droopy lids, etc: • Make ambient lighting uniform within a room and room-to-room. Older eyes take longer to adjust to changes in light levels. • Higher levels of light: Age-related eye changes restrict and absorb light, so more light is needed to compensate. • Glare-free light: Light scatters within the eye causing an increased sensitivity to glare. • Light that helps distinguish colours: The lens of the eye yellows with age, so proper lighting can help compensate. • The colour rendering index (how true colours will appear) should be 80 or above. Paint walls and ceiling with lighter colours, using a flat finish in general areas, or a satin finish in kitchens and bathrooms. Most paint companies list the light reflective value (LRV) of each paint colour either in the index or on the paint chip. Suggested range for the ceiling is an LRV of 75 to 90 and the range for the walls is an LRV of 60 to 80. The higher the number, the more light will be reflected. Adapted from Lighting Your Way to Better Vision (Illuminating Engineering Society of North America, 009)

short wavelength blue while the back reduces the reflectance. When outdoors, frames that provide better coverage with increased face form can help; wrap frames do the best job. Yes, it’s a balancing act between the fashion, style and protection in sunwear. Use those great lens tools and make a difference in the great looks of sunglasses while you deliver great performance.

Indoor Lenses: Lastly, the ability to block UV indoors is easily accomplished using UV transmitting coatings and UVabsorbing lens materials. However, blocking blue light indoors has been difficult in clear lenses since any of the blue-absorbing tinttype treatments added significant yellow to the lens, until now. New blue-light blocking AR lenses are available. Some examples are, Essilor Crizal Prevencia, Hoya BlueControl and Nikon SeeCoat Blue. Each of these lenses handles blue light blocking

somewhat differently. Some use absorption, others reflectance and vary the properties of the front and back surfaces differently to produce the desired blockage. Contact your laboratory for technical details and availability.

Colour, sleep and contrast Selectively managing the colour spectrum through lenses is important. Altering normal colour perception through glasses can have improved effects for sports and general lens use because lenses can be made to increase the vibrancy of what is seen. For the ageing eye, this can be an important stimulus when cataracts, cloudy media, small pupil, retinopathy or any of a variety of special needs has compromised the visual system. When a yellowing crystalline lens scatters blue wavelengths, it can mask differences in the shades of violets, blues and greys. That makes these colours appear duller. An example may be a gutter where

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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

SUSTAINING VISION

it becomes impossible to distinguish the edge. That is also true for overcast days or dusk. That can slow reaction time, a critical driving requirement. Therefore, for outdoor eyewear use spectacle lenses that improve contrast. They are beneficial to the ageing eye’s requirement for all daily tasks. From ‘Ageing of Eyes Is Blamed for Range of Health Woes’ (L. Tarkan, New York Times, February 20, 2012): “The gradual yellowing of the lens and the narrowing of the pupil that occur with age disturb the body’s circadian rhythm, contributing to a range of health problems… In a study published in The British Journal of Ophthalmology, Dr Mainster and Dr Turner estimated that by age 45, the photoreceptors of the average adult receive just 50 per cent of the light needed to fully stimulate the circadian system. By age 55, it dips to 37 per cent, and by age 75, to a mere 17 per cent.” The journal study went on to say, “Researchers in Sweden studied patients who had cataract surgery to remove their clouded lenses and implant clear intraocular lenses. They found that the

incidence of insomnia and daytime sleepiness was significantly reduced. Another study found improved reaction time after cataract surgery.”

Behind the wheel Lenses, colour, selective absorption, visual reaction time and ageing all affect driving ability. Since a car is a lethal weapon, recommend the best eyewear for driving. Practitioners, in one-on-one conversations are likely driving confidence counsellors. Get them out of that cheap pair of plano sunglasses they bought at the petrol station that they quietly wear together with their other glasses while driving. Demonstrate to every senior how the right colour (filter) and treatment can enhance their outdoor vision while it protects their eyes.

Spreading the word Become an expert by understanding the effects of UV and HEV for every one of your aged patients. However, it’s a bit like selling progressives; if you are not presbyopic, it is hard to understand the problem.

Regardless, be empathetic, tease out the real problems and use the tools that you have in high-contrast outdoor AR lenses and clear and photochromic indoor AR lenses. Let your patients know of your expertise in an email newsletter that perhaps describes three facts about the effects of UV and the products that address that issue. Add Facebook posts as a service to your patients and to communicate the opportunity that you have in the products and expertise of your practice. Each patient card represents a potential family in which there is a senior whose eyes require care. For those whose vision is affected by the long-term affects of UV and HEV, consider a personal letter addressing their care plan. Notes to them about the importance of good outdoor eyewear, the right darkness and colour, photochromics and a reexamination schedule can make a difference maintaining the sight that they do have.

Conclusion Discuss UV and HEV with every patient. That opens the door to

being more than just a place to buy glasses. The patient should see you as an expert whose advice they seek. Know the lens solutions available and be able to describe them to patients in simple terms. Ensuring visual independence is a lifelong goal. It’s a practitioner’s work to ensure only minimal daily doses of UV and HEV. However, once your patient is aged, the requirements to maintain independence are critical. ■

*Mark Mattison-Shpnick, ABOM, is currently director of education for Jobson Medical Information LLC, has more than 40 years experience as an optician, was senior staff member at SOLA International and is a frequent lecturer and trainer. John Lahr, OD, FAAO, is vice president of provider relations and medical director of EyeMed Vision Care. ‘Vision’s declaration of independence—Part two—UV, HEV and the Ageing Eye’ was originally published in 20/20, a publication of Jobson Medical Information LLC.

Easier claim lodgement with DVA

rom 1 July you lodgement of Department of Veterans’ Affairs claims will be easier using a new web-based channel called DVA Webclaim. DVA Webclaim is a no-cost service designed primarily to assist dental and allied health providers who only have a small number of DVA clients to claim. It will provide practices with efficiencies by reducing the delays and costs associated with mailing

manual claim forms and will allow lodgement of health service claims and will provide instant responses to the status of claims. DVA Webclaim will be available on the Department of Human Services’ (DHS) Health Professional Online Services (HPOS) portal. Some of the features of DVA Webclaim include: • claims assessed in real time; • most claims will be processed

immediately and paid the next business day into nominated bank accounts (compared to 20 business days for manual claims; • complex claims that require manual assessment are processed within two business days; • access up to two years of a practice’s DVA claiming history; and • access to the HPOS secure email facility to ask DHS questions about your claims. Access to DVA Webclaim

will need: • PC or laptop with a USB port; internet connection; and individual Medicare Public Key Infrastructure (PKI) certificate – to apply for an individual PKI certificate go to humanservices. gov.au/pki. For more information on DVA Webclaim visit: humanservices.gov.au/hpos or www.dva. gov.au/service_providers/Pages/ Webclaim.aspx. ■

Award for Sydney ophthalmologist

YDNEY ophthalmologist Associate Professor Frank Martin has been awarded a peer-nominated second annual Michelle Beets Memorial Award, which brings $20,000 to buy medical equipment to improve and further the provision of care

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for children in his field. Prof Martin is an ophthalmologist at the Children’s Hospital at Westmead, Sydney, and, according to his colleagues at the hospital, he was the driving force behind a campaign to encourage young ophthalmologists to train

in paediatric ophthalmology. He also conducts voluntary outreach services in Australia and overseas to provide ophthalmic care to disadvantaged children with sight-threatening diseases, and is in private practice as well.

