Insight February 2021

INSIGHT FEB

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

Is business ownership on your horizon?

We’re continuing the expansion of our network with new stores coming in 2021. Talk to us now about the opportunities in one of our new locations.

Governments told to improve exemption system for eye doctors in future outbreaks.

WHERE TO NOW FOR GEORGE & MATILDA? The company's CEO reveals his blueprint for the future of independent optometry.

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ANXIETY OVER 2021 BORDER BATTLES

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03

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INSIGHT FEB

2021

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

CONCERN OVER THIRD-WAVE BORDER CLOSURES PROMPTS CALL FOR NATIONAL SOLUTION

A Victorian optometrist and South Australian ophthalmologist are spearheading calls for state governments to embed better decision-making processes around healthcare worker travel exemptions, should COVID-19 outbreaks lead to more hard border closures in 2021.

Ms Angie Trinh, an optometrist at Eyecare Sunraysia, and Dr Arthur Karagiannis, a visiting ophthalmologist based in Adelaide, believe exemption panels need to better cater for health professionals after hundreds of patients they co-manage in Mildura, in north-west Victoria, were cut off from ophthalmological care for eight months.

Like many border communities, health services in Mildura rely on visiting specialists from across the border in Adelaide, but Karagiannis

and other specialists couldn’t practise in Victoria from April to December due to a requirement to self-isolate for two weeks on return to SA. Before SA re-opened its border to Victoria on 1 December, Karagiannis applied for at least three exemptions, but was refused each time. This was despite logistics operators being granted waivers, and him learning that an orthodontist – which lends itself to greater infection risk through aerosol generation – was approved for quarantine-free travel.

Sporting organisations could also meet with state governments and formulate a COVID-safe plan, but the same opportunity wasn’t afforded to medical professionals, he said.

“There’s work going into a national definition for a COVID hotspot, and

other person who wants to bring their cat over for de-sexing or a truck driver that’s delivering goods. We are dealing with the health of people – we should in effect have our applications expediated and a point of contact to discuss issues with.”

Dr Arthur Karagiannis.

there should be an across-the-board agreement as to what constitutes an essential traveller,” Karagiannis, who has visited Mildura for 16 years, said.

“If you don’t deem a health worker an essential traveller then something is wrong with the system. There also needs to be a method for considering health professional exemptions, rather than sending your application to the same email address as every

Speaking before the latest round of border closures related to the NSW outbreak over the New Year period, Karagiannis was concerned his Mildura patient backlog could lengthen further if blanket border closures are reimposed this year.

He also wants to shine a light on the issue to avoid similar problems in border communities like AlburyWodonga and towns at the Queensland and northern New South Wales border. continued page 8

ANTI-VEGF BECOMES MOST EXPENSIVE DRUG ON PBS The Australian government spent more than $610 million on antiVEGF treatments during the past year, with aflibercept (Eylea) leapfrogging a hepatitis C drug to become the costliest subsidised drug for the first time.

Aflibercept and ranibizumab (Lucentis) were the only two eye therapies to appear in Australian Prescriber’s top 10 drugs based on Pharmaceutical Benefits Scheme (PBS)/Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions from July 2019 to June 2020.

In total, the government spent $392 million (not including rebates) on aflibercept to cover 315,200 prescriptions, making it the most

expensive PBS treatment. For ranibizumab, which ranked seventh by cost, it paid $218 million for 190,126 injections.

The PBS listed price for anti-VEGF therapies is $1,042.89 (special pricing arrangements apply), with the general patient charge being $41.30.

Although the anti-VEGF therapies were among the most expensive, they weren’t the most prescribed overall. But prescriptions for both therapies rose considerably compared with the 2018/19 period, with aflibercept increasing by 25,700 and ranibizumab by 9,400.

Ms Dee Hopkins, CEO of the Macular Disease Foundation Australia, said it was difficult to determine what led to the increase.

“It could be due to more diabetic macular edema (DME) patients getting treated, it’s possible that age-related macular degeneration (AMD) is being better diagnosed and perhaps increased compliance.

However, it is impossible to say if a higher proportion of those in need are being treated without further data,” she said.

The figures also capture a significant portion of the COVID-19 lockdown period when the MDFA raised concerned about the number of macular disease patients missing sight-saving intravitreal injections.

“With regard to COVID, intravitreal injections of anti-VEGF were prioritised as being medically continued page 8

REVOLUTIONISING CATARACT WORK UP Correct IOL selection is a labourintensive process fraught with the potential for human error. An Australian surgeon has piloted new Zeiss software that is transforming safety and workflow at his practice. page 30

A new momentum 2021 is already shaping up to be a year of growth and development for Specsavers.

We have advanced plans to expand our optometry network, providing ever greater access to eye care services across both Australia and New Zealand.

And with this growth comes a new level of opportunity for optometrists, optical dispensers and retailers – in both partnership and employment roles – to build greater connections with our local communities.

As we step up our store opening and expansion programs, now is the time to position yourself for a role at Specsavers.

To find out more, contact Marie Stewart on 0408 084 134 or marie.stewart@specsavers.com or visit Spectrum-anz.com

IN THIS ISSUE FEBRUARY 2021

EDITORIAL

FEATURES

WHAT TO WATCH THIS YEAR The summer break always provides an ideal time to reflect on the previous year and ponder what may lie ahead. So, here are the developments I’ll be watching with the most interest in 2021.

Atop the agenda is how the Federal Government handles the MBS Taskforce review into ophthalmology items. The finalised optometry and ophthalmology reports are now with the health minister and, interestingly, still contained the recommendation to consider allowing optometrists, nurses and GPs to perform intravitreal injections.

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LEADING EDGE George & Matilda’s CEO explains why independents need to embrace data and tech.

24

WHAT’S AHEAD? Leading figures predict what 2021 will have in store for the ophthalmic sector.

With optometry advocates pursuing this change, and ophthalmology pushing back, the government has a delicate situation on its hands and will need to carefully consider the safety, accessibility and political implications. All parties would be keen to avoid another legal showdown like the glaucoma scope-of-practice dispute in 2013, which could well be used as a precedent if this eventuates.

I’m also keen to see what happens with tele-optometry, which, despite heavy advocacy during COVID-19, never got the Medicare number it probably deserved. There’s little doubt government inaction here caused frustration.

It would have significantly eased the blow, especially in Victoria which should now have the end of its mammoth patient recall list in sight.

Although the COVID-19 peak is behind us, we got a snippet into how tele-optometry could fit into future care models. The government should expect more pressure here in 2021.

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PRACTICE FIT-OUT Optometrists recount the lessons they learned from recent renovations.

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CORNEAL CONUNDRUM Homegrown projects are leading the way to overcome corneal transplant limitations.

EVERY ISSUE 07 UPFRONT

44 MANAGEMENT

09 NEWS THIS MONTH

45 CLASSIFIEDS

42 ORTHOPTICS AUSTRALIA

45 CALENDAR

43 DISPENSING

46 SOAPBOX

Myopia will also make headlines for different reasons. Optometrists are concerned about progression rates due to lockdowns and screen time. Thankfully, the myopia management market is a hotbed of activity. Last year Hoya released a myopia control spectacle lens, and Essilor is also developing one. Bausch + Lomb recently signed a deal to make a new contact lens with BHVI, and Johnson & Johnson is also advancing a contact lens program.

We look forward to a year of recovery, renewal and more innovation.

MYLES HUME Editor

INSIGHT February 2021 5

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UPFRONT Just as Insight went to print, the MBS TASKFORCE has forged ahead with plans to cut the rebate for intravitreal injections and consider allowing nurses and optometrists to perform the procedure, despite opposition from ophthalmology groups.

More than a year after a draft document was released for public consultation, the taskforce in December unveiled its final report that contains 19 recommendations for the government to now consider.

ASO vice president Dr Peter Sumich said

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WEIRD

the recommendations were the work of technical experts clearly investigating ways to make cost savings, rather than deliver clinical services. "Australia has the best clinical outcomes in the world because the current system works," he said. IN OTHER NEWS, the MBS Taskforce also released its endorsed report for optometry items. It backed 11 of the Optometry Services Clinical Committee’s 14 recommendations. Most notably it rescinded two items, with one being a proposal to change the frequency for comprehensive eye exams from three to two years for people aged 50 to 64. The taskforce felt there was “no clear justification” for this. It also didn’t back a new item for brief

consultation co-claimed with a computerised perimetry in glaucoma due to concerns over potential misuse as a screening tool.

FINALLY, Specsavers has unveiled plans for an additional four locations across Australia, bringing the current figure to nine new stores already in the works for the first half of 2021.

The four new locations include Alice Springs (Northern Territory), Mt Isa (Queensland), Parkes (New South Wales) and South Melbourne (Victoria). The company’s Australian practice network will expand to 353. Specsavers expects to announce further new locations on an intermittent basis over the coming months and has launched another program to expand existing stores.

STAT

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WACKY

Mr Craig Hershoff, who was diagnosed with Fuch’s dystrophy and has had three corneal transplants, had issues with shaking hands and anxiety after his wife died. The US inventor and scleral lens wearer developed the Cliara Lens Robot that helps people with dexterity issues insert and remove their contact lenses. The device has a camera attached so wearers can see how the lens is being placed.

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UK actor Mr Hugh Grant said COVID-19 made his eyeballs feel “three sizes too big”. The Notting Hill star, 60, made a virtual appearance on a US talk show and said he tested positive for virus anti-bodies several months after the symptoms, which also included loss of smell and the feeling of “some enormous man” sitting on his chest. n

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INSIGHT February 2021 7

NEWS

AGREED HOTSPOT DEFINITION COULD FIX ISSUE continued from page 3

LONG BACKLOG AWAITS

Australian Society of Ophthalmologists president Associate Professor Ashish Agar said the problem was not confined to Mildura, with Broken Hill – where he visits in far west NSW – also experiencing similar issues with SA specialists.

On top of their usual patient load, Trinh and her optometry colleagues at Eyecare Sunraysia in Mildura were left to manage many of Karagiannis’s patients with chronic eye conditions and report back to him remotely, while his cataract patients sat idle.

At the root of the issue, he said, was a lack of an agreed definition on a COVID hotpsot among state governments.

A major frustration, Trinh said, was a lack of clarity around the criteria to obtain an exemption from the SA Government. She pointed out Mildura had only six COVID-19 cases in total, with the last in May. The practice had a COVID-safe plan and Karagiannis even proposed only performing consultancy work, without operating.

“What Arthur’s case points to is the fact there is still no system in place to manage this if it happens again,” he said.

“It’s a dog’s breakfast across the country, and unfortunately people who have no direct involvement pay the price whether it’s family members stranded across borders or patients on one side, doctors on the other.”

Agar said the ASO had been working with individual ophthalmologists affected by border closures and feed their dissatisfaction back to state governments.

“Firstly, we are strongly encouraging all states and the Federal Government to come to a common definition of a hotspot, so everyone can agree when a border is closed so it’s neither a surprise, nor a political decision. And secondly, we’re urging a proper policy around who is exempt [from quarantine] and who isn’t to make sure patient interests always come first, because that has not been happening,” he said.

In a letter to the SA premier Mr Steven Marshall, Trinh outlined these concerns and the impact it was having on patients in a regional community where it was difficult to find replacement specialists.

She received a response from the SA deputy chief public health officer Dr Emily Kirkpatrick who said several healthcare worker exemptions had been granted taking into account clinical urgency, location of work and plans for risk mitigation.

it was irrelevant to his situation because he performed surgery at Mildura Health Private Hospital, which was not treating COVID-19 patients, and ophthalmologists typically used sedation/topical anaesthetic, as opposed to general anaesthetic.

"IT CREATED A GAP IN MEDICAL CARE FOR REGIONAL PATIENTS THAT MIGHT HAVE BEEN NECESSARY WHILST THE CASES IN MELBOURNE WERE HIGH BUT BECAME HARDER TO JUSTIFY" ANGIE TRINH, EYECARE SUNRAYSIA

“Their fears could have been put at ease in a five-minute phone call. Clearly, they don’t know what we do as ophthalmologists in a hospital setting for them to even make that statement, and the fact they wrote that to a person who sent an email in and didn’t have any kind of correspondence with me speaks volumes about the process,” Karagiannis said.

Although further outbreaks have already prompted border closures in 2021, Trinh hoped that with more time to prepare, state exemption panels could be more nuanced in their decision making.

“Applying the same restrictions over an eight-month period, despite the improvements that happened in Melbourne and without speaking to the actual medical professionals affected, didn’t work,” she said.

“It created a gap in medical care for regional patients that might have been necessary whilst the cases in Melbourne were high but became harder to justify as the situation in Melbourne improved.”

However, Karagiannis’s exemption wasn’t approved due to concerns the work was being undertaken in a hospital setting and involved anaesthetic procedures.

Karagiannis said he would be performing catch up work well into 2021. This included weekly visits to Mildura through December, and working Saturdays. n

Kirkpatrick’s response to Trinh was the first time Karagiannis heard this rationale, despite his own emailed requests. He said

LEADING THE WAY WITH INJECTION REIMBURSEMENT continued from page 3

essential, even during the early lockdown period (during the period of these statistics) so the impact may have been less than expected,” Hopkins said.

Australian government was quick to appreciate this and provide reimbursement to patients,” she said.

“Also scripts would have been written even if patients did not necessarily come for treatment in a timely fashion.”

“Since anti-VEGF treatment was first listed on the PBS for wet AMD treatment, the Australian government has continued to support patients with other treatable types of macular disease by gradually expanding the indications for PBS reimbursements.”

Since 2007, when anti-VEGF treatments first became available on the PBS, Hopkins said Australia had become a world leader in the management of neovascular AMD, arguably delivering the world’s best outcomes.

Possible drugs that could be reimbursed in future include brolucizumab (Beovu), which is yet to be recommended for the PBS for nAMD, and ranibizumab for proliferative diabetic retinopathy, which obtained TGA approval in September.

“Australian ophthalmologists recognised very early the revolutionary, sight-saving nature of these treatments, and the

Despite the significant costs to the taxpayer, Hopkins said the government had given no indication to reduce

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INSIGHT February 2021

reimbursement for anti-VEGF treatments.

Dee Hopkins, MDFA.

“What price can you put on saving sight?

If this treatment was not available, it would result in higher costs in other areas of the health and welfare systems due to people losing their sight and becoming more dependent on government support.

The access to publicly listed medicines in Australia is one of the best and most equitable in the world,” she said.

Other drugs in the top 10 most expensive were for cancer, various types of arthritis, osteoporosis, plaque psoriasis and anticoagulants. Sofosbuvir + velpatasvir, a drug for chronic hepatitis C infection, was the costliest drug in 2018/19 ($391 million), followed by aflibercept in second ($358 million). However, sofosbuvir + velpatasvir dropped to sixth place last year. n

NEWS

NSW CATARACT PATIENTS WAITING 71 DAYS LONGER POST-COVID "MY CONCERN IS THAT WE ARE FAR FROM ADDRESSING THE BACKLOG, AND THERE IS A RISK OF US GOING BACKWARDS"

The Australian Society of Ophthalmologists (ASO) has criticised major public hospitals in New South Wales for operating at 20% capacity or less, contributing to a wait time blow out for ophthalmic patients who now spend 330 days on average before receiving an operation.

Ophthalmology patients within the NSW public health system are waiting the longest for elective surgery than any other specialty, the latest Bureau of Health Information Healthcare quarterly report reveals, with the median wait time for cataract surgery alone ballooning to 343 days.

In the three months to September 30, ophthalmologists performed 10,298 procedures in the public system, with just 66% of those on time. This is a 32% drop from the same quarter last year when 98% were delivered within the recommended timeframe.

The 330-day median wait time for an ophthalmic procedure is a 98 day increase on the same period in 2019 and the largest rise among all medical specialties.

Of the 8,426 cataract procedures performed in the September quarter, the median wait time was 343 days – the fourthworst of all common procedures and 71 days longer than last year.

There was also a major rise in the number of ophthalmology patients waiting longer than clinically recommended (365 days), which swelled from 52 patients in the September 2019 quarter to a staggering 1,444 this year. Most were awaiting cataract procedures, which rose from 40 patients in 2019 to 1,268.

ASO president Associate Professor Ashish Agar said although there was a hangover from the shutdown on elective surgery earlier this year, some public hospitals were only operating at 20% or less of their usual ophthalmic capacity.

He said this was contributing to ophthalmology’s unfavourable statistics. It also wasn’t conducive to the purpose of a work-sharing agreement struck with private hospitals to create greater overall capacity to clear the COVID-19 backlog.

“Most ophthalmic surgery in Australia is done in day and private surgeries so there is a lot of experience, skill and potential there to really help reduce waiting lists, and we certainly support those initiatives,” he said.

“But that shouldn’t be at the expense of

IN BRIEF

ASHISH AGAR, ASO The median wait time for cataract surgery was 343 days.

the public hospital surgery being wound back to an almost token-like level. My concern is that we are far from addressing the backlog, and there is a risk of us going backwards, particularly if some of these major hospitals don’t restore their previous levels of public hospital surgery because then we haven’t got a hope in catching up.”

Agar said the public system was already struggling pre-pandemic, and the system needed more capacity now – not less.

“The last thing patients need is a system that’s going to push them even further back,” he added.

From July to September, 2,171 elective surgical procedures were contracted to NSW private hospitals, representing 3% of all elective surgical procedures performed.

NSW Health Deputy Secretary Ms Susan Pearce told the Sydney Morning Herald that, given all non-urgent surgery was suspended during the shutdown, procedures with larger cohorts would experience significant waiting times when the program recommenced fully in July.

“It should be noted patients scheduled for non-urgent surgeries are able to be re-categorised by their own specialist to a more urgent category, if their clinical condition required their surgery to be conducted sooner than initially planned,” she said.

“Almost 100% of urgent surgery was performed on time (99.8%) and more elective surgical procedures were performed this quarter, than in any other quarter over the last five years.”

Labor health spokesman Mr Ryan Park said the government had lost control.

“The record-long waitlists are a result of a decade of neglect and under-resourcing.

It has little to do with the elective surgery suspension earlier this year,” he said. n

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GUEST EDITOR

UNSW academic and contact lens expert Dr Nicole Carnt has been named as a guest editor for a special issue of Contact Lens and Anterior Eye, the journal of the British Contact Lens Association. She will be joined

by Dr Maria Jesus Gonzalez Garcia, from Spain’s Instituto Universitario de Oftalmobiología Aplicada, in editing an issue on the long-term effect of contact lens wear to be published in January 2022. “We have a better understanding of ocular surface response to contact lens wear, but how have the wearers who have joined us in this journey fared?”

Carnt said. The journal will soon be calling for papers for consideration.

