Insight February 2020 by Prime Creative Media

INSIGHT FEB

2020

MBS PROPOSALS COULD IMPACT ACCESS TO CARE Whether optometrists should perform intravitreal injections is also up for debate.

NATIONAL EYE HEALTH UNDER THE MICROSCOPE New Specsavers data reveals the organisation's successes in preventative eyecare.

INSIGHT MAGAZINE FRONT COVER FEB 2020.indd 1

AUSTRALIAâ&#x20AC;&#x2122;S LEADING OPHTHALMIC MAGAZINE SINCE 1975

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INSIGHT FEB

2020

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

QUESTIONS OVER VIABILITY OF MBS PROPOSALS

Proposed cuts to the rebate and fee for intravitreal injections will impact bulk billing services and access to treatment, Australia’s ophthalmic sector has warned.

The first would reduce the intravitreal injection MBS fee from $305.55 to $95.10. In turn, the patient benefit/rebate would drop 69% from $259.75 to $80.85.

Optometry Australia (OA) has also voiced its support for changes that would allow nonophthalmologists to perform the procedure, however the Australian Society of Ophthalmologists (ASO) is against the move.

The second recommendation raises the prospect of optometrists and nurse practitioners performing intravitreal injections, a proposal that has split the sector.

The comments follow the passing of the 20 December deadline for submissions on the draft Medicare Benefits Schedule Review Taskforce Ophthalmology Report. Released in October, the report recommended revision of 31 of the 189 Medicare Benefits Schedule (MBS) items under review. Ophthalmic submissions have centred on two controversial recommendations.

In its submission, the ASO states it “strongly opposes” both recommendations and warns changes might impact access to macular disease treatment. “The suggested patient rebate cut for intravitreal injection procedures, for which there has been no clinical or economic proof offered by the taskforce, will ultimately drive patients from the current established and highly effective and efficient private system, into an already struggling public system,

substitution”. It was “simply a cost cutting mechanism” that could seriously threaten patient safety.

David Andrews, RANZCO CEO

indeed a public system that in many areas is non-existent,” the submission stated. “Patients suffering critical macular conditions will have their eyesight severely impacted if left to wait for treatment or attempting to locate and secure services in areas where currently none exist.” The ASO also claimed allowing optometrists and nurse practitioners to independently treat macular disease patients amounted to “task

The submission referred to a 2013/14 legal case in which the ASO opposed a significant scope of practice change to allow some optometrists to diagnose and independently manage glaucoma. “The ASO driven court action to challenge that optometrists were not qualified to treat glaucoma patients as they did not have the specialist training and skills required was recognised and accepted by both the Australian Health Practitioner Regulation Agency and the Optometry Board of Australia. “The ASO is confident, given this legal precedent, that a similar court finding would apply to nonophthalmologists attempting to treat continued page 6

PROGRESS MADE TOWARDS UNITING DISPENSERS Recent changes to bylaws and constitutions are slowly bringing together Australia’s two dispensing organisations, following a 2019 commitment by the representative bodies to merge. The Australian Dispensing Opticians Association (ADOA), the NSW-based national body, has altered its bylaws to allow anyone within the ophthalmic sector, including both independent and non-independent dispensers, to join. Speaking to Insight, Ms Amelia Roberts, ADOA president, said the new constitution now allows “non-independent dispensers, wholesalers, optometrists and

reception staff,” as well as anyone else in the industry who does not hold a Certificate IV in Optical Dispensing, to join the group. “We will shortly be changing the fee structure to make it more tiered for individuals through to company/corporate organisations,” Roberts said. The formal merging of ADOA with ADOA Victoria, the state body, is also advancing. Roberts said a meeting with Ms Dina Anastas, ADOA Victoria president, last November has re-established the two groups’ shared goal after the departure of former ADOA Victoria president Mr Cameron McLeod stalled progress. “As that was a change post-

O=MEGA, a lot of ground needed to be rehashed as past-president Cameron had not conveyed our discussions before he departed,” Roberts said. Earlier in November, ADOA Victoria held an open meeting, attended by Insight, to discuss what has been achieved since O=MEGA19 Optical Dispensing Forum. In particular, the meeting focussed on what has been done to establish a united voice for dispensing in Australia – a clear desire of the country’s dispensers, according to the results of the Optical Dispensing Forum Survey presented at O=MEGA. continued page 6

SPECSAVERS REPORT SHOWS IMPACT OF EYE HEALTH STRATEGIES For the past two years, Specsavers has been measuring the impact of its progressive models for preventative eyecare, resulting in the country’s largest eye health data set. page 28

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UPFRONT Just as Insight went to print, the BUSHFIRE CRISIS has spurred Australia’s ophthalmic community into action. Eyecare Plus Bairnsdale, Hannaford Eyewear and Specsavers were among eyecare providers to offer free spectacle replacements to people who lost their homes and belongings in the disaster. Specsavers also committed to donating $5 from every sale in January, up to $100,000, to support bushfire relief appeals, while the Optical Distributors

WEIRD

and Manufacturers Association promised to donate $10,000 to a cause. IN OTHER NEWS, Optometry Australia has told the Federal Government an additional $13.7 million could improve Australian eye health, while reducing the social and economic burden of vision impairment. It has made five recommendations ahead of the release of the 2020/21 Federal Budget, including an extra $9 million to reinstate biennial Medicare rebates for a comprehensive initial examination for Australians aged between 45 and 64 years, $7.84 million over three years to expand the Visiting Optometrists Scheme and $1.5 million for future

optometry service models, including virtual consultations. FINALLY, the Centre For Eye Research Australia’s Professor Robyn Guymer has received $5 million for the world’s most intensive investigation into why a particular group of age-related macular degeneration patients are at greater risk of vision loss. The study will investigate the specific genetic and other factors and work to understand how they influence eye function. “Understanding what is different about the high-risk group, who can be determined by modern imaging techniques, and why this group is more likely to lose vision, is the key to saving sight,’’ Guymer said.

STAT

WACKY

A rescue cat called Truffles has been filmed trying on spectacles at an opticians’ shop in Pennsylvania. The Daily Mail reports the feline showed off her green and pink-framed glasses, even admiring herself in the mirror, and taking them off. The practice came up with idea to build confidence in children who are apprehensive about wearing glasses.

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Published by:

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Henry Cavill, star of the new Netflix series The Witcher, has revealed the contact lenses he wore for the role were sending him blind. Cavill told Metro.co.uk he ignored advice to not wear the yellow contacts needed for his role for more than three hours, but he soon listened to his eye technician after experiencing discomfort. n

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INSIGHT February 2020 5

NEWS

OPTOMETRISTS COULD EASE INJECTION BURDEN continued from page 3

macular diseases independently.” RANZCO CEO Dr David Andrews said the college also disagreed with both recommendations. He said plans to reduce the MBS fee for intravitreal injections were “economically unviable”. “Simply put, it’s below the actual cost of providing the service; time, tests needed, consumables and drugs taken into consideration,” he said. “Even bulk billers won’t be able to afford to provide the service. This means patients will almost certainly be billed an out-of-pocket fee or have to find a public hospital that does injections. These are very few, because state governments don’t fund it appropriately.” He added RANZCO's position was that intravitreal therapy should only be performed by trained ophthalmologists. OPTOMETRY WELCOMES CHANGE In its submission, OA applauded the recommendation to pursue options for intravitreal injections to be performed by non-medical doctors, including optometrists. OA stated injections have also increased the burden on the health system, with patients often requiring serial treatments. “The timely access to the right practitioner at the right time is vital for an efficient and effective health system,” part of the submission supplied to Insight said. “Not all patients require specialist advice and intervention for every episode of care and the skills of all the

access to some public but mostly privately bulk billed services, so the costs of those services are going to be severely impacted first. The risk is that specialists offering those services won’t be able to deliver them for $80.85, the proposed cut.”

practitioners in the health system should be used to their fullest. “Optometry Australia believes that an efficient and effective system would support ophthalmologists to spend the majority of their time undertaking tasks that only they can perform, and that those patients who can be managed safely by an optometrist or a nurse would be managed by these health professionals.” OA referenced evidence demonstrating non-medical professionals could undertake intravitreal injections safely. “It has been shown that optometrists are able to correctly classify disease activity with the same accuracy as ophthalmologists. It is also shown that these changes can be implemented with high levels of patient satisfaction and increased throughput of retinal clinics.” CONCERN OVER PATIENTS Macular Disease Foundation Australia (MDFA) CEO Ms Dee Hopkins said while the organisation supported a review into the current care model, it was concerned about the proposed patient rebate cut. She said Australia boasted some of the world’s best outcomes for neovascular age-related macular degeneration and diabetic macular oedema patients. This could be jeopardised if people are required to pay additional out-of-pocket costs, which currently average $1900 per patient annually. “Invariably MBS cuts inherently get passed on to patients, we have seen it time and time again,” Hopkins said. “Between 18–23% of people are getting

"A CUT TO THIS ITEM FOR SIGHT SAVING TREATMENT WILL EFFECTIVELY COST SHIFT TO OTHER PARTS OF THE HEALTH SYSTEM" DEE HOPKINS, MDFA CEO

Hopkins said the MDFA’s submission featured modelling that demonstrated a rebate cut would increase costs to other parts of the system. She had spoken with Commonwealth Health Minister Mr Greg Hunt who advised her that the review was not financially motivated. “In our economic modelling, we have shown him there won’t only be MBS savings, there will also be significant [Pharmaceutical Benefits Scheme] savings, however when people lose their vision they are eight times more likely to fall, fracture a hip, mental health issues, there’s the cost of carers, less productivity. “A cut to this item for sight saving treatment will effectively cost shift to other parts of the health system, and result in direct net costs to the taxpayer.” Hopkins said the MDFA was open to non-ophthalmologists performing intravitreal injections in future, particularly under supervision by an ophthalmologist, but there isn’t enough detail yet. “We would welcome an opportunity to explore alternative models, but we would be seeking to ensure we retain the good patient outcomes we already enjoy in Australia, as well as safe access and quality care for patients. If that can be done, and while it’s a valid suggestion, it would however take a long time to implement.” n

STRONG DESIRE FOR NATIONAL ASSOCIATION REMAINS continued from page 3

ADOA Victoria’s board indicated the organisation is still enthusiastic to either merge or, if necessary, assist in the establishment of a new national body. ADOA Victoria’s strategic vision is: “To work towards a National Industry Association representing all optical dispensers, dispensing opticians, dispensing assistants and suppliers/ manufacturers of associated products.”

INSIGHT February 2020

In June ADOA and ADOA Victoria, which have previously struggled to cooperate due to historic rifts, revealed to Insight that both groups were coming together to form a national body capable of representing all of Australia’s dispensers. In July both groups presented the results of Optical Dispensing Forum Survey to O=MEGA attendees. Key findings from the survey indicated Australia’s dispensers were frustrated at

the profession’s lack of leadership but were keen to support an organisation that provided representation, recognition, support and education. Mr Ron Baroni, former Australian country manager for Optometry Giving Sight, offered to assist in the reestablishment of a representative body, initially on a volunteer basis. Roberts confirmed to Insight that Baroni has already been “instrumental” in helping with the merger. n

NEWS

DOUBTS SURROUND COMMON OPTICAL BUSINESS STRUCTURE Optometry practices are being urged to review their payroll tax obligations and business structures following a court ruling that could put some healthcare businesses in breach of tax laws.

The Optical Superstore adopts a co-location model with its optometrists, which it says are independent practitioners conducting their own optometry businesses. Experts say it classified payments to the optometrists as fees or revenue, as opposed to taxable wages. Mr Matthew McKee is a tax lawyer and partner at the Sydney firm Brown Wright Stein Lawyers. He told Insight the ruling, which was handed down in September, could set a new precedent that affects medical and allied health practices. He said the case centres on the use of a tenancy/agency model by The Optical Superstore, one of the most common business arrangements in the optometry industry. In this instance, the practice collected fees from the patient or Medicare, and deducted a fee for providing management services such as rent, administration staff, marketing and practice supplies. The remainder is then paid to the optometrist. McKee said the payments were treated as fees or revenue earned by the optometrists, rather than wages, which would be subject to payroll tax. The system worked on the basis that the money being paid to the optometrists already belonged to them, and it was simply being held by the practice ‘on trust’. Therefore, it was understood that when the practice remitted the amount to the optometrist, it was not a payment to the optometrist for or in relation to the services provided to the practice. “The intention of these arrangements is that the medical practitioners, whether

n "THE INTENTION OF THESE ARRANGEMENTS IS THAT THE MEDICAL PRACTITIONERS ... ARE PLYING THEIR OWN TRADE."

The alert follows a successful challenge by the Commissioner of State Revenue in the Victorian Court of Appeal concerning The Optical Superstore, which operates more than 65 practices across Australia. The court ruled in favour of the commissioner, who argued payments the company made to optometrists operating out of its premises should have been subject to payroll tax.

IN BRIEF

it be an optometrist or otherwise, are plying their own trade effectively from the premises with certain administrative support from the practice, but ultimately they are meant to be running their own show,” McKee said. “Such arrangements are intended to provide certainty as to the tax obligations of the practice.” McKee said Victorian revenue officers considered the agreement between the optometrists and The Optical Superstore to be a ‘relevant contract’ for work, according to the laws around payroll tax, and should be treated as wages for payroll tax. He added that there were unique elements in The Optical Superstore’s case. This included a reimbursement amount that was paid based on the hours worked by the optometrist, which involved a signed-off timesheet. Additionally, the optometrists did not provide an invoice for hours worked. In addition, the optometrists received the same hourly rate regardless of how many patients they saw or how they were billed. An ‘occupancy fee’ was deducted from the payments to optometrists. If the total consultation fees were less than the amount that the optometrist was entitled to, based upon their hourly rate, the difference was treated as a ‘location attendance premium’ (GST would be paid and a recipient created tax invoice issued). McKee said while the arrangements adopted by The Optical Superstore may not align with more traditional structures, it appeared the judge adopted a broad view of what constituted a contract for work. This meant tax officers could review similar structures in future, and practices may be required to consult a tax professional to assess their risk. n

MATTHEW MCKEE, BROWN WRIGHT STEIN LAWYERS

VISION AUSTRALIA

Associate professor Julian Rait, who also holds multiple leadership roles with the Australia Medical Association, has been appointed to the board of Vision Australia. A respected ophthalmologist who has been practicing for more than 30 years, Rait said he is looking forward to contributing to the organisation’s future success. “I have had a long association with Vision Australia and have much admired and appreciated the support that has been provided to many patients.”

GLAUKOS ACQUISITION

Glaukos has announced it has completed its acquisition of US-based Avedro. Mr Thomas Burns, Glaukos president and CEO, said Avedro will form the cornerstone of the company’s new corneal health franchise. “This transaction pairs two highly complementary, hybrid pharma and device organisations, combining Avedro’s novel bio-activated pharmaceutical solutions and R&D capabilities with Glaukos’ global commercial scale, proven market-building and shared reimbursement expertise, and extensive clinical and regulatory infrastructure.”