The Michelle Beets Memorial Awards are funded by the NSW health department to honour the work of the late Michelle Beets, a nurse manager in the emergency department at Royal North Shore Hospital who was murdered in 2010 and her killer jailed for life. ■

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DISPENSING

What’s New

New freeform bifocal – Shamir’s Duo

hamir has just released a new digital freeform bifocal – Duo. The new addition to its product range was developed owing to the many restrictions that apply with the old fashioned D-seg bifocal design. The old style bifocal causes image jump when the eyes drop into the reading zone; that does not apply with the free-form Duo. Many D-seg bifocal wearers complain of the “unsightly line” that really dates the age of the wearer and detracts from the look of the

spectacle appearance. Shamir’s Paul Stacey said: ‘When coating a traditional bifocal a build up of coating on the seg line owing to the ledge, is always apparent. That is eliminated with Duo. As well as that, now practitioners can choose any material or any index, ™ which is not the case with the oldfashioned bifocals. “When ordering Duo measure and fit on the pupil centre; not on the bottom eyelash line. The minimum fitting height is 15mm.” ■

SHAMIR DUOTM

FLAT-TOP

SHAMIR DUO VS. FLATTOP BIFOCALS The difference that makes the difference

Let’s Talk We all know good service is key to a successful business, but good service should also lead to good business, that is, a good bottom line. Yet practitioners are increasingly faced with the dilemma of patients who come in and want their PD measurement so they can purchase their glasses online, or a non-customer who might want a missing screw or nosepad replaced or a frame adjustment, all without charge of course, just because you are in a convenient location. You can charge for the service or you can provide the service with a smile and use the opportunity to increase your own bottom line. All you need to do is start a dialogue. For some talking points that can lead to a productive and profitable experience, check out these Insight Basics.

Time for a change

A customer stops in to have a lost screw replaced. This is the perfect opportunity to suggest he or she take a look at your latest screwless styles, which will seem especially appealing in light of the missing screw.

Essilor’s FGX partnering 13,500 convenience-store group in US

ssilor International’s whollyowned subsidiary since March 2010, FGX International, has entered a sunglass distribution partnership with Eby-Brown, one of the largest distributors to convenience stores in the United States, servicing more than 13,500 locations. The partnership expands FGX’s presence within the convenience channel of distribution. Eby-Brown has been operating for 120 years. “They have provided us with great market insight and an extremely strong brand that will allow us to deliver the right solutions to our customers,” Mr Steve Burbridge, executive vice president of sales at FGX, said. “This is an important area of growth for our company. Convenience stores efficiently cater to time-starved consumers and EbyBrown is a crucial partner to ensure FGX’s impressive portfolio of brands is easily accessible to consumers.” According to the National

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Association for Convenience and Fuel Retailing, convenience stores serve nearly 160 million people each day and 58 billion customers each year. FGX began distribution to convenience stores two years ago and continues its commitment to growing within this category, the company said. “We are extremely pleased to be partnering with FGX on a new program for eyewear, which will serve as one of the key elements of our overall general merchandise assortment,” Mr John Roach, vice president of merchandising at Eby-Brown, said. “They have provided us with great market insight and an extremely strong brand that will allow us to deliver the right solutions to our customers.” Eby-Brown has seven distribution centers, and began distributing Foster Grant and selected licensed brand sunglasses, such as NASCAR, in May. ■

A new you

For the customers wearing a traditional aviator or rectangle, hand them your newest preppie, clubman or CatEye design, just to try on. Be sure a mirror is handy. If a style looks good, take a photo and email it for future reference.

Material matters

With materials, there are many options, not just plastic and metal. Make sure your customers are aware of what’s available in titanium, beta titanium, aluminum, memory metal and eco-friendly materials. If you carry horn or wood, show these products to everyone who walks in your door.

Add a little colour

From the runways to the sidewalks, colour – lots of it in multiple mixes and patterns – is everywhere. Observe what your customers are wearing and point out various colours from your frame displays that might coordinate and enhance their wardrobes.

Let the sun shine

Everyone needs sunwear. Make it a priority to offer all customers, paying and non-paying, all the sun options available, including clips. Many people are not aware that custom clips can be made for virtually any eyeglass frame.

Stay in touch

Follow up this dialogue with a brief handwritten note and/or an email reiterating your suggestions and thanking the customer for stopping by. ‘Let’s Talk’ by Gloria Nicola was originally published in April 2014 in 20/20, a publication of Jobson Medical Information LLC.

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TRIBUTES

Obituary Michael (Mike) Materazzo 1944-2014

ike Materazzo, the man who built, owned and ran the most successful courier service south of the border, passed away on Monday 7 April, aged 69. He had been in the full-time care of his wife Gina, who nursed him through the most difficult three months of his two-year battle with cancer. Born in Melbourne and educated at Marcellin College, from an early age, he always wanted to know how something worked. He loved pulling cars apart and putting them back together again, before setting his eyes on the optical industry in 1961, a journey which spanned over 50 years. His first taste of our industry was with OPSM where he started a traineeship as an optical dispenser at 17 years of age. He started at their Camberwell branch and then continued to work at various OPSM branches over the next three years. Remember it was 1961, and back then, we didn’t have any fancy machines to cut, edge and fit the lenses. He did it all by hand, and his precision was second to none – a perfectionist from the beginning. In 1964, he joined the team at Harry Held as an optical dispenser and over a four-year tenure managed the Malvern, Ashburton and Moonee Ponds stores but more importantly, met and married Gina in 1967. It was now 1968, Mike was 24 and after seven years in the optical trade he decided to take a short break from our industry to try his hand at selling insurance with the Man from Prudential. After four years on the road at Prudential, he realised his heart was in the optical industry and that was where his future lay. In 1972, he joined Jerry Neihmyer’s company, General Optical. He was 28 and with his newfound sales knowledge, he embarked on a travelling sales role selling frames across country Victoria for three years. But he was used to an insurance man’s salary, and 36