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TAX BREAK

Melbourne biopharmaceutical company Opthea has received an $8.5 million research and development (R&D) tax credit from the Australian Tax Office ahead of pivotal Phase 3 trials of its lead drug candidate. “This R&D tax incentive credit of $8.5 million further strengthens our balance sheet as Opthea prepares to initiate patient recruitment into pivotal Phase 3 clinical trials of OPT-302 in wet AMD early in 2021,” CEO Dr Megan Baldwin said. It follows Opthea’s debut on the Nadsaq stock exchange in October when it reportedly produced the largest initial public offering conducted by a development-stage Australian life sciences company (AU$175 million).

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AUSSIE IMPLANT

Australian biopharmaceutical company PolyActiva reported positive results from a Phase 1 study examining the safety of its biodegradable Latanoprost FA SR Ocular Implant for glaucoma. It was well tolerated in all eight patients with no significant safety findings. The study also showed the implant persists for the six-month treatment period after which it biodegrades completely over six weeks. This biodegradation profile should enable repeat dosing with the implant, the clinical-stage company stated. The implant is designed to provide a constant daily therapeutic dose of commonly prescribed glaucoma eye-drop Xalatan. It’s administered in a simple procedure using PolyActiva’s bespoke administration device.

INSIGHT February 2021 9

NEWS

DISPENSING WAGE SUBSIDY ‘BACK ON’ FOR EXISTING STAFF AFTER GOVERNMENT CHANGES TUNE The Federal Government has reversed its decision to restrict a major optical dispensing trainee wage subsidy to new employees only, reinstating the original scheme that included longer term staff.

The new Boosting Apprenticeship Commencements (BAC) program was announced on Federal Budget night on 6 October and provides employers with a tax-free 50% subsidy to upskill around 100,000 people across multiple sectors. It is only available for one year until September 30, 2021, to a maximum of $28,000.

When the scheme was launched, almost all unqualified optical dispensers were eligible, prompting hundreds of practices to enquire about the initiative and enrol optical assistants in training programs.

Then, on 28 October, the government announced a crucial change, limiting BAC to new employees only. Overnight, many optical assistants who were set to sign up became ineligible.

But just weeks later Australasian College of Optical Dispensing (ACO) director and senior trainer Mr James Gibbins confirmed the program was “back on”, after the government reversed its 28 October decision.

ACOD director Chedy Kalach (right).

“The Federal Government has amended its amendments of October 28, and in summary reversed the decision of October 28 that excluded the longer-term employees from this traineeship program and the huge 50% wages subsidy that goes with it,” he said.

"ALMOST ALL PART TIME AND FULL TIME UNQUALIFIED OPTICAL ASSISTANTS WILL NOW QUALIFY FOR THE FULL 50% WAGES SUBSIDY" JAMES GIBBINS, AUSTRALASIAN COLLEGE OF OPTICAL DISPENSING

“We are therefore back to the original criteria for optical assistants – almost all part time and full time unqualified optical assistants will now qualify for the full 50% wages subsidy – subject to the usual eligibility tests.”

announced in the Federal Budget – which provides employers either $100 or $200 per week in wage subsidies for each new job they create for the next year. “[Many employers] have correctly deducted that it has little benefit. The JobMaker program is helpful for an industry that has no apprenticeships or traineeships available. Thankfully our industry has optical dispensing traineeships, which comes with up to six times more financial benefit, includes training for dispensing, and is open to a far greater field of applicants,” Gibbins said.

“And any employee that would qualify for Job Maker will automatically qualify for this BAC Program. In short, there is no comparison, and already hundreds of employers around Australia have engaged this program now and are already reaping the benefits. But we are also aware that many employers are either unaware or have been confused by promotions for JobMaker.”

Gibbins encouraged employers to promote the enrolment of their staff into this program promptly for two reasons – to ensure they are included in the program before it’s over-subscribed (100,000 cap), and to maximise the wages subsidy which is backdated to the date of registration on the ACOD website. n

Gibbins also moved to clarify “much confusion and misunderstanding” in the optical sector regarding which program has the most relevance and benefit for employers.

He said many had only heard of the JobMaker Hiring Credit – also

RANZCO UPDATES AMD REFERRAL PATHWAY FOR OPTOMETRISTS Professor Robyn Guymer has led an expert panel to update RANZCO’s referral pathway for age-related macular degeneration (AMD), which accounts for greater accessibility to retinal imaging equipment and reminds clinicians to be aware of nearby clinical trials.

Guymer, head of macula research at the Centre for Eye Research Australia, was asked by RANZCO to write the first AMD referral pathway for optometrists and other primary health professionals in 2016.

In April 2019, a RANZCO working group was formed, led by Guymer and comprising five retinal specialists, to revise the document, seeking input from various other stakeholders. It took more than 12 months to complete and

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INSIGHT February 2021

received RANZCO Board approval in late 2020. According to RANZCO, the revised pathway is fit-for-purpose in a new era of more personalised, community-based monitoring where increased availability of retinal imaging instruments allows for greater recognition of retinal pathology and the risk of progressive vision loss.

Using the pathway will also ensure communication between eyecare professionals is consistent so that AMD patients receive correct management.

“The two main aspects that I was very pleased to see included or reinforced in the revision was the encouragement to use OCT imaging if AMD is present to allow the clinician to gain a much greater understanding of the individual’s disease

and risk of further progression to vision loss,” Guymer said.

Prof Robyn Guymer, CERA.

“With the major increase in our ability to identify OCT-based anatomical changes that are considered risk factors in AMD, the pathway encourages clinicians to perform OCT, if available, when AMD is clinically identified or suspected, to gain this greater appreciation of an individual’s disease and, as such, better target the counselling and the review.”

Guymer said the updated document also isn’t as cluttered, with an improved design layout and fewer words. The working group added a note for eyecare professionals to be aware of clinical trials in AMD in their region. n

NEWS

TAXI DRIVER LEFT BLIND BY FLYING ROCK RELIES ON EYE DOCTOR ADVICE IN LEGAL STOUSH Ophthalmologists have played a central role in a dispute between an Australian insurance company and a taxi driver who won a $250,000 payout after becoming legally blind in one eye when a rock was thrown through his car window.

The case was recently brought before the Australian Financial Complaints Authority (AFCA). It was asked to determine whether the taxi driver’s injury was covered by his employer’s insurer – Lloyd’s Australia – whose policy included a quarter of a million-dollar lump sum payment for total loss of sight in one eye.

Initially, Lloyd’s paid the complainant $15,500 in weekly benefits until he regained employment, but rejected a claim for the lump sum benefit, saying his impairment did not constitute a total loss of sight. As part of the case, both the taxi driver and the insurer sought advice from at least three ophthalmologists that

provided the basis of their arguments over the August 2018 incident.

The complainant was examined by an ophthalmology registrar who said he had a mild cataract that was likely to deteriorate, a corneal abrasion (healed), hyphaema (resolved) and a fractured nasal bone (stabilised). However, the primary injury was permanent and irreversible central macular damage.

The man’s visual acuity due to the accident was 6/60, which is legally blind. It was further noted his sight was not improved with either pinhole or corrective lenses.

The complainant also travelled overseas where he obtained the opinion of another ophthalmologist who advised the damage was “permanent, irreversible and likely to deteriorate”.

Lloyd’s engaged its own consultant ophthalmologist who, using Australian

Medical Association guidelines, concluded the percentage of vision loss to the complainant’s eye was 89%.

The driver's visual acuity became 6/60.

Using these findings, the insurer stated the complainant was not entitled to the policy benefit for total loss of sight in one eye.

In its determination, the AFCA panel accepted the policy only provided the benefit for total loss of sight, however it didn’t define total loss. The available medical evidence demonstrated that he no longer had “any effective eyesight” in his right eye.

It also said the Certificate of Insurance states that should any ambiguity exist in the clauses, they will be interpreted in favour of the insured.

The AFCA ruled Lloyd’s was liable to pay the complainant $234,434.18, being the lump sum benefit of $250,000, less the weekly benefit of $15,565.82. n

NEWS

AUSTRALIAN OPTOMETRY COMPANY ACQUIRED IN $43 MILLION DEAL WITH ALLIED HEALTH GROUP "THERE EXISTS A SIGNIFICANT OPPORTUNITY TO CONTINUE OUR ORGANIC AND ACQUISITIVE GROWTH"

Australian optometry group The Optical Company (TOC) says it now has a clear mandate to expand its 41-store portfolio after announcing a multi-million-dollar deal to join a major Australasian allied health group.

ASX-listed Healthia Limited Australia acquired TOC – a 14-year-old vertically integrated optical group specialising in optometry services, retail and eyewear distribution – outright for $43 million late last year.

TOC owns and operates established eyewear frame distributor, Australian Eyewear Distributors (AED), and operates 13 Kevin Paisley Optometrists stores, 10 nib Eye Care practices, eight Optical Warehouse stores, six TOC stores, and four Stacey & Stacey Optometrists.

Healthia’s TOC acquisition was completed on 30 November 2020 and will increase its dedicated allied health divisions across podiatry, physiotherapy and optometry, with the addressable market opportunity of $9.8 billion annually.

As a result of the acquisition, TOC founder CEO Mr Colin Kangisser will be appointed CEO of Healthia’s newly formed Eyes & Ears division and as an executive director of Healthia. Kangisser is a registered optometrist with more than 30 years’ optometry experience. He has founded

The Optical Company operates 13 Kevin Paisley Optometrists stores.

COLIN KANGISSER, THE OPTICAL COMPANY

multiple optical businesses including Kays Optical and prior to establishing The Optical Company in 2006, held an executive leadership position with OPSM Group

strategic objectives of acquiring value accretive businesses in the allied health industries,” Coote said.

“The Optical Company also provides Healthia with the expertise, people, platforms and systems required for continued organic and acquisitive growth in the optometry industry.”

Mr Aaron Kangisser is TOC’s head of retail, having worked across the business for more than 10 years, plus a period working in management at Boot’s Opticians in the UK. He told Insight the company was excited by the opportunities in joining Healthia.

“TOC together with Healthia has a clear mandate to grow both organically and through acquisitions and this will provide TOC with additional resources to do so,” he said.

“We are excited to partner with Healthia.

We believe there is a strong alignment between our respective businesses and that there exists a significant opportunity to continue our organic and acquisitive growth,” he said.

“TOC and Healthia have a close alignment as allied health-led businesses and both are underpinned by our people and culture.

We look forward to working with Healthia on building the network and continuing to provide great experiences for our people and customers.”

Mr Wesley Coote, CEO and managing director at Healthia Limited Australia, described TOC as being in strong alignment to Healthia’s strategic objectives.

“The opportunity to acquire a highly complementary allied health business of the quality and size of The Optical Company is compelling. The Optical Company is a natural fit with Healthia and its stated

Following the acquisition, Healthia will operate three distinct segments; Feet & Ankles, Bodies & Minds and the newly formed Eyes & Ears. n

VISION 2020 AUSTRALIA APPOINTS NEW CHAIRMAN Former senior cabinet minister and Liberal Mr Christopher Pyne has been elected as chair of Vision 2020 Australia – the latest in a string of appointments since he retired from federal politics in 2019.

The position strikes a personal note for Pyne whose father Dr Remington Pyne was an eye specialist instrumental in creating the first National Trachoma and Eye Health Program.

Pyne had a 26-year parliamentary career in which he rose through the Liberal ranks to the post of defence minister before departing politics before the 2019 election.

He was the youngest person (25) elected to office when he won the Adelaide seat of Sturt in 1993. As chair of Vision 2020 Australia chair, he succeeds his former parliamentary colleague Ms Amanda

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INSIGHT February 2021

Vanstone AO. Since his retirement from politics, Pyne has combined roles as chair of corporate strategic advice firm Pyne and Partners and a Professor in the University of South Australia’s Business School with other appointments, including directorship of the International Centre for Democratic Partnerships, as well as its Foundation.

“It is an honour to be joining the board of an organisation of such importance to the health and wellbeing of Australians,” he said.

“Fixing people’s vision and giving them the capacity to see the world around them is one of the great things a person can do to help others and I’m pleased to have this opportunity to contribute to this significant work.”

Vision 2020 Australia CEO Ms Judith Abbott said the organisation was fortunate to have a board chair of Pyne’s calibre.

Christopher Pyne, Vision 2020 Australia.

“His expertise, energy and enthusiasm will help ensure that more Australians have the best vision possible,” she said. “With the number of Australians living with vision loss forecast to almost double within 10 years, there has never been a more important time to have eminent Australians like Christopher supporting improvements to eyecare.”

Abbott thanked Vanstone for her significant contributions to the organisation.

“She steered the board with a consistent combination of laser-like focus and good humour and brought a wealth of knowledge, networks and intellect to the role." n

NEWS

MAGPIES EUTHANISED OVER ATTACKS THAT LEFT VICTORIAN RESIDENTS WITH SEVERE EYE INJURIES A man who was one of two people that required emergency eye surgery after a recent spate of magpie attacks in a Victorian town says he may yet require cataract surgery, as authorities confirmed two birds had been euthanised.

Several weeks after the attack, retired businessman and aircraft electrician Mr James Glindemann, 68, still had poor vision and six sutures in his left eye after suffering a penetrating corneal wound as he sat to eat lunch near the Gippsland Centre in Sale, about 200km east of Melbourne.

He was among five people reportedly attacked by magpies in the area late last year, in what was thought to be an apparent scare tactic to acquire food from people.

Just days before his incident, fellow Victorian Ms Jennifer Dyer was targeted in similar circumstances at the same

location. According to the ABC, she required multiple eye operations, including one to remove her lens after a cataract formed.

The Victorian Department of Environment, Land, Water and Planning (DELWP) told Insight it had issued two approvals to the Wellington Shire Council euthanise magpies in October and then November.

“Land managers must exhaust all practical non-lethal options before applying for an Authority to Control Wildlife for lethal control, which is a last resort,” a DELWP spokesperson said.

six signs erected with DELWP alerting people to swooping magpies,” the spokesperson said.

James Glindemann was attacked in October.

Glindemann, a retiree who has a small side business as an aviation electrician, said he could legally drive, but his vision was still poor out of his left eye which prevented him from performing detailed, near vision tasks such as wiring and assembling connectors.

A Wellington Shire Council spokesperson said a DELWP-approved contractor performed the work.

“I’m not too sure if I will require a lens in the left eye, and I don’t know if the doctors know yet either, but my impression is that there is a greater risk of a cataract forming, and if my eyesight doesn’t improve in the next six months or so, I’d prefer to have a lens put in,” he said.

“Council [also] erected 12 warning signs, six asking people not to feed the birds – it’s thought that feeding is linked to the attack behaviour – and

Glindemann had mixed feelings when it came to euthanising the birds, and understood the arguments for and against the action. n

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NEWS

POPULAR AUSSIE TV PRESENTER RESPONDS TO DILATED PUPIL CONCERNS Australian ophthalmologists joined other worried viewers in contacting the ABC when News Breakfast presenter Mr Michael Rowland appeared onscreen in hotel quarantine with a dilated pupil.

In responding to the “torrent of concern”, Rowland penned an online article to explain to viewers that this was his right eye’s permanent state, but there was no cause for alarm.

“Like David [Bowie], my eye condition is the result of trauma,” Rowland explained, referencing the singer’s anisocoria that occurred during a fight with friend George Underwood in 1962.

In January 1988, Rowland was a passenger in a car driving through Sydney’s inner west with windows wound down when he suddenly felt a blow to his right eye.

“At first it didn’t hurt. There was just a general numbness. Then came the excruciating pain, and the eye started filling with blood,” he wrote.

“It later turned out someone was firing slingshot pellets at cars that night, and I just happened to cop a bullseye.”

He was sent to the old Sydney Eye Hospital in Woolloomooloo for emergency surgery. A team, led by ophthalmologist Dr Frank Martin, managed to save the eye, but the pupil was to stay permanently dilated.

Rowland, who is also colour blind, said he was acutely aware of how different his eyes looked, and spoke of being self-conscious about his “bung eye” growing up.

He said several doctors and ophthalmologists had contacted him after the hotel quarantine segment expressing concerns for his ocular welfare.

“Close-ups and harsh lighting accentuate the larger pupil, especially as it can’t adapt to light and shade,” he said, adding this was the case in the recent appearance. n

ABC News Breakfast co-host Michael Rowland.

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INSIGHT February 2021

GENE THERAPY SHOWS POTENTIAL TO REGENERATE OPTIC NERVE "WHAT WE’VE SEEN IS THE STRONGEST REGENERATION OF ANY TECHNIQUE WE’VE USED BEFORE" KEITH MARTIN, CERA

A Melbourne professor has helped lead new research using a gene therapy to regenerate damaged optic nerve fibres, in a discovery that could determine future glaucoma treatments.

The pre-clinical study by Professor Keith Martin, from the Centre for Eye Research Australia (CERA) and University of Melbourne, was published in the journal Nature Communications recently and also involved Dr Richard Eva, Dr Veselina Petrova and Professor James Fawcett from the John van Geest Centre for Brain Repair at the University of Cambridge.

The team tested whether a gene responsible for producing a protein known as protrudin could stimulate the regeneration of nerve cells and stop them from dying when they were injured.

According to CERA, the researchers used a cell culture system to grow brain cells in the lab. They then injured them using a laser before introducing a gene to increase the amount of protrudin in the cells, vastly increasing their ability to repair and regenerate.

Tests of eye and optic nerve cells found the protein enabled significant regeneration weeks after a crush injury to the optic nerve.

Martin said the research demonstrated almost complete protection of nerve

Professor Keith Martin, CERA.

cells from a mouse retina growing in cell culture, a technique which would usually be expected to result in extensive cell death.

“What we’ve seen is the strongest regeneration of any technique we’ve used before,’’ he said.

“In the past it seemed impossible we would be able to regenerate the optic nerve but this research shows the potential of gene therapy to do this.’’

The international team is continuing its collaboration in Melbourne and Cambridge. Martin said next steps were to explore the ability of protrudin to protect and regenerate human retinal cells.

The research was supported in the UK

by The Medical Research Council, Fight for Sight, The Bill and Melinda Gates Foundation, Cambridge Eye Trust and the National Eye Research Council. n

OA NAMED APAC PROFESSIONAL ASSOCIATION OF THE YEAR Optometry Australia (OA) has been named the 2020 APAC Professional Association of the Year, with judges commending the body’s COVID-19 response.

Customer relationship management platform Glue Up revealed the 4th annual APAC Association Awards winners in December. It recognises the achievements of associations and individuals across the region and their impact on communities and professions.

The judging committee – consisting of senior-level association experts including from Australia, Africa and the Philippines – examined nominee’s activities, member acquisition and engagement as well as challenges overcome in 2020.

The judges highlighted OA’s commitment to its members early in the COVID-19 pandemic when 90% Lyn Brodie, Optometry of practices Australia. closed or shifted to telehealth services only. This was while it kept aiming to deliver its core project work to advance the profession and optometry.