BMW JOINS MARCOLIN

Marcolin announced it has entered into an exclusive worldwide licencing agreement with German car and motorcycle manufacturer BMW. Under the agreement Marcolin will produce both sunglasses and eyeglasses for the BMW, BMW M and BMW M Motorsport labels. “BMW has a strong influence in fashion, with products that are exciting to luxury audiences globally,” Mr Massimo Renon, Marcolin Group CEO, said.

INNOVATION LEADER

Professor Stephanie Watson, head of eye innovation at the Save Sight Institute and a Sydney Medical School Foundation Fellow, has been awarded the 2019 NSW Premier’s Prize for Leadership in Innovation. The accolade recognises her significant contributions to ophthalmology, including her work in gene therapy and clinical trials. “Working within NSW Health and at the University of Sydney, the award affirms the world-class environment being created to support innovation,” Watson said.

INSIGHT February 2020 7

NEWS

AUSTRALIAN SOCIETY OF OPHTHALMOLOGISTS DEMANDS APOLOGY FOR ‘DEFAMATORY’ CLAIMS The Australian Society of Ophthalmologists (ASO) has defended the organisation that was awarded a $2.2 million government contract to perform cataract procedures in Indigenous communities amid accusations it was charging double the market rate.

"I FEEL DREADFULLY HURT FOR THESE FINE AUSTRALIANS WHO HAVE HAD THEIR REPUTATIONS IMPUGNED."

An article published by the Sydney Morning Herald in December also called into question the contract given to Indigenous and Remote Eye Health Service (IRIS) due to the organisation’s Liberal Party connections and the lack of a tender process. ASO president Dr Peter Sumich and vice president Dr Ashish Agar have labelled the report “utterly incorrect” and “misinformed”. They have defended the character of those named in the article and called on the publication to apologise. The report claimed the office of Mr Ken Wyatt, Minister for Indigenous Australians, was lobbied to approve the contract for 500 eye surgeries for IRIS in 2018. A staff member was quoted as being concerned that a private Queensland company was contracted for $4000 per surgery. This fee, the article claimed, was almost double what eye surgeons in Sydney or Melbourne charge to remove cataracts and more than five times the Medicare Benefits Schedule fee of $772. IRIS DIRECTORS ‘DEFAMED’ In a statement published on its website, the ASO said it “backs the Indigenous and Remote Eye Health Service (IRIS) amidst unfair media defamation” and is proud to be associated with the organisation and its directors. Agar said the fee of $4000 mentioned in the Sydney Morning Herald article refers to the whole service provided. This includes pre-operative clinic and post-operative care, consumables and operative eye fluids, intraocular lens implants, a medical and nursing team and a concessional surgeon fee. Other costs include air transportation for people and equipment, staff accommodation and meals for up to a week, charter plane for very remote locations or other transport to pick up Indigenous patients from remote settlements, and a team trained in cultural sensitivity on site for up to one week prior

INSIGHT February 2020

Peter Sumich, ASO president

to surgery to locate, prepare and care for patients. “By comparison, the NSW Government Statewide cost price for Cataract Surgery used in NSW Public Hospital budgets is $4823,” Dr Agar said “The Sydney Morning Herald article is utterly incorrect to state that the $4000 fee is ‘double the going rate’. The original journalist who has since been requoted in The Guardian and ABC media, has been misinformed by his source and should properly apologise to those he has defamed.” Sumich said IRIS is a practical example of ASO’s support for the ‘Closing the Gap’ national initiative and defended the reputations of Dr Bill Glasson and lobbyist Mr Kerry Gallagher, who were listed as IRIS directors between 2016 and 2019 Glasson is an ophthalmologist, former Australian Medical Association president and former Liberal candidate who unsuccessfully ran for the Queensland seat of Griffith in 2013 and 2014. Gallagher was reported to own Vanguard Consulting, the ultimate holding company of IRIS. The company also operates Vanguard Health, the company listed as the winner of the contract in question, which has donated to the Liberal National Party of Queensland since 2009. “Dr Bill Glasson, AO is a respected peer leader and has for decades performed cataract surgery from Longreach to Birdsville and in other Indigenous communities. His reputation is totally beyond reproach,” he said. “Mr Kerry Gallagher, AM likewise,

is a distinguished war veteran who has dedicated much of his time to running IRIS at very little personal benefit. Dragging these two upstanding Australians into what is essentially a politicised employment dispute within Minister Wyatt’s office is deplorable.” Sumich said Wyatt and Federal Health Minister Mr Greg Hunt have continued the tradition of bipartisan support for Indigenous remote outback eye services. “It is terribly regrettable that these facts were not checked prior to publication. The article disrespects the doctors, nurses and support staff who have a passion for treating Indigenous blindness, not to mention the Indigenous patients who willingly took part in this groundbreaking program. “I feel dreadfully hurt for these fine Australians who have had their reputations impugned.” MINISTER DEFENDS CONTRACT In a statement, a spokesman for Wyatt said the contract to Vanguard was awarded “following advice provided by the Health Department” on 1 August 2018. “The Australian Society of Ophthalmologists – through Vanguard Health – was provided funding from the previous Labor federal government in 2010/11, to plan and develop a four-year plan for eye services (IRIS 1.0),” the spokesman told The Guardian. “The IRIS proposal was assessed by the Indigenous Health Division, in line with the standard process for unsolicited proposals under the Indigenous Australians’ Health program, and was assessed as suitable for the funding on the basis it would meet the unmet need for cataract surgery. “Given the pending delivery of the ‘roadmap’ for Indigenous Eye Health and relative value for money considerations, the department recommended the IRIS initiative be funded as a two-year trial, with an independent evaluation in the second half of year two to assess effectiveness and efficiency.” The spokesman reportedly said the advice was that “the initiative would deliver 500 eye procedures for Aboriginal and Torres Strait Islander people over the two years”. n

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Transforming eye health

NEWS

MELBOURNE STUDY TO PUT NEW AMD TOOLS UNDER MICROSCOPE The University of Melbourne has recruited optometrists to test new clinical tools, as well as an auditing system, it has developed for management of patients with age-related macular degeneration (AMD). Entitled Optimising optometric care provided to people with AMD, student Ms Sena Gocuk, Dr Laura Downie and Professor Allison McKendrick are conducting the study that aims to involve 45 Australian optometrists. The project will focus on investigating the implementation of a set of new clinical tools the group has developed to support optometrists with AMD patients. It will also ask optometrists to audit their own clinical practices using the Macular Degeneration Clinical Care Audit Tool (MaD-CCAT). For the study, optometrists will be randomly allocated a clinical practice tool for the next 10 patients with AMD they manage at their practice. “They will then be asked audit their own AMD clinical practices using the MaDCCAT for the 10 patients they used their practice tool for, as well as 10 consecutive patients with AMD seen prior to using the clinical practice tool,” Downie said. “Clinical audit, involving the systematic review of one’s own patients’ medical records against bestpractice standards, is recognised as an important component of medical professional accountability and continuing professional development. “We will use information gained from this study to inform the next-generation set of clinical tools. In the longer-term, if these tools are shown to be useful in practice, they have the capacity to be disseminated both nationally and internationally,” Downie added. n

NEW MEASURE HELPS PRACTICES IDENTIFY INDIGENOUS PATIENTS "THERE’S NO RESOURCE LIKE THIS IN MAINSTREAM EYECARE, AND WE ARE NOW HOPING TO STIMULATE CONVERSATIONS" MR MITCHELL ANJOU, IEH

Indigenous eye health advocates have designed a new resource to help eyecare practices initiate conversations with patients who identify as Aboriginal or Torres Strait Islander.

and Torres Strait Islander people would consider to be a culturally safe place to receive care,” optometrist and IEH deputy director Mr Mitchell Anjou told Insight.

The University of Melbourne’s Indigenous Eye Health (IEH) unit is distributing the reception desktop resource that has been specially developed for mainstream optometry and ophthalmology practices. The group aims to promote cultural safety and ensure Indigenous patients can access appropriate care.

“There’s no resource like this in mainstream eyecare, and we are now hoping to stimulate conversations within practices about improved approaches to service and care for Aboriginal and Torres Strait Island people who present at their practices.”

The two-sided, ‘tent-shaped’ resource has been designed in consultation with the Aboriginal and Torres Strait Islander community and works as a prompt by asking patients: “Are you of Aboriginal or Torres Strait Islander origin?” The stafffacing side reminds practice employees to ask the same question to each patient, while remaining sensitive, confident and respectful. “The prime motivation is to try help the professions of optometry and ophthalmology, and the practices they run, create a setting that Aboriginal

INSIGHT February 2020

This includes access targeted services designed for Indigenous patients such as subsidised spectacle schemes, prioritisation for cataract surgery, and specific Medicare rebates or funding. Anjou said other specific service options may be available, including access to Aboriginal hospital liaison officers and Aboriginal health workers.

AUSTRALIAN STUDENTS AWARDED GLOBAL SCHOLARSHIPS Four Australian students have been awarded Practice Excellence Scholarships from the American Academy of Optometry Foundation (AAOF) for their outstanding academic performance and commitment to independent optometry. Ms Emily Banks from Deakin University, Mr Dylan Bentley from Flinders University, Mr Derek Shiu Him Lay from the Queensland University of Technology and Ms Ivy Kol from the University of New South Wales were all awarded their grants at the American Academy of Optometry’s (AAO) annual meeting. The funding provided by each grant allowed the students to attend the AAO’s annual meeting, which was hosted alongside the 3rd World Congress of Optometry for 2019.

From left: The University of Melbourne’s Dr Laura Downie and Ms Sena Gocuk.

Anjou said stronger data and evidence could assist in eye service planning and delivery, helping to further reduce Australia’s eye health disparity. Improved identification could also have a positive impact in terms of clinical management.

The Australian scholarships are a new addition to the wider Practice Excellence Scholarships awarded by the AAOF. In

From left: Emily Banks, Dylan Bentley, Ivy Kol, Derek Shiu Him Lay

2019 nearly US$200,000 (AU$293,000) in grants were awarded to fourth-year optometry students in the US, Puerto Rico and Canada, as well as Australia. Funding for the scholarships is provided by the VSPs Global Charitable Fund, which is administered through the AAOF. “The Practice Excellence Scholarship is another example of our commitment to optometry’s next generation," Dr Gordon Jennings, VSP global board chairman, said. n

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HEAR SEPHORA’S STORY Hi everyone, I joined the OPSM family as a Dispenser at the Eastgardens store in my fourth year of Optometry school at UNSW. Under the leadership of my manager James and the mentorship of Optometrist Norton, I felt immediately drawn to OPSM’s warm team culture and knew that this was a company that valued recognition of its employees. Norton eagerly shared interesting clinical cases with me, and James built a tight-knit team dedicated to our mission to help people see better and live better! This incredible atmosphere, combined with OPSM’s technological investments in the future of eye-care, led to a world-class experience for our customers. This was where I wanted to be after graduation.

Attending the company’s CPD nights regularly also allowed me to continue developing myself clinically and connect with the wider community of OPSM Optometrists. Through these events, I discovered the numerous opportunities OPSM offers to nurture the professional growth of its Optometrists; this includes the LEDA scholarship which currently supports my studies in advanced contact lenses. I also joined other like-minded Optometrists at OneSight clinics on their mission to help the world see. This extremely rewarding experience gave us the privilege of witnessing firsthand the tremendous impact we can have on other peoples’ lives.

I am incredibly grateful for OPSM’s continued support of my professional development and am super excited to now have Naturally, I was thrilled when I was later given the opportunity the chance to give back to this amazing company. In my new to work in the World Square store as a full-time Optometrist. role as Managing Optometrist of World Square, what I hope to do most is to grow the store by supporting my colleagues in Within a week of working at World Square, I knew I had pursuing their own clinical passions and finding thei excitement found my new home. My Optometry mentors Saleem and to come to work each day. Kelly were extremely supportive, and the number of challenging clinical cases I managed with the help of both Optos and OCT SEPHORA MIAO Managing Optometrist presented an extraordinary learning opportunity. OPSM World Square Wide World of Optometry

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BIONIC EYE FEATURES AT GERARD CROCK LECTURE “[THE PARTICIPANTS HAVE] ADDITIONAL PIECES OF INFORMATION TO USE IN CONJUNCTION WITH OTHER AIDS.”

The results of more than a decade’s work were showcased in Melbourne for the Centre for Eye Research Australia’s (CERA) 11th Annual Gerard Crock Lecture. Associate Professor Penny Allen, Australia’s first female vitreoretinal surgeon and lead researcher on CERA’s bionic eye project, delivered the 2019 presentation to a full theatre at the University of Melbourne campus. Australia’s bionic eye project dates back to 2010, when funding was allocated by the Australian Research Council to support its development. Collaborators from the Bionics Institute, CERA and the University of New South Wales came together under the banner of Bionic Vision Australia to develop the device, which culminated in a two-year clinical trial involving three patients with profound vision loss. The bionic eye consists of a series of electrodes placed in the eye’s suprachoroidal tissue that stimulate the retinal nerves at the back of the eye. It is designed for patients with retinitis pigmentosa and helps them overcome

Penny Allen presenting the Gerard Crock Lecture

their lack of functional photoreceptors. A camera attached to a pair of glasses captures images, which are processed and transmitted to the implant via an external device.

PENNY ALLEN, CERA

Patients with the implant see flashes of white light, which are designed to help them navigate the world in conjunction with other aids. This initial trial showed the surgery and device were both safe, with all three patients undergoing successful visual rehabilitation and experiencing improvements in their daily life. Patients reported awareness of elements of their environment they were not aware of with their natural eyes, such as people

passing by and parts of buildings. The prototype’s success allowed the team to develop a second-generation version, which is currently being tested in a four-patient trial. The new device has a larger array of electrodes for greater detail, and participants are currently learning how to use the visual information it provides. “[The participants have] additional pieces of information to use in conjunction with other aids,” Allen said The project now has more preclinical data than any other bionic eye project in the world. Future versions are expected to have an improved resolution, however its capacity to slow the progress of retinitis pigmentosa might be a more significant benefit. Several studies have shown that stimulating the retina with low levels of electrical current activates Müller cells, leading to an increase in growth factors and a decrease of inflammation. The annual lecture is named in honour the first professor of ophthalmology at the University of Melbourne and pioneering researcher and inventor Professor Gerard Crock. n

FRENCH COMPANY ACQUIRES ELLEX LASERS ASSETS IN MULTI-MILLION DOLLAR TRANSACTION Ellex Medical Lasers has agreed to sell its lasers and ultrasound business segment to French company Lumibird Group for $100 million. Under the terms of the 24 December deal, the European laser technology giant will acquire the Ellex brand, research and development and production site in Adelaide and its commercial subsidiaries based in Australia, Japan, the US, France and Germany. The transaction concerns only Ellex’s lasers and ultrasound devices, its largest business segment that accounts for as much as 80% of its total revenue ($65.5 million in FY19). The company will retain its iTrack minimally invasive glaucoma device and its Retinal Rejuvenation Therapy laser 2RT therapy for intermediate age-related macular degeneration.