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having just welcomed the arrival of their first daughter, Tania, he needed some extra money. Mike spent his evenings throwing dough in the air for Arezza, his brother-in-law’s restaurant in Kew, where Gina was also known to wash a dish or two. By now it was 1976, and soon after their second daughter, Simone, arrived, Mike joined Hoya Lens Australia in a sales-management capacity to manage the Victorian and South Australian regions. As a well-travelled 32-year-old, he ran a tight, friendly team and developed strong and lasting relationships with his clients, many of whom were present at his funeral. He enjoyed taking both his team and the optical wholesalers out for lunch. They usually dined at one of his family-run-or-owned Italian restaurants and loved ‘keeping it in the family’. As many would attest, lots of great discussions were had on a huge range of topics over those long Italian lunches. As vino was par for the course, what happens at lunch, doesn’t leave the table. During an economic downturn in 1991, he found himself out of the industry he’d grown to love, so he did what any businessman would do – started planning his next move. Less than 12 months later, he was back in the optical industry with the launch of his own company. After an impressive work history with some of the industry’s key players, he wanted a new challenge and one he could call his own. In 1992, Optical Courier Service commenced operations in Victoria, with him at the helm. Having interacted with many delivery operations throughout his previous roles at OPSM, Harry Held, General Optical and Hoya, he felt there was a gap in the market, and a requirement for a dedicated and reliable courier operation to service the optical industry. Mike created a courier company that not only addressed what he felt was lacking in the Victorian market, but delivered a service of economy, stability and

simplicity that the optical industry could count on. At the end of the day, that is what prospective customers were asking for. OCS’s personalised service would ensure the end customer would get their spectacles in time for an important family event or business meeting. He had well and truly achieved what he set out to do back in 1992. Twenty-two years after the first OCS run, it has two depot managers and 21 drivers. The team at OCS interacts with over 100 wholesalers nationally and over 700 retail outlets across Greater Melbourne to move over 3,000 packages through their depot daily. In 2002, National Optical Distribution commenced operations. NOD is the joint venture between OCS in Melbourne and Harts Optical Courier in Sydney. It is the brainchild of Mike Materazzo (OCS) and Alex Mueller (Hart’s). NOD formed partnerships with Vision Couriers in Brisbane, Neba Couriers in Perth and Australian Air Express enabling national coverage from day one. The objective of creating a national freight service was to utilise the stability and reliability of the existing optical courier service rather than inventing something entirely new. That consolidation added extra services to an already-great service delivery, without compromising or replacing them. NOD brings together the experience and understanding of

the companies concerned to ensure that the industry has a complete, efficient, economical and stable distribution service – from wholesale clients to optical practices nationally. Mike’s business acumen, tenacity and strength will be missed by many. He leaves his wife Gina, daughters Tania and Simone, and grandson Jake. He was a loving husband and wonderful father and will be missed by all who knew him. Our family is grateful for all the kind words and stories that friends and colleagues have shared in their condolences. So in the words of those who admired the Victorian Optical Courier chief: “The profession will not be the same without Mike... My family and I are going to miss you dear old mate... Mike was on the surface easy going, however he had a fiercely competitive nature... Mike was a person of real compassion, caring, understanding and love, I miss him... One of nature’s gentlemen, without a doubt... He will be greatly missed as both an admired and respected colleague, and a great friend... I am sorry that he has gone and I am a lot sorrier for those who never met him... He was a man with a wicked sense of humour, a genuine mate whose generosity knew no bounds... Mike will be remembered as a terrific person, such a kind, caring and thoughtful man.” ■ – Tania Rann (nee Materazzo)

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TRIBUTES

Obituary Graham Auld

raham was born in Mackay, Queensland, on 27th October 1939 and began what was to be a 50-year career in optics when aged 16 he commenced a five-year apprenticeship as an optical mechanic in 1955 for the Australian Optical Company in Brisbane. At the end of his apprenticeship exams he topped Queensland in mathematics. In the late 1960s, following the demise of his first marriage, Graham left the optical workshop where he was making hand-ground lenses and set off as a salesman, firstly for British Optical and later for Allso International, selling eyewear frames to opticians from Coffs Harbour to Cairns. Graham joined the Scouting movement as a Cub and continued on as a Scout and then took on a role as leader. He was as passionate about scouting as he was about optics and relished in the fun, learning, companionship. Graham moved to Melbourne in 1982 to open a branch for Allso and to be closer to his three daughters who had moved there with their mother, Graham’s first wife, Yvonne. There he serviced clients in Melbourne, country Victoria and Papua New Guinea. He also opened a small optical shop in the Melbourne suburb of Hampton, which was manned by his daughter Desley and a friend. When he came home at night he would make up the lenses and fit them to the frames of those ordered through the shop during the day. He again took up a position in Scouting and met the lady who was to become his second wife, Lynn. In 1989 he was offered a position with Optical Products in Brisbane to cover the same Queensland area as he had done previously and being a Queenslander through and through he accepted and moved

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back to his beloved Brisbane. Lynn followed and they were married in 1991. Graham returned to Scouting; and as a sales rep travelled the length and breadth of northern NSW and Queensland, and periodically to Darwin. By some of the clients he was referred to as ‘The Oracle’, such was his knowledge of things optical. In 1998 Optical Products and Japanese eyewear manufacturer, Charmant Group set up a joint venture company, Charmant Australia, to which Graham transferred where he continued to carry the first titanium frame range to be sold in Australia, ‘Charmant’, and the Charmant Group’s Aristar range. He was well liked and respected by his clients, he did very well for his employers and was referred to by many as ‘Titanium Man’. His health problems, which had begun in Melbourne, continued to haunt him and he had a quadruple bypass in 2002. Not feeling well he visited his heart specialist and was told to go to the hospital for immediate surgery, but true to form, he told the specialist he would be back in two weeks as he had a Cairns trip booked and was leaving in two days. The doctor warned that he may well die on the road but Graham decided to take the chance. He made it, but was hospitalised as soon as he returned home. In 2003 he began to have problems with his left leg and after numerous small operations over a period of 12 months it was decided that to save his life he would have to lose his leg and this necessitated his retirement from optics and his 50 year involvement with Scouting in 2004. In 2005 Graham and Lynn moved back to Victoria, to Rosebud to be closer to their respective families. Graham joined The Rosebud Lions thereby acquiring another

family. He was very community minded and always regretted that he was unable to contribute more than he did due to his disability; but he found a way and that was to become the Lions Christmas Cake man in the Rosebud Plaza as well as deliver Lions Mints and Fudge to local businesses. The Lions donated a scooter which gave him so much independence and it became his lifesaver; he loved his scooter and all that it enabled him to achieve. He became quite a well-known figure

around Rosebud and loved the Lions Club and was its president for two years. Perhaps his one shortcoming was as an ardent Collingwood supporter, although many may disagree with that. Graham died suddenly on the 15th of April. His funeral, organised by his beloved Lions, was attended by over 100 people, many from interstate. A testament to a man who lived life well and full. ■ – Diane Quaife