OA president Mr Darrell Baker said he was proud to lead an award-winning professional organisation. n

NEWS

AHPRA ANNOUNCES ADVERTISING AUDIT AFFECTING OPTOMETRISTS, NEW GUIDELINES PUBLISHED Non-compliant advertising will be on the radar of the regulator from this month when it begins a nationwide audit of health practitioners and introduces a new declaration for optometrists to sign.

The Australian Health Practitioner Regulation Agency (AHPRA)’s advertising clampdown will begin in February 2021 and involve practitioners who renewed their registration in 2020.

The authority believes it will be an effective approach to determine overall advertising and non-compliance rates after conducting an advertising audit pilot in 2019. Advertising that breaches the National Law may lead to prosecution and a $5,000 penalty per offence for an individual or $10,000 per offence for a body corporate.

“Auditing will support improved compliance with advertising obligations across the entire registrant

population, not just those who have had an advertising complaint,’ AHPRA regulatory operations executive director Ms Kym Ayscough said.

“It will also provide opportunities to become more proactive in preventing non-compliant advertising by registered health practitioners.”

As part of the new measures, when applying to renew their registration, practitioners will need to complete a declaration about their advertising compliance. Its wording reminds practitioners of their obligations.

The audit process will not delay a decision on an application for renewal.

According to AHPRA, the Advertising Compliance and Enforcement Strategy for the National Scheme was launched in April 2017 to support improved compliance with the National Law advertising requirements. A revised

strategy, along with updated guidelines for advertising a regulated health service to help health practitioners understand their advertising obligations, has been released and came into effect 14 December 2020.

AHPRA begins the audit this month.

Changes to the guidelines include: • More content about testimonials, protected titles and claims about registration, competence and qualifications.

• New content about the evidence required for claims about the effectiveness of a regulated health service and what is acceptable evidence.

• Re-structuring of content so that information is easier to find.

There are also new flowcharts to help assess when advertising needs to be supported by acceptable evidence and whether a review is considered a testimonial. n

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NEWS

MELBOURNE COMPANY ADAPTS PERIMETRY SOFTWARE TO MEET CHANGING NEEDS An Australian software solution that measures visual fields on multiple platforms, including iPad, has now been translated into a browser-based interface, making it compatible with common IT equipment.

The brainchild of Glance Optical directors Dr George Kong and Professor Algis Vingrys, Melbourne Rapid Fields (MRF) was developed with The Royal Victorian Eye and Ear Hospital and The University of Melbourne.

The technology shot to prominence during COVID-19 due to its usability as a telehealth tool and significantly reduced risk of viral transmission compared with standard perimetry bowls.

The latest software development means MRF can be used for a broader range of remote ophthalmology and optometry telehealth purposes.

Prof Vingrys, former head of optometry and vision sciences at The University of Melbourne, has extensive experience in vision testing and developed the perimeter and online vision test jointly with Dr Kong.

“The translation of our software to a browser-based interface means it can be used with any equipment – so long as it is similar in size or larger than a 9.7-inch iPad – after a calibration step,” Vingrys said.

“I believe there are a few Queensland optometry practitioners who run outreach from their home base using this

Dr George Kong.

Prof Algis Vingrys.

telemedicine potential for diabetic patients who may live quite a distance away.”

"THE TESTING CAN BE PERFORMED USING COMMONLY FOUND IT EQUIPMENT IN OPTOMETRY AND OPHTHALMOLOGY CLINICS AND EVEN IN PATIENTS' HOMES" GEORGE KONG, GLANCE OPTICAL

has been validated in several peer-review papers and has TGA registration and FDA registration.”

Kong said there had been a surge of interest in the technology from the local and global ophthalmic community.

“This is because the software allows patients to perform a reasonably good assessment of the visual field and visual acuity using their own computer at home, therefore providing meaningful information that is valuable for telehealth consultations. It also helps to triage patients who most need clinic appointments.”

He continued: “In addition, using a computer screen for visual field testing solves a concern associated with conventional perimeters, that is, the risk of cross infection due to patient’s aerosolised breath lingering in the dome of the conventional perimetry machines. There is no need for contact between the patient’s face and device. It’s also easy to clean between patients when used in clinic.

Kong – an ophthalmologist, glaucoma specialist and medical technology entrepreneur – and Vingrys formed Glance Optical in 2015.

Since the COVID-19 outbreak, they have been adapting the MRF software to align with new demands on the public health system.

“The software is designed to allow accurate visual field testing (static perimetry) using any computer or tablet screen such that the testing can be performed using commonly found IT equipment in optometry and ophthalmology clinics and even in patients' homes,” Kong said.

“Therefore, MRF is valuable even in the clinic setting in place of standard perimetry.

I have been using the MRF exclusively in my own private practice in the past year for this reason.”

MRF software performs testing quickly, Kong said, taking three-and-a-half minutes per eye, on average and has capability for binocular field testing. It is distributed by Designs For Vision. n

“The software performs a simple calibration step to allow the test to be displayed on different size screens with different specifications. Our software

IRIS PROGRAM PERFORMS 500TH CATARACT SURGERY The Indigenous and Remote Eye Health Service (IRIS) delivered on its two-year government contract to perform 500 cataract surgeries, as coordinators warn of the disastrous implications if the program loses funding.

A specialist IRIS team travelled to Katherine, in the Northern Territory in late November to conduct the final round of cataracts as part of the IRIS 2.0 program.

Vanguard Health, operated by CEO Mr Tim Gallagher, was awarded a $2.2 million Federal Government grant in August 2018 to deliver the 500 cataract surgeries in priority areas by 30 June 2020. The

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INSIGHT February 2021

deadline was extended to 31 December 2020 due to COVID-19.

“I’m very proud of what IRIS has achieved, and proud of the professions of optometry and ophthalmology that have made a big difference to people’s lives,” Dr Bill Glasson, the IRIS co-chair and Queensland lead, said.

“What I love about the program is, with the dollars we get, 99% of it goes into treating patients in their communities – no one’s being paid to sit in committee meetings, and those that do, do it for nothing because we think it’s such a great service.”

IRIS 1.0 originated in 2009 and performed thousands of eye health services until

2014 when the funding expired, causing eye health to decline. Reinstated in 2018, Glasson hoped the government would continue to recognise its importance and renew the contract for 2021 and beyond.

Rosemary was the 500th patient.

“I keep saying to the government it’s costing you bugger all for the outcomes we are delivering, so please continue to fund it.

If it loses funding, the service will fall apart and all these patients who already have three times the rate of vision loss compared to non-Indigenous Australians could blow out to six times more – we will have more people losing vision, losing confidence in themselves and sustaining falls and becoming depressed.” n

NEWS

OPTOMETRY STUDENT ATTRACTING INDIGENOUS AUSTRALIANS INTO UNIVERSITY EDUCATION A Deakin optometry student who pursued a career in healthcare after seeing her family’s health deteriorate to diabetes and eye disease is fronting a new campaign to inspire more Indigenous Australians into higher education.

Ms Shahnaz Rind, who has previously completed a Bachelor of Nursing at the same university, is one of four students to feature in the Indigenous OpportUNIty campaign, launched by Universities Australia with the National Aboriginal and Torres Strait Islander Higher Education Consortium (NATSIHEC).

Rind is a 27-year-old Yamatji-Badimaya woman from north-west Western Australia who moved to Melbourne for her final years of high school before heading to Deakin University.

After completing her nursing degree in 2018, she became a project officer at the Youth Affairs Council Victoria working

with Indigenous young people across the state, and in 2020 commenced her optometry degree.

“I decided on optometry after conducting a survey into eyes and what they mean to people. I think they’re significantly underestimated, especially coming from an Aboriginal community and family where elders and young people just think ‘yeah you lose eyesight as you get older’, which is true but there are so many ways to prevent and treat it,” she said.

her father has had heart issues due to the disease. She suspects other relatives have undiagnosed diabetic eye disease, and some have recently had cataract surgery.

Shahnaz Rind, Deakin University.

“And that’s just my own family, there are plenty of others in the wider community who are going through cataract surgeries and diabetic retinopathy that wasn’t diagnosed or treated at an early stage,” she said.

When Rind eventually enters the optometry profession, she will be one of approximately 12 (0.2% of 6,043) optometrists who identify as Aboriginal or Torres Strait Islander, according to the latest Optometry Board of Australia figures.

“My nan, who’s eyesight was deteriorating a lot, wasn’t actually diagnosed or even looked at because our mob doesn’t really go to get their eyes checked unless people come out to them. And that all comes down to cultural safety as well; because there are no community members in that healthcare system to make them feel safe and approachable.”

In her family, Rind has seen the debilitating effects of diabetes. A respected elder in her community known as a grandmother to many has lost limbs and

Her message to prospective students on the challenge of university study is: “Our people have been resilient for 60,000 years plus. Keep going.” n

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NEWS

FOUR DIRECTORS JOIN OPTOMETRY AUSTRALIA’S SEVEN-SEAT BOARD

SAFILO MARKS CARRERA MILESTONE Safilo is celebrating the 65th anniversary of its proprietary eyewear label Carrera with a relaunch of its most iconic designs.

In January, the Italian eyewear giant said it would introduce the Carrera Icons Collection, coinciding with the peak of the Australian spring/summer season.

Following that, in April Safilo Australia will launch two remastered styles exclusive for the Australian market.

With Carrera dating back to 1956, the Icons collection is said to represent the authentic daring spirit of the brand, featuring the drop shape and C-logo engraved on the front.

Born in the 1980s, Safilo’s Champion, Hot, Cool, Changer and Safari designs are among best-sellers in its Carrera archive. The company has remastered the designs with new and original design codes, updated technical features and craftmanship.

“The drop-shaped or squared sunglasses in Optyl or metal are personalised by the iconic C-logo on the front, as the unmistakable signature symbol, and they are highlighted by net graphic lines on the top-bar as well as on the temples, recalling the Flag of Carrera,” the company stated.

The collection also features Panamerika65 and Endurance65 designs, which will become available from April 2021.

Meanwhile, to celebrate Australia’s contribution to Carrera’s global success, Safilo is releasing Carrera 22 exclusively to the local market.

Building on the strong style synonymous with Carrera in Australia, Carrera 22 is a lightweight acetate construction with a transparent trim in the universal Carrera shape.

The style has been remastered and updated with new colour schemes and the addition of polarised lens options.

"[THEY] WORKED TIRELESSLY TO SUPPORT MEMBERS THROUGH THE COVID-19 PANDEMIC INCLUDING PARTICIPATION ON THE NATIONAL CRISIS LEADERSHIP GROUP" DARRELL BAKER, OPTOMETRY AUSTRALIA

Four new directors including two nonoptometrists have been appointed to Optometry Australia (OA)’s national board with incumbent president Mr Darrell Baker granted a third year.

Investment and innovation analyst Mr Neil Wesley, barrister and solicitor Ms Sarah Byrne, and optometrists Dr Rob Howie and Ms Sarah Coudrey became the newest board members after the organisation’s annual general meeting on 27 November 2020.

Mr Murray Smith has been re-appointed deputy president for a second year and Ms Tori Halsey has been appointed treasurer.

Baker thanked the three departing board members for their combined 18 years’ service. Mr Gavin O’Callaghan was the longest serving director (12 years) who joined in 2008 and has been the organisation’s Treasurer since 2011. Ms Kylie Harris spent four years on the board and Mr John Palassis two years.

Baker said the departing directors had been instrumental in making sound governance decisions.

“Importantly, they have overseen the delivery of our current strategic plan which has enabled a wide range of initiatives to be introduced to the benefit of our members, the sector and community eye health,” he said.

“And they this year, along with all national directors, worked tirelessly to support members through the COVID-19 pandemic including participation on the national Crisis Leadership Group and the development

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INSIGHT February 2021

and implementation of the member fee offer that reduced fees by 50%.”

Baker said OA has been prudent in its financial management and investment decisions under O’Callaghan’s “watchful eye”.

“This has enabled the organisation to fund a range of activities, such as the Good vision for life campaign which has been instrumental in raising awareness of eye health amongst the Australian community and delivering several million optometry Darrell Baker, president. appointments.”

He added that the organisation’s strong financial position enabled it – along with its state divisions – to offer all members a 50% discount off their FY2020/21 membership fees, equating to six months free membership. n

MYOPIA PROFILE JOINS FORCES WITH CANADIAN INSTITUTION The world’s largest childhood myopia education resource developed by Australian optometry couple Dr Paul and Dr Kate Gifford has formed a new alliance with the renowned Centre for Ocular Research & Education (CORE).

The Australian-based Myopia Profile and Canadian institution CORE – part of the University of Waterloo’s School of Optometry & Vision Science – unveiled the joint venture that aims to expand both organisations’ services and reach.

Champion65 is among several iconic Carrera designs being reintroduced.

New national directors (from left) Dr Rob Howie, Sarah Coudrey, Sarah Byrne, and Neil Wesley.

According to CORE, the affiliation will grow its own clinical research capabilities,

adding expertise in specialty lenses, gas permeable, orthokeratology and scleral contact lenses.

It will also provide Myopia Profile with priority access to a world-leading clinical research site, and further extend the professional and patient education capabilities for which each team is internationally known, including the areas of myopia management.

“We share many points of view with CORE – clinically and personally – making this partnership a natural evolution of our relationship,” Dr Kate Gifford said. n

TECHNOLOGY

MYOPIA CONTACT LENS RATED AMONG TOP 100 SCIENTIFIC BREAKTHROUGHS OF 2020 CooperVision’s MiSight 1 day contact lens has been ranked in Popular Science’s top 100 innovations of 2020, alongside a fast, ultra-cheap coronavirus test, and joining past winners such as the portable defibrillator and the first spacecraft to visit Pluto.

past winners including the first portable defibrillator (1997), NASA’s New Horizons voyage to Pluto (2015), the first FDAapproved gene therapy (2017) and 5G cellular (2019).

The contact lens manufacturer announced that its daily wear, single use contact lens for myopia control had been recognised in the health category as part of the magazine’s 33rd annual Best of What’s New Awards.

2020's winner of the health category was Abbott Laboratories’s BinaxNOW rapid test, which received emergency-use authorisation from the US Food and Drug Administration (FDA). It detects COVID-19 in fifteen minutes for around $5 (AU$6.70) per test – without the need for specialised lab equipment.

Popular Science is an American quarterly publication featuring science and technology content for general readers.

Its awards recognise the most innovative technologies from the past year across 10 categories, such as health, home, aerospace and security.

Commenting on CooperVision’s award, ANZ professional services manager Mr Joe Tanner said: “MiSight 1 day is the only FDA approved treatment that can help reduce the severity of myopia progression and we are delighted that Popular Science has recognised the impact of this technology.”

Each product or technology must represent a significant step forward, with

Other ophthalmic-related products to feature in Popular Science’s top 100 were

the MedWand, by MedWand Solutions, and eyewear by a company called Stoggles.

MedWand is a clinical-grade diagnostic kit that allow doctors to gather information remotely that typically requires an inperson visit.

Joe Tanner, CooperVision ANZ.

About the size of a small coffee mug, the USB-connected setup gives physicians realtime access to data from 10 examination tools, including a stethoscope, otoscope (for the ears), ophthalmoscope (for the back of the eyes), and a dermatoscope (for skin lesions) – as well as a thermometer, a pulse oximeter (for monitoring heart rate and blood oxygen levels), and an ECG sensor.

The device is pending FDA clearance.

Stoggles are eyewear featuring protective side shielding. The glasses are American National Standards Institute-certified as safety goggles and feature blue-light filtering, UV reactivity to provide tinted sun protection, and an anti-fog coating. n

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RESEARCH

STUDY DISCOVERS AGEING RETINA CELLS CAN BE RECHARGED LIKE A BATTERY Scientists have shown that it is possible to significantly improve vision that has declined with age using short bursts of exposure to longwave light.

Specifically, 670 nanometre deep red light.

The discovery, published in The Journals of Gerontology, was based on a study involving 12 men and 12 women, aged between 28 and 72, who had no ocular disease.

All participants’ eyes were tested for the sensitivity of their rods and cones at the start of the study.

Rod sensitivity was measured in dark adapted eyes (with pupils dilated) by asking participants to detect dim light signals in the dark, and cone function was tested by subjects identifying coloured letters that had very low contrast and appeared increasingly blurred.

All participants were then given a small LED torch to take home and were instructed to place their eye over the end of the torch to look into its deep red 670nm light beam for three minutes a day for two weeks. They were then re-tested for their rod and cone sensitivity.

Researchers found the 670nm light had no impact in younger individuals, but in those around 40 years and over, significant improvements were obtained. Cone colour contrast sensitivity improved by up to 20% in some people aged around 40 and over.

Improvements were more significant in the blue part of the colour spectrum that is more vulnerable in ageing. Rod sensitivity also improved significantly in those aged around 40 and over, though less than colour contrast.

Lead author Professor Glen Jeffery of the University College London Institute of Ophthalmology said the study shows that it is possible to significantly improve vision that has declined in aged individuals using simple brief exposures to light wavelengths that recharge the energy system that has declined in the retina cells, “rather like recharging a battery”.

“The technology is simple and very safe, using a deep red light of a specific wavelength, that is absorbed by mitochondria in the retina that supply energy for cellular function. Our devices cost about £12 (AU$22) to make, so the technology is highly accessible to members of the public,” Jeffery said. n

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INSIGHT February 2021

CORNEA RESISTANT TO THE NOVEL CORONAVIRUS – STUDY "A SUBSET OF PEOPLE MAY HAVE CORNEAS THAT SUPPORT GROWTH OF THE VIRUS, BUT NONE OF THE CORNEAS WE STUDIED SUPPORTED GROWTH OF SARS-COV-2" JONATHAN MINER, WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

A new study has suggested the cornea can resist infection from the novel coronavirus, in findings that bode well for corneal transplants and similar procedures.

Researchers from the Washington University School of Medicine in St Louis wanted to see how SARSCoV-2 interacted with the cornea after previous studies established herpes simplex virus can infect the cornea and spread to other parts of the body in immunocompromised patients, and Zika virus has been found in tears and corneal tissue.

“Our findings do not prove that all corneas are resistant,” first author Dr Jonathan Miner said. “But every donor cornea we tested was resistant to the novel coronavirus. It’s still possible a subset of people may have corneas that support growth of the virus, but none of the corneas we studied supported growth of SARS-CoV-2.”

Miner, an assistant professor of medicine, of molecular microbiology and of pathology and immunology, teamed up with ophthalmologist Dr Rajendra Apte to study mouse and human corneas exposed to the herpes simplex, Zika and SARS-CoV-2 viruses.

“Some COVID-19 patients get eye symptoms, such as conjunctivitis (pinkeye), but it’s not clear that the viral infection itself causes that; it could be

Dr Rajendra Apte. Image: Washington University School of Medicine.

related to secondary inflammation,” Apte said.