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Lumibird is headquartered in Lannion, France. It sells its lasers and ultrasound devices under the Quantel Medical brand, and in 2018 delivered revenues of €34 million (AU$54 m). Quantel has installed more than 30,000 lasers and employs more than 140 people across 110 countries globally. Ms Maria Maielli, CEO of Ellex, said the proposed sale, which includes state-ofthe-art manufacturing facilities in Adelaide, highlights the value of the company brand, the dedication of its employees and the strategic importance of its global sales and distribution network. “Lumibird will make an excellent strategic fit for Ellex’s market leading range of lasers and ultrasound to treat a range of important eye diseases,” she said. The deal is also set to strengthen the

global market coverage of Lumibird and Quantel, whose European presence will be complemented by Ellex’s established operations in Japan and the US.

Maria Maielli

Lumibird chairman and CEO Mr Marc Le Flohic added: “To truly create a difference in the lives of as many people affected by laser treatable blindness as possible, it is vital for companies such as Quantel Medical and Ellex to come together in order to reach a critical mass and make the most of their respective strengths; be that in diagnostic devices such as ultrasound or in treatments based on laser products.” The acquisition will be submitted to Ellex’s shareholders for approval at a general meeting during the first half of this year. Ellex’s board of directors has unanimously recommended shareholders approve the deal. n

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NEWS

EQUALITY IN VISION CARE STILL A LONG WAY OFF Humanitarian, researcher, and academic Dr Jacqui Ramke gave a lecture at the University of New South Wales as part of the School of Optometry and Vision Science’s Vaegan Seminar series.

living with blindness or vision impairment (VI) ‘only’ have cataract or uncorrected refractive error, both treatable conditions. Treatment is affordable, even in low and middle-income countries.

She is currently in the UK on a Commonwealth Rutherford Fellowship at the London School of Hygiene & Tropical Medicine. She is also a contributor to the Lancet Global Health Commission on Global Eye Health, is involved in setting the priorities of the Cochrane Eyes and Vision group, and is a Technical Working Group member helping develop the World Health Organization’s (WHO) Package of Comprehensive Eyecare Interventions.

Furthermore, for a whole range of poorly understood reasons, women and other marginalised groups experience barriers to accessing good, and in many cases any, eyecare.

This follows on from her previous work in Indigenous communities throughout the Northern Territory and Timor Leste. She has also spent more than 10 years managing programs for nongovernmental eye health organisations across the Asia-Pacific region. Her research is focused on equity in eye health, particularly in low and middle-income countries and between the sexes. The topic is close to her PhD research, which used epidemiological and health systems research to promote equity in eye health. Globally, three out of every four people

contribution, and lower social capital. Marital status is used as a proxy for social capital in some studies and, generally, the unmarried are treated inequitably.

Jacqui Ramke

Social groupings also often reveal divides in access to eye health care services. For example, 88% of the white Australian population have ready access to cataract services, whereas the figure for indigenous people is around 52%.

In 2015, most countries, including Australia, agreed to a set of sustainable development goals that aim to ‘leave no one behind’. For that to be achieved in eye health, better evidence is needed on how to improve access to eyecare for everyone. In essence, adequate eyecare is an integral part of universal health coverage, something that has yet to be achieved in most countries.

Research to quantify efforts and outcomes are underway, but according to Ramke more work is still needed. Other problems that are still poorly understood include failure to attend services even when appointments have been made, and long delays before re-appointments. Exactness of appointment and phone access are relevant factors.

Although inroads have been made into rates of blindness and VI, population growth rates are outstripping progress. While numbers are currently stagnant, they are expected to deteriorate if further interventions are not forthcoming.

Expected standards of treatment exist and the quality of interventions involving cataract surgery is guided by a WHO Quality Framework. Other research was undertaken by the Queen Elizabeth II Trust-funded Community Eye Health Consortium, which was operated from 2014 to 2019. Inequity remains an entrenched problem, and the current figure of 30% for female participation in eye health programmes shows there is still a long way to go. n

On a global scale, 89% of vision loss is in poorer countries, and almost universally, female eyecare lags behind males. This leads to, among other things, lower economic status, reduced independence, reduced societal

CENTRE FOR EYE HEALTH CELEBRATES ITS FIRST 10 YEARS The Centre for Eye Health (CfEH), located on the Kensington Campus of the University of New South Wales (UNSW), celebrated its first 10 years of operation on Sunday 17 November. The CfEH, which is a collaboration between Guide Dogs NSW/ACT and the UNSW, offers state-of-the-art diagnostic and ocular disease management at no charge to patients referred to it by outside health professionals. In addition to an outstanding array of instrumentation and equipment, it also has a well-developed research program involving both internal and external staff. It also provides education services to optometrists and offers lengthy clinical rotations to final-year UNSW optometry students covering ocular pathology, physiology, and therapeutics. UNSW

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become a leader in ophthalmic clinical research. Given that in its first decade it has seen 65,000 patients and, as evidenced by the number and range of research publications on display at the event, it would seem to have achieved its research goal as well. Attendees at the CfEH's anniversary celebrations

higher degree candidates also study in the Centre. The CfEH also has satellite clinics at The Sutherland Hospital (a diabetic retinopathy clinic) and the Cameron Centre in Parramatta, servicing patients referred by Westmead Hospital. The CfEH was created to deal with non-urgent ocular disease and to

The seed for the centre involved Mr David Pye, then clinic director at the School of Optometry and Vision Science UNSW, Professor Michael Kalloniatis, and Mr Barry Stevens, the then President of Guide Dogs NSW/ACT. All the signs suggest that the CfEH is going from strength to strength and there was no doubt that the centre was heading for a further decade of sterling service to the community, building on the sound foundation laid in its first decade. n

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INTERNATIONALLY RECOGNISED OPTOMETRIST JOINS GEORGE & MATILDA Gerry & Johnson Optometrists, owned and operated by renowned Australian clinical optometrist and researcher Dr Kate Gifford, is the latest high-profile practice to join George & Matilda Eyecare (GME). The independent optometry group announced in November that Gifford’s Brisbane CBD clinic would become the 80th practice to join its national network. GME, which launched in 2016, will take over the business management of the practice, allowing Gifford to continue her work on clinical research and peer education both in Australia and internationally. “One of the biggest achievements of George & Matilda Eyecare in the past three years has been that we have become the natural home for the best talent in independent optometry,” Mr Chris Beer, GME CEO, said. “Dr Kate Gifford helps us cement that position, and with one of the most impressive CVs of any optometrist in the country, I am sure she will enrich our growing community in many ways.” GME’s unique business model allows practices to maintain their independence while providing significant support in terms of back-office needs and buying power. GME purchases the assets of the business and co-brands the practice in the majority of cases. In this instance Gifford’s practice will be renamed: Gerry & Johnson, by George & Matilda Eyecare. Gifford, who is also a former president of Optometry Australia, said she was impressed by GME’s commitment to innovation and practice-centric commercial acumen, especially in paediatric optometry practice and myopia management “And as such I have realised the benefit to my practice, my patients, my staff and myself in becoming a part of this business model,” she said. “I have owned and operated my practice for over 12 years. With so much evolution in the knowledge, technology and business landscapes over that time, it is crucial for optometrists and their practices to stay at the cutting edge." n

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NSW EYECARE PRACTICES PITCH IN ON BUSHFIRE EFFORTS "DALE AND I WERE GOING TO FUND IT OURSELVES, BUT THEN A COUPLE OF OUR SUPPLIERS, RIMOPTICS, TIGER VISION AND HOYA, ASSISTED." PETER MCKAY, EYECARE PLUS

Eyecare Plus practices located in and near some of the regions hardest hit by the New South Wales bushfires have banded together to offer free glasses to affected communities. Practices located in the towns of Taree, Forster, Tuncurry and Gloucester have committed to providing free pairs of glasses to anyone who has lost their home. Speaking to Insight, Taree optometrist Mr Peter McKay said the idea for the initiative came from fellow Eyecare Plus optometrist and practice owner Mr Dale Rolfe. “I jumped on board straight away and initially Dale and I were going to fund it ourselves, but then a couple of our suppliers, Rimoptics, Tiger Vision and Hoya, assisted with it by giving us some discounted product.” Five people have taken advantage of the offer so far, but McKay expects that to change. “It’s actually less than we thought it would be, but we expect there will be a few more that trickle in over the next

Sarah Williams

couple of weeks, just as people get back on their feet and move from bare necessities to picking up the pieces and trying to get their life back in order.” Some Eyecare Plus staff in the region have also had a direct hand in fighting fires. McKay said one of his staff, who is training as a firefighter with the New South Wales Fire Service, has been filling air tanks at the local station. Sarah Williams, an optical assistant who works across Eyecare Plus practices throughout the Central Coast region, told Insight her employers have been very supportive of her work with the New South Wales Rural Fire Service. n

SPECSAVERS SEEKING APPLICATIONS FOR BIGGEST EVER SALARY PACKAGE Specsavers is offering a $225,000 salary package for three optometrist positions located in regional towns across the country, with more to come this year. The salary package, which is the biggest ever offered by the business, is more than double what is available for roles in the chain’s metropolitan stores. Located in Taree, New South Wales, Berri, South Australia, and Emerald, Queensland, all three practices boast a supportive steam of staff, two test rooms, and the latest optometry equipment, including optical coherence tomography (OCT). “We’re really excited to offer these fantastic packages to encourage optometrists to consider the move to a regional location,” Mr Raj Sundarjee, director of professional recruitment at Specsavers, said. “We’ve had an extraordinary response

to the opportunities in Berri, Emerald and Taree, and we will be offering additional packages for other regional locations in the new year. Those who are interested in taking up these opportunities should get in touch now to gain advance notice of where and when these new sets of locations will come online.” The regional lifestyle that accompanies each of these roles is a key part of each offering. All three practices are located either within driving distance or a short flight from capital cities and offer flexible rosters. The company is also promising these roles have the potential for fasttracked career progression. Applicants are expected to have two years of clinical experience in either Australia or New Zealand, as well as a proven ability to exceed key performance indicators. Future details of the positions are currently available in Insight’s classifieds’ listings. n

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ODMA UNVEILS LATEST BOARD APPOINTEES FOR UPCOMING TERM AND DETAILS 2019 SUCCESSES Essilor’s new Australasian head Mr Pierre Longerna has joined the Optical Distributors and Manufacturers Association (ODMA) as a director, while Mr Robert Sparkes returns for a third term as chairman.

also departed from his role as an ODMA director in July after serving more than 10 years on the board.

Hennessy into Sunshades. We also lost France Medical, MYM and Black Lilly,” Sparks said in his AGM report.

Sparkes, managing director of Optimed, was unanimously re-elected to the position of chairman for a third term.

The organisation, which runs marquee industry events O=MEGA and the O-SHOW, revealed its new nine-member executive for the next two years following its recent annual general meeting.

The remaining appointees were Mr Richard Grills, of Designs For Vision, Mr Mark Altman, of Device Technologies, Mr Brad Saffin, from Marchon, Mr Craig Chick, of Hoya Lens Australia, Mr Lionel Minter, of Mimo Australia, Mr Sean Rosenberg, from Frames Etc, and Ms Hilke Fitzsimons from Zeiss.

Sparks hailed the success of O=MEGA19 in July, which ODMA hosted with joint venture partner Optometry Victoria South Australia (OVSA). The event saw 130 primary exhibitors covering 3,900m2 of floorspace to accommodate 5,308 visitors over the three days.

Longerna, who is the newest member to join the board, was recently appointed as CEO of Essilor’s Australia and New Zealand division after a two-year tenure as chief operating officer. He has been with Essilor International since 2005, holding several high-level roles across both Europe and Canada. In Paris he managed the company’s Nikon partnership throughout the European markets, before moving to Canada in 2012 to take on the role of president at Nikon Optical North America. At Essilor, he replaced Mr Phuong Nguyen, who has retired after a career with Essilor that started in 1987. Nguyen

Sparkes also updated ODMA members on the previous year’s activities, and advised the organisation now serves 50 members. Frames and sunglass companies account for 56% of the membership, equipment 19%, lenses 13%, accessories and other 8% and contact lenses 4%. “In 2019 ODMA’s membership numbers had some ups and downs and there are now 50 members after several consolidations such as Healy Optical merged into Frames Etc and Jono

Pierre Longerna

“The exhibitor and visitor surveys, which were sent out immediately following the fair, indicated that exhibitors and visitors alike were very happy with O=MEGA19 and many stated it was the best event ever staged,” Sparkes said. “It has been very exciting working with OVSA and you would all have received our exciting news that we will together host the 4th World Congress of Optometry at O=MEGA back in Melbourne, in September 2021.” Sparkes also revealed that ODMA has completed its latest update of the Australian Eyewear Analysis report, which was first conducted in 2002. n

ORTHOPTICS AUSTRALIA RESTRUCTURES FOR THE FUTURE Orthoptics Australia’s (OA) new president will oversee measures designed to bring the organisation in line with modern corporate governance standards.

intended for NSW based associations. For an association with members from and activities across Australia and a desire to expand further, it makes sense to amend the legal structure. It’s fantastic and will be an exciting time ahead for OA.”

At the recent 76th Orthoptics Australia Annual Conference delegates welcomed Jane Schuller as the organisation’s newly elected president. Schuller comes to the role with 25 years’ experience in eye health care delivery. She is a qualified orthoptist in both Australia and the US, past OA Victorian branch chair and a longstanding member of the organisation. She replaces Marion Rivers, who is stepping down after two years in the role. Her first major priority will be to work with the new board to strengthen the governance processes to provide OA with a more robust system for the future as the association continues to evolve.