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INDUSTRY INSIGHT

Business Briefs Hoya’s lens business helps boost 4Q revenue and profit Hoya Corporation has credited the strong performance of its ophthalmic lens business for a 19.9% revenue increase over a year-ago in the fourth quarter ended 31 March. The company reports that revenue for its Life Care segment, which includes ophthalmic lenses and contact lenses, grew 26.1% to 74.2 million yen during the quarter, as its eyeglass lens business recovered from the flooding in Thailand. The transfer of the ophthalmic lenses operation from Seiko Epson Corporation and healthy sales growth in both the contact lens and endoscope businesses also contributed, apart from the effect of a weak yen, to increased sales, the company said. As a result, Hoya’s fourth quarter sales totaled 115,224 million yen, up 19.9% from the same period the previous year. “Both revenues and profits of the ophthalmic lens business fully recovered from the flooding in Thailand in the fourth quarter. We are planning to increase production capacity by opening a new plant this year,” Mr Hiroshi Suzuki, Hoya’s chief executive officer, said. Hoya reported that its profit before tax totaled 19,892 million yen, while profit for the term amounted to 12,758 million yen, a decline of 37.1% and 47.5% from the previous year, respectively. In the same period, the previous year included insurance income of 14,275 million yen as compensation for damage suffered from flooding in Thailand. Excluding this oneoff factor, profit before tax increased from the same period last year, according to Hoya. For the fiscal year ended 31 March, Hoya’s revenues totaled 427,575 million yen, up 14.8% year on year. Profit before tax was 85,486 million yen and profit for the term was 60,140 million yen, a decline of 6.3% and 16.9% respectively year on year. The company’s Life Care unit posted revenue of 265,470 million yen for the fiscal year, up 27% versus the prior year.

Allergan’s sales rose 13% in 1Q Allergan reported total product net sales of $US1,619.1 million for the quarter ended 31 March , a 13.0% increase versus year ago. Total specialty pharmaceuticals net sales increased 10.4%, or 12.0% on a constant currency basis, compared to total specialty pharmaceuticals net sales in the first quarter of 2013. Total core medical devices net sales

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increased 23.3%, or 25.2% on a constant currency basis, compared to total core medical devices net sales in the first quarter of 2013. Total specialty pharmaceuticals and core medical devices net sales excluding sales from the transition services agreements related to the sale of Allergan’s obesity intervention business unit, increased 12.2%, or 13.9% on a constant currency basis, compared to total specialty pharmaceuticals and core medical devices net sales in the first quarter of 2013. Revenue from sales of eye-care pharmaceuticals rose 10.9% in the first quarter of 2014, to $730.4 million. “In the first quarter, Allergan delivered strong sales and earnings per share growth above the high end of our expectations,” Mr David Pyott, chairman of the board and chief executive officer, said. “Furthermore, we are pleased with the continuing strength of our growing markets around the world and our market share gains in many businesses.” For the full year of 2014, Allergan said it expects total product net sales between $6,775 million and $7,000 million, excluding any future anticipated revenue from the transition services agreements related to the sale of the obesity intervention business. Allergan is in the midst of a takeover battle with Valeant Pharmaceuticals International which made a hostile bid on 22 April for all of Allergan’s outstanding shares for a combination of 0.83 of Valeant common shares and $48.30 in cash per share of Allergan’s common stock. Allergan said in a statement that its board is weighing the Valeant offer and will “pursue the course of action that it believes is in the best interests” of Allergan’s shareholders. And it reminded investors that it adopted a one-year poison pill late last month. One thing the company did not do was announce a cost squeeze, meaning the company appears to have chosen not to make drastic cost cuts to demonstrate its operating leverage. As The Wall Street Journal reports, the Irvine, California-based Allergan is the latest apple of deal-happy Valeant’s eye. And allied with activist investor Bill Ackman--who recently flew under the radar to amass a 9.7% Allergan share – it might just have the heft to pull off a pickup, with or without Allergan’s blessing. The combined Valeant/Allergan company would enjoy a high single-digit tax rate, not to mention more than $2.7 billion in synergies – the sort of cost cuts Valeant is famous for. Some 80% of those cuts would come in the first six months, and the rest would follow

within the first year. Allergan’s largest shareholder, Ackman’s Pershing Square Capital Management, is already on board. According to the WSJ, Ackman in February agreed to work with Valeant to pull off a buyout. Valeant’s chief expressed interest in Allergan, and from there, Ackman got to work buying stock. He then switched to over-the-counter call options, which helped him to accumulate his stake without attracting much notice. Last August, Valeant outlaid $8.7 billion to buy Bausch + Lomb.

Allergan to try for Ireland’s Shire For Allergan, it could soon be ‘take over or be taken over’, and the California company apparently wants Irish company Shire to help it avoid the latter. After some failed talks in recent months, Allergan is readying another attempt at picking up the Irish company, which could help it dodge an unwanted $US46 billion offer from Valeant Pharmaceuticals. Allergan is preparing another approach to Shire and could present a bid soon. A merger between the two would create a pharmaceutical company with a market capitalisation of nearly $US72 billion and annual sales topping $11 billion. After swallowing a poison pill last week to defend against a hostile bid from Valeant and activist investor partner Bill Ackman, an outof-town buyout is just what Allergan needs. Allergan is threatening to dilute its shares if Mr Ackman dials up his nearly 10% stake in the company. However, analysts say Allergan’s best bets for rebuffing the R&D-averse Valeant are finding a higher bidder or buying up a rival to make itself unattainable, and now, according to analysts, the company is doing both. Nabbing a company on foreign soil could help it complete a tax inversion, and Shire – which enjoys Ireland’s low 12.5% tax rate, compared to 35% in the US – would get the job done. If Allergan can find its own tax advantages, it could cancel out one of the biggest selling points in Valeant’s $47 billion offer. But whether Shire would have any interest in Allergan’s plan isn’t clear; it has rebuffed the company once already this year, and the company would rather be the acquirer than the acquired – the company last northern summer reportedly enlisted financial advisers to fight a potential unwanted takeover

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INDUSTRY INSIGHT

Business Briefs amid rumors that a hostile bid was coming. Since then, Shire has done its own deal-making, landing orphan drugmaker ViroPharma for $4.2 billion. Allergan may have a backup plan, however. It has contacted companies including Sanofi and Johnson & Johnson to assess their interest in an acquisition; both are said to be considering their options.