“The cornea and conjunctiva are known to have receptors for the novel coronavirus, but in our studies, we found that the virus did not replicate in the cornea.”

Apte and Miner also identified key substances in corneal tissue that can promote or inhibit viral growth.

One inhibitor they identified is called interferon lambda. They found that it prevented efficient growth of Zika virus and herpes simplex virus in the cornea.

But with SARS-CoV-2, levels of the substance had no effect on whether the virus could replicate. It could not gain a foothold whether interferon lambda was present or not. n

OPHTHALMOLOGISTS TREAT RARE CORNEAL BEE STING Ophthalmologists have detailed how they treated an unlikely case of a corneal bee sting in renowned peer-reviewed medical journal The New England Journal of Medicine.

Dr Teena Mendonca and Dr Gladys Rodrigues from the Kasturba Medical College Mangalore, Mangalore, India, reported the 22-year-old man appeared in an emergency department with redness, pain, and decreased vision one hour after being stung by a bee in the left eye.

His visual acuity in the right eye was 20/20, but he reported seeing only hand movements close to his face with the left eye. Their examination showed diffuse

corneal haziness caused by corneal edema; a retained stinger that was surrounded by infiltrates.

The ophthalmologists said the patient was treated with a moxifloxacin ophthalmic solution, and the stinger was removed under local anesthesia.

The corneal wound was secured with sutures after thorough cleansing of the anterior chamber, and the patient was prescribed a two-week course of topical glucocorticoids, antibiotics, and cycloplegic medications.

At the three-month follow-up, the corneal edema had resolved and the visual acuity was 20/40 in the left eye. n

COMPANY

MENICON SETS SIGHTS ON SMART CONTACT LENS TECH Japanese contact lens manufacturer Menicon has signed a joint development agreement with a US firm producing the world’s first augmented reality contact lens that overlays images and text on wearers’ natural field of vision.

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The company has reached an agreement with Mojo Vision.

The company announced the deal late in 2020 with Mojo Vision, which will combine Menicon’s expertise in rigid gas permeable lenses with Mojo’s smart contact lens microelectronics, systems integration and consumer products innovation.

Mojo is working with the US Food and Drug Administration through its Breakthrough Devices Program, and has several proprietary technologies, including the smallest and densest dynamic display, a power-efficient image sensor built for computer vision, a high-bandwidth, low-power wireless radio, and motion sensors for precise eye tracking and image stabilisation.

Through the agreement, Mojo and Menicon will conduct a series of feasibility studies, centring on contact lens materials, cleaning, and fitting, among other topics.

If the feasibility studies succeed, Mojo and Menicon may work closer in future.

“This agreement with Mojo is a key step forward in our expansion of Menicon’s technology initiatives,” Menicon president Dr Hidenari Tanaka said.

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“Mojo is an innovative company with a technology platform and a vision for the future of contact lens wear that aligns with Menicon’s aspirations. We believe that both companies can bring together skill sets and technologies that will support the successful development of a truly breakthrough product.”

Mr Drew Perkins, CEO and co-founder of Mojo Vision, said the development agreement was a significant step forward for the company, which has raised more than US$159 million (AU$210 m) to date.

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“Menicon’s team of seasoned professionals will bring significant contact lens research and development expertise to Mojo. We look forward to a long, productive working relationship.”

Mojo Vision is currently developing the world’s first augmented reality smart contact lens, called Mojo Lens, backed by years of scientific research and numerous technology patents. It overlays images, symbols and text on users’ natural field of vision without obstructing their view, restricting mobility or hindering social interactions.

Its work with the FDA is a voluntary program designed to provide safe and timely access to medical devices that can help treat irreversibly debilitating diseases or conditions. n

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OPTOMETRY

TAKING INDEPENDENT OPTOMETRY TO THE George & Matilda Eyecare has rapidly grown its network to around 90 practices in four years. With plans to double in size by 2024, founder and managing director MR CHRIS BEER explains how data scientists, AI, and advanced digital assets are driving value to independent optometry.

D

espite 36 years in the optical industry, Mr Chris Beer, founder and managing director of George & Matilda Eyecare (G&M), says his biggest lesson has been to forget almost everything he has learned and be guided by the data.

It’s a mindset that aligns with the way in which the world’s leading optical businesses operate to dominate their respective markets today.

And more importantly, according to Beer, is critical to the survival of independent optometry.

“Seven years ago, I was on record saying if you don’t have a data scientist you’re going to die, and I believe if you don’t have one today, you are dead, you just don’t know it yet,” he says.

“In the next year or two I think George & Matilda would be as digitally-savvy as the best in the world in the optical business – and right now we are certainly well advanced of most companies in Australia. But the problem is it’s too late for those businesses that haven’t already invested. Many simply may not even know about the technology yet, and once they do the cost of entry isn’t small.”

Technology and the advantages of buying, marketing and administrative power are major components of G&M’s value proposition for its independent community that has grown to around 90 in just four years.

Beer says the company has invested ahead of the technological curve. This includes customised supply chain software, as well as artificial intelligence that leverages databases and can send more than 700 personalised patient communications depending on age, sex and demographic. Underpinning this is a centralised data system that’s analysed by an in-house data scientist, with the company set to appoint another in the coming months.

When G&M launched in 2016, it vowed to become the independent pillar

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INSIGHT February 2021

George & Matilda CEO and managing director Chris Beer founded the company in 2016.

and third major player in the Australian optical market. Its mantra was to be the engine behind Australia’s best independent optometrists that are embedded within the fabric of their communities.

While the values-driven company has outlined ambitions to double in size over the next three years, it remains selective about who it chooses and has turned away more than it has brought on board.

“For us it’s about building a quality community, not a drag race for size and scale,” Beer says, adding that some practices are coached before later joining the network.

“The way I describe George & Matilda Eyecare to my friends is when I’ve got the man flu on a Sunday night, I don’t care who I see. I just want to go to the 24-hour clinic and make sure it’s nothing worse and maybe get some medication.

“There’s already others doing that today [in optometry] – and there’s nothing wrong with it, they do that well – but if I get chest pain, I want to go to the doctor I’ve been seeing for the last 20 years who’s got all my history, family history, and will spend more time with me. That’s what George & Matilda is and that’s the DNA we go through to choose who’s part of our community.”

SUCCEEDING WHERE OTHERS FAILED G&M’s business model provides significant back-office support and infrastructure so its partner optometrists can dedicate more time to their patients.

In the majority of cases, it purchases the assets of the business and co-brands, building on the existing brand equity.

But Beer says continual investment in technology – with the benefits of scale – is where it generates significant value for its partner practices.

It’s an area he identified when formulating the G&M business plan more than five years ago. Beer always believed independents needed to be better coordinated, and this was confirmed after visiting the graveyard of failed allied health businesses, and researching what worked.

“It’s all well and good to cobble together a few stores, but if you don’t build platforms or technology and therefore add value, it doesn’t work. All you’re doing is adding some overhead infrastructure costs, and if it wasn’t profitable before, it’s going to be worse today,” he explains.

“As an independent you can’t afford to have Salesforce turned on doing A/B testing, interactive messages, and using AI tech and the data scientists behind them. The big guys are already doing it, and the gap isn’t linear, it’s accelerating.”

While it’s a technological challenge, Beer says G&M’s strength is its ability to allow practices to maintain their individuality, while embedding the back-end systems that customise to each practice’s requirements.

“We want our partners to come on board because they’re good at what they do, and we want them to continue that. Where we can add value we will, and where we can’t, we leave you alone. Our technology accounts for the customised frames assortment in each practice, and, in theory, every customer will have a personalised customer journey and all the digital assets will continue to build upon that every time.”

“Even though I’m one of the most experienced people in the room, one of the key learnings has been to forget everything I have learned and understand what the data says. When we’re sitting around the table, I want to know what our data scientist thinks because that’s where the answer lies – and often it’s very different to what people think.”

POISED FOR RAPID GROWTH While many businesses reacted to the changing landscape in 2020, Beer says G&M used it as an opportunity to reset.

It is now much clearer on its ambitions, which includes being even more selective with people and practices that align with its values and vision, while also forming deeper business ties with fewer suppliers.

G&M wasn’t immune to the pandemic; it shut and merged some marginal practices that were included in package deals and figured out how to do more with less. It also halted acquisitions and head office worked seven days a week to ensure liquidity, renegotiate rental/loan agreements, review supplier arrangements and provide key business and employment advice to practices – including up to 100 businesses that weren’t part of G&M (outside normal business hours).

When Beer spoke with Insight in December, the recovery was in full swing, and he had just completed a three-day off-site meeting with the board and senior team to outlay the strategy for the next three years.

As mentioned, a major component is doubling the practice network. The first phase happened in late 2020 with the relaunch of its acquisitions program, seeing Meyer Optica in Balmain, New South Wales, and Mt Martha Optical, in Victoria, join the network.

Traditionally, G&M has preferred to focus internally on driving value to its practices and patients and placed little emphasis on consumer marketing. But that is also set to change this year.

“You will see the launch of George & Matilda 2.0 for want of a better term, and we will start going to market through a number of different channels and digital assets. We can start driving more people to the stores and building that brand equity,” he says.

“We have got to a size and scale now that economically it makes sense.

There becomes a tipping point where you can invest that money and it becomes a virtual circle, but if it’s done too early, you’re not big enough to get scale, so you’re not really driving the value.”

Another major focus will be succession planning for the future leaders of the industry. G&M has some partners – and key opinion leaders – seeking to transition to retirement.

“Succession planning is not just about finding a great partner, but a great partner who wants to take the baton and the legacy and be part of what the future of the industry is going to be for the next 20 to 30 years. We are spending a lot of time around succession planning and I think that’s going to be quite interesting.” n

With the imminent appointment of another data scientist, a large part of that work involves looking for correlations in data collected through each practice’s Sunix or Optomate practice management systems. Insights are fed back to practices to help grow sales and run more efficient businesses.

This extends to looking at certain customer groups and their basket values, and figuring out what motivates purchasing decisions.

“Historically, in a meeting of decision makers, there’s usually two outcomes: the most passionate person in the room wins because they convince the majority, or the leader says no we are going to go this way.

And it’s all done usually with good intentions, good will, some information and bias,” Beer explains.

Since COVID-19, the company has become more selective with practices it partners with.

INSIGHT February 2021 23

2021 PREDICTIONS

WHAT'S IN STORE FOR

2021 With one of the most turbulent years in living memory behind us, this year promises to be a year of recovery and renewal. We ask some of the Australian ophthalmic sector’s brightest minds to gaze into their crystal ball and predict what’s ahead in 2021.

24

INSIGHT February 2021

DR BRENDAN CRONIN

AMANDA LEA

ORGANISATION:

ORGANISATION:

Queensland Eye Institute, corneal and anterior segment surgeon

UNSW Optometry Clinic, staff optometrist

AREA OF INTEREST:

AREA OF INTEREST:

Cataract surgery, corneal disease, dry eye and glaucoma

Myopia and paediatric optometry

Hopefully 2021 will be the year we switch from epithelium off corneal collagen cross-linking to epithelium on, oxygen enhanced crosslinking. We are already performing the new procedure called Boost but the Glaukos FDA study results should be released in the next 12 months on this protocol, seeing it go mainstream.

We have now combined oxygen enhanced epithelium on crosslinking with our topography-guided cross-linking system (the only one in Australia) for over a year. This means people can have their corneal topography and vision improved with faster recoveries, without even having their epithelium removed. It’s definitely the way forward in cross-linking.

The ongoing challenges from COVID-19 will continue in 2021. We are a large clinic with an on-site hospital. Managing patients with social distancing as well as patient and visitor registration will be an ongoing issue. Hopefully a vaccine makes that much easier.

Innovations in spectacle and contact lens designs, investigations into the efficacy of different atropine doses, and a growing public and optometric awareness mean 2021 promises to be the year of myopia management, and hopefully the year of getting outside for some green time.

The UNSW Myopia Clinic has been bursting at the seams, which is indicative of the year we’ve had, being stuck indoors and on devices.

I’m excited our students graduate with a good understanding of the importance and mechanics of myopia management. This will shape outcomes for kids Australia-wide. Advocacy by optometrists, whether it’s locally or as part of global efforts, will reduce the burden of eye disease and disability in future.

While we prescribe contact lenses to lots of kids, there’s still some resistance to the idea. Contact lenses can be life-changing for a myopic child, and are safe and effective for myopia control. There’s opportunity to investigate and overcome barriers in this area.

FINOLA CAREY

DR PETER SUMICH

ORGANISATION:

ORGANISATION:

Optical Distributors & Manufacturers Association (ODMA)

Australian Society of Ophthalmologists, vice-president

AREA OF INTEREST:

AREA OF INTEREST:

Manufacturers and suppliers

Ophthalmology, cataract and refractive surgeon

Someone recently said the pace of change in technology development has never been faster and will never be this slow again. The key feature that will shape the ophthalmic equipment market is not so much keeping up with new technology as the software behind it; incorporating AI algorithms that use data to diagnose disease or predict treatment outcomes.

Suppliers will be keen to return to face-to-face demonstrations to maximise the instant asset write-off available to practitioners. ODMA’s biggest challenge – but one we’re certain we can deliver – is instilling confidence that September’s O=MEGA21 in Melbourne will be COVIDsafe for everyone to attend. While there is plenty of talk about virtual events, we won’t pursue them as we feel they offer reach but not depth.

A major milestone for 2021 is my 25th year as CEO. When you have been in a job this long it’s critical to remain agile and I’m proud of our ability to reinvent our shows during my tenure, while successfully collaborating with 10 different chairpersons.

Medibank Private has taken a 49% shareholding in Eastern Sydney Hospital and it appears that vertical integration is on the agenda.

It will initially invest $8.8 million in the business to fund capital investment and operational costs required for the hospital to scale its short stay model of care.

We continue to monitor the insurers and note how their policy plans are incrementally coming between patient choices and surgeons. We feel strongly that patients should come to surgeons by way of referral, rather than as directed by insurers who have packaged up surgery with their own contracted doctors and hospitals.

Similarly, there are instances of private hospitals elsewhere doing deals with insurers to cut non-contract surgeons from care pathways. When a patient is directed by their health fund to follow a clinical pathway where the insurer determines the hospital, doctor and treatment, we are seeing US-style managed care in operation.

INSIGHT February 2021 25

WHAT'S IN STORE FOR

2021 CHARLES HORNOR

A/PROF SIMON SKALICKY

ORGANISATION:

ORGANISATION:

Specsavers Australia & New Zealand, communications director

Glaucoma Australia, president

AREA OF INTEREST:

Glaucoma

AREA OF INTEREST:

Optometry – corporate

We see the year ahead as one of new momentum and growth for our store partners, while being mindful that COVID-19 could reemerge unexpectedly.

In the run up to the new year we announced the first raft of 2021 new store openings and in addition we will be expanding many existing stores into larger premises. We know the competition for the limited number of optometrists in the market will be as strong as ever this year and so we are excited to see the new University of Western Australia optometry school get up and running to create a new stream of graduates for the future.

On another note, we are excited about the development of Specsavers HealthHub. 2021 will see a full year of national reports produced and delivered via the site using anonymised eye health data.

Importantly, each report will coincide with the key dates in the eye health calendar for glaucoma, diabetes, the Medicare year-end and more.

COVID-induced primary care service reductions will have a lingering impact this year. Many established glaucoma patients didn’t access routine monitoring visits, and fewer undiagnosed patients were detected. Now care is being accessed, there’s a significant backlog of clinical and surgical work that may strain the healthcare system. Telehealth may be utilised in glaucoma monitoring for isolated patients should further outbreaks occur.

GA’s period of strategic growth and transformation will continue through 2021 and 2022. This includes expanding risk awareness campaigns driving early detection, improving board and governance processes, expanding revenue sources to support patients and fund meaningful Australian glaucoma research. GA is developing objective metrics and collecting data to quantify the benefits of its services.

During Glaucoma Awareness Week (7-13 March) we’re launching a new ‘Treat Your Eyes’ campaign, prompting people to consider the value of their sight and get tested. GA’s family link risk awareness campaign ‘Begins with You’ prompts people with glaucoma to ask their family to get tested.

DR FRED CHEN

JANE SCHULLER

ORGANISATION:

ORGANISATION:

Lions Eye Institute, clinicianresearcher

Orthoptics Australia, president

AREA OF INTEREST:

Orthoptics

AREA OF INTEREST:

Macular degenerations and inherited retinal diseases

Recognition of geographic atrophy as a potentially treatable condition – with new trials on the horizon – could be a key feature shaping retinal disease landscape in Australia and globally this year.

I’m also eager to see the emergence of longer acting drugs for neovascular age-related macular degeneration (AMD) and new trials of port delivery systems for old drugs like Lucentis, allowing longer actions. Inherited retinal disease (IRD) is increasingly recognised as a subspecialty with multidisciplinary approach to management.

At LEI in 2021, we will run multiple clinical trials in AMD, retinal vascular disease and IRDs. There will also be a focus on long-term outcomes of chorioretinal anastomosis for retinal vein occlusion, expanding genetic analysis of patients with IRDs, and diabetic retinopathy imaging of retinal vasculature.

We will also continue collaboration with PYC Therapeutics on development of a retinitis pigmentosa (RP) therapy. We’ve also been awarded research funding to genotype dominant and recessive RP and Stargardt disease families, and investigate juvenile diabetic retinopathy and retinopathy of prematurity.

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INSIGHT February 2021

Innovative care models will be a key feature in 2021. There are already good examples of orthoptic-led clinics within the public system, but this was bolstered in 2020 with the emergence of the orthoptic-led postoperative cataract clinic (OSOP) at The Royal Victorian Eye and Ear Hospital, and a student-led orthoptic clinic at La Trobe University.

Orthoptists are highly skilled, and I’d like to see more clinics like these to address cataract and other waitlists.

A challenge in 2021 will be continued uncertainty around COVID-19 until a vaccine rollout. Our events are planned well in advance so we are predicting member confidence to travel, while finding the right balance between face-to-face and virtual meetings. We expect to see further innovation with our online learning capabilities.

Our annual scientific conference is planned for the Brisbane Convention and Exhibition Centre, co-located with RANZCO 20 to 22 November.

PROF KEITH MARTIN

LYN BRODIE

ORGANISATION:

ORGANISATION:

Centre for Eye Research Australia, director

Optometry Australia, CEO

AREA OF INTEREST:

Optometry

AREA OF INTEREST:

Eye research and glaucoma

The legacy of COVID-19 and the backlog of undiagnosed and untreated eye conditions will be a key focus of eye research in 2021.

CERA’s new Health Services Research Unit will examine how innovative new technologies, telemedicine and better coordination of the eyecare sector can tackle the backlog and prevent blindness.