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Sydney hosted the 2019 OA Annual Conference

“The members voted in favour of a number of special resolutions at the annual general meeting to amend our existing legal structure from an association incorporated in New South Wales, to an association incorporated under the commonwealth Corporations Act and adopt a new constitution to comply with that” Schuller told Insight. “OA is currently an association under the New South Wales law, which is

Schuller said that the biggest change will be a streamlined organisational structure. OA is currently governed by a board made up of representatives from each state proportionate to member numbers. Under the new structure it will be led by a smaller, skills-based board. “There’s a trend in associations to shift away from geographic representative boards to a generally elected board, and this is in line with good corporate governance principles,” Schuller said. Around 400 delegate attended OA’s Annual Conference, the largest ever in the its history after a significant period of growth. n

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ZEISS GIFTS GOLD STANDARD OPTICAL BIOMETRY DEVICE TO INDIGENOUS EYE CLINIC Carl Zeiss Meditec donated one of its latest-generation optical biometry device to the Indigenous Diabetes Eyes and Screening (IDEAS) Van at the RANZCO Scientific Congress in Sydney. The mobile eye health clinic was presented with the IOLMaster 700 to assist ophthalmologists with pre-operative measurements for cataract surgery. “It’s quite exciting to have a company like Zeiss approach us, and I’m looking forward to furthering that relationship,” IDEAS Van executive director Ms Lyndall De Marco said. “This is a next generation machine, so it will be very helpful going forward, especially now that we are seeing so many more people in Queensland and Victoria along with our hospital partnerships.” Zeiss’ head of Australia and New Zealand Mr Joe Redner presented the device to De Marco, as well as other IDEAS Van representatives, including ophthalmologist Dr Rowan Porter and CEO Mr Ian Prowse. “We believe that this gold standard technology should be available to all Australians requiring cataract surgery, and we know the IOL Master’s ability to penetrate very mature cataracts will be particularly useful in treating the patients that the IDEAS Van team care for,” Redner said. He added: “Supporting such endeavours is inherent to the very essence of the Carl Zeiss Foundation, and we are proud to be able to play a small part in assisting the team.” Originating in Queensland in 2014, the IDEAS Van is a fully equipped, three-room ophthalmic treatment clinic designed to screen and treat Indigenous patients. n

NEW RANGE OF FRAMES DESIGNED WITH INDIGENOUS ARTISTS "I’VE ALWAYS LOVED THE ARTWORK, EVEN WHEN I WAS YOUNGER AND BACK IN IRELAND." MURRAY O’KEEFFE, JUKURRPA DESIGNS

A new collection of frames that showcases and directly supports the work of Australian Indigenous artists has been released on a national scale. The recently launched Jukurrpa Designs collection features work from members of Warlukurlangu Artists, one of the longestrunning aboriginal-owned art centres in Central Australia. Each of the eight frames that make up the collection are based off a specific piece created by one of the artists working at the centre. As well as a custom case, each design comes with a cleaning cloth that features the complete artwork and a card detailing both the artist and the story behind the original piece. Mr Murray O’Keeffe, designer of the collection, said the idea to feature the artworks of indigenous artists on frames has been in development for almost three years. “It has always been at the back of my mind because I’ve always loved the artwork, even when I was younger and back in Ireland. I used to watch a lot of Australian programs.” O’Keeffe said the idea of the complete

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package was to link the design, the artist and the patient together. “We work directly with [the artist] and use any of their artwork under a license agreement and give 10% of all sales, whether wholesale or retail, back to the community. That’s shared amongst the artists and the community to fund various projects, like a dialysis machine and a swimming pool.” O’Keeffe said he plans to produce more designs in the future, but finding suitable artworks can be tricky. “You have to include the majority of the artwork on the temple," he said. The frames are now avaliable to order.

HOYA SECURES ‘VIP STATUS’ FOR AUSTRALIAN BORDER CHECKS Australian border officials have granted Hoya Lens Australia a special status that will reduce red tape and smooth out the supply of its products. The lens manufacturer and supplier revealed it has been awarded Australian Trusted Trader (ATT) status by the Australian Border Force (ABF) following an independent assessment. Hoya Lens Australia supply chain manager Mr Raj Shankar said throughout the robust accreditation process the company demonstrated its secure supply chain and compliant trade practices. “Customs clearance for us is going to happen a lot faster especially with most of the manufacturing happening in Thailand after our lab in Sydney closed in March last year,” he said.

From left: Zeiss Australia and New Zealand head Mr Joe Redner with IDEAS Van ophthalmologist Dr Rowan Porter, executive director Ms Lyndall De Marco and CEO Mr Ian Prowse.

Jukurrpa Designs' first collection

“Beforehand, a lot of the work was getting done locally, but now we rely a lot more on the supply chain to be working 100% to get all our goods back

on time. The model we work on right now involves the goods being manufactured in Thailand, sent here [via air freight]. We do the packaging, and then we send it out to our customers.” Shankar said the company received daily deliveries to its Banksmeadow facility in Sydney. Since the “VIP status” was implemented on 7 November, delivery times have been cut by up to two hours resulting in an immediate flow-on effect to customers. Hoya now also has a direct line into ABF to resolve clearance issues. According to ABF, it only accredits businesses it deems as low risk. In addition to priority border treatment, other benefits include use of the ATT logo, the opportunity to partnership with ABF on initiatives related to its industry, data reports and a simplified visa process for overseas skilled workers. n

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REMARKABLE AFGHAN REFUGEE AND OPTOMETRIST RECOGNISED IN DEAKIN ALUMNI AWARDS A Deakin optometry graduate, who fled his war-torn homeland for Australia and has gone on to change lives through philanthropy, has been recognised with a top university award. Mr Khyber Alam, an Afghan refugee who arrived in Melbourne with his family in 2007, was the 2019 recipient of the Deakin Young Alumni of the Year award. The accolade recognises graduates around the world who have achieved success in their communities and professions. The award is in recognition of Alam’s selfless devotion to people less fortunate. While furthering his own career he has been a volunteer optometrist in rural Australian communities, Bangladesh and India. He has also raised more than $75,000 for various charities. Using his own savings Alam has also established an orphanage in eastern Afghanistan, which he hopes will house up to 60 children and become the first of many across his native country. “I’m grateful to everyone who nominated me for the award, but I don’t think people need to be praised or acknowledged for serving our global community. It should be our duty – if we can do it, we should do it, and we must do it,” Alam, who is currently working towards his PhD at Deakin, said.

Khyber Alam at the orphanage he established

"I DON’T THINK PEOPLE NEED TO BE PRAISED OR ACKNOWLEDGED FOR SERVING OUR GLOBAL COMMUNITY."

nine onwards my teachers have been exceptional and instilled the faith in me that I have the capacity to do well if I stay focussed and work hard.”

KHYBER ALAM, DEAKIN UNIVERSITY

Spurred on by his childhood experiences, and with two of his grandparents in Afghanistan suffering untreated vision problems, he was drawn to optometry for its ability to transform lives.

Alam was 13 when his parents and eight siblings fled Afghanistan due to the turmoil left from the Soviet-Afghan war between 1979 and 1989, and later the 2001 US invasion.

Alam was also inspired by his hardworking parents and quickly became proficient in his adopted language. He continued to excel and eventually became school captain in his final year.

As well as working as an academic and clinician Alam is now undertaking a PhD in the School of Medicine on vision impairment.

As a teenage refugee he arrived in Australia with his family traumatised and shy, two challenges exacerbated by the fact he could not speak English. “I went to an English language school. I still have a card that I used to carry with me, which said if I’m lost please return me to the school.

However, it is his Afghan orphanage named ‘House of Knowledge’ that is perhaps his biggest achievement. His father has been influential in the project, even travelling to Afghanistan to identify a location.

“The age of 13 and 14 is the age when you’re starting to know yourself and you’re starting to know other people around you. I was put in this strange environment, having to learn about this new society, the language, values and way of life.

“Growing up I have met a lot of kids and people who have been orphaned unfortunately, and I always wanted to do something for them. Now being in a place of some influence and in a position in life I can give back to them rather than choosing a luxurious life for myself.” n

“It was challenging, but from year

INXS STAR BECOMES GLAUCOMA AUSTRALIA AMBASSADOR When Annie Gibbins became CEO of Glaucoma Australia (GA) two years ago, never did she fathom the prospect of fighting the same cause alongside a rock star and the Governor-General. However, that is the unlikely scenario she faced when she met with Mr Kirk Pengilly, from the iconic Australian band INXS, and Governor-General Mr David Hurley at his official Sydney residence. Pengilly has been announced as an ambassador for the charity. He will use his own experience with the disease as motivation to raise greater awareness and drive early detection among the general population. The saxophone and guitar player, who

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is also a backing vocalist, becomes the latest public figure to support GA after the Governor-General was announced as patron. “It’s great to have them on board. Independently, both men have high impact profiles. To have them available to extend our reach is quite exciting. This is terrific news for people with glaucoma,” Gibbins said. “Since launching their new referral pathway in 2018, Glaucoma Australia is thrilled to be receiving thousands of new patient referrals from eye health professionals. “However, to find the 50% of people with glaucoma who are currently

Kirk Pengilly

undiagnosed in the general community, it requires high-profile influencers to extend our reach. It’s particularly exciting to bring Kirk on board; he’s got glaucoma, he’s a patient and he understands what it’s like to value sight saving treatment which enables him to get on with life.” In 1985, Pengilly “came within an inch” of losing his sight after the onset of narrow-angle glaucoma, which affects about 10% of all glaucoma patients. “Due to the severity of the disease, I was fast-tracked to a pioneering Australian ophthalmologist who quickly treated my deteriorating sight and prevented further damaged to my vision. Until that point, I had no idea what glaucoma was,” he said. n

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SA AUSTRALIAN OF THE YEAR CONTINUES HIS TIRELESS EFFORTS TO END BLINDNESS Sight For All co-founder and South Australia’s Australian of the Year Dr James Muecke wants to use his newfound status to prevent diabetesrelated blindness worldwide. The Adelaide eye surgeon and blindness prevention pioneer is one of the four SA recipients who was recognised at the recent state awards. The honour earned him a ticket to the national awards ceremony in Canberra on 25 January, as well as the potential to be crowned Australian of the Year. The award, which was the result of an anonymous nomination, recognises Muecke’s humanitarian efforts over the past two decades, most notably the establishment of Sight For All. The social impact organisation is dedicated to fighting blindness in mainstream and Aboriginal communities of Australia, as well as 10 low-income

countries in Asia and Africa.

Muecke pointed to a project in Myanmar where a 2007 Sight For All study revealed nearly half of all children were needlessly blind as his proudest achievement.

“I feel honoured and humbled to be the 2020 Australian of the Year for South Australia,” Muecke, who donates 40 hours of personal time each week to Sight For All, told Insight. “However, I must acknowledge that this is a huge team effort, not the least of which is the goodwill and expertise donated by the more than 120 Australian ophthalmologists and optometrists who have been involved in our varied projects over the past decade.” Muecke, who started his medical career in Kenya, hopes the award will raise awareness of Sight For All’s work and enhance its fundraising efforts. “Most importantly though, I’m hoping that our work will reach even more patients who are afflicted with blinding and potentially avoidable eye diseases.

James Muecke

In a first for the county, he arranged for the hands-on training and equipping of a paediatric ophthalmologist in Australia. Ten years since commencing the initiative, the ophthalmologist, Dr Than Htun Aung, is providing close to 30,000 treatments each year at Yangon Eye Hospital and is training two to three paediatric ophthalmologists annually. “This is just one of Sight For All’s many educational projects that are now impacting on the lives of approximately one million people every year, both in Australia and in some of the poorest countries of the world,” he said. Sight is a human rights issue, Muecke said, particularly since 80% of the world’s blindness could have been prevented. n

COMPANY

BIOGEN UNVEILS INTENTION TO COMMERCIALISE GENERICS

ALCON ANNOUNCES PLAN FOR MULTI-YEAR TRANSFORMATION Alongside its third quarter results for 2019, Alcon has announced a multiyear transformation program to invest in strategic growth initiatives. According to the company the program is designed to build on its recent success and work towards long-term goals. “Our momentum is strong as an independent company,” Mr David Endicott, Alcon’s CEO, said. “We’re going to build on this success by proactively implementing a multi-year transformation program that will further simplify and streamline our processes, accelerate innovation and strengthen our commercial position. We will reinvest these savings to support new product development and launches. We expect this will drive top line growth, deliver the operating leverage described in our long-term objectives and ultimately create significant value for our customers, patients and shareholders.” Explaining the plan in more detail during an earnings call, Endicott said 85% of the company’s sales were running through a new, standardised process and it has identified a number of opportunities to rationalise and eliminate complex bureaucratic layers that were put in place when it was part of Novartis. It then plans to reinvest these savings into new product sales, development and marketing. The company also announced positive results for the quarter. Worldwide sales increased by 6% on a constant currency basis to total US$1.8 billion (AU$2.6 b, with the results attributed to growth in the company’s advanced technology intraocular lenses, vitreoretinal, Dailies Total1 contact lens and Systane Complete eye drops. For the first nine months of the financial year, sales totalled US$5.5 billion (AU$8.1 b), up 5% on a constant currency basis. Alcon was spun off from Novartis in April 2019. n

INSIGHT February 2020

"SAVINGS ENABLED BY BIOSIMILARS PROVIDE PAYERS AND HEALTH SYSTEMS GLOBALLY THE BUDGETARY HEADROOM." CHIRFI GUINDO, BIOGEN

Multinational biotech company Biogen has proposed a deal worth up to US$310 million (AU$453 m) to supply biosimilar treatments of Lucentis and Eylea to major global markets, including Australia. The US-based drug developer has outlined plans to purchase the rights and commercialise generic versions of the therapies from Samsung Bioepis, a joint venture Biogen established with South Korean firm Samsung BioLogics in 2012. Regeneron/Bayer’s Eylea and Roche/ Novartis’ Lucentis are the two leading therapies for neovascular age-related macular degeneration (nAMD), as well as other associated diseases such as macular edema following retinal vein occlusion, diabetic macular edema and diabetic retinopathy. In 2018, combined global sales for the drugs reached almost US$11 billion (AU$15.9 b), with the US accounting for more than US$5.8 billion (AU$8.4 b) alone. However, Eylea patents in Europe and Australia are due to lapse in 2025, and even sooner in US and some Asian markets, while Lucentis faces expiration in the US next year and Europe in 2022.

Biogen intends to commercialise its own cheaper versions of the treatments in major global markets, including the US, Canada, Europe, Japan and Australia where Eylea and Lucentis are listed on the Pharmaceutical Benefits Scheme. “We believe savings enabled by biosimilars provide payers and health systems globally the budgetary headroom to fund innovation,” Mr Chirfi Guindo, Biogen executive vice president and head of global product strategy and commercialisation, said. “In the US alone savings generated from biosimilar uptake could reach as high as US$150 billion (AU$217 b) over a 10-year period. We look forward to expanding our biosimilars portfolio in major markets worldwide.” The proposed deal would see Biogen pay US$100 million (AU$145 m) upfront to Samsung Bioepis. Biogen may also pay Samsung Bioepis up to US$210 million (AU$304 m) in additional development, regulatory and sales-based milestones. Samsung Bioepis will be responsible for development and will supply products to Biogen at a pre-specified gross margin. n

ZEISS POSTS TENTH CONSECUTIVE RECORD-BREAKING YEAR The Zeiss Group’s Medical Technology segment, in particular the Vision Care unit, has been announced as a major contributor to the group’s record-breaking financial success over the last year. Announcing the results of its 2018/19 fiscal year, which ended in September, the organisation revealed revenue had grown 11% over the previous year to reach €6.43 billion (AU$10.4 b). Revenue rose by 8% when adjusted for currency and acquisition effects. Earnings before interest and taxes also posted a significant increase, reaching €1.06 billion (AU$1.72 b). Notably, the results mark the tenth consecutive year of record-breaking financial success for the company. All four of Zeiss’ segments posted an increase in revenue for the year, however the greatest change was seen in its Medical Technology segment. The company said this was due to greater

From left: Group press spokesman Mr Jörg Nitschke, CEO Dr Michael Kaschke and CFO Dr Christian Müller

demand for both microsurgery and ophthalmology solutions. Zeiss’ Vision Care business unit, which is part of the company’s Consumer Markets segment, was also singled out for its above-market growth and revenue for the first time surpassing the €1 billion (AU$1.6 b) mark. “All Zeiss segments have developed extremely well,” Dr Michael Kaschke, Zeiss group president and CEO, said.