Essilor posts strong 1Q results Essilor International has reported revenue for the three months ended 31 March climbed to €1.32 billion, an 8.4% increase over a year ago, excluding the current effect. Like-for-like growth in the first quarter was 2.4%. The increases were propelled by a rebound in its lenses and optical instruments division, Essilor said. “With 8.4% growth in revenue excluding the currency effect, Essilor delivered one of its best quarterly performances of the past three years, in a more favorable global environment,” Mr Hubert Sagnieres, Essilor’s chairman and chief executive officer, said. “It reflected the vitality of our value creation strategy built on product innovation, consumer marketing, the development of a high-quality sunwear range and the deployment of our unique partnership model. “Since 1 April, Essilor has also strengthened its business base with the acquisitions of Transitions Optical and Coastal.com, the world leaders in photochromic lenses and online vision care retail. Our teams are determined to capitalize on these promising trends and these new competitive advantages to strengthen the company’s momentum in the coming quarters.” Essilor said that despite the impact of the loss of a major contract in Europe in 2013 and unfavorable weather conditions in North America, the division reported a 3% like-forlike gain, its best performance since fourthquarter 2012. Growth was driven by a number of factors, including popular new products such as the Crizal Prevencia lens, the new Transitions Signature photochromic lens and the Xperio range of polarised lenses, according to Essilor. Other growth factors cited by Essilor were a powerful dynamic in fast-growing markets, such as Brazil, China and India, and a recovery in their export business; an upturn in demand in most developed markets, especially the United States, and a solid performance by its

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progressive-lens product line, especially products made using digital surfacing technology. The other divisions were adversely affected by a number of expected one-time events, such as the weak backlog in the equipment division early in the year and the unfavorable inventory situation in the readers division. Newly acquired companies increased reported revenue for the period by 6%, led by a major contribution from Costa Inc in the US and Xiamen Yarui in China, two sunglass distributors that are leaders in their respective market segments. In North America, Essilor reported that its growth rebounded sharply, rising 2.7% like-for-like. In the US, revenue was lifted by growing demand for the company’s progressive lenses made using digital surfacing technology, the positive impact of managed vision care networks on the laboratory business and the successful sales of new products. Crizal anti-reflective lenses returned to sustained growth, the Varilux S series progressive lens enjoyed faster momentum and the new Transitions Signature photochromic lens launched early in the year got off to a promising start. The polarizing lens segment was also very dynamic, led by strong growth of the Xperio range, Essilor said.

Pfizer’s move on AstraZeneca outrages politicians in UK and US Pfizer has managed to upset just about everybody with its $US106 billion takeover offer for United Kingdom-based AstraZeneca. AstraZeneca doesn’t like it. The UK Parliament has launched an inquiry, concerned about possible losses of job and status. Some US politicians see it as a tax dodge, and even a couple of US governors are speaking out, fearing Pfizer will slash AstraZeneca jobs in their states. Pfizer has promised that it would keep 20% of its research and development jobs in the UK, but UK politicians are not convinced and will have Pfizer chief executive officer Ian Read before Parliament in hopes of pinning him down. His assurances to the UK, however, have politicians in the US thinking that to achieve the kind of cost-cutting it has done with previous buyouts, Pfizer will sacrifice jobs in the US instead. With 5,700 jobs at stake in Maryland and Delaware, the state governors there have

written to Read to let him know about their “deep concerns” about the planned deal. The UK company has about 3,100 employees in Maryland, and another 2,600 in Delaware. The company said: “We believe a potential combination with AstraZeneca would build a stronger company by bringing together our assets, people and scientific expertise to create vibrant businesses with new potential growth and opportunities to meet patients’ needs.” A combination of the two companies might make Pfizer stronger, but it will weaken the US tax base as Pfizer plans a tax ‘inversion’. Senate Democrats are preparing legislation to take steps to stop that, at least in the future, and some Republicans are saying they are ready to give it a look. The Pfizer proposal is even being heckled from the sidelines. Swedish Prime Minister Fredrik Reinfeldt has chimed into the debate, saying Pfizer didn’t keep its word to his country about jobs stability after its 2002 buyout of Pharmacia. And the company’s history shows just how deeply it is willing to cut to achieve the earnings it expects. One example was what it did after buying Wyeth in 2009. It said it expected to cut $4 billion in costs to help pay for the deal and initially said it expected to reduce headcount by about 20,000. Over the next seven years, by cutting jobs and selling off units, the company had eliminated 51,500 positions.

Safilo Group reports increased profit for 1Q In the first three months of this year, year, Safilo Group posted a decrease in net sales of 1.3%, from €297.0 million in 2013 to €293.2 million for the same period in 2014. The group’s net profit posted a 22.9% increase, reaching €16.5 million from €13.4 million recorded in the first quarter of 2013. “In this first quarter of 2014, results were broadly coherent with the medium and long term strategy that we have chosen to implement for our business, and that guides our operational choice,” Ms Luisa Delgado, Safilo Group’s chief executive officer, said. “We aim to grow our business in a sustainable and profitable way. Our focus is to design leading-edge branded eyewear, strengthen the quality of our distribution worldwide to bring to life the different DNA of our brands, and partner with our customers through joint business planning.” ■

JUNE 2014

MANAGEMENT INDIGENOUS SERVICES

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Contact Contactus usat: at: email: style@intelligentstyling.com.au Email:www.intelligentstyling.com.au shopfitting@intelligentstyling.com.au web: Web: www.intelligentstyling.com.au Phone: 1300 550 612 Phone: 2 96340121 Mobile: +61 + 0411 384 384

ACO’s Visiting Practice Dollars Optometrists Scheme extended in Vic and SA TT – By Karen Crouch*