The pandemic has also accelerated the development of technologies for remote screening and diagnosis, which reduce a patient’s need to attend clinic. Using artificial intelligence and powerful new imaging technologies, our team is investigating new ways of detecting eye disease earlier to prevent vision loss.

We are excited about the next phase of our research into the role of vitamin B3 in preventing nerve cell damage from glaucoma. We’re also continuing research to develop new gene therapies – and look forward to enabling Australian patients to be part of international gene therapy trials.

Optometry Australia is full of optimism for 2021. In the new year we will launch our 2021-2024 Strategic Plan to guide the evolution of the sector over the next three years and towards our 2040 transformation goals.

We will progress opportunities for optometrists to work to their fullness of scope, particularly in management of chronic conditions, patient access, system efficiency and continue to advocate for telehealth.

As members transition to the new CPD regime, we will provide the systems and tools to meet the OBA’s regulations whilst delivering our quality education program.

We will watch carefully the launch of new technology and AI and work with the sector on advancing these into the Australian market where applicable.

And as consumers become more environmentally conscious, we will need to start finding ways that optometry can reduce its collective footprint. In pursuit of these efforts, we will recall the powerful lessons of 2020, and remain agile, attuned to changing contexts and the new opportunities they present.

PHILIP ROSE

A/PROF ASHISH AGAR

ORGANISATION:

ORGANISATION:

Eyecare Plus, national business development manager

Australian Society of Ophthalmologists, president

AREA OF INTEREST:

AREA OF INTEREST:

Optometry – independent

Cataract, glaucoma and general ophthalmology

During the pandemic, independent optometry proved a reliable partner to the communities in which they operate. Many of the chains closed, while the local independent kept offering in-person services, as the official guidelines allowed it. This brought in many new patients and the challenge is to now keep them. Another primary focus will be catching up on delayed patient recalls.

We’ve now won the Canstar Award for Most Satisfied Customers three years in a row. We will focus strongly on our group brand advertising into our practices’ local communities, particularly as many patients continue to work from home. Our members will continue to benefit from cost sharing, to maintain a consistent presence across various advertising channels.

We’re looking forward to our national conference in October and, obviously, we’re excited about the positive news around a vaccine. 2020 has caused much reflection about personal priorities, and changes will be implemented throughout 2021. We look forward to a prosperous year ahead.

In 2021 ophthalmology will continue to adapt to the ‘new normal’ brought about by the COVID-19 pandemic.

Following COVID-safe guidelines for social distancing and infection control doesn’t just protect patients and the community. The pandemic has exposed just how vulnerable healthcare workers are to infectious diseases, especially eyecare professionals, who work 400mm from the patient.

The after-effect of lockdowns is also still reverberating across the nation, especially in Victoria. Delayed presentations mean more severe eye conditions to be managed, along with a backlog of patients.

Public surgery waiting lists have blown out and some hospitals still yet to resume normal levels of activity despite restrictions being eased months ago.

INSIGHT February 2021 27

WHAT'S IN STORE FOR

2021 PROF NITIN VERMA

CHRIS BEER

ORGANISATION:

ORGANISATION:

RANZCO, president

George & Matilda Eyecare, CEO

AREA OF INTEREST:

AREA OF INTEREST:

Ophthalmology

Optometry - independent

Obviously COVID-19 will, unfortunately, still be with us in 2021. I am looking forward to seeing how technology can connect us better; to peers, to family, to patients and to community.

At RANZCO, we’ll be working to implement our strategic plan with a focus on education, members, community, equity and sustainability. We will continue to work productively with the New Zealand and Australian (federal and state level) governments, especially on the outcomes of the MBS Taskforce Review into ophthalmology items where we are keeping patient access and safety front of mind.

Addressing inequity across both countries represents an enormous challenge but I hope RANZCO can lead collaborative efforts and partnerships to meet this most critical of needs. I am optimistically looking forward to a face-to-face RANZCO Congress in November in Brisbane. I hope to see everyone there!

While 2020 has presented many challenges for our industry, those who are prepared to be bold and adaptable can thrive.

We ended 2020 by bringing onboard more practices, after a period of us focusing on how we can evolve our existing business to be as future-proof as possible.

Our focus going into 2021 will be to attract the best practices and talent into our growing community. We then leverage the benefits of technology and data-analytics to provide a customer experience like no other.

As CEO, I will be constantly challenging myself and my team to think differently about how we can offer our patients a world-class experience. In a world where nothing stays the same, innovation is no longer a ‘nice to have’ but a necessity.

PROF HUGH TAYLOR

A/PROF TIM ROBERTS

ORGANISATION:

ORGANISATION:

University of Melbourne, Indigenous Eye Health chair

Vision Eye Institute, medical director

AREA OF INTEREST:

Ophthalmology – private

AREA OF INTEREST:

Indigenous eye health

The Aboriginal Community Controlled Health Organisations (ACCHOs) were outstanding and showed their leadership when they took charge of arrangements to protect their communities from COVID-19 last year. This should set the pattern for the ongoing development of eyecare services that should be based in ACCHOs and primary care.

There is also a pressing need to catch up on eye exams and care, including surgery, that has been postponed or cancelled because of the lockdowns.

Eyecare provision will be shaped by the long-awaited national road map of action to “eliminate avoidable blindness by 2025” as listed in the Long Term National Health Plan.

We will continue to provide technical support and advocacy for regional eyecare networks and services, and the promotion of good hygiene and safe housing in the trachoma areas.

The fourth National Aboriginal and Torres Strait Islander Eye Health Conference will be held virtually 20 to 22 April. It will be a great opportunity to celebrate successes and identify and define areas requiring work.

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INSIGHT February 2021

Private health insurers are likely to continue to seek ‘package’ arrangements from doctors and hospitals to ensure certainty around out-of-pocket costs for their members. We have already seen a number of large insurers seek tender responses and expressions of interest from hospitals that incorporate the fees for the attending surgeon and anaesthetist.

Succession planning in the context of an ageing medical and nursing workforce is also a priority, as well as balancing increasing patient numbers with the various, prudent COVID-safe processes and procedures across our 27 clinics in Victoria, New South Wales, Queensland and South Australia.

With the pandemic forcing us toward a virtual interactive environment, we expect most of our continuing professional development activities, including our large scale Eye360 and EnVision events, will be delivered online given the success of this approach in 2020.

BRENDON GARDNER

PROF MICHAEL KALLONIATIS

ORGANISATION: The Royal Victorian Eye and Ear Hospital, CEO

ORGANISATION:

AREA OF INTEREST:

AREA OF INTEREST:

Public eye hospital

Advanced ocular imaging, diagnostic and management services

It is an understatement to say 2020 was a challenge. The key focus for the hospital in the first part of 2021 will be attending to the backlog of elective surgery and specialist clinic patients.

I was pleased to see how the hospital innovated during this period both in response to COVID-19 and in further embedding telehealth, where appropriate, into safe patient care. Understandably, last year took a toll on our staff which has prompted a focus on hospital-wide wellness initiatives.

What I am most proud of is how the hospital has still managed to move forward during this time. Some very exciting milestones included the progress of the hospital’s redevelopment, with the first of our departments moving to the new Surgical Admissions and Recovery suite. Further achievements saw the launch of our Innovate Reconciliation Action Plan which marks a significant second step on our journey towards reconciliation.

Centre for Eye Health, centre director

2020 laid the foundations for an exciting period of growth and development at CFEH and optometry in general. The disruption in clinical care challenged us and triggered the initiation of alternate procedures for clinical care delivery through the expanded use of information and communication technologies (ICTs): the genesis of ‘tele-optometry’.

CFEH expanded the use of ICTs through online/virtual history and identified patients in need of care: we have modified and continued to use this approach as restrictions were lifted. Further, through research collaborations, we will begin further multi-year research studies in 2021 to further develop this. We will also launch a new education initiative with the development of the "CFEH Atlas" – an online resource for optometrists showcasing posterior eye disease through the use of multimodal imaging helping users better understand how to interpret advanced imaging, and assist with disease diagnosis: another use of ICTs. We expect use of ICTs to become the new norm thereby streamlining optometric care, communication and changing the way we practice.

STEVEN JOHNSTON

TIM MCCANN

ORGANISATION:

ORGANISATION:

ProVision, CEO

Rodenstock Australia, general manager

AREA OF INTEREST: Optometry – independent

AREA OF INTEREST: Spectacles/lenses

ProVision hopes that many of the behavioural shifts that have gained rapid adoption in 2020 become lifelong habits.

This includes increased take up of ordering technology such as ProSupply, which needs to continue to help make the independent supply chain as efficient as possible in 2021 and beyond.

We also hope more patients continue to embrace online bookings which is a win for both the patient (convenience) and the practice (time). Changes to the way we work, such as working from home rather than office, will impact the way we consume our eyecare with many patients choosing to support genuine “locals”.

This year may also see increased utilisation of digital channels among patients to research and choose eyecare providers. ProVision is well placed to help progressive independent practices grasp these opportunities with both hands with inhouse systems complemented by best of breed referral partners.

We will be announcing exciting developments to our members and supplier partners at separate meetings in February.

The final months of 2020 were promising and give a good indication of a positive 2021, and we can put all the challenges of 2020 behind us and into perspective.

We are definitely seeing a development in product mix to higher quality product and a continued increase of interest in technical innovation and lens improvements. Rodenstock will continue to focus on the DNEye innovation that provides an extremely high level of personalisation using measurements from the DNEye Scanner 2 device. Practices that have implemented so far are experiencing high levels of interest from patients and reporting success in many areas of their practice.

Rodenstock has been working with Matrix Eyewear for a number of years and this partnership will continue. From 2021, however, the Porsche Design Eyewear, which is manufactured by Rodenstock and distributed by Matrix, will instead by distributed and sold directly by Rodenstock. The brand is developing worldwide and there are a number of exciting releases planned for 2021.

INSIGHT February 2021 29

CATARACT SURGERY

Eliminating inefficiencies

AND NEVER-EVENTS IN CATARACT SURGERY Ensuring correct intraocular lens selection is a labour-intensive process fraught with risk and the potential for human error. Queensland surgeon DR MATTHEW RUSSELL explains how new software has transformed cataract safety and workflow at his practice.

I

ncorrect intraocular lens (IOL) implantation is one of the most dreaded incidents for any cataract surgeon, exacerbated by the patient’s inability to comprehend such a critical and avoidable error.

Intricate diagnostic tools, multiple data points, small font, complex formulae, print outs and manual transcription provide the ingredients for potential neverevents, and explain why cataract surgery carries the greatest risk of inserting the wrong implant than any other procedure.

Such errors may occur at any stage from the decision to operate, to implantation, but are almost universally due to a breakdown in safety protocols.

In 13 years of private practice Dr Matthew Russell, an Australian surgeon with significant experience with toric and multifocal IOLs, has only encountered one such incident when a typo for the IOL power resulted in a 2.0 D refractive surprise for the patient.

“Other than a serious complication during cataract surgery, it is one of the most dreaded things. But the problem with an IOL selection error is that it’s very difficult for the patient to comprehend how it could have ever happened,” Russell, the founder and director of OKKO Eye Specialists Centre, which has

30

INSIGHT February 2021

three sites in Queensland, says.

“That was a long time ago and we have continually sought to refine and improve our processes. But that comes at an enormous cost. Having two team members simultaneously checking transcription in every step within our clinic and then a further check pre-op takes a lot of administrative time. And even with those checks in place, it was still possible to find small errors occurring at that final check.”

Dr Matthew Russell, OKKO Eye

Specialists Centre.

Such events are also stressful for the ophthalmologist. A review of claims to the NHS Litigation Authority in the UK found cataract care to be the largest share of litigation in ophthalmology and awarded the highest total damages.

Despite rigorous checking processes, no system is immune from errors when humans intervene. And the issue becomes even more complex when implanting toric IOLs with several more potential error sources and timeconsuming steps.

For years, Russell has yearned for a system that overcomes the burdens of checking procedures, while almost completely eliminating the risk of manual transcription errors and toric axis misalignment.

Since 2019, his clinics have been among a few worldwide to pilot the new Zeiss EQ Workplace, which then became available in Australia in May 2020, with 12 sites now using the technology.

The latest addition to the Zeiss cataract suite, the software is a digital surgical planning tool that allows seamless, automated data access and transfer.

According to Russell, it’s had a transformative impact on safety and practice efficiency. Working across three sites, he can also access patient data and surgery plans from any location on multiple devices.

“Spending less time worrying about the possibility of an error and being able to make a selection that I know is going to be the one that turns up in the operating room when I’m with the patient gives me tremendous peace of mind,” he says.

ELIMINATING RISK Traditionally for Russell, the moment fraught with the most risk was when his support staff would take the lens selection print out and manually type the data into other systems to inform the day surgery of the selected IOL and order the lens from the supplier.

Now, with EQ Workplace, the information from diagnostics to operating room is effectively shut off from human intervention.

To explain how it works, Russell says measurements taken from the IOLMaster and other devices such as keratometer and wavefront aberrometer are transferred to the cloud and presented together on his customised desktop computer using Zeiss Forum. The biometry data is also pre-populated for automatic IOL calculations.

With the patient sitting next to him, Russell can then go through the IOL selection process.

“And once that plan is approved, from there we automatically send a PDF to order the implant, and that same PDF goes to the day surgery. There is almost zero-risk of transcription errors, with no other humans involved in the process.

And because we are ticking a box directly to select the IOL, there is no typing involved, that information is immutable, it can’t be changed,” he says.

“Furthermore, any business has the pressure of limited staff resources, and so it’s great to know that our staff aren’t spending numerous hours with processes that are almost invisible to the ophthalmologist and practice managers – they can now spend more time in patient-fronting roles.”

Importantly, the open platform doesn’t discriminate against IOL manufacturer, allowing the surgeon to select any preferred lens.

From there, Russell uses the Zeiss EQ Mobile app. It’s essentially an extension of EQ Workplace that allows him to transfer his surgical planning information from his central data management point (the cloud) at his main practice to be accessed by a remote device.

In his case this it is an iPad he takes into the theatre. But it also means he can amend a patient’s plan – such as the use of an alternative IOL – later down the track from any location.

Once in the theatre, his iPad – through EQ Workplace and EQ Mobile – connects with his microscope and Zeiss Callisto eye, which is a computerassisted cataract surgery system. When starting surgery all relevant patient and IOL information, as well as assistant functions for the surgery (rhexis, incisions and target axis for toric IOLs), are already pre-set.

“At this point we then check the implant model, the power, the toric power and the axis before we begin surgery,” Russell says. “We can compare what’s on the screen against what we have got in our hand to double check we have selected the right lens for the patient, based on what was sent via EQ Workplace. This is now the only time in the process that a human is double checking the IOL selection.”

OVERCOMING TORIC TROUBLES The EQ Workplace removes another potential error source involved in toric lens implantation, which has its own set of complexities.

According to Russell, the Callisto eye system has been transformative in its ability to perform markerless alignment with toric IOL surgery, negating the requirement to perform corneal marking on patients pre-operatively.

Corneal marking has inherent issues such as poor mark visibility, eye movements or cyclorotation. Further, it’s been shown that with every single

EQ Workplace is the latest addition to the Zeiss cataract suite, which passes important data between key instruments and programs in the lead up to surgery.

degree that a toric IOL is off-axis, its effect for reducing astigmatism is decreased by 3%.

“Since the introduction of Callisto eye we have been able to upload images of the eye to the microscope and that has been a significant time-saver, but it did involve manually having to select the toric alignment axis, which is another potential source of error, and often in theatre situations these tasks often get delegated to non-doctor staff,” he explains.

“But now all of that data comes from EQ Mobile and the original plan is uploaded automatically to the scope and Callisto eye – it’s pre-populated and there’s no need to manually select the axis.”

“With any toric IOL there are multiple steps along the way where errors may creep in, any one of those could result in an error. Or with cumulative small errors at each point, such as marking errors and so forth, it doesn’t take much to create five degrees of misalignment,” Russell says.

GREATER PATIENT DEMANDS To fully understand the benefits EQ Workplace, Russell is running a prospective study looking at the impact on efficiency in the practice, which he aims to publish.

He believes the technology’s arrival has been timely, coinciding with an explosion in new multifocal and extended depth of focus IOLs during the past five years.

With advanced IOLs, the work up is more complex to ensure correct candidates and lens selection. Multifocal, EDOF and toric IOLs are also less tolerable to small errors, with residual astigmatism or spherical error of 0.5 D or more known to have a significant impact on unaided vision of patients receiving multifocals.

“With that complexity comes the growing possibility of risk for a selection error, and EQ Workplace dramatically simplifies the whole process of selecting an IOL and making that likelihood of an error almost remote,” he says.

Russell believes EQ Workplace is an early example of the digital transformation of ophthalmology, changing how patient information and devices interact.

Until now, he says the use of technology like application programming interface (API) systems – code that enables different services and applications to share information with each other – has been limited in ophthalmology.

“These things are very common in business software, but EQ Workplace is an example of how digitising a process that’s been traditionally manual can have an enormous positive impact on patient safety and also result in efficiency improvements in medicine,” he says. ■

INSIGHT February 2021 31

FRAMES

FOR SAFILO’S OPTICAL OBJECTIVES Australia was a shining light for global eyewear supplier Safilo last year. But the company holds even greater hopes for the country’s thriving independent market and has plans to significantly expand its presence here in 2021 and beyond.

I

n recent years Italian eyewear giant Safilo has made no secret of its ambition to return to its origins as a go-to supplier of optical frames and rely less on its sunglass business.

What few people may not realise is the role Australia is set to play in this evolution when Safilo’s South East Asia and Pacific regional headquarters in Singapore relocates to Sydney later this year.

As Safilo’s senior director of Asia Pacific Mr David Pearson explains, there are several reasons behind investing in Australia, partly motivated by the country’s healthy optical market underpinned by strong reimbursement mechanisms and patient-centric eyecare professionals.

“Singapore is a great place to reach the South East and North East Asian markets, but one thing COVID-19 taught us is that you don’t have to be right next to the market to be effective. We see Australia – as well as China – as one market that’s really going to grow over the next five-to-10 years, so we want to be part of it,” he says.

While the bulk of Safilo Group’s business is conducted in Europe (44%) and North America (43%), Australia is a top 10 market and a major contributor to the Asia Pacific business, with Asia Pacific accounting for around 8% of the group’s revenue.

Pearson acknowledges 2020 was a tough year for the group, whose revenue shrunk 21% for the first nine months of 2020 compared with 2019.

But a third quarter rebound surprised analysts when sales grew 6% at constant exchange rates compared with 2019.