INTERNATIONAL

NOVARTIS TARGETS EUROPEAN APPROVAL FOR AGERELATED MACULAR DEGENERATION TREATMENT Novartis’ new therapy for neovascular age-related macular degeneration (nAMD) has advanced part-way through the European regulatory process after winning the approval of independent advisors. On 12 December, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) recommended granting a marketing authorisation for Beovu (brolucizumab 6 mg). It comes after the anti-VEGF therapy received its first market approval by the US Food and Drug Administration in October. “[The] CHMP opinion brings us another step closer to providing wet AMD patients in Europe with a new treatment option,” said Mr Nikos Tripodis, Novartis’ worldwide franchise head of ophthalmology. “At Novartis, we remain committed

to reimagining treatments for patients suffering from wet AMD, a leading cause of blindness worldwide.” Beovu is now the third major player to enter the global anti-VEGF market to treat nAMD. It competes with Roche’s Lucentis, the anti-VEGF treatment that is also sold by Novartis in markets outside the US. It will become the main rival to Bayer/ Regeneron’s Eylea (aflibercept), which has established itself as the marketleading therapy since its launch in 2011. Last year the drug generated US$6.75 billion (AU$9.83 b) in global revenue. Beovu and Eylea have already gone head-to-head in two key clinical trials (Hawk and Harrier) and have shown comparable results.

one treatment every 8-12 weeks. Eylea’s recommended regimen is three monthly injections, followed by a treatment every eight weeks thereafter. A treat-and-extend dosing regimen has also been approved for Eylea, meaning some patients may be eligible for treatments every 12 weeks or more. According to Novartis, 56% of patients in Hawk and 51% in Harrier treated with Beovu 6mg maintained a three-month dosing interval immediately after the loading phase through year one. The CHMP stated that a key benefit with Beovu is its ability to preserve visual acuity, demonstrated throughout two years of treatment. “The most common side effects are conjunctival haemorrhage and eye pain as well as intraocular inflammation and retinal artery occlusive events,” the committee concluded. n

A key factor in nAMD treatment is the frequency of treatment. The recommended dose for Beovu is three initial monthly injections, followed by

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RESEARCH

CORRELATION FOUND BETWEEN AIR POLLUTION AND GLAUCOMA A large UK study has linked air pollution to increased rates of glaucoma, adding to a growing body of evidence suggesting environmental factors might add to development and progression of the disease. According to research recently conducted by University College London (UCL), people living in neighbourhoods with high levels of fine particulate matter in the air were 6% more likely to have glaucoma than those in less polluted areas. “We found a striking correlation between particulate matter exposure and glaucoma,” Professor Paul Foster, lead author on the study, said. The study included 111,370 participants throughout Britain who received eye tests between 2006 and 2010. As well as being asked if they had glaucoma, participants received an optical coherence tomography scan and had their intraocular pressure (IOP) measured. Each patient’s result was compared against the level of pollution near their home, with researchers focussing on the rate of fine particulate matter in the air. Fine particulate matter, which are particles are equal to or less than 2.5 micrometres in diameter, can come from a variety of polluting sources such as wood fires and vehicle engines. Researchers found that those living in the most-polluted 25% of areas were 6% more likely to report having glaucoma than those in the least-polluted quartile. Additionally, people in the most polluted area were also more likely to have a thinner retina. Despite this, no association was found with elevated IOP levels. “Given that this was in the UK, which has relatively low particulate matter pollution on the global scale, glaucoma may be even more strongly impacted by air pollution elsewhere in the world," Foster said. “And as we did not include indoor air pollution and workplace exposure in our analysis, the real effect may be even greater.” While it has not been confirmed exactly how air pollution and glaucoma are linked, Foster said the team would like to continue their research to find if there are any avoidance strategies that could help people mitigate health risks. n

INSIGHT February 2020

PROGRESS MADE TOWARDS GENETIC TEST FOR MYOPIA Researchers from the UK have developed a genetic test capable of predicting an individual’s risk of developing childhood myopia. The team behind the project, from Cardiff University and the University of Bristol, hope the test could mean earlier interventions and better outcomes later in life for myopes. “Treatments are available for slowing down the progression of short-sightedness,” Professor Jeremy Guggenheim, director of research at Cardiff University’s School of Optometry and Vision Sciences and co-lead on the study, said. “Knowing a child is at high risk would help parents and clinicians decide if treatment should be started.” Using data from the UK Biobank and the Avon Longitudinal Study of Parents and Children, the team analysed the genetic differences between 700,000 individuals against myopia progression. Based on the results of their study, the team claim they can identify one in 10 individuals who are 6x more likely than average to develop myopia by the time they reach adulthood.

“A genetic test can be carried out at any age, so a test like this - for a high risk of myopia - could give children who are likely to become very short-sighted a head start if carried out when they are young and if there are effective suitable treatments,” Dr Cathy Willaims, from the University of Bristol and co-lead on the study, said. In order to develop a more accurate and complete genetic test for the condition, the team claims further work, as well as a larger genetic sample, is needed. The findings have been published in the journal JAMA Ophthalmology. It builds on the same team’s previous investigations into childhood myopia, which found a correlation between a child's level of education and the condition. n

HEAT MAY IMPROVE EFFECTIVENESS OF ANTI-VEGF INJECTIONS Inconsistent or ineffective macular disease treatments might have an easy solution according to new research from the California Institute of Technology. Research presented at the American Physical Society’s Division of Fluid Dynamics’s 72nd Annual Meeting has suggested that the inefficient mixing of anti-VEGF treatments could be the cause of ineffective treatments or unwanted side effects. Ms Jinglin Huang, a graduate student in medical engineering, has suggested a thermally induced fluid mixing approach will allow the medication to more effectively mix with the vitreous body. “Because thermally induced mixing in the vitreous chamber can promote the formation of a circulation flow structure, this can potentially serve the drug delivery process,” Huang said.

“Since the half-life of the drug is limited, this thermally induced mixing approach ensures that more drug of high potency can reach the target tissue.” The application of heat after the injection is the only additional step necessary to include the technique in a procedure. “It can potentially reduce the amount of drug injected into the vitreous. It is definitely easy to be implemented,” Huang said. n

TECHNOLOGY

AUGMENTED REALITY MESH HELPS LOW VISION PATIENTS SEE Augmented reality (AR) glasses that cast a wireframe net over the world have shown potential in helping people suffering from retinitis pigmentosa navigate their surroundings. According to the results of a recent study conducted at the Keck School of Medicine, University of Southern California, modified augmented reality glasses can improve patients’ mobility by 50% and grasp performance by 70%. “Current wearable low vision technologies using virtual reality are limited and can be difficult to use or require patients to undergo extensive training,” said Dr Mark Humayun, professor of ophthalmology at the Keck School. “Using a different approach – employing assistive technology to enhance, not replace, natural senses – our team has adapted AR glasses that project bright colours onto patients’ retinas, corresponding to nearby obstacles.” The system works by overlaying objects within a 1.8 metre range with bright, distinct colours, which the wearer sees through the lenses. These colour clues help people with limited vision interpret and navigate the space around them, even in poorly lit conditions. The augmented reality glasses render the 3D structure of a room in real time,

Image credit: Scott Song, USC Roski Eye Institute

appearing to project the coloured o verlay on both the world and potential obstacles. The technology can even work in devices already commercially available. While trialling the glasses, patients with retinitis pigmentosa showed improved navigation of an obstacle course and were able to grasp a specific wooden peg against a black background with higher accuracy. “Patients with retinitis pigmentosa have decreased peripheral vision and trouble seeing in low light, which makes it difficult to identify obstacles and grasp objects,” Mr Anastasios Angelopoulos, study lead on the project, said. “They often require mobility aids to navigate, especially in dark environments,” The team hopes the technology could become practical for widespread use in the near future. n

OCT GOES BEYOND OPHTHALMOLOGY The use of optical coherence tomography (OCT) might no longer be limited to the ophthalmic sector, with new breakthroughs now allowing the technology to be used in other parts of the body. A team from Duke University have developed a method to perform scans within parts of the body that are impossible to reach will a full-sized machine, such as the inside of joints. The technique, which utilises a rigid borescope to deliver the infrared light necessary for the procedure, is expected to provide practitioners with information that previously could only be learnt through invasive surgery. “We saw a need for OCT image guidance in arthroscopic surgery, a

minimally invasive procedure that uses an endoscope to address joint damage,” Mr Evan Jelly, research team leader on the project, said. The scans provided by OCT include information on cartilage thickness, which assists with the treatment of conditions like osteoarthritis. “We took the low-cost OCT imaging platform we previously developed and adapted it to meet the requirements of this application,” Jelly added. Duke’s low-cost, portable OCT device, which was unveiled last June, is 15x lighter and smaller than a traditional device while not sacrificing image quality. The team’s findings were published in the journal Optical Letters. n

“CURRENT WEARABLE LOW VISION TECHNOLOGIES USING VIRTUAL REALITY ARE LIMITED AND CAN BE DIFFICULT TO USE.” MARK HUMAYUN, KECK SCHOOL

MOORFIELDS MOVES AI RESEARCH TO GOOGLE HEALTH The UK’s Moorfields Eye Hospital has announced it has moved its artificial intelligence research partnership from DeepMind to Google Health, following the 2018 announcement that the AI firm’s’ research teams would transfer to the technology giant. Following what was described as months of careful consideration, Moorfields has agreed to transfer its current agreements with DeepMind across. The hospital believes that the updated partnership will make better use of Google’s vast resources and expertise to further its cutting-edge research. “In 2016, we started a collaboration between Moorfields Eye Hospital and DeepMind, leading to ground-breaking artificial intelligence research published last year in Nature Medicine,” Dr Pearse Keane, consultant ophthalmologist at Moorfields, said. “Now we’re tremendously excited to work with Google Health on the next phase to further develop this AI system so it can be used by patients all around the world. I believe that this technology has the potential to help save the sight of millions of people and I’m proud that Moorfields, the NHS, and the UK as a whole, can play a central role.” Pearse Keane DeepMind’s collaboration with Moorfields is focussed on using AI systems to read eye scans and automatically detect several different retinal diseases. Last year the technology was reported as being more accurate than a doctor when diagnosing certain conditions including diabetic retinopathy, glaucoma and age-related macular degeneration. Google acquired DeepMind in 2014, and in 2018 it was announced that the AI firm’s health division was being transferred to Google. The transfer has been controversial, following concerns regarding both the security and use of patient data, which resulted in the UK’s Information Commissioner’s Office ruling that a UK hospital using DeepMind Technology was not doing enough to protect the safety of patient data. n

INSIGHT February 2020 27

FEATURE

NEW SPECSAVERS REPORT SHOWS IMPACT OF EYE HEALTH For the past two years, Specsavers has been measuring the impact of its progressive models for preventative eyecare, resulting in the country’s largest eye health data set. MYLES HUME analyses the company’s second annual report on its progress.

pecsavers’ latest snapshot into Australian eye health has revealed referrals for eye disease are soaring to new and unprecedented levels.

Thanks to the blanket use of imaging technology to inform the standard eye test, ophthalmology-led education and other clinical interventions to deliver timely and accessible care, the optical chain’s latest statistics show it is continuing to move the needle on disease detection rates. The data, from its Specsavers Eye Health Report 2019-20, detailed the major inroads its optometrists are making, particularly in terms of earlier glaucoma detection and referral. The organisation is identifying more patients in their 40s with the disease, while also aligning actual detection rates with prevalence estimates. Released late last year, the 88-page document is a follow up to the company’s inaugural 2018 State of the Nation Eye Health Report. Billed at the time as the most in-depth examination of Australian eye health, it established a yardstick to measure future reports and outcomes against. In its latest report, Specsavers analysed data

INSIGHT February 2020

from 8.5 million patient journeys to quantify both the impact of its strategies and the Australian public’s attitude towards eye health. It is the largest publicly available data set of its kind in the region, increasing by an additional 3.5 million data points this year. Asked about the significance of the updated report Mr Peter Larsen, Specsavers’ group eye health strategy director, explained: “Its purpose is to present our own data – collected systematically in every patient engagement – to demonstrate clearly that a systematic approach to patient care delivers improved health outcomes. “We want all stakeholders within our broad profession to be able to access and use this report as a benchmarking tool in itself, against which they can test their own patient data.” GLAUCOMA: TURNING THE TIDE Specsavers’ most notable impact has been in the detection and referral of glaucoma and diabetic eye disease, underpinned by its initiative to include optical coherence tomography (OCT) as an element of every patient’s eye exam. The figures show glaucoma referrals have almost tripled in two years. Between July and

December 2017, when OCT was installed in just 3% of stores, Specsavers referred 10,562 patients to ophthalmology. By 31 July last year glaucoma referral numbers had increased to 24,477. With OCT now available across all 334 Australian stores, referrals were projected to reach 42,000 by the end of 2019, an increase of 19% on 2018 (34,053) and 64% on 2017 (15,145). Overall, sample statistics show 86% of referrals have been deemed appropriate by ophthalmologists, with 14% being false positives. “The findings [also] indicate that more than half (53%) of the referrals to ophthalmology in 2019 were new referrals. This closely aligns with the findings of the Blue Mountains Eye Study from 1992-1994,” the report states. “Furthermore, new glaucoma diagnoses made up the majority of referrals for those under the age of 49; 72.8% for people under the age of 40 and 68.7% for people 40 to 49.” TACKLING DIABETIC EYE DISEASE The convergence of IT, data, training and collaboration strategies has allowed Specsavers to expand its focus on other causes of preventable vision loss. One of those has been diabetic retinopathy. At 31 July 2019, 7,028 patients were referred to ophthalmology for the disease. Based on the current referral rates, this figure was projected to reach 12,000 patients by the end of 2019, an increase of 34% on 2018 (8,982) and 205% on 2017 (3,931). “This year, following enhancements to Specsavers’ patient management system to enable optometrists to simply and consistently identify patients with diabetes, and the introduction of the KeepSight portal, for the first time we are able to properly start measuring eye health outcomes for this subset of the total population,” the report states. “The ability to analyse data specifically for patients with diabetes opens up many opportunities to better understand eyecare for this at-risk group.” Specsavers is currently registering 1,500 diabetes patients every week to the KeepSight database to ensure they receive regular eye test reminders. Total registrations were forecast to reach 36,000 by the end of 2019. Additionally, the data reveals that in 2018 20.1% of diabetic eye referrals from practices using OCT identified macular oedema compared with 12.8% for non-OCT practices. CLINICAL INTERVENTIONS Specsavers’ OCT rollout means 1,000 optometrists will now use the technology on as many as four million patients a year, translating to one in six registered optometrists across Australasia. While the systematic use of OCT has been the catalyst for significant change, other clinical interventions are also having a measurable impact. This includes use of the RANZCO Referral Pathways, the Oculo e-referral platform and Optometry Benchmark Reporting. Increased use and same day performance of visual fields on at-risk patients is also helping minimise the