Changes to Privacy Laws

Australian Privacy The Principles The ACO provides care new sites are: hehe Australian College the handling of perAboriginal Health Services of communities experiencof (APPs) regulate Optometry’s sonal Optometrists information by at Australian Kerang, Morwell and ing disadvantage through Visiting government agencies and some private Bendigo in Victoria and at Mt the provision of compreScheme contract with the sector health organisations, including health and ser- the Riverland hensive public health eye Gambier federal department vice providers. You to canin-findregion the 13inAPPs care. South Australia. has been extended in Schedule 1 of the Privacy ActAdditional 1988 (the sites were ACO staff also contribclude some additional sites PrivacytoAct). added to increase the focus ute as locum optometrists through June 2014. The of APPs, came into force on aged care cli- in the Brien Holden Vision on residential Some the which new sites 12 identified March 2014, replaced the National elderly clients and cli- Institute program in the were by the de- ents, Privacy Principles previously applied ents with diabetes. Those Northern Territory. partment as areas that where to health-service Further information: more services were providers. required sites are: Boort and Birchip This article briefly explores two of Victoria and Dr Genevieve Napper, lead in central for Aboriginal communities. morethe significant aspects of the new Minyip, Jeparit, Rainbow optometrist at Aboriginal Asthe a result ACO applied Principles of interest to health-care for, and was granted addi- and Edenhope in the Services (03) 9349 7476 or practices. gnapper@aco.org.au. ■ Horsham region. tional funding. to the life, health or safety of any individual, or to public health or public safety; Privacy Policy • Giving access would have an unreasonable impact on the privacy of other The new Principles extend the information individuals; you are required to provide in your privacy • The request for access is frivolous or policy which should include: vexatious; • The kinds of personal information the • The information relates to existing or anpractice collects and holds; ticipated legal proceedings between the • How the practice collects and holds perpractice and the individual, and would sonal information; not be accessible by the process of dis• The purposes for which the practice colcovery in those proceedings. lects, holds, uses and discloses personal The practice must respond to the reinformation; • How an individual may access personal quest for access to personal information information about the individual that is within a reasonable period after the reheld by the practice and seek the correc- quest is made and must give access to the information in the manner requested by tion of such information; • How an individual may complain about the individual, if it is reasonable and praca breach of the APPs and how the prac- ticable to do so. Any refusal to a request for information tice will deal with such a complaint; • Whether the practice is likely to dis- must be provided in writing stating the reaclose personal information to overseas son for refusal and how the patient may complain about that refusal. recipients; Whilst the APPs have harmonised na• If the practice is likely to disclose persontional privacy legislation, state privacy legal information to overseas recipients— The Melbourne Exhibition and Convention Centre the countries in which such recipients islation remains in force in some states and stillof be complied with, for example, are to be located. of the discounted rate of helikely Melbourne Focus distance from amust range Health Records and Information Privacy Act Book Conference is being hotels to suit any budget. $295 for a King Room. 2002 (NSW). ■ held in the Victoria Focus Conference’s accom- directly through www.focus-

Focus Conference: Melbourne in May

APP 12, Access

capital on 25 May, which pro- modation partner, Hilton melbourne.com.au If the holds information * Karen Crouch is managing director of Health vides an practice opportunity forpersonal del- Melbourne South Wharf, is about an individual, the practice must, on Practice Creations Group, kcrouch@hpcnsw. to do? egates to explore the delights ideally placed with direct ac- What request by the individual, give the individcom.au. Why not register to the Helplinefor to of that city in mid-Autumn. cess to MCEC. This modern Melbourne is HPC renowned ual access to the information.and stylish hotel in located access Industrial, Practice Management on fineLegal, dining establishments Thisto Principle Business Management experts all year Where stay?lists the circumstances the banks ofinthe Yarraand River – many of which are located which you may deny access, including: round for all your practice queries. Send your Melbourne Exhibition and with rooms offering city or within Melbourne’s CBD. • The practice reasonably believes that queries to helpline@hpcnsw.com.au or Convention Centre (MCEC) bay views. Focus Conference Why not treat yourself on giving access pose a delegates serious threat call 1300 660 694. can take advantage is located withinwould walking Continued on page 28 JUNE 2014

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CLASSIFIEDS

Phone: 0425 532 888 Email: classifieds@insightnews.com.au

MarketPlace POSITIONS VACANT Optometrist – Two Positions Available

Practice for Sale – Airlie Beach, QLD Well established practice of 8 years in one of the most beautiful locations in the world. Enjoy a laidback lifestyle while drawing a significant wage. Consulting on average 4.5 days in a 6.5 day/week practice. Well trained, loyal staff. Astonishing local support, with clients also traveling from up to two hours away to receive excellent service and select from boutique frame range. High quality equipment, including full edging lab (optional in sale). Practice built out of love, and only on the market because of changing family situation.

Please phone 0401 693 253

ARE YOU A QUALIFIED OPTOMETRIST? PASSIONATE ABOUT TRAINING AND DEVELOPMENT? We are currently seeking an Optometry Development Manager to join our Professional Development team. This role will be responsible for the development and delivery of core training programs for our optometrists across Australia and New Zealand. The successful candidate will be responsible for identifying training needs and developing professional excellence through appropriate training mechanisms within the Specsavers volume optometry model.You will be responsible for facilitating multiple workshops across Australia/New Zealand, provide coaching and support to optometrists with varied levels of experience in-store to develop professional expertise as required. This role will work collaboratively with our Global Professional Development team in the UK and Europe to ensure that consistently high standards are met.You will be required to travel frequently across Australia/New Zealand to present at conferences, workshops and graduate events. The successful candidate will possess the following skills and experience: • A qualified Optometrist with 5+ years’ experience within a volume based environment • Strong customer focus and the ability to work in a fast paced environment • Previous experience within a training/coaching and/or mentoring role • Ability to manage multiple projects and meet strict deadlines • Previous exposure to e-learning will be advantageous • A strong communicator with excellent presentation skills and the ability to present to a large group • Strong attention to detail • Ability to work with and further develop structured frameworks and standard operating procedures • Strong interpersonal skills with the ability to build professional relationships • Please note: this position is based in Melbourne but will require frequent travel around Australia/NZ At Specsavers we value our people and not only offer competitive reward and benefits but also on-going development and training. We support creative minds and recognise hard work. If this sounds like you, why wait? Submit your application today! To apply for this position please visit: www. http://opportunities.specsavers.com.au/ for any questions in regards to this position, please email: nicky.tanatad@specsavers.com