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INSIGHT February 2021

Looking ahead, Safilo wants to reinstate its position as a leader in the global optical frames market. Its history can be traced to 1878 with the establishment of Italy’s first lens and frame manufacturing site in the Venetian Alps. The Safilo name itself dates back to 1934 when Guglielmo Tabacchi bought the production facility and founded a new eyewear company, making it the oldest player in the Italian eyewear industry.

In an interview with Insight in 2019, Safilo Group’s chief financial officer Mr Gerd Graehsler explained that until the 1980s – before Luxottica’s expansion – Safilo was the number one maker of optical frames. Since then, it diversified to incorporate sunglasses, which grew to account for two thirds of total revenue, while optical made up the rest.

With a portfolio of 27 licensed brands and six house brands, Pearson says re-imposing Safilo on the optical market is now a central focus across all regions.

“That’s for a couple of reasons. We were an optical company from the start so that’s where we want to be and that’s who we are deep down,” he says.

“Secondly, the fundamentals of optical frames and retail offers much more stability.

It’s a steady business whereas sunglasses can fluctuate more in terms of fashion and brands. If you get the fundamentals right in optical frames, you can really support the customer and the retailer a lot better.”

With this in mind, Pearson says shifting David Pearson, Safilo senior the South East Asia and Pacific regional director of Asia Pacific. headquarters to Sydney aligns with Safilo’s optical objectives. Importantly, Australia displays some of the best fundamentals in patient-driven optical retail in the region.

“Australia has strong support in the form of legislation and government to ensure people have great access to eyecare – and that’s going to stay.

It also has fairly strong support from the private health insurance system,” Pearson explains.

“Traditionally Australia is also a strong sunglass market for us, and the optical market has really good practitioners who care about their patients, so we want to be a part of that. To support this we are investing more heavily in the design and size of our optical collections, with 2021 set to have the largest collections allowing us to support more patient segments in terms of style, brand and price.”

Australia was also the region’s “shining light” during the COVID-19 pandemic thanks to government support for business, speedy recovery and an emphasis on galvanising client relationships during the turbulent trading period.

The new Missoni collection.

David Beckham Eyewear.

“South East Asia has been difficult with countries in lockdown.

March, April and May were really tough, but since then we have grown progressively stronger each month, and the business is travelling well into the peak period. Overall, we have had a strong second half of [2020] in Australia.”

FOCUSING ON THE FUNDAMENTALS As part of the 2021 plan, Safilo Australia will move out of its stylish Surry Hills office in inner Sydney and into the new South East Asia and Pacific regional headquarters. Likely to be in suburban Sydney, the new site will need to accommodate space to combine its commercial operations with the warehousing and logistics division.

The company is doing away with the frills and Pearson says it’s part of a strategy that places more emphasis on service and delivery.

“That’s the other thing we learned from COVID-19 – having a beautiful office in a lovely location doesn’t really help our customers that much,” he says.

“Getting the product out on time and making sure it’s to the customer’s requirements is really important, especially in the Australian market, so we are bringing the commercial and logistical and warehousing operations back together. That will be happening mid-2021.”

In terms of its Australian product portfolio, in 2020 Safilo launched the Eyewear by David Beckham collection in February, and the latest female collection from Italian luxury fashion brand Missoni in September.

Pearson says the David Beckham range – aimed at the premium male segment – had a strong start in Australia. Backed by a major name with a reasonable price point ($280 to $470), it filled a distinct gap in the market.

“And everyone has been excited by the Missoni collection. It’s got some real points of difference; having the fabric inlaid inside the frame, it’s very traditional and made in Italy. It’s a beautiful range with amazing history behind the brand, so we have been excited about those two brands.”

Safilo’s home brand Carrera has also performed well, while the company reaped the benefits of making Jimmy Choo and Kate Spade accessible to a broader market via price reductions.

For 2021, Safilo has confirmed two launches for Australia. It will feature a new collection from iconic French fashion luxury label Isabel Marant.

The other is Love Moschino, a colourful and playful feminine range with an affordable $120 to $150 price point.

Another major announcement, Pearson says, is expected for the Smith Optics proprietary brand. “We have plans to grow that brand and make it a powerhouse. It is, in my opinion, the coolest, best brand we have. In the US it’s a mega brand so we see it has a lot of the fundamentals to be great for the Australian public.”

Dr Andrea Pham, her mother Anh and brother Andrew, of Eye Mechanics.

local, friendly and helpful to understand their requirements so we can help with the basics of business and selling the product through.

“Gone are the days of just making a sale into the customer; now it’s about how are we going to help you merchandise it, train your staff and make it look awesome to your patients. Are we are going to supply it on time, and what’s the right pricing? That can be confronting – sometimes being helpful means saying no or doing something different to the way the practice has in the past.”

GLOBAL STYLE WITH LOCAL SERVICE One independent practice that has benefitted from this approach is Eye Mechanics in the burgeoning greater Sydney suburb of Gregory Hills in the south east.

Practice director Mr Andrew Pham set up the greenfield practice with his sister Dr Andrea Pham – a therapeutically-endorsed optometrist – and their mother Anh in a small shopping centre during the December 2019 bushfires before the pandemic took hold.

“Safilo are by far our largest frames supplier,” Andrew Pham explains.

“We wanted to partner with them because they have a lot of those all-star brands, but we also wanted a supplier with reliable distribution, and the after-sales care from the reps feels really interpersonal.”

Pham believes the independent market is narrowing, but partnering with a big-name supplier who focuses on independents has made it easier for the young practice to swiftly carve out its market. Safilo also provides substantial support and rebates for marketing assets.

While Safilo has never lacked in quality brands and portfolio diversity, Pearson says nailing the fundamentals has never been more important.

“With there being so many large franchise players, for us to still offer that familiarity of product is important. When people see Givenchy or David Beckham banners at the front of the practice, they walk right through the door,” Pham explains.

“No one drives to work as an independent optometrist thinking about whether Kate Spade is cool or not. They’re thinking about how they can make their customer happy and get them interested in a certain frame.

We want to help by being in-store, and making our sales teams super

“That brand recognition helps us with patient acquisition, but when people see there is quality behind the brands – the frame doesn’t warp or bend at the slightest touch – it soon becomes retention and they know they can always come back to us.” n

INSIGHT February 2021 33

PRACTICE FIT-OUT

sland. ical, Queen geeraba Opt Before: Mud

After: Mudgeeraba Opt ical, Queensland.

TIME TO UPDATE

and renovate?

Whether it’s a newly acquired optical practice or a wellestablished business needing a major facelift, the decision to renovate requires significant investment, planning and patience.

The problem becomes all the more difficult for independents who are required to do their own leg work, and don’t always have previous experience to draw on.

Three practice owners from across Australia talk to RHIANNON BOWMAN about their recent practice refits, detailing their very different experiences with tradespeople, budgets, timeframes, and design and functionality.

Before: Acuity Eyecare Doncaster,

Victoria.

ictoria. aster, V re Donc a c e y E cuity After: A

Before: Dys on and Lo ng, Victori a.

After: Dyson and Long, Victoria.

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INSIGHT February 2021

WHEN ONE PLAN LEADS TO ANOTHER What started out as a small project to improve the layout in a regional practice with a large floorplan turned into a major renovation that tripled in budget.

When independent Bairnsdale optometry practice Dyson and Long embarked on its own renovation journey, optometrist and partbusiness owner Dr Cameron Dyson described it as “like an episode of Grand Designs.”

The practice has been in business for 30 years. What began in 1990 as a 75sqm practice has now more than quadrupled in size.

“When I started, the practice consisted of a visiting optometrist and dispenser. We moved to our current location – which is a massive space at 350sqm – about 18 years ago and now offer a more upmarket, medicallyorientated eyecare service. We also dropped bulk-billing when we moved and adopted a fee-for-service model,” Dyson says.

Before: reception desk.

After.

A few years ago, Dyson and his business partners agreed they needed a new look but mainly wanted to redesign the layout, including the reception desk that lacked functionality.

“It started off as wanting one big reception desk instead of the existing two, but one thing led to another,” he says.

The practice eventually employed a Melbourne-based duo to completely redesign the practice. The design process took an entire year with the designers ultimately creating detailed 3D models of the new practice, which was then handed to Box Retail, a company specialising in turn-key shop fit-outs for the optical industry, to bring to life.

“We closed the practice for the renovation and put the bulk of the practice’s contents in storage. We leased rooms in a nearby office space and ran a skeleton practice for a month or so. We did this for two reasons; continuity of patient care, and to mitigate cost,” he says.

Although the budget blew out – tripling what they’d initially imagined – the proposed design looked fantastic and they didn’t want to cut corners, Dyson says.

“It looked amazing when Box Retail finished the fit-out. Their workmanship was literally spoton. When comparing photos of the finished renovation with the 3D plans, they looked virtually identical,” Dyson says.

The project may have gone over budget, but it was delivered on time.

“When we were organising to move into temporary office space, we said to Box Retail that we’ve leased this office space for four weeks, and had booked appointments in the

After: shop floor in fro nt of reception desk.

new practice, so they’ve got to be done and out by that day – and they did it, to their credit.”

Dyson says even now, a few years since renovating, people always comment on the practice’s pleasing aesthetic.

“Makeovers give businesses a boost. You’ve got to weigh up the business boost against the cost of doing it. We could afford to do it,” Dyson says.

Although his business partners were nervous about the cost, he reassured them it would be money well spent. “We didn’t scrimp or cut any corners.”

This was, in fact, the second fit out Dyson has done since the practice moved to its current location 18 years ago. He took a different approach this time after realising the importance of having professional input.

“When we originally moved in, I did the whole exercise myself, and took it all to cabinet makers who made it to my specifications. It

Before.

was incredibly time-consuming, and I made mistakes, such as bench width and height, so I knew to outsource the job this time.”

He believes the budget to renovate Dyson and Long isn’t representative of most practices, due to the large floorplan; for example, the cost of carpet was high because carpet is sold by the square metre – and they had a lot of floor space to carpet.

His advice to optometrists considering renovation: “Decide what you want to spend; assume quotes and add about 50% more; and decide if the business income can support monthly loan re-payments.”

DR CAMERON DYSON operates Dyson and Long, an independent optometry practice in Bairnsdale, Victoria.

INSIGHT February 2021 35

PRACTICE FIT-OUT

EXPERIENCED RENOVATORS LEAVE IT TO THE EXPERTS

After: reception desk.

Before.

COVID-19 Stage 4 restrictions and a financial contribution from the landlord provided an optometry practice in north-east Melbourne with the ideal time to renovate.

Optometrists and university mates Mr Steve Dinh and Mr Quent Wain established Acuity Eyecare in 2003 when they purchased an existing practice in Sale in Victoria’s Gippsland region.

Since then, they have grown their business to a group of five independent practices, acquiring locations in Doncaster (2003), Wallan (2006), Epping (2010), and opening a greenfield practice in Vermont South in 2017, which features a modern fit-out and state-of-the-art diagnostic equipment.

Last year they got to work renovating their Doncaster practice and commenced plans to do the same for the Sale store.

“We’ve been operating both practices for 17 years. Things date – it was time to rejuvenate,” Wain explains.

Dinh and Wain had worked with building designer Mr Rohin Adams, director of Two Designs, to design and install the practice fit-out of their greenfield store in Vermont South three years ago, and turned to him again for the Doncaster project.

“Opening our Vermont practice was a ‘wow’ moment, so it was a no-brainer to go back to Rohin for the Doncaster practice facelift,” Wain says.

“Steve and I agreed we had too much involvement the first time around, and it was best left to the designer to come up with ideas, with a fresh set of eyes.”

The Doncaster renovation was completed last year while the Sale refurbishment was still in the design phase in December 2020.

Like their Vermont South and Epping stores, the Doncaster practice is situated within a medical centre enabling them to work alongside a medical team including general practitioners and ophthalmologists.

Prior to commencement, Dinh and Wain had to renew their lease with the Manningham Medical Centre.

In re-negotiating the terms of the new lease, they secured a financial contribution from the landlord that was allocated towards the renovation.

To complete the Doncaster renovation,

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INSIGHT February 2021

After.

Before: shop floor.

they closed the practice during Stage 4 restrictions, which came into effect for metropolitan Melbourne from 6 August before being able to resume routine service on October – 10 weeks later.

“That set of restrictions limited our operation anyway, so we utilised that opportunity to close and complete the renovation in July/August,” Wain says.

Interestingly, the budget to fit-out the Doncaster practice and greenfield Vermont practice were comparable.

“This was partly because we completely transformed the Doncaster practice. When we opened 17 years ago, the tendency was for practices to have a separate waiting area. Today, that element has changed, and now the waiting area tends to be an open space to encourage patients to browse frames,” Wain says.

With this in mind, they removed a wall that divided the waiting room, installed a new reception area, and cabinetry, and updated both consulting rooms so everything matched aesthetically.

“We discovered that the cost of refacing the original joinery would be comparable to installing new joinery. With that in mind we got Rohin to redesign from the ground up rather than ‘facelift’. This meant adding a little to our original budget but it was certainly worth it.”

Unlike the Doncaster location, their Sale

practice faces the street front, and is located in a shopping strip.

“It’s a long building, not exceptionally wide – only five or six metres – but deep. We want to utilise the space more efficiently,” Wain explains.

“We’re changing the floorplan to increase the retail space and to display more frames, and give it a more open feel.”

When Wain spoke with Insight in December, he said they were looking to utilise the quieter Christmas period to complete the fit-out, but if that didn’t eventuate, he hoped the project would be completed in early 2021.

“A refurbishment makes a practice more attractive, adds street appeal, and it’s a more enjoyable space to be working in dayto-day,” he says.

“Our Doncaster renovation has attracted comments from patients that have been coming for years and it’s fresh, modern look is certainly noticed by new patients and people who randomly walk in too. It was overdue.”

QUENT WAIN AND STEVE DINH established Acuity Eyecare in 2003, and have grown the Victorian independent network to five practices.

TUSSLING WITH A TIGHT TURN AROUND When a former lens specialist bought his first optometry practice in early 2020, he set himself the ambitious task of completing a renovation within a week before re-opening under his new ownership.

Mr David Wallace purchased independent optometry practice, Mudgeeraba Optical, located in Mudgeeraba Market Shopping Centre on the Gold Coast, in February 2020

After.

He purchased the business from the previous owner who owned the store for 20 years.

Although it’s his first plunge into full ownership, Wallace was able to lean on his experience as the previous owner of Wallace Everett Lens Technology. It started as a small lab providing personalised service to Gold Coast area optometrists and grew to offer an exclusive range of lens designs and coatings. The business was sold to Essilor in 2009.

He travelled extensively in his role as a sales representative for the lens lab, gaining exposure to several optometry practices, particularly in Queensland and New South Wales.

“I was in and out of up to eight practices a day, so I knew what I liked and what I didn’t like in terms of fit-out,” he says.

This accumulated knowledge proved invaluable when he decided to gut and re-fit Mudgeeraba Optical, which created its own set of challenges being located in a shopping centre. After considering the refit for a later date, he quickly realised he needed a clean start and set himself an ambitious goal of completing the renovation within a week before launching.

He enlisted local company FAB Design who designed a new look and co-ordinated trades.

Wallace also decided to keep the practice name, but had a new logo designed.

What attracted Wallace to FAB Design was its inexperience with re-fitting optometry practices.

Established by Ms Fiona Donald, the company specialise in the project management of highrise apartment and home renovations, but has recently completed commercial fit-outs, including real estate agent offices.

“Part of FAB’s appeal was their limited shop fitting experience; I liked the idea of a fresh set of eyes, who could add a sense of personality to the space,” Wallace says.

Donald, who brings a wealth of expertise as a qualified designer and builder, was upfront about setting a budget.

“I asked David, how much do you want to spend?. We are smart about bang for buck and delivering on budget – we don’t go over. David had a $60,000 budget,

Before: shop floor.

and we came in just under,” Donald says.

Wallace and Donald discussed concepts and agreed on a coastal theme.

“We decided to keep it coastal, tropical, but not glitz and glamour. We went for an organic look with details including natural wood mirrors and a wood-looking floor,” Donald explains.

“As this was my first optical store fit-out, I needed to gain an understanding of how David’s business works, such as the importance of shelving and display cases. It took a bit of thinking. Lighting is also crucial; it needed to be functional but also have some wow factor,” she says.

With a tight timeframe and shopping centre constraints to consider, Donald ensured the project ran smoothly, co-ordinating tradesmen and supplies.

“David took possession of the business on a Friday, and we were on site gutting and demolishing the old interior on Saturday morning,” Donald says. “We had seven days to complete construction work in limited hours – mostly after business hours when the shopping centre closed. We completed the décor in the last two days.”

FAB Design completed the project within nine days, with the only delay being the unexpected task of rewiring the ceiling lights.

After.

“We had everything planned prior to starting work on site – cabinetry, display cases, new flooring. We wanted wow factor, and David had selected wallpaper, and pendant lighting for that purpose,” Donald says.

The shopping centre management were accommodating but tradesmen had to work after business hours – a challenge which made managing a team of trades an “absolute godsend”.

“It was a tight time frame. I was there most of the time, and the project flowed well, from one trade to the next. Fiona and I had talked extensively about what I wanted – such as shelving, flooring and lighting – so we were well-prepared,” Wallace says.

A year after opening, Wallace says the outcome has been “absolutely fantastic”.

“I don’t think there’s been a week since we renovated the practice that someone doesn’t say how amazing it looks,” he says.

DAVID WALLACE owns Mudgeeraba Optical, an independent practice on the Gold Coast Queensland.

INSIGHT February 2021 37

CORNEA REPORT

ADVANCES IN CORNEAL DISEASE Advances in corneal research and development are shifting the landscape, potentially making transplantation of donor corneas – and even corneal surgeons – obsolete in future.

RHIANNON BOWMAN investigates the homegrown projects leading the way.

D

disease and damage to the cornea is a leading cause of blindness globally but remarkably only one donor cornea is available for every 70 needed.

Transplantation with corneal graft tissue has been the mainstay for treating corneal blindness, but a global shortage and rejection issues continue to expose the need for more advanced treatment options, even in developed countries like Australia.

Studies show corneas are procured in approximately 82 countries, with only a few exporting them in large numbers.

About 53% of the world’s population have no access to corneal transplantation.

Australia is at the forefront of improving surgical techniques and developing innovations that might quell current demands on eye banks and offer more reliable, personalised

38

INSIGHT February 2021

and affordable solutions to a greater number of patients.

These include intricate devices that enable more ophthalmologists to perform the most complex procedures, new bioengineered corneas and materials that mend corneal wounds otherwise destined for transplant surgery.

Four leading experts share their perspectives on advances in this field, including the director of one of Australia’s largest providers of donated eye tissue who provides an update on the current donation landscape and new pressures caused by COVID-19.

SIMPLIFYING COMPLEX PROCEDURES

PROF MARK DANIELL is developing a device with the potential to make DMEK surgery the default endothelial corneal transplant method.

to compare the performance time and scores between beginners and experienced anterior segment surgeons.