An overview of the key Australian eye health statistics the sector is aiming to address.

number of patients lost to follow up. Another major contributing factor has been the recently-introduced ophthalmology-led education workshops. Called the Ophthalmologist Local Education and Engagement Program (OLEEP), the initiative is designed to improve optometrists’ decision making and ability to detect glaucoma suspects. The face-to-face events have so far been held in 18 sites across Australia and New Zealand, reaching some 200 optometrists. Among those who have attended the events, glaucoma referrals have increased by 35%, further aligning with national prevalence rates. This increase in referrals has also aligned with increased use of visual field testing – from 8.1% to 11.4% of patients. Additionally, ophthalmological feedback has helped deliver greater consistency and a reduction in the number of false positive referrals, which are expected to continue to decline over time. EYE DISEASE AWARENESS AND UNDERSTANDING Specsavers also uses the annual report as an opportunity to track public awareness and understanding of eye disease. Of the three major sight-threatening eye diseases, diabetic retinopathy again had the lowest awareness levels. Only 34% of Australians have heard of the condition, with 78% not knowing anything about it. Prompted awareness of glaucoma remained steady at 74%, with 53% admitting they aren’t aware of it. Awareness of macular degeneration remains low in Australia at 60%. While the vast majority believe they should get their eyes tested regularly, 33% of Australians couldn’t recall having an eye test in the past two years. The top three reasons were; not thinking there’s anything wrong (20%); cost concerns (20%); and don’t have time/haven’t gotten around to it (17%). While the cost of standard comprehensive eye test is government funded in Australia, 41% did not know tests are bulk billed through Medicare. As many as 30% of people (up from 22% in 2018) think they’ll be out of pocket between $20 and $100+, while 11% (down from 19% in 2018) don’t know whether they will be charged for an eye test or not.

Glaucoma referrals have risen as the number of practices with OCT has increased.

“The confusion around costs in Australia could be as a result of some optometrists charging gap payments for diagnostic tests, such as retinal photographs, OCT and visual fields. Regardless, more education is required to inform Australians of their entitlements under Medicare," the report states. n

INSIGHT February 2020 29

Sunglass Collective sibling owners Ms Lisa Wymond (from left) and Mr Mark Wymond with head of sales Mr Paul Harrison have launched a new business venture.

FEATURE

e v i t c e l l o C Sunglass

COMBINES INTERNATIONAL STYLE WITH LOCAL SERVICE

The family team behind Eyes Right Optical have launched their latest venture, promising to bring a new level of style and service to the Australian and New Zealand sunglass sector.

unning an independent optometry practice in 2020 requires more than just an outstanding level of care and service. While both are critical to maintaining a consistent clientele, people are also demanding access to a selection of high-quality frames that are varied enough to suit their own personal style. In the harsh Australian summer, a pair of sunglasses that are just as fashionable as they are functional is an absolute necessity. With the market dominated by a few major brands, independent practices are searching for ways their product selection can stand out. As a result, a new company has launched to bring a selection of unique and fashionable sunglasses to create a point of difference for both practices and customers. Sunglass Collective, the new company from the team behind Eyes Right Optical, has launched to provide a selection of high-quality, innovative and stylish sunglasses to independent practices. The Melbourne companyâ&#x20AC;&#x2122;s arrival has already seen two major brands jump on board with exclusive distribution deals, and more expected to join in the near future.

INSIGHT February 2020

FAMILY TIES The launch of Sunglass Collective represents a significant moment in Eyes Right Opticalâ&#x20AC;&#x2122;s history. Founded in 1992 by Gaye and David Wymond, the company has built a reputation as a distributor of high-quality, designfocussed and fashionable eyewear targeting the mid- to high-end market. Since its launch, Eyes Right has grown to encompass 32 employees, embrace modern information technology and service systems, and expanded to service Australia, New Zealand and the Pacific. It has even been recognised with a variety of awards for product, sales and customer service. More recently, Eyes Right has been undergoing a transformation, while still remaining true to the values that led to its success. After preparing for succession fpr many years in 2018, Mark Wymond, managing director, and Lisa Wymond, national brands manager, took over the day-to-day running of the business. In 2019, they purchased Eyes Right from their parents David and Gaye.

“The Wymond Family Business Advisory Board was formed with an independent chair. It is great chance to review the past quarter and plan a year ahead,” Mark Wymond says. “We look for beautiful and innovative product that is of the highest quality. “We represent these products as an easy-to-deal-with company with excellent delivery rates and marketing capabilities.” Now, with the launch of Sunglass Collective, the Wymonds are looking to take this philosophy to a previously unreached segment of the market. “Eyes Right Optical is well known for premium quality, design-focussed spectacle frames, but is not so well known for sunglasses,” Mark says. “The idea to start a new company that is purely focussed on sunglasses made a lot of sense for us. It will make the company more manageable, and capable of reacting quickly to global sunglass trends.” BOLLE AND SERENGETI Leading Sunglass Collective’s portfolio are Bollé and Serengeti, two brands with highly distinct offerings. Bollé’s history dates back to 1888, when in Oyonnax, France, the Bollé family began manufacturing combs and hair accessories from horn. In 1936 the company moved into manufacturing frames from celluloid and rhodoid. After World War II the company focused on moulded nylon and gradually expanded its products to include safety glasses, ski goggles and cycling eyewear. Serengeti has a different story. Throughout the company’s 45-year history it has committed to developing the world’s most advanced sunglass technology on the market. In 1980 it patented its Spectral Control filter lens process, which is designed to enhance contrast and reduce glare by filtering out blue wavelength light. Since then it has built on this legacy by applying leading lens technology to frames that are durable, reliable and fashionable. Michael Sakellaris, senior director of global sales at Bollé Group, says while the two share some behind the scenes resources, both are proudly independent of each other and boast drastically different styles. “Our intention is to make Bollé the most innovative and premium performance sport brand,” Sakellaris says. For Serengeti, the focus is on technology. “This is why we are working on developing creative styling using the ultimate in premium materials and lenses to deliver a market leading offer,” Sakellaris says. Australia is an incredibly important market for sunglasses. “Australia has the highest rate in annual sunglasses purchase per person globally,” Sakellaris says. “So for us as a sunglasses-focused company the market is absolutely key. “Bollé and Serengeti have a long tradition in Australia and with the new distribution through Sunglass Collective, backed by the Wymond family, we are convinced that this will continue.” “The Wymond family have an international reputation for the highest quality distribution, customer service and ease of doing business.” Currently the Bollé Group has three main priorities: the Customer First

Serengeti

program, its Corporate Social Responsibility (CSR) program, and the establishment of its Excellence in Product Innovation and Creativity (EPIC) centre. Sakellaris says the aim of the Customer First program is to deliver premium service and systems to all of the company’s retailers. “The group has invested massively in a new [enterprise resource planning] system to provide our partners with optimal conditions so they can offer our end consumers the best possible experience.” In terms of CSR, Sakellaris said the company is incorporating sustainable business development practices in order to meet the high expectations of today’s socially conscious environment. For the products Bollé Group are bringing to the local market through Sunglass Collective, direct benefits will be felt from the EPIC centre. “This development laboratory is located at our headquarters in Lyon and Carlsbad, where our product teams develop the most advanced optics and helmets, so our end consumers enjoy high-end and qualitative products,” Sakellaris says. DIFFERENTIATED PORTFOLIO Mark Wymond says Bollé and Serengeti, as well as Morel Azur, will be the first brands re-launched and launched by Sunglass Collective. Eyes Right is proud of their 20-year relationship with Morel, which is continuing with Sunglass Collective. “We are particularly proud to present Morel Sunglasses to the Australian market, and our journey is just starting with Bollé Brands,” Mark says. “All of these powerful global brands have a strong heritage of design focused sunglasses, which feels like a perfect fit for what we like to sell.” Between these three powerhouse French brands, Mark believes that the selection of frames will help independent opticians stand out from the corporates. While advantages like next-day deliveries will help from a service perspective, the selection of brands will also help independents offer more personal service. “I see more and more a push from end consumers to visit independent opticians because they want to feel important.” Mark says. “They are looking to have a thorough eye test, followed by a great retail experience that focuses on their needs, while also allowing them to look trendy and a bit different from their friends.” Having a selection of unique frames that are not available everywhere is an excellent way to do this. “The sunglass sale is very import in practice, not only for the practice’s revenue stream but also the patients comfort while outdoors and driving,” Mark says. “I love wearing my prescription sunglasses even though I have a relatively small prescription.” Between all of these initiatives, Sunglass Collective has come into the industry as a wholesaler offering a selection of sunglasses that will help independents differentiate their range with leading, global brands to help their customers stand out. n

Bollé

INSIGHT February 2020 31

FEATURE

IN PURSUIT OF

progressive perfection

Advances in lens design and manufacturing processes have spurred the development of the ‘premium’ progressive lens market. It has also created endless possibilities for lens makers and eyecare professionals to satisfy any patient who walks through their door. MYLES HUME reports.

hether it be a tailor-made suit, engagement ring or cufflinks, research suggests there is a growing appetite for personalisation among consumers.

Optical products are no exception, and there are few that can match the level of individualisation now being offered by progressive lenses. The market’s best products, commonly referred to as ‘premium’ progressives, are at the vanguard of spectacle design. Through a combination of precision manufacturing techniques and advanced design informed by highly personal measurements, these top-of-the-line products aim to provide a tailored eyewear solution to match a patient’s physiology and daily activities. Today, premium progressives remain the largest revenue earner for any lens manufacturer. They also demand a superior skillset from the dispensing practitioner, presenting an ideal opportunity to create a differentiated business proposition in an increasingly crowded marketplace.

INSIGHT February 2020

INSIDE THE PREMIUM PROGRESSIVE

In order to appreciate premium progressive lenses, Australian optical dispensing consultant and RMIT University teacher MR LEIGH ROBINSON says it is important to understand what lens manufacturers are attempting to achieve.

RMIT University teacher Mr Leigh Robinson believes the best progressives will focus the light at the fovea for any gaze direction at any point on the lens. “Nearly all ophthalmic lenses give clear sight through and around the optical centre of the lens, but peripheral vision is compromised with a variety of lens forms, and that is the Holy Grail for lens designers. “The performance of the lens when the eye looks away from the optical axis, that's what is driving the technology that underpins these progressive lens products. Premium progressive lenses consider the position of the lens in front of the eye and how this changes the effect of the lens on the optical system.” Robinson says the market can be split into two distinct classes. The first is optimised progressive lenses. These use default measurements that consider how the frame might sit on the patient’s face. In contrast, personalised lenses provide unrivalled visual outcomes by incorporating specific measurements such as facial dimensions, back vertex distance, pantoscopic tilt and facial wrap of the frames. “This is important, it lets the lens companies know how the frame is sitting on the face so they can personalise these lenses to compensate the prescription,” he says. “That’s an area a lot of practices find complicated to understand. The lens compensation is not changing the prescription, it’s changing the effect of the prescription by adapting the lens design and matching the prescription from its written form to the as-worn position on the face.” According to Robinson, the use of Computer Numerical Control (CNC) technology in the manufacturing process has been the key to producing highly accurate lens designs, known as digital or freeform surfaced progressive lenses. Traditionally, lenses were designed with the power of progression on the front of the lens, however the advent of digital and freeform surfacing has allowed this to also be done on the back. “This has advantages of a wider field of view, and less magnification of the lens,” he says. “Some lens companies will also say that they have now got 1000 or more individual value points on a lens, which is essentially like 1000 individual tiny lenses in the one lens.” PRECISION MANUFACTURING

Key measurements from Rodenstock’s DNEye Scanner 2 can be incorporated into its digitally surfaced lens designs.

Thurn says in the traditional surfacing process, the back of the lens was cut using two curves to produce the sphere, cylinder and axis of the prescription. Once completed, the rough surface was “fined" and "polished" using a metal tool to match the two curves. Specific pads on the tools removed the roughness before making the lens transparent. Today’s more advanced digital surfacing process, according to Thurn, allows the back of the lens to take any form, such as an aspheric design or progressive surface. Manufacturers can also use this complex surface to overcome the shortcomings of the base curve, regardless of whether it is a simple or more complex front surface. “The surface is cut with a precision diamond tool. The design is a computer file and, in our case, is generated for each lens via complex calculation software which can take into account new parameters such as the frame tilt, wrap and back vertex distance and other information that will be added into the calculations,” he says. “The surface is cut so finely that the only additional process is called ‘soft polishing’ – a gentle polishing that removes just enough material to make the lens transparent without impacting the complex surface that has just been cut.” Thurn says the use of CNC to produce digitally surfaced or freeform lenses has opened endless possibilities for manufactures. However, he stresses it is merely a process, and the true performance lies within the design. He believes three key components make digital/freeform surfacing such a remarkable process. Each component is dependent on the other to ensure the final product benefits the wearer: • The machinery involved to manufacture highly accurate lens surfaces.

Digital surfacing is a key component in Essilor’s Varilux progressives, which have long been a pioneering lens of the category since first coming to market in 1959, Essilor Australia and New Zealand professional services director MR TIM THURN says.

Essilor's Varilux range of lenses, spearheaded by the Varilux X Series, encompass more than 50 patents, with each individual lens incorporating up to 30 patents alone. A move from traditional to digital surfacing techniques lead to a renewal of these patents. Essilor Australia and New Zealand professional services director Mr Tim

• T he process, including the operating procedures, software system, calculation engine, consumables, experience and quality control. • T he design, capturing the latest innovation in the science of sight, the source of the optical benefits to the wearer. Asked what constitutes a premium progressive lens, Thurn says one should consider the technology and research invested, rather than its price point. “A lot more goes into it and it’s backed with good solid proof as well. I know one of our Varilux products was worn by approximately 4500 people around the world in clinical trials before it went to market.” Reducing swim effects and broadening the field of vision are the most common issues optical engineers have been attempting to overcome for decades.