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• NSW South Coast location, ideal for families • 3 hour drive from Sydney and 2 hours from Canberra • 2 Full time positions available • Great lifestyle - sun, surf, sand and easy commute to the snow. Busy full scope practices incorporating the latest diagnostic equipment require a committed optometrist for a rewarding career. Excellent working conditions are a feature and there is considerable potential for professional growth. Our practices deliver optimum patient care through traditional full scope service; we also provide and supply contact lenses and quality fashion eyewear. The practices have been established for over 25 years and recently underwent a complete ultramodern fit out. We need two experienced and enthusiastic optometrists with skills in patient care, problem solving, a desire to help others and willingness to expand their role and grow the business. Graduate Optometrists are welcome to apply. An excellent salary is available and professional development encouraged and supported. For more information contact Clare Foreman (02) 4455 1288, or email clare.f@cameronoptometry.com.au

Sales Agent NSW Paul Davids Eyewear is well established Optical Wholesaler specialising in high quality metal and Acetate eyewear with 35 years of experience in the industry. We are looking for a motivated sales agent wanting to carry another quality range of products . Our range of products include our very famous Hi Rise frame, our well excepted Veterans Affairs frames, our popular Tuff Stuff frames and our high quality Hand Made Acetate range. Please contact Paul on 08 8270 6437, mob. 0418 834 098 or paul28652@hotmail.com

Receptionist, Sydney CBD Full time Receptionist required. Fantastic opportunity to join a long established independent optometry practice. We require an enthusiastic and dedicated front desk / support person. You will need reception and secretarial experience and be computer literate, preferably in optical programmes. This dynamic practice prides itself on exceptional service so we require someone with excellent interpersonal skills and the confidence to assist in the sales process. Monday – Friday, great city location. Contact Antony 02 9460 9766 or infosl@whitehouseoptometrists.com.au

CONFERENCES Ski Conferences for Eyecare Professionals January 24-30, 2015 Rusutsu Ski Resort, Hokkaido, Japan Website: www. skiconf.com Email: info@skiconf.com

PRACTICE FOR SALE North Perth, WA Want to walk into an established practice in North Perth ? Suits new graduate, dispenser or optometrist looking for inexpensive purchase. Located in busy and up and coming Fitzgerald St in North Perth. We have negotiated lease terms that are very low and have a database of over 7,600 patients. Established for over 20 years, this currently part-time practice has solid potential for further growth. Has lots of potential and little cost to run. The shop is located near a post office , medical / dental centre , North Perth Plaza, hair salons and busy cafes and restaurants. We don’t have enough time to run this shop so that is why we are putting it up for sale . It is currently only open 4.5 days a week. Originally asking $165 000 but we have dropped the price for a URGENT SALE to $120 00. Phone 0422 344 561.

Practice Manager/Dispenser-Sydney We are recruiting for a Practice Manager position at Amanda Macknight EyeQ Optometrists St Ives. A wonderful opportunity exists to join an experienced and professional team in a well located Sydney practice on the north shore. Experience in management and dispensing is essential as well as a desire to develop new business opportunities. Help create the exciting future growth of this successful business and share the rewards. For more information and a confidential discussion, contact Lily on 0488 154 682 or email l.wegrzynowski@eyeq.com.au

JUNE 2014

EFORE the federal election, Tony ‘Trust Me’ Abbott promised: “No cuts to education, no cuts to health, no change to pensions, no change to the GST and no cuts to the ABC or SBS”. All but the GST pledge have been broken and now the states are being set up to have to demand an increase in the GST and broadening of it following the $80 million ‘theft’ of health and education funding by the federal government, designed to ensure the states, not the federal government, will end up being blamed for the inevitable increase in the GST. The then opposition leader also confirmed before the election that the state of budget would be no excuse for breaking any of his promises. Post election: “Nothing is being considered, nothing has been proposed, nothing is planned,” when ruling out any introduction of a GP co-payment on 1 February, which he reiterated in parliament on 25 February.

OT convinced? Here is an extract of an interview ‘Trust Me’ gave on Newcastle radio on 13 June 2013 (three months before the election): “Well, I can understand why just at the moment politicians aren’t much trusted because we’ve had too many politicians who say one thing before an election to win votes and then do the opposite after the election”. I rest my case.

JUNE 2014

ID you notice how ‘Trust Me’ looked during opposition leader Bill Shorten’s angry address-in-reply to the budget? It was the same shocked look as when former PM Julia Gillard was giving him a hard time in her famous misogyny speech.

ND what about foreign minister Julie Bishop on budget night: her new hairdo made her look like a drowned rat!

LOSER to home, federal health minister Peter ‘Plod’ Dutton isn’t doing so well in the honesty stakes, with allegations that he’s been “spreading a carefully cultivated falsehoods” and “using scare tactics and exaggerated claims” about the unsustainability of the health-care system, coming from four health and economic experts interviewed by Fairfax Media. The four experts are Stephen Leeder, emeritus professor; health economist Jeff Richardson; economist Saul Easlake; and Stephen Duckett, health program director at the Grattan Institute.

INGALINGS of the Year would have to be MPs Joe Hockey and Matthias Corman for letting themselves be caught out smoking big cigars, with smug looks on their faces as they savoured their stogies. Just the sort of thing to impress the populace at large.

T’S interesting to note a common thread in optometrists’ reaction to the federal budget dudding them is mainly concerns about income generation, with hardly a mention of patient care. Doesn’t that matter?

HE group of comedians who make up the federal government’s Commission of Audit wanted a ‘co-management’ (weasel word) levy/tax to be paid for every visit to a GP – not $6 a time, as was earlier speculated, nor a $15 ‘sick tax’. In the end, it’s to be $7. The only hope of avoiding it is the Senate, which promises to give the government a hard time over its legislation agenda, including health measures such as the $7 fee and the changes to payouts to optometrists and their patients under Medicare. But much of the funds raised through the $7 levy/tax are to supposedly go into a yet-tobe-established medical research fund. Oh yes, can you imagine the flourish of activity that will bring out, with research outfits of all sizes and shapes banging on the door seeking funding for their pet projects, useless as many will be, as we have seen in the ophthalmic arena on too many occasions! It will be an enormous bunfight, the likes of which we have never seen.

ND would someone please do something to stop use of the word ‘impact’ as a verb,

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rather than a noun, It drives readers mad!. The correct word to use as a verb is ‘affect’, not ‘impact’, which is usually to do with teeth!