It found the DMEK wet lab model offers a close to reality, feasible, resource-sparing and valid teaching technique that allows all DMEK surgical steps to be performed. It also offers the possibility of varying the surgical difficulty by changing the anterior chamber depth.

Endothelial keratoplasty is a hotbed of research activity, Daniell says, and some developments could change the need for a corneal transplant altogether.

Promising research shows Descemet’s stripping only – or Descemetorhexis without endothelial keratoplasty (DWEK) – can improve visual acuity in early to intermediate stage Fuchs’ endothelial corneal dystrophy, without corneal transplantation.

“DWEK strips the diseased endothelium, allowing it to heal with healthy cells re-growing over that area. This procedure could change the need for corneal transplant,” Daniell says.

Cultured human corneal endothelial cells as a tissue engineered endothelial graft (TEEK), human corneal endothelial cells (hCECs) injection therapy, iPSC converted to CEC, and bioengineered corneal stroma to treat keratoconus, stromal scarring and stromal dystrophies are amid the troves of research taking place into corneal disease, he says.

Ophthalmic surgeon Professor Mark Daniell is head of corneal services at the Royal Victorian Eye and Ear Hospital and leads the Centre for Eye Research Australia’s (CERA) corneal research unit.

Bowman layer transplantation and artificial intelligence to treat keratoconus are also among the corneal disease research Daniell is interested in.

With Daniell at the helm, CERA has begun engineering corneal tissue in the laboratory for transplantation, which could help millions of people regain their sight.

“Artificial intelligence is being utilised in patients with keratoconus for early diagnoses, prediction of progression, and corneal topography with Pentacam, in corneal cross-linking,” Daniell says.

While transplantation of donor tissue is common in Australia and the US, there is a major shortage of donor tissue elsewhere, leaving an estimated 6.5 million people without access to a transplant operation.

Gene therapy is another area of growing interest, he says, unlocking its potential to treat Fuch’s endothelial dystrophy and corneal stromal dystrophies without a transplant.

In response to the global shortage, the team has successfully grown cells from donated corneal tissue and is now working on creating corneal cells out of stem cells taken from blood or skin. Daniell says with the development of tissue-engineered cornea, the next stage will be using the patient’s own cells to amplify them.

The I-CAN study in 2014 showed that aganirsen eye drops significantly inhibited corneal neovascularisation in patients with keratitis. The need for transplantation was significantly reduced in patients with viral keratitis and central neovascularisation.

In addition to gene and cell therapy solutions, CERA’s corneal unit recently received half a million dollars in medical research funding to fast-track development of CorGel, an ultra-thin hydrogel film that is used to insert donor corneal tissue to restore vision.

CORNEAL BIOPEN REWRITES CONVENTIONAL TREATMENT

The grant will support 18 months of preclinical work to refine and test CorGel before progressing to a clinical trial and the first human study.

Daniell says the device was borne out of a challenge associated with Descemet’s Membrane Endothelial Keratoplasty (DMEK) surgical technique, which replaces only the endothelium layer. DMEK procedures have better patient outcomes but is surgically more complex because the graft membrane tends to scroll up when inserted into the eye. CorGel overcomes this by acting like a ‘scaffold’ which is attached to the transplant to keep the donor corneal tissue flat when it is inserted into the eye.

“We’re looking at endothelial transplants and the best way to do those.

Japanese researchers are transferring endothelial cells from the lab into the eye by injecting cells into the eye. We’ve found it’s better to attach endothelial transplant cells to a scaffold. Trials indicate the scaffold has nice properties and handling during surgery,” he says.

The CorGel device has the potential to make DMEK surgery the default endothelial corneal transplant method globally due to being more efficient and with better outcomes.

The possibilities seem endless.

Within his career, PROF GERARD SUTTON says it's possible corneal disease could be prevented entirely, rendering corneal surgeons obsolete.

Vision Eye Institute consultant Professor Gerard Sutton is one of Australia’s leading ophthalmic surgeons and is internationally recognised as an expert in corneal transplantation.

Sutton’s affiliations include Professor of Clinical Ophthalmology and Eye Health at The University of Sydney, Save Sight Institute; Medical Director at NSW Eye & Tissue Banks, Australian Ocular Biobank; Professorial Fellow Australian Institute for Innovative Materials, University of Wollongong; and Sydney Eye Hospital Foundation Board Member.

The CorGel device also aims to simplify the surgery so any anterior segment surgeon can perform it.

He was the first Australian surgeon to perform corneal transplantation with the femtosecond laser, and the first to successfully use an artificial cornea in New South Wales.

Last year a study of a new wet lab model of DMEK using human corneas mounted on an artificial anterior chamber with an artificial iris aimed

With a strong research interest in corneal bioengineering, Sutton is currently involved in a number of projects that have the potential to make a

INSIGHT February 2021 39

CORNEA REPORT

significant difference in corneal disease and reliance on donor corneas.

“My research is part of a well-organised collaboration with Lions NSW Eye Bank, the Save Sight Institute at the University of Sydney, and the Intelligent Polymer Research Institute at the University of Wollongong. This structure joins together scientists, surgeons and eye bankers. Undertaking research can be a challenging, torturous regulatory pathway, so this set up means a pipeline is already established,” Sutton says.

The collaboration has close ties with iFix Medical, an Australian medical device company commercialising innovative technology and products for ophthalmologists to better manage and treat corneal disease, corneal repair and corneal transplantation.

One of their most advanced projects which Sutton is working on is the development of a corneal biopen, known as the iFix System, to treat corneal ulceration. The device won Sydney’s Big Idea Innovation Award in 2017, receiving seed funding to reach the next stage of commercialising the device. Further funding followed when the device was awarded $1.15 million in the 2018 NSW Medical Devices Fund.

According to the product website, the iFix System has two components: iFixPen and the iFixInk. The iFixPen is a hand-held device that delivers a 3D-printed structure directly onto corneal defects.

The patent-pending iFixInk creates a completely transparent and biodegradable structure to seal the wound, better preventing infection, relieving pain and accelerating healing.

Sutton says the team has completed animal trials and is preparing to conduct human trials.

He is also involved in developing a bioengineered cornea and supporting collagen fibres with the University of Wollongong’s ARC Centre of Excellence for Electromaterials Science. This cornea overcomes common issues like durability by using an electro-compaction technique that maintains excellent and critical optical properties.

“Millions of people don’t have access to donor corneas. The donor system is flawed internationally. A bioengineered cornea made or modified from a patient’s own cells would be superior to our current options,” Sutton says.

“The whole concept of bioengineering is taking off around the world.

Cell-based therapy and growing cells in the lab is also an area of research moving along,” Sutton says.

The Australian and New Zealand Corneal Bioengineering working group (ANZCorBio), which Sutton and Professor Daniell are both members of, held their first face-to-face meeting in Sydney last year and were due to meet again in November.

Sutton says among the key speakers were a New Zealand group led by Associate Professor Trevor Sherwin and his colleagues at The University of Auckland who have been trying to determine if an eye drop can permanently stabilise and reshape the cornea, and thus provide treatment for condiitons like keratoconus.

Having completed animal trials, Sutton says the eye drop is yet to go in front of an ethics committee to be approved for human trials but it is hoped ingredients of the formulation – which have previously been used in other clinical trials – will speed up the approval process.

The next step after human trials would be to treat end-stage keratoconus patients in order to help them avoid a corneal graft. Following that, the treatment could be applied to patients with earlier disease, to help reshape and ‘freeze’ the cornea in the new shape.

“Corneal cross-linking has been around for a while, and although it’s terrific, it’s not perfect. Newer versions of cornea endothelial transplant, such as treatments devised by Professor Noriko Koizumi from Doshisha University in Japan, mean more options for patients, and an eye drop treatment means less surgery. With these new developments, it’s possible that in my working lifetime corneal surgeons will become extinct and we can prevent corneal disease developing and reduce the need for corneal transplant,” Sutton says.

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INSIGHT February 2021

“For patients, that means more accessible treatment, less expense and quicker recovery.”

CORNEAL ADHESIVE TO REDUCE DEMAND ON DONOR SYSTEM

A/PROF CHAMEEN SAMARAWICKRAMA says corneal research is a hotbed of activity because surgeons are yet to see adequate treatments for perforations that don't rely on transplantation.

Associate Professor Chameen Samarawickrama, from the University of Sydney’s Faculty of Medicine and Health and The Westmead Institute for Medical Research, has helped develop and perform preclinical testing of LiQD Cornea, an adhesive liquid that mends damaged corneas.

Currently, corneal perforation from infection or inflammation is sealed with cyanoacrylate glue. However, the resulting cytotoxicity means that without follow-up corneal transplantation, sight could be lost.

“Corneal perforation from trauma or infection is painful. The current treatment strategy is to seal the wound using glue to buy time to treat the infection and inflammation, but the glue is not a perfect solution. It causes scarring, and often blood vessels grow in, decreasing vision. If the hole is in the periphery, it may not affect vision, but if the hole is in their central vision, they need a transplant to restore vision” Samarawickrama says.

He says Australia is a powerhouse of corneal research, meaning funding applications are a highly-competitive process.

“Funding can be difficult to secure and it’s a time-consuming task. Last year I was fortunate to secure National Health and Medical Research Council funding for LiQD Cornea but a common response I receive from funding bodies is that although the device is both interesting and fundable, there is a limited amount of funding to go around,” Samarawickrama says.

He was the only successful applicant in Australia to secure a NHMRC Investigator Grant for funding commencing in 2020 for cornea research, valued at $366,925.

Samarawickrama says one reason why there’s so much corneal research activity is because surgeons don’t yet have an adequate treatment option for corneal perforations that doesn’t rely on transplantation, a problem exacerbated by the current shortage of donor corneas.

“There are about 4,300 corneal perforations on average in Australia each year. There isn’t any global data on perforations but approximately 1 in 70 who need a transplant get one. The other 69 have no choice but to endure poor vision,” Samarawickrama says.

“If we can treat corneal perforations so patients don’t need a transplant, those who need a transplant for other corneal diseases can get one. Our aim with LiQD Cornea is therefore two-fold: offer a better treatment for a problem that already exists, and eliminate the need for a transplant so that limited resources [donor corneas] can be diverted to others who genuinely need it.”

LiQD Cornea is a cell-free, liquid hydrogel matrix for corneal regeneration. It comprises short collagen-like peptides conjugated with polyethylene glycol and mixed with fibrinogen to promote adhesion within tissue defects.

“Cornea surgeons have a specific skill set but with LiQD Cornea we wanted to develop a device that could be used by a general ophthalmologist. You don’t need advanced surgical skills to squeeze a syringe onto the eye. It is purposefully designed so any ophthalmologist can use it safely.”

Five years into development, LiQD Cornea has been successfully tested

in animal models, with developers now looking towards next steps to get approval for human trial.

“LiQD Cornea is a collagen-based glue because the cornea is predominantly collagen. Collagen is the native ingredient. Animal-testing demonstrated the cornea maintained clarity and didn’t become inflamed, with no scarring or vascularisation. LiQD Cornea bio-integrates into the eye; simplistically this means that we are achieving corneal regeneration,” Samarawickrama says.

“The next step is meeting the TGA’s Good Manufacturing Practice (GMP) codes for the authority to proceed with human trials. We’ve completed one animal trial but we need to complete a second one, although with COVID affecting research, it might end up being next year.”

AUSTRALIAN EYE BANK UPDATE

DR GRAEME POLLOCK says crosslinking has reduced donor tissue demand from keratoconus patients, with Fuch's dystrophy now the most common reason.

Donor corneas can be stored for up to 30 days using an organ culture storage technique the Lions Eye Donation Service adopted in 2005.

on average.

Qualified in pathology and holding a PhD in surgical medicine, Dr Graeme Pollock established the Lions Eye Donation Service (LEDS) in 1991 and has never left. Now director, he has more than 30 years’ knowledge of the statistics and science behind corneal transplant. He works closely with Professor Daniell who is medical director of LEDS. LEDS is one of Australia’s largest providers of donated eye tissue for transplant and medical research. It is a collaboration between CERA, The Royal Victorian Eye and Ear Hospital, the University of Melbourne, and supported by the Lions Clubs. “[In 2019] there were 1,498 eye donors in Australia and surgeons performed 2,385 transplants. Australia is one of the few countries that supplies donor corneas to other counties; for instance, LEDS supplies donor corneas to New Zealand, so the number of corneas provided

by Australia eye banks is even larger than just the Australian figures,” Pollock says.

The 2020 statistics will look markedly different with coronavirus making those who tested positive unable to donate. “[In 2020] we’ve had a decrease in donations but this is not due to ruling out a large percentage of the population because they have had COVID-19.

Lockdowns have put pressure on donor referral systems out of hospitals, and those referral systems rely on staff having donation front-of-mind.”

Pollock says the organ donor consent rate has also decreased.

“Bereavement is complicated and difficult at the best of times, but more so during COVID-19 with restrictions on travel and funeral numbers making it even more difficult for families to make a decision on donating organs and tissues.”

Although there has been a marked drop in cornea donations, there have also been fewer transplant surgeries.

“A large percentage of corneal transplants are elective. There has been less demand for donor corneas than usual, but it varies depending on which state you’re in. For example, elective surgery in Victoria is operating at about 75% of normal demand (at the time of writing), so any increase in donations is not reflected in transplants not being done,” Pollock says.

Donor corneas can be stored for up to 30 days using an organ culture storage technique LEDS adopted in 2005, extending the previous sevenday storage life using refrigeration. Pollock says the time between LEDS receiving a donated cornea and releasing it for transplant is 14 or 15 days

While the storage window has increased, prolonging opportunities, other developments are shaping the future of eye banks.

“We’re seeing the number of patients needing a transplant for keratoconus reducing, and cross-linking is playing its part in that,” Pollock says.

“Simultaneously, we’re seeing a growing number of transplants for other reasons; Keratoconus used to be the most common reason for requiring a donor cornea in Australia – but now it’s Fuch’s dystrophy.”

He says different corneal transplant techniques that have emerged in the past 10 to 15 years, such as DMEK and DSEK, have changed the donor landscape.

“Since doing that type of transplant for Fuch’s Dystrophy, patient recovery is much better, compared to recovery from a full thickness transplant. Because patient recovery and visual outcomes have improved with endothelial keratoplasty techniques, more patients with Fuch’s dystrophy are undergoing corneal transplant,” Pollock says.

“Over the last 10 years the demand for corneas for transplantation has more than doubled. This is largely driven by newer techniques which provide added benefit.”

Pollock predicts there won’t be significant change to corneal transplants in the next five years and expects current trends to continue with more endothelial keratoplasty. He says almost 75% of all transplants are now DSEK or DMEK. Looking further ahead, he believes stem cell therapy is the next big thing.

“Successfully growing endothelial cells could negate the need for donor corneas,” he says. “There is limited ability to culture those endothelial cells other than injecting into the anterior chamber.”

A pilot clinical examination recently conducted in Japan researched the viability of a cell‐infusion treatment for patients with bullous keratopathy.

“That’s the direction it’s going in. Evidence-based literature is coming out from that technique but those studies haven’t involved large numbers,” Pollock says.

“It’s still some way off being a routine type of therapy, but I suspect eye banks will evolve from being transplant tissue service providers into cell therapy service providers.” n INSIGHT February 2021 41

THE YEAR AHEAD FOR ORTHOPTICS AUSTRALIA AS 2021 DAWNS, ORTHOPTICS AUSTRALIA HAS PLANS TO REINSTATE FACE-TO-FACE MEETINGS, EMBED ON-DEMAND CONTENT AND ESTABLISH AN EARLY CAREER MENTOR PROGRAM. PRESIDENT JANE SCHULLER MAPS THE YEAR AHEAD.

I

n 2020 after the World Health Organisation officially declared the coronavirus outbreak a pandemic, many businesses were forced to shelve projects and re-evaluate their strategic plans.

JANE SCHULLER

"IT’S IMPORTANT THAT WE GET THE DESIGN RIGHT FROM THE START, AS WE KNOW MANY MENTORING PROGRAMS START WELL BUT DON’T ALWAYS DELIVER"

Orthoptics Australia (OA) was no exception as business plans were upended and our focus was redirected to support members through the crisis and the majority of our continuing professional development programs were converted to virtual events.

The economic forecasts for 2021 indicate modest growth and recovery for businesses and provides some reassurance for us to develop a positive strategic approach for the year ahead. A key focus is always to evaluate our value proposition for members and continue to enhance our programs.

Through OA’s annual member satisfaction surveys, we continually seek to understand the perceptions and engagement of members in OA’s initiatives and programs. The results inform strategic planning and decisions to introduce new benefits or reposition others.

As a result of feedback in the 2018 and 2019 surveys, several programs and initiatives were introduced. We partnered with Insurance House to offer industry-leading professional indemnity insurance coverage for members. We also delivered more continuing professional development content through OA’s online learning management system ‘OAOE’ and established three special interest groups to increase opportunities for member engagement in specialist areas.

A recurring theme in the feedback is that early career orthoptists want more support and opportunities to exchange skills and knowledge through mentoring and networking. This year OA has committed to developing a formal mentoring program to support early career orthoptists to have a better understanding of the industry, the skills needed to succeed, the careers available and opportunities to further develop their ‘soft skills’.

We have a large pool of talented

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INSIGHT February 2021

mentors across most areas of eye health care, from those in research or academia to others in policy and advocacy or industry. This is a great opportunity for more experienced orthoptists to give back and foster the next generation of orthoptists. It’s a winwin for all involved.

It’s important that we get the design right from the start, as we know many mentoring programs start well but don’t always deliver. It’s an exciting initiative, and we look forward to sharing our progress.

In addition to the mentoring program, the continuing education committee is tasked with developing a number of upskill packages using the new online learning management platform. The content will be high-quality, interactive learning packages in key areas that align with other initiatives.

Promoting and supporting evidencebased research remains a core strategic objective for OA. Last year, OA redesigned the Australian Orthoptic Journal (AOJ) with a modern look and better functionality with an improved search-enabled function.

The most recent website analytics show the open access journal has good reach and engagement. In 2020, the editors set some short and longerterm goals for the AOJ and have plans for 2021 to expand the reach and impact to further reflect the history and quality of publication.

With the success of the virtual 2020 Victorian orthoptic continuing education seminar series, the 2021 series will continue virtually to enable greater access for members with the additional benefit of the content being available on-demand all year for new graduates and members. The longer-term goal is to convert this into a national initiative to draw on the expertise of member orthoptists across the country.

Despite the benefits of virtual learning, many of us are looking forward to returning to face-to-face continuing professional development meetings.

In 2020, the Victorian July Scientific

Key priorities for 2021 have been devised from the results of member surveys.