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FEATURE

giving a larger usable area – have made a difference in Rodenstock's lenses. Rodenstock Australia national sales and professional services manager Ms Nicola Peaper says the company is now the only manufacturer that can build a different distance and near cylinder power and axis into a progressive lens design. “The value to the patient is near vision will be incredibly sharp and the full corridor width usable." In addition to its lens designs, Rodenstock has developed the DNEye Scanner 2 device, which itself is indicative of how far lens companies are prepared to invest in progressive lens technology. “Lens manufacturers have been looking for ways to compensate for higher order aberrations (HOA) for some time and different solutions have been offered,” Peaper says. “Rodenstock can measure the HOAs of the individual patient and are the first to incorporate this in a lens that is also calculated using eye length,” she says. The DNEye Scanner 2 offers topography, pachymetry, aberrometry, tonometry and pupil size readings. The measurements can then be incorporated into Rodenstock’s Multigressiv and Impression level lens designs. Zeiss' Progressive Len Individual 2 is optimised for the eyes, frame, face and main daily activities.

Thurn says while today’s best products work to address those issues, they also go much further to consider other factors such as depth of field. “In Varilux X, the big change produced by our optical engineers is that the lens surface lets me sit here with my phone in front of me, take it away and without moving my head I look at my computer screen and it’s clear,” he says. “I don’t have to move my eyes or my head. Then if there’s an object beyond that, it would also be in focus. This very clever overlapping of those different depths of field means you have this continuous, seamless vision that is not only wide, but deep as well – that’s the real revolution.” Essilor elevates its premium progressives, such as its top of the range Varilux Xclusiv, to the level of personalisation with the use of an iPad app that simulates the way people read without using text. It involves the patient tracking a blue dot across the screen, while the iPad camera measures the down gaze, offset from centre and the reading distance. It also factors in the patient's visual behaviour. At one extreme keeping their eyes still and tracking with their head or, at the other, keeping their head still and tracking with their eyes - and all the combinations in between. From this personal data the design of the lens is modified to shift their volume of vision to exactly match their parameters. Other designs factor in whether the patient is right or left-handed. Optical company OSA, which is part of the Essilor group, does this with its Intuitiv lens. UNPRECEDENTED PATIENT INTEREST

Rodenstock Australia national sales and professional services manager MS NICOLA PEAPER believes two aspects have greatly improved progressive lens comfortability and usability.

The incorporation of frame parameters to reduce the effect of aberrations and calculating compensations for the way an eye moves across the lens –

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Reports produced by the device can show patients the effect of HOAs that haven’t been compensated for, and how compensation will improve their vision. This also gives the practitioner the advantage of visual demonstrations to show why lenses may be superior to competing products. “This is the first time I, personally, have seen patient interest in what they are experiencing. Patients have called the laboratory to find out where they can access this technology,” Peaper adds. “We hear from our customers that they have patients travelling 400 to 500km to purchase a pair of spectacles, and it is commonplace for all family members to come in for a pair.” RISING ABOVE THE CORPORATES

Hoya Lens Australia national training and development manager MR ULLI HENTSCHEL says patient satisfaction is one of the most important qualities premium lenses can bring to a practice.

It’s no secret the technology built into premium progressives has made the lenses far more capable. But what use would it be if eyecare professionals couldn’t translate this into positive outcomes? “This segment is one area that the independent practitioners can really have to their own, because a premium, really high-end progressive lens takes more time and skill to dispense," Mr Ulli Hentschel, Hoya Lens Australia national training and development manager, explains. “This demonstrates to the patient that they have a much deeper understanding of lenses and the patient’s lifestyle needs which, in turn, positions them in a league above their corporate counterparts. “We find practices that get on board with these high-end products have such great feedback from patients and get much better word-of-mouth referrals. It is one of the most important segments of the independent lens business, and it’s one of the most profitable as well.” Hoya’s top premium product is the MyStyle V+. Aside from incorporating the full range of parameters, the lens design factors in the patient’s lifestyle and even their experience with previous lenses. Hentschel says Hoya has also achieved success with its MyStyle Profile range, a derivative of the MyStyle V+. Launched in 2018, MyStyle Profile comprises five pre-defined designs that are specially customised to different wearers’ common visual requirements for far, intermediate and near vision.

“It has been one of the more successful product launches we have had,” he says. “The feedback has told us that it’s easier for eyecare professionals to grasp and explain to the consumer, while still giving that level of customisation they haven’t been able to achieve in the past. The patients are really understanding the differences between the lifestyle-based designs and that is often the most difficult aspect to overcome.” Hentschel says both MyStyle V+ and Mystyle Profile include patented technology that considers the right and left prescription as individual components when calculating the required binocular lens design. This improves depth perception and provides comfortable binocular vision. VISUAL AGE

Shamir's academy training manager MR DAVID SULLIVAN says the company's lens has been developed on the back of big data analysis that has proven a patient's visual behaviour changes in relation to their 'visual age'.

Shamir’s premium progressive, the Autograph Intelligence Lens, takes a different approach by looking at a patient's 'visual age'. The visual age is a term referring to the physiological age of the eye (the required reading power) and is generally correlated with the patient’s chronological age. As such, it has developed 12 integrated designs (additions) for each ‘visual age. "New technologies recently developed by Shamir has allowed us to design a lens with four visual zones integrated together – driving, computer, smartphone/tablet and printed reading material," Mr David Sullivan, the company's academy training manager, says. “Visual behaviour is a new direction taken by Shamir. Research conducted by Shamir on 1300 participants looking at their prescriptions, visual habits and vision preferences, put their needs into groups and percentages, allowing us to design a customised lens for every individual lens produced.” Shamir research also discovered wearers visually switched distances more than 300 times per day. “All additions and patients will benefit from this technology, designed to automatically adapt to a patient’s visual need, whilst offering crystal clear vision unique to the individual.” GOING BEYOND FOR PATIENTS Robinson, from RMIT, is frequently surprised by the advances lens companies can incorporate into their designs and associated devices. He says eyecare professionals have an obligation to themselves, as well as their patients, to harness such technology. “Today's shoppers want to know how you can improve their life, they don’t understand or care about the technology. Can their life be improved? Can you give them something that they can brag to their friends about? “Unfortunately, what’s happened over the years is that a lot of professionals have developed the attitude that this patient has become used to this brand, let's save any complications and give it to them again. So the patient walks out with a new pair of glasses with technology that is about 10 to 15-years-old, rather than advised into these newer products. “It takes a lot more work to sell the new product, and it's going to be more expensive, but sell the benefits of it. We have a moral obligation to offer the very best that is out there for our patients.” To overcome this, he says individual optical dispensers and optometrists need to upskill and familiarise themselves with the available products. This could be achieved by aligning themselves with manufacturing companies and attending professional development programs built around specific products.

Essilor's Varilux X Series progressive seamlessly captures every detail within arm's reach with high precision, as well as beyond.

Companies are also working hard to ensure eyecare professionals remain on top of technological advances. Zeiss, like other lens manufacturers, supports eyecare professionals with regular visits from its business development representatives. Ms Elmarie Pretorius, Zeiss Australia’s clinical support and training manager, says with the average age of Australians falling within the progressive lens range, it is an important category for the company. “Zeiss allows eyecare professionals to differentiate themselves by offering their customers a trusted branded product from the leaders in optics, and therefore they can be rest assured that their customers are getting the best optical solutions,” Pretorius says. “This grows their reputation and revenue. Zeiss also offer state-of-the-art equipment as part of our partnership with our eyecare professionals that assists them to do the best eye examination, and gain all the information they need with digital centration so that it is easy to order their premium progressive lenses.” THE VISUAL CORTEX, AND MORE Optical companies expect there to be increased use of the frame parameters among eyecare professionals, while increased computer power will likely lead to even more complex and accurate lenses. While there have been great leaps in science and lens development in recent years, Rodenstock’s Australia and New Zealand general manager Mr Tim McCann believes optical industry has some way to go to before meeting every patient need. “There is a lot involved in making great specs. The physics of light and restrictions of the materials and environment are the areas that are most often associated with lens design,” he says. “As science develops we are now able to account in part for the physiology of the eye more than before – and then there is a visual cortex which is largely completely unknown and a huge field of future research.” McCann says the more that can be measured in the eye, the more lens companies can do to develop highly personalised lenses now and into the future. “Harnessing technology to its fulness allows us to continue expanding our research and understanding of the visual system and providing solutions,” he says. “It is exciting and important to note that we stand only at the doorway of how much there is to know about each patient and their needs.” n INSIGHT February 2020 35

SCC8 REACHES FOR

EVEN GREATER HEIGHTS The annual Specsavers Clinical Conference has become an unmissable event on the ophthalmic calendar. LEWIS WILLIAMS concludes his report on the 2019 event, held at Melbourne’s Convention & Exhibition Centre on the 7th and 8th of September last year.

he Sunday program was opened by Mr Peter Larsen, who is now operating out of the UK’s Guernsey Channel Islands as Specsavers’ group eye health strategy director.

Larsen, who took up his current role last August, opened his address with some patient referral data. From a total 220,000 referrals his organisation has now completed 40,000 glaucoma referrals, 11,000 diabetes-related referrals, 168,000 reports to GPs, and 14,200 referrals to patient support groups. This is from more than 8 million patient interactions across the company’s network. He also confirmed that the nation-wide rollout of optical coherence tomography (OCT) to Specsavers practices was completed around the time of the conference. He noted that normal-tension glaucoma explained a significant number of undetected glaucoma cases, confirming yet again that tonometry is a very blunt screening tool. Earlier data suggested that only about 12% of optometrists at large assess visual fields (VFs). About 60% of Specsavers patients now have their VFs assessed, usually on the same day as their eye examination. As a result of improved instrumentation and continuing education, Larsen put the false positive glaucoma referral rate as being about 15%. Of the diabetic patients seen by the group, 5% were found to have referable diabetic retinopathy (DR). He noted that 28% of Specsavers’ diabetic patients were now registered with Diabetes Australia’s KeepSight programme. 36

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DIABETIC RETINOPATHY SCREENING UK ophthalmologist Professor Peter Scanlon is the programme director of the NHS Diabetic Eye Screening Program (DESP), a position he has held since 2003. It caters for the UK’s 3.3 million diabetics as well as the 270,000 new cases added each year. He previously visited Melbourne as part of a push for a similar initiative in 2014. Despite the best of intentions, screening programmes are not diagnostic and only have a sensitivity of about 90%, meaning that one in 10 diabetics are missed. Similarly, the specificity is also about 90%, meaning that one in 10 referrals are unnecessary. He labelled “regular non-attenders” as the ones most at risk. Accessibility and affordability are not problems as the scheme is part of the UK’s NHS, and detection and care has proved to be more cost-effective than subsequent impairments and treatments. He stated that simple laser treatment alone halves the risk of vision loss. About 11.3% of diabetics have moderate non-proliferative DR (NPDR). Pleasingly, he noted that diabetic specialists are now reporting fewer latepresentation DR patients than they were 10 year ago, suggesting that the screening, early detection, and greater public awareness are having beneficial effects. Furthermore, DR is no longer the leading cause of blindness in the UK (the leading cause is now hereditary retinal disorders).

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To be a part of a screening program, all staff ranging from technicians, optometrists, other health professionals, and image reviewers require accreditation and participation in ongoing quality assurance training. Those grading submitted images are reviewed monthly to maintain standards, and the data generated is added to a database backing the screening programme. He noted that scanning for DR in pregnancy was more important because of the increased risk which necessitates more frequent eye exams. An ongoing problem he identified was patients who opted-out, with the 18 to 34-year age group the most difficult to maintain follow-up with. A common question is: Is SD-OCT after digital retinal photography cost effective? Scanlon said it was highly cost effective when OCT is only done on those with positive signs in photographs. In a Scottish study, automated image analysis reduced the workload of image reviewers by 50%. On the topic of anti-VEGF therapy, Scanlon estimated that those with DR required progressively fewer injections as the years go by, which is in contrast to the usual experience of age-related macular degeneration. He also noted that compared with rates from the recent past there were now fewer laser treatments being done. Staying on the theme of DR, Scanlon was followed by ophthalmologist Associate Professor Peter van Wijngaarden. As well as his role as deputy director of CERA, van Wijngaarden holds appointments at the University of Melbourne’s Department of Surgery and the Royal Victorian Eye and Ear Hospital. According to van Wijngaarden, who is also KeepSight’s clinical director, the program now has 13,000 registered diabetic patients, with more than 65,000 expected to be registered within 12 months. The aim is to have 200,000 registered eventually. Surprisingly, half of the world’s diabetes cases are located in the Asia-Pacific region. This means there is disproportionate representation of the disease in the patients likely to be seen in Australia, without Australia actually being at the epicentre of the problem. Currently, the problem claims between 1:11 to 1:12 of the population, but that is expected to eventually become 1:10. One of the many ramifications for the health care system is the shortage of ophthalmologists, especially those operating in the relevant eye sub-specialties. He saw optometrists as being central to DR screening, especially in view of the low uptake of a screening function by GPs. Barriers to good care include the general ignorance of those already with diabetes and the common two-year period between ophthalmological examinations. If treatment is required, an ophthalmologist is necessary. Proliferative diabetic retinopathy requires either laser or surgical intervention. He also acknowledged that others outside the eye care professions needed

Peter Scanlon

Lyndell Lim

to be involved, including the patient’s endocrinologist, dietician, and podiatrist. Prevalence figures vary according to geography, but he offered the following data: Non-indigenous: 28.5% of those over 50 years of age, 4.5% with threatened vision; indigenous: 39.5% of those over 40 years of age, 9.5% with threatened vision (diabetes is 2-7x more common in indigenous peoples); 7080,000 Australians have diabetic macular oedema and three out of five cases have threatened vision. Exacerbating issues include increased sugar intake, elevated blood pressure, elevated cholesterol, and smoking. According to van Winjgaarden, only about 50% of people are getting eye examinations at the recommended rate. Diabetes Australia and its KeepSight initiative are trusted sources of evidence-based information and appointment reminders. However, to a significant extent, KeepSight is dependent on health professionals registering their patients with the organisation. He also noted in passing the role AI will play in the future of screening programmes, particularly given that the US Food and Drug Administration has now approved an AI-based, deep learning DR screening system for use in primary health care. OCULAR ONCOLOGY Former Queensland optometrist turned ocular oncologist/ophthalmologist Dr Lindsay McGrath gave a presentation on decoding the alphabet soup of ocular oncology. Given the vision-threatening potential of ocular tumours, the topic is both important and timely. Major issues are ocular-surface neoplasia and choroidal melanomas. Apart from anterior melanomas, there are posterior tumours including uveal melanomas, uveal metastases, and posterior-pole tumours. Central to tumour

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usually result in collateral damage to the retina. Metastases of choroidal melanomas are usually 88% to other parts of the choroid, 9% to the iris, and just 2% to the ciliary body. In males, the lungs can also be a source, whereas in females it can be the brain but is more likely the breasts. If the primary tumour is treated, the ocular tumour often decreases as well. Choroidal haemangiomas are usually benign but if they are located in the sub-macular area or leak, vision can be adversely affected. They are generally not treated unless vision is affected and they don’t leak. Features that are the focus of any examination include: pain, colour, location, number, intrinsic blood vessels, sub-retinal fluid, hard exudates, presence of cells in the vitreous, results of fluorescein/ICG angiography, and reflectivity of the tumour in an ultrasonic B-scan. Peter Larsen