HY is it that politicians of all kinds, when babbling on about tax income, outgoings, etc, don’t mention the total size of their respective budgets? For example, despite all of the hype in the lead-up to the 2014-15 federal-government budget, not a mention (or if there was, it was tucked away somewhere so that we wouldn’t find it). The Australian economy is worth $1.5 trillion ($1,500 billion) and the federal government’s revenue and expenditures both about equal at $400 billion. So when a politician, such as health minister Dutton, moans and whinges about the cost of health care due to what he endlessly describes as “Labor’s mess” (without providing any figures too back up that comment), if the the current figure for providing health services of $64 billion for a country with an ageing population is lined up beside the current $400 billion total expenditure by government it’s not too bad; certainly not as bad as ‘Plod’ would have us believe, nor Treasurer ‘Smokin’ Joe’ Hockey. At present, federal government expenditure on health is 4% of GDP, but some are claiming it will soon rise to 7%. However, even if Australia reached that 7% figure, the government would still be spending less on health as a proportion of GDP than currently spent by OECD countries such as Germany, the United States, Japan and Britain.

ROM the Useless Information Department: The head of the Prime Minister and Cabinet Department has a $42,000 rise coming up in July, taking his annual salary to $844,000 plus perks. And he won’t accept any new work after 4pm each day! But that’s nothing compared to some of the massive salaries and benefits paid to some of the captains of industry, many of whom are of dubious quality.

OTICED on an email sign-off: ‘Clinical Optometrist, Orthokeratologist, Behavioural Optometrist, Ophthalmic Medicines Prescriber’. Any time left to do refractions?

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EADING a worldly piece by the boss of a buying group, all was going well until I came to this gem: “… the independent optometrist can specialise in contact lenses or behavioural optometry or perhaps dealing with brain injury (my emphasis). Maybe the Medical Board of Australia would be interested in that; patients with brain injury too.

FTER taking two years to make up its mind, the New Zealand government has appointed six retail groups consisting of 196 preferred suppliers, representing about 56 per cent of optical outlets, to provide optical goods and services to beneficiaries, pensioners and low-income earners. In the usual laudatory press release announcing its decision, the government refers to ‘arrangements with opticians’ (my emphasis). But as New Zealand Optics points out, there is no such thing as an ‘optician’ under NZ law, “and they didn’t mean dispensing opticians either as they were the only body that never received any communication from the department to pass on to its members”. The dead (or is it dopey?) hand of government strikes again!

HE Vision Council in America has embarked on an imaginative fund-raising advertising campaign pitched at eye-care practitioners seeking their support for a consumer campaign. The campaign features a compelling photo of an infant, pointing out that in her lifetime she will have 160 dental exams but just 16 eye exams. And boosting the 16 eye exams over a lifetime is what the campaign is about, something the locals here could well set out to do, rather than just accepting the usual lack-lustre performance of their leaders. Eye care is a tough commercial world, and winners of market share will be those who put in the hard commercial work in order to survive. To not do so is to not even survive, let alone flourish.

HE decision of the hierarchy of Optometrists Association Australia to change the organisations’s name to Optometry Australia and its state divisions’ names to, for example, Optometry Victoria, probably makes some sense, being easier to say, but judging from the comments your humble scribe has

received, there is considerable bewilderment and/or anger at the decision. What seems to be the most annoying is the cost that many floor members will have to eventually incur, from printing of new stationery to replacing uniforms, having the outside of premises windows re-painted, electrical signage and having changed all of the other bits and pieces that a practice has denoting staff membership of OAA (now to be OA). OAA says the new name “will play a much more visible and high profile role than it previously has in areas such as government lobbying and advocacy, highlighting eye-health issues and promoting optometry to consumers and the health care sector”, whatever that means. However if anything, the name is a little passé, organisations such as Glaucoma Australia and Medicines Australia having adopted their respective names several decades ago. Back to the drawing board?

OU would think the last group of people who would wish to obliterate a word from the English language would be those involved in ophthalmic-prescription-lens manufacturing. Worldwide, they refer to the ‘lab’ instead of the ‘laboratory’, most likely because it’s a shorter and easier-to-pronounce word. But it sounds lazy, if nothing else. So if ‘laboratory’ is too pretentious for what actually goes on inside them, then another word (or, preferably an entirely new word) should be found. If it can’t, then ‘laboratory’ should be used rather than the dreadful ‘lab’

T’S intriguing to hear so many whine and whinge about online dispensing, whether it’s contact lenses or prescription glasses or sunglasses. Most (perhaps all) of them would have bought goods online – books, DVDs, travel and accommodation, clothing, shoes, leather goods, electronic games and just about everything else that you can bring to mind. But isn’t it odd that they don’t want anyone buying optical goods online. “Ah, that’s different,” is the usual cry!

INALLY, just to put the cat among the pigeons, there is a strong, but unconfirmed, rumour that a large German optical company wants to come here soon, as does an Indian one; both are loaded! ■

JUNE 2014

Is your equipment finance as complex as cataract surgery? It’s time for a second opinion As you well know, running a practice involves balancing a myriad of priorities. Purchasing equipment is high on the list, but it’s often devilishly complicated – it takes specialist expertise to put together a simple, cost-effective solution. This is where Investec comes in. We specialise in providing financial solutions for medical professionals, so our team thoroughly understands the pros and cons of different methods of funding your equipment. Whether it’s buying outright or leasing, you can rest assured that we’ll work out the optimal structure for you; even better, you can finance the equipment on an Investec credit card and earn Qantas Points* on your eligible purchase.

Visit investec.com.au/medical or call our financial specialists on 1300 131 141 to find out how we can help.

Specialist Banking Home loans | Car finance | Transactional banking and overdrafts | Savings and deposits | Credit cards | Foreign exchange | Goodwill and practice purchase loans Commercial and industrial property finance | Equipment and fit-out finance | SMSF lending and deposits The Investec credit card is issued by Investec Bank (Australia) Limited ABN 55 071 292 594 (Investec Bank) AFSL/Australian Credit Licence 234975. All finance is subject to our credit assessment criteria. Terms and conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. You may cancel the account by writing to us within fourteen days of the date of our notification to you confirming that the account has been opened, without giving any reason and without paying any charges. Investec recommends that you seek independent tax advice in respect of the tax consequences (including fringe benefits tax, and goods and services tax and income tax) arising from the use of this product or from participating in the Qantas Frequent Flyer program or from using any of the rewards or other available program facilities. *Qantas Points are earned in accordance with the Investec Qantas Rewards Program Terms and Conditions available at investec.com.au/cards. Points and bonus points are earned on eligible purchases only. You must be a member of the Qantas Frequent Flyer program in order to earn and redeem points. Qantas Points and membership are subject to the Qantas Frequent Flyer program Terms and Conditions available at qantas.com/terms. See definition of Eligible Transaction in the Investec Qantas Rewards Program Terms and Conditions, available at investec.com.au/cards.