Meeting and the NSW Continuing Education Weekend were both postponed due to COVID-19 and we’re excited to finally be able to gather together safely. It’s a perfect opportunity for members to re-connect with colleagues, as well as benefit from an excellent scientific program.

OA’s showcase event is the annual scientific conference. This year promises to be no exception with the meeting scheduled for 20-22 November at the Brisbane Convention and Exhibition Centre. The premier event will bring together delegates from across Australia to share best practice, hear the latest research and provide valuable opportunities to network.

As we begin 2021, we look forward to a positive year ahead and a bright future for OA. n

ABOUT THE AUTHOR: JANE SCHULLER is the president of Orthoptics Australia. She currently works at the Royal Melbourne Hospital and a number of private ophthalmology clinics.

ORTHOPTICS AUSTRALIA strives for excellence in eye health care by promoting and advancing the discipline of orthoptics and by improving eye health care for patients in public hospitals, ophthalmology practices, and the wider community. Visit: orthoptics.org.au

DISPENSING

A FRAME IS NOT JUST A FRAME PATIENTS LOOK TO OPTICAL DISPENSERS FOR THEIR EXPERTISE WHEN IT COMES TO FINDING THE BEST FITTING FRAME. AND THE PRESCRIPTION OFTEN HAS A BEARING ON WHAT’S FEASIBLE, WRITES DINA ANASTAS.

C

hoosing the correct frame for the patient’s prescription. This is the fun part of the optical dispensing process that hopefully leaves the patient with a fashionable pair of spectacles that allows them to express themselves.

DINA ANASTAS

"IF THE PRESCRIPTION REQUIRES A HIGH PLUS POWERED LENS, YOU MAY STEER AWAY FROM A RECTANGULAR SHAPE FRAME AND FAVOUR A MORE ROUND OR OVAL SHAPE"

Today, there are so many styles, brands and shapes – along with different materials and colour options – that it is important to know your practice’s product range.

A simple first step is cleaning your frames every morning, making sure they are all in their correct locations. This might seem trivial, but if a customer comes in asking for a red frame, this daily exercise will enable you to quickly locate every red frame in your store.

Anyone with reasonable skills can help someone select a new fashion piece of eyewear, but it takes a little more thought on understanding how the aesthetics of that patient’s prescription will look in the frame selected.

As Mr Murray O’Brien mentioned in the October issue, matching the lens and frame curves is very important and therefore my recommendation is to always look at the prescription first, then choose your lenses factoring in the following: • Pupil distance (PD) • Astigmatism • Prism • Index of material The last piece of the puzzle is choosing a lens design that best suits the patient needs and lifestyle before selecting the frame.

That way, you will have already considered how their lens prescription may look in a particular frame shape. For example, if the prescription requires a high plus powered lens, you may steer away from a rectangular shape frame and favour a more round or oval shape for best visual aesthetics and thinnest lenses.

Not only is the prescription a priority before selecting the frame, but just as important is the shape. Consider the following: Shape – Correct shape for their face but also for their prescription.

Eye size – Width of the frame, not too wide and not too narrow. Does the

Dina Anastas says there's always scope to adjust frames, even if the patient says they're comfortable.

frame come in multiple sizes to suit the patient’s face?

Bridge fit – Is it fitting comfortably on their nose? Are there gaps? Would they be better with nose pads for ease of adjustability?

If choosing a shell frame, make sure it fits perfectly as it cannot be adjusted later.

Temple length – Make sure you check they are not too long or too short. This will impact their final fitting adjustment at collection, so it should be reviewed at frame selection. This point is often overlooked and the spectacles will never be a great fit.

Patient’s PD – If the patient has a small PD, then make sure the frame you select is not too big. The main reasons for this are aesthetics, thickness and weight but also for lens blank diameter as it may not be suitable even when grinding customised lenses.

Material – Weight may be a consideration at the time of dispensing, so make sure you ask the correct questions early for the patient’s comfort and wear. For example, if they are wearing a rimless frame and want a new look, make sure the new fullframe is either a lightweight SPX plastic or titanium metal frame, as the patient is already comfortable in a lightweight frame and choosing an acetate frame may feel too heavy.

If the frame the patient selects isn’t the best fit in your opinion, recommend they choose another frame. Explain the reasons why and with your expertise and guidance, show them something similar that will be a far better fit.

As a trained optical dispenser, our patients are looking to us for our expertise and knowledge, to guide them to the best fitting pair of spectacle frames. Don’t just let the patient decide because it’s easier. Often this can lead to them returning week after week for regular adjustments because they don’t fit correctly and are uncomfortable for daily wear. We have all learned this the hard way at some point in optics.

Always adjust your patient’s spectacle frames on collection. Even if they say they feel fine, there’s always a small minuscule adjustment possible to make them great not just OK. We are the experts, so show them you know what you are doing.

The ultimate objective as an optical dispenser is to get the best fit the first time, every time. n

DINA ANASTAS is a partner and practice manager at Harris Blake & Parsons Optometrists and a director of the National Australian Dispensing Opticians Association. She graduated with an optical technician diploma and has 35 years’ industry experience.

INSIGHT February 2021 43

MANAGEMENT

PATIENT INFORMATION OR ADVERTISING? THE REGULATOR HAS ANNOUNCED AN AUDIT OF HEALTH PRACTITIONER ADVERTISING THAT AFFECTS EYECARE PROFESSIONALS. AVANT’S RUANNE BRELL AND DR VICKY PHAN OUTLINE WHAT’S ACCEPTABLE AND WHAT TO AVOID.

H

ow do you communicate with patients about your practice and services? Like other aspects of running a business at present, that seems increasingly complicated.

RUANNE BRELL

VICKY PHAN

Some practices now produce information videos to help patients understand what particular treatments involve. Can you also post these on your website and social channels? Could that be seen as advertising?

In our experience, most healthcare professionals recognise the need for responsible advertising that won’t compromise the public’s healthcare choices. However, as healthcare businesses explore more ways to communicate with patients online, understanding what exactly is advertising under the National Law and when the rules apply is increasingly complex.

The Australian Health Practitioner Regulation Agency (AHPRA) has progressively added to its guidance on advertising regulated health services.

Its updated Guidelines for advertising a regulated health service (2020 Guidelines) came into effect on 14 December 2020 and help clarify some of these nuanced issues.

HAVE THE RULES CHANGED? The 2020 Guidelines don’t substantively change the requirements for advertising regulated health services.

They provide further explanation and examples of the way AHPRA interprets these obligations and what it considers advertising. We focus on sections 3, 4.1, 4.4 and the Definitions section of the 2020 Guidelines.

WHEN IS CONTENT ADVERTISING? Content could be described as something other than an advertisement: advertorial, branded content, content marketing. It may be verbal, printed or electronic.

As the boundaries increasingly blur between advertising, education and information, AHPRA is focusing on the intention and effect of communications.

Any communication may be considered advertising if it promotes and seeks to attract a person to a regulated health service provider and/or attract a person

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INSIGHT February 2021

to use the regulated health service.

Social media content could also be considered advertising. As could podcasts, public speaking engagements, books, media appearances, patient information sheets, patient recalls or other professional notices, office signage or mobile communications.

A patient information video explaining treatment or costs isn’t considered advertising if it’s provided in the context of a consultation where the patient has adequate opportunity to discuss the information and ask questions. However, the 2020 Guidelines warn against including material that could be interpreted as promoting the practitioner’s services.

Additionally, not all services provided by a healthcare business may be regulated health services. Products such as medicines or medical devices are not covered by the National Law but fall under different schemes including the Australian Consumer Law and Therapeutic Goods Act and associated regulations.

Many of the same principles apply, for example misleading and deceptive conduct would be prohibited under these regimes as well. If notified, AHPRA would refer complaints about these aspects of a healthcare business to the appropriate regulator, and the specific prohibitions and penalties differ.

WHAT CAN YOU SAY? Importantly, advertising regulated health services is permitted. AHPRA acknowledges advertising can be helpful and effective. You can still produce content AHPRA considers advertising, as long as it complies with the advertising requirements under the National Law. The 2020 Guidelines include examples and decision trees to help clarify what is and isn’t permitted. Advertisements could breach the National Law if, for example, they: • Create an unreasonable expectation of outcomes or recovery time.

• Overstate the potential benefit, or • Minimise the complexity or risk.

Be particularly careful to avoid: • Claims your health service is superior.

Patient stories and testimonials can be a contentious area for practices.

• Claims about the effectiveness of a particular treatment or suggesting it can ‘cure’ a condition.

• Suggesting treatments are ‘safe’, ‘effective’, ‘painless’, ‘infallible’.

• Implying the practitioner has an exclusive or unique skill, or a particular qualification that they do not hold.

• Patient stories or images that may create an unreasonable expectation of benefit.

Any claims about effectiveness need to be backed by acceptable evidence, and the guidelines also explain what sort of evidence would be acceptable.

In the case of an agency or third party publishing material, AHPRA considers you the advertiser if you publish or authorise content, direct someone else to draft or publish it, or if you are able to remove it.

Ensure anyone creating or publishing content on your behalf understands the advertising restrictions, and that you review content produced as you will be ultimately responsible.

While AHPRA has announced an audit of health practitioner advertising, it reiterates its strategy is to encourage compliance, and any regulatory action will be proportionate to any risk to the public. With this in mind, continue to communicate with patients but understand your obligations and seek advice if in doubt. n

RUANNE BRELL is a senior solicitor of the Medico Legal Advisory Service at Avant, and DR VICKY PHAN is a GP and Avant risk adviser.

2021 CALENDAR FEBRUARY 2021 ANZGS SCIENTIFIC MEETING Australia-New Zealand (virtual) 20 – 21 February anzgsconference.com

OV/SA BLUE SKY CONGRESS 2020 Adelaide, Australia 26 – 27 February

RANZCO NZ BRANCH ANNUAL SCIENTIFIC MEETING

OA VIC BRANCH JULY SCIENTIFIC MEETING

Christchurch, New Zealand 19 – 20 March ranzco.edu

Victoria, Australia 27 March orthoptics.org.au

WAVE 2021 HYBRID CONFERENCE Fremantle, Australia 20 – 21 March optometry.org.au

MARCH 2021

WORLD GLAUCOMA WEEK International 7 – 13 March wga.one

MAY 2021 100% OPTICAL London, UK 8 – 10 May 100percentoptical.com

AUSTRALIAN VISION CONVENTION 2021 Gold Coast, Australia 27 – 28 March optometryqldnt.org.au

VISION EXPO EAST New York, USA 25 – 28 May east.visionexpo.com

silmobangkok.com

bluesky.optometry.org.au silmobangkok.com

To list an event in our calendar email: myles.hume@primecreative.com.au

APRIL 2021

ANZSS (SQUINT CLUB) Christchurch, New Zealand 21 March kathpoon@bigpond.com

RANZCO VIC BRANCH SCIENTIFIC MEETING Melbourne, Australia 27 March ranzco.edu

JUNE 2021

BARCELONA SPECS Barcelona, Spain 10 – 11 April barcelonaspecs.com

MIDO EYEWEAR SHOW

NATIONAL ABORIGINAL AND TORRES STRAIT ISLANDER EYE HEALTH CONFERENCE

Milan, Italy 5 – 7 June mido.com

Australia (virtual) 20 – 22 April mspgh.unimelb.edu.au

SPECSAVERS – YOUR CAREER, NO LIMITS A

ll Specsavers Recruitment Services (SRS) - Who are we?

Specsa ve stores rs SRS are an in-house recruitment team who specialize in attracting and recruiting talented optical and retail now w it h OCT professionals for our Specsavers stores across Australia and New Zealand. We have dedicated permanent and locum recruitment consultants that focus on specific geographic locations across ANZ. Your SRS consultant is on hand to support you through all your recruitment needs and will take excellent care of you and your future career. For any locum opportunities, please contact Maddy Curran at madeleine.curran@specsavers.com or 0437 840 749.

Optometrist Joint Venture Partnership Opportunity – Specsavers Warwick Specsavers has an opportunity for an experienced Optometrist to join us as a Joint Venture Partner in our brand-new store coming to Warwick, QLD in 2021. Warwick is a thriving rural city 140kms south west of Brisbane, on the banks of the Condamine river. Rich in heritage, Warwick features well-preserved churches, cottages, railway stations, impressive private schools. With an initial investment of only $1/share, a market rate salary plus a share of the store profits, $60 million combined annual marketing fund as well as a sign on bonus and relocation allowance, this opportunity will not be available for long!

SP EC TR VISI UM T -A NZ .CO M

SO LET’S TALK! In a few short years, Specsavers has achieved market leadership in Australia and New Zealand with more people choosing to have their eyes tested and buy their prescription eyewear from Specsavers than any other optometrist. To learn more about these roles, or to put your hand up for other roles as they emerge, please contact us today: Joint Venture Partnership (JVP) enquiries: Marie Stewart – Recruitment Consultant

marie.stewart@specsavers.com or 0408 084 134

Optometrist/Retailer Joint Venture Partnership Opportunities – Specsavers Alice Springs Specsavers is on the lookout for an experience Optometrist and Retailer to join us as Joint Venture Partners in our brand-new store coming to Alice Springs, NT in 2021. Nestled between the East and West MacDonnell Ranges, Alice Springs is famous for its beautiful desert landscapes, colourful outback characters, opportunities for adventure and a strong Aboriginal culture.

With an initial investment of only $1/share, a market rate salary plus a share of the store profits, $60 million combined annual marketing fund as well as a sign on bonus and relocation allowance, this opportunity will go quickly!

Australia Employment enquiries: Madeleine Curran – Recruitment Consultant

The Specsavers Graduate Recruitment team are currently recruiting for a number of vacancies in Perth, WA. If you’re looking to make a genuine impact, and deliver patient-centric, evidence-based preventative eye care and work collaboratively to manage health outcomes, then we urge you to talk to us about how you can join our mission to transform eye health. At Specsavers you will have access to cutting edge technology and be part of the driving force bringing Optometry into the forefront of the healthcare industry.

New Zealand employment enquiries: Chris Rickard – Recruitment Consultant

Full-time Optometrist Opportunity – Specsavers Shepparton, VIC Specsavers Shepparton are on the lookout for an Optometrist to join their fantastic team of experienced Optometrists and friendly retail staff. With Shepparton only being a two-hour drive from Melbourne, it offers the benefit of a relaxed regional town but all the amenities of a big city. Specsavers can offer an excellent work environment, market leading equipment – including OCT in every store, experienced retail support teams and a host of professional development opportunities. There are a range of full-time, part-time and fixed-term positions available.

madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader

cindy.marshall@specsavers.com or 0450 609 872

chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries: apac.graduateteam@specsavers.com

SOAPBOX

THE AUSTRALIAN SAVE SIGHT REGISTRIES of AMD is amongst the highest in the world, the drugs are reimbursed without restrictions, practitioners are paid adequately for the procedure and most practitioners use the ‘Treat and Extend’ regimen that has been found to be the most efficient way to deliver an adequate number of treatments.

We provided amongst the first real-world data on the induction and maintenance phases of treatment of nAMD, the relative efficacy of the available agents and 10year outcomes which has helped establish Treat and Extend as the most widely used regimen internationally. Data are coming out of the FRB! diabetic macular oedema and retinal vein occlusion modules that suggest there is room for improvement in treating these diseases.

W

hen people ask me how on Earth I decided to be an eye doctor I have to admit my father was one. I had never intended to do what he did and I thought I had ignored all his advice. When he told me that ‘observational’ (a.k.a. ‘Phase 4’ or ‘postmarketing’) studies were needed to show that treatments identified by randomised clinical trials (RCTs) actually worked in routine clinical practice, I thought he was just trying to boost his publication list.

It turns out that I was wrong about that too. I have come to believe that conducting observational research is one of the fastest and most cost-effective ways to improve treatment outcomes for patients at scale.

RCTs became the sine qua non for registration of a medical intervention last century. They show whether a treatment actually works under ideal conditions but not necessarily whether it will work when the average Joyce attends her doctor in ‘real-world’ clinical practice.

Clinical trials do not represent the general population, they tend to include otherwise healthy people, which many of our patients aren’t, and they may ‘enrich’ the study population to get the desired result. For example, many studies of injections for macular diseases have an upper limit on visual acuity (VA) so there is room for improvement when the primary outcome is VA gain.

As a result, there are extremely limited data from RCTs on the benefit of

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treating eyes with neovascular macular degeneration (nAMD) with visual acuity better than 6/9, even though this is exactly when we would like to start treating them.

Conversely, analysis of RCT outcomes led the UK’s National Institute for Health and Care Excellence to limit treatment for diabetic macular oedema to eyes with >400 microns central macular thickness, excluding a large number of patients with thickness between 300-400 microns no matter how bad their vision is.

My friend Nigel Morlet explained the idea behind observational research as our feet dangled from the wharf one year at RANZCO in Hobart. The exponential growth of technology means eventually all ‘pseudanonymised’ information from patients will be extracted from the system, analysed and fed back in to change things for the better. This change can in turn be verified and further improvements made. It sounded simple and any technical understanding of IT whatsoever did not seem to be a prerequisite to embarking on a career of observational research.

We founded the Fight Retinal Blindness!

(FRB!) Treatment outcomes registry with support from the RANZCO Eye Foundation in 2008 to track the outcomes of bevacizumab (Avastin), which everyone was using on the basis of very few data.

We were fortunate to have started in Australia, where several factors make it an ideal environment for achieving good nAMD outcomes: general recognition

We have developed other modules to study outcomes of treatments for other eye diseases, some of which had very limited supporting data. Fight Glaucoma Blindness! is amassing large amounts of data on stents, while Fight Corneal Blindness! (FCB!) is publishing outcomes for keratoconus. FCB! is the first module to include data from optometrists. Ideally the system will ultimately track, analyse and report outcomes data from all professionals looking after eyes, not least the patients through ‘patient-reported outcomes’. Modules to track outcomes regarding ocular melanoma, inherited retinal degenerations and retinopathy of prematurity (Fight Baby Blindness!) are under development.

It’s worth keeping an eye on observational research because its primary interest is the actual outcomes of your patients. Participation, e.g. by joining one of the Save Sight Registries modules, allows practitioners to compare their patient’s outcomes with national benchmarks. This is a relatively easy way to achieve what we want: the best outcomes for our patients despite the constraints of the system in which we work. n Name: Professor Mark Gillies Qualifications (in abbreviations): MB BS, PhD, FRANZCO Business: Save Sight Institute, University of Sydney; Eye Associates Position: Director of Research Location: Sydney Years in the profession: 30

CONDUCTING OBSERVATIONAL RESEARCH IS ONE OF THE FASTEST AND MOST COSTEFFECTIVE WAYS TO IMPROVE TREATMENT OUTCOMES FOR PATIENTS AT SCALE

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