Lindsay McGrath

sustenance is angiogenesis because without an adequate blood supply tumour persistence, let alone growth, is not possible. The umbrella term ‘cancer’ is a derivative of the behaviour of a crab - it grabs and doesn’t easily let go. Cancer is characterised by new growth, an invasive ability, and the ability to spread. However, the term tumour does not necessarily mean cancer. Rather, it implies a mass, whereas cancer is a threatening type of tumour. Neoplasm/neoplasia is the umbrella term for benign tumours, malignant tumours, and cancer. Uveal melanomas are posterior in 95% of cases, with just 5% involving the iris. Choroidal melanoma remains the most common malignancy in adults with a rate of about 6/million white people of Northern European descent. The Caucasian rate is about 8x that of darker races. Those with pale skin and a propensity to sunburn rather than tan are at the greatest risk. The average age of a choroidal melanoma at first diagnosis is 55. Exposure to sunlight has not been proved to be a factor and there is no proven connection to latitude. Diet, smoking and exposure to chemicals have been implicated. Choroidal melanomas push against the RPE and decrease blood circulation locally, leading to exudates, haemorrhages, and retinal effects that can result in decreased vision. Metastatic uveal melanomas account for around 50% of cases. Of those, some 90% are derived from the liver and travel to the eye via the circulatory system, not the lymph system. Some expand outwards or exit via the vortex veins, and the optic nerve is rarely a target. Survival rates depend on tumour size, extra-scleral extension, location, local tumour recurrence, histology, and the presence of chromosomal abnormalities. Tumour presentation is a problem for all concerned because, in 3040% of cases, they are asymptomatic and can remain so for a very long time. Symptoms can include blurred vision, a paracentral scotoma, and a progressive but painless loss of VFs. Choroidal naevi are generally symptomless derivatives of melanocytes and are detectable in about 20% of people over 50 years of age. Although males are more likely to be affected, only about 1:5,000 cases become malignant. The symptoms of choroidal melanoma can be summarised as SPOTS: Symptoms of flashes, floaters, shimmer Proximity to the optic nerve (if <3 mm greater vigilance is required) Orange pigment (lipofuscin) Thickness (>2 mm) Sub-retinal fluid Treatment options include transpupillary thermotherapy (TTT) using an infrared laser (now less common), photodynamic therapy using 630 nm light and a photosensitising dye, plaque brachytherapy using either Ru106 or I125 radiation sources, or some combination of those. Unfortunately, those methods

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Iris melanomas were described by McGrath as “very rare” and only account for about 3-5% of ocular melanomas. They are more likely to appear in elderly Caucasians, and secondary glaucoma is most likely to be the presenting finding. Squamous cell carcinomas (SCCs) are an uncommon tumour of the conjunctiva with a prevalence of between 0.02 and 3 cases per 100,000 of the population. It is known to be related to sun exposure. The papilliform variant looks like a stuck-on thick, white mass (leukoplakic). SCC predisposing factors include radiation exposure, smoking, and UV light that cause DNA damage. Sometimes a virus can also be a confounding factor. McGrath’s recommendation was to avoid touching the tumour for fear of spreading cells beyond the original source. Primary acquired melanosis (PAM) is a conjunctival melanocytic tumour that is usually unilateral and asymmetrical affecting Caucasian females in middle age. It is usually confined to the epithelium and is not cystic. Conjunctival melanoma incidence has increase over the last 25 years and has a 10-year survival rate of 70-75%. Any changes after 10 years should ring alarm bells in the mind of an examiner. Normally the initial treatment is topical chemotherapy, although some practitioners prefer to reduce the tumour’s size using cryotherapy, for example, before commencing chemotherapy. McGrath summarised tumours as: BCC 85%, SCC 12%, sebaceous CC 3%, melanoma <1%. The most common site is the lower lid followed by the nasal, superior, and finally the temporal aspects of the eye. In 6% of cases of SCC, there is orbit invasion via local nerves. She also urged caution when dealing with what looks like a chalazion, suggesting that the under lid be examined thoroughly because it could actually be a much more serious sebaceous gland carcinoma (SGC). Signs of malignancy can include: asymmetry, border irregularity, abnormal colour, and size. She reinforced the Slip, Slop, Slap message promulgated to reduce sun damage. OCULAR INFLAMMATION IN OPTOMETRIC PRACTICE Melbourne ophthalmologist Associate Professor Lyndell Lim gave an energetic, effervescent, and engaging presentation on the optometric management of ocular inflammation. Lim is a principal research fellow and head of the Clinical Trials Research Unit at CERA. She is also the head of the Ocular Immunology Clinic at the Royal Victorian Eye and Ear Hospital. Lim stated that while uveitis accounts for fewer than 1% of all ophthalmological presentaw tions, it accounts for more than 15% of all cases of legal blindness and more than 30% of cases of blindness presenting at tertiary referral centres. It is also between the 5th and 6th biggest cause of blindness in the US. Uveitis generally afflicts younger patients. The first signs are ocular redness and pain, and acute uveitis has a sudden onset. Classification is anatomical anterior, intermediate, posterior, and panuveitis. Anterior uveitis only involves the anterior aspect of the iris and is accompanied by ciliary injection and cells in the anterior chamber, causing aqueous flare. The latter is best seen in a darkened room with the slit-lamp beam set

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to a 1 mm square at maximum light intensity. The beam should then be angled across the anterior chamber against a backdrop of a dilated pupil (simulating dark-field microscopy). Intermediate uveitis is anterior vitritis or pars planitis with the slit-lamp appearance of car headlights in a fog. Posterior uveitis is a retinitis or choroiditis. Panuveitis is a ‘burger with the works’: a combination of anterior uveitis, vitritis, retinitis, and choroiditis. The uveitis variants, along with episcleritis and orbital inflammation, make up the ocular inflammatory disorders. In some cases, a uveitis can be associated with HLA-B27 diseases such as scleritis, pre-existing viral keratitis (PVK), rheumatoid arthritis, granulomatosis (formerly Wegener’s disease), psoriasis, ankylosing spondilylitis, ulcerative colitis, and systemic lupus erythematosus (SLE). According to Lim there are challenges in dealing with uveitis, including the diagnosis phase, because it is not always clear just what is being dealt with. For example, herpetic anterior uveitis might be accompanied by a history of cold sores. There are still no substitutes for a thorough history and a comprehensive eye examination. Treatment can include a steroid, acyclovir, and topical intraocular pressure (IOP) lowering agents (timolol or brimonidine). Lim pointed out that there can be no diagnosis of ‘anterior’ uveitis without first doing a comprehensive posterior eye examination to rule out a wider problem. Early detection and intervention are required to address acute retinal necrosis. If significant vitritis is suspected or present, a full BIO examination is required as most infection sites are peripheral and a challenge to observe. An initial step in uveitis management is to exclude infection as an aetiology. Regardless of the treatment regimen chosen, Lim’s advice was to “go hard”. She nominated Pred Forte as the most potent treatment, always bolstered by the use of a cycloplegic (cyclopentolate 1% was suggested). She suggested hourly treatment and a prompt re-examination (a few days maximum). Possible downsides to the use of steroids include glaucoma, cataracts, and a worsening of a corneal infection, especially if HSV is implicated. She cautioned to not leave patients on eye drops for an extended period, especially in cases of HLA-B27 uveitis, which accounts for about 50% of acute anterior uveitis (AAU) cases. Treatments other than eye drops include periocular or intraocular steroid injections, intravitreal triamcinolone, and dexamethasone (Ozurdex). However, if glaucoma is already present, steroid injections are contraindicated as elevated IOP, cataract, and orbital fat prolapses are possible side-effects. In the POINT trial, intravitreal Ozurdex or triamcinolone were shown to be the most effective, although 25-30% of patients experienced IOP increases, especially on Ozurdex. Syphilis, the great mimic, should also be excluded because its prevalence is now 3-4x previous levels and is no longer just a male affliction. Biologics, engineered molecules of therapeutic proteins, hold promise as another line of treatment. For uveitis, Behçet’s disease, bilateral panuveitis, and steroid responders, the TNF-alpha inhibitors are possible therapies. Other possibilities include oral prednisolone, cyclosporin, and methotrexate. Humira (adalimumab), a biologic, is suitable for autoimmune diseases. Patients treated with it were 50% less likely to subsequently flare-up. Humira is also a suitable therapy for juvenile idiopathic arthritis (JIA). One possibility that warrants careful consideration is the potential presence of MS. Lim’s parting comments included advice to refer all cases that are more extensive than anterior uveitis and to try to avoid under-treatment which always remains a possibility. Once again, the Specsavers Clinical Conference series has delivered on what was first promised with SCC1. The faculty was top shelf, the attendance was high (750), and the presentations maintained or exceeded the standards of preceding events. SCC9 is to be held at the Brisbane Convention and Exhibition Centre from 12-13 September, 2020, and has a high standard to maintain. n

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MYOPIA, PRESBYOPIA AND AT ICCLC The Cornea and Contact Lens Society of Australia’s 17th International Cornea & Contact Lens Congress delivered an array of entertaining and informative presentations. LEWIS WILLIAMS completes his report on the proceedings. RGPS, TORIC SCLS, AND THE GREY AREAS IN BETWEEN

entity to the original, and predicting its on-eye behaviour is fraught.

Mr David Foresto, Brisbane optometrist with a contact lens (CL)-focused specialty practice, was in peak form with an engaging and entertaining presentation. Despite dealing regularly with difficult cases he still accepts the importance of patient satisfaction, although reaching the standard that can be achieved in more straightforward cases is not always possible.

He also pointed out that when prescribing prism-ballast or periballast CLs, vertical prism is introduced which can lead to a vertical imbalance. He mentioned that the Johnson & Johnson toric SCL is not ballasted. Rather, it is a variation of the double slab-off, dynamic stabilisation concept.

He also reminded his relatively young audience to not be fooled by high sphere-low cyl Rxs when correcting for vertex distance. Commonly, the effective cyl power also changes even when the ‘magic’ 4 D limit is nowhere near being exceeded by the amount of cyl. Lamenting the low availability of disposable CLs with high cyl Rxs, he stated that some patients do not like their best meridians being blurred by the use of Rxs offering less than a full astigmatic correction, spherical equivalents, or spherical compensations for less than the full cyl. On the topic of spare spectacles, particularly for keratoconics, he posed the question – best sphere or a full correction for the best meridian? When compensation is required for the rotational mislocation of a particular toric CL design (clockwise you add, or the more obtuse LARS [left you add, right you subtract]), Foresto suggested trying a different toric CL design rather than chasing mislocation. This is in the hope that little or no compensation will be required with the alternative design. While not all would agree with him, his suggestion was to avoid making compensations of more than 10 °. Others, including this writer, would be prepared to consider 15 to 20 ° compensation but the fact remains that with such a large change pending, the next CL ordered is a different

David Foresto

David Stephensen

In his experience with keratoconics, Foresto has also identified a shift in CL practice brought about by the wider adoption of corneal cross linking (CXL), especially the adoption of the so-called Athens Procedure (CXL and either phototherapeutic keratectomy [PTK] or photorefractive keratectomy [PRK] in the same treatment session). The number of cases with aided vision worse than 6/12 has decreased, as have the number of cases exhibiting large Rxs. Regardless, he still believes that CLs are better than laser procedures overall. Supporting that belief is his rejection of the description of CXL (Athens procedure or otherwise) as being a ‘stabilising’ procedure, because CXL actually results in a progressive flattening of Ks over time. In his experience, that flattening can be extreme (4 to 9 D). Furthermore, corneal topography is altered significantly by CXL and can appear to be Ortho-K-like. Because of this, Foresto stated that CXL was not a refractive procedure. He reserved CXL referral to only those who were CL intolerant or for whom CL or spectacle vision was inadequate after all avenues were explored. If a cornea needs to be regularised to improve aided vision, he saw the choice as being between laser or a CL (rigid or soft). Even daily disposable (DD) SCLs can mask up to 2 D of corneal astigmatism. He reported that the Kerasoft specialty keratoconic SCL was always a useful consideration, as well as the combination of a DD SCL worn under spectacles.

Kate Gifford

Paul Gifford

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REPORT

On the topic of toric SCLs versus rigid gas permeable (GP) CLs, he noted that in cases of residual astigmatism, any posterior toricity or irregularity is difficult to deal with regardless of CL type because the posterior cornea is inaccessible optically. As with many types of CLs fittings, the management of patient expectations is of paramount importance, especially in challenging cases in which 6/6 or better vision is difficult, if not impossible, to achieve. Obviously, lower expectations are easier to meet. An approach he uses early in his interactions with difficult cases includes, ‘If I can get you five (or slightly better) out of 10 vision, will you be happy?’. Excessive expectations either needs to be lowered by education, or the patient referred to another practitioner who might be able to meet their desires. Unfortunately for Foresto, he is often the ‘end of the line’ and left with an insoluble problem. Vision stability is dependent on CL rotation, CL movement, CL surface dryness, and CL dehydration (that is water content inside the CL, not just its surfaces). Although relatively uncommon, there were still applications for toric periphery/spherical optic zone, bi and quad asymmetric periphery CLs, and true bitoric CLs. In cases of early bilateral keratoconus, Foresto does consider CXL early, on the basis that 6/6 vision can often be achieved with CLs, albeit CL with changing Rxs to track CXL-induced topography changes. When optical path difference (OPD) aberrations are corrected (in the context of wave-frontguided aberration corrections) he reported reductions of 32% in coma, 6% in trefoil, and 60% in spherical aberrations. MYOPIA – THE EVERGREEN TOPIC Dr Kate Gifford and Dr Paul Gifford shared the stage for a presentation on some of the finer points of myopia, myopia progression, and axial length (AL), as well as treatment options. Seemingly unrelated elements, such as pupil size, have been shown to be a factor. A large pupil affects the magnitude of the eye’s peripheral refraction, which has been shown to be a significant factor in myopia development and progression. Pupil size can also impact myopia interventions. For example, it can alter any induced peripheral refraction, thereby affecting the treatment’s efficacy. Similarly, a CL’s treatment zone diameter can affect peripheral refraction, as can CL decentration or anatomical pupil decentration. Pupil diameter also affects paraxial aberrations. The loss of beneficial peripheral refraction effects can be marked when pupils are >5 mm in diameter. In addition to atropine studies undertaken in East Asia, there is now increasing acceptance of a combination of MF CLs and atropine treatment. Other studies have shown that hyperopic peripheral refraction (HPR) leads to choroidal thinning, which results in a small increase in apparent axial length and therefore myopia. However, the combination of HPR and atropine showed no change in choroidal thickness.

Jason Teh

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Laura Downie

THE POSSIBILITIES OF PRESBYOPIA Brisbane-based optometrist Mr David Stephensen, who shares a focus on specialty CLs with Foresto, chose the thorny topic of presbyopia correction. He estimates that when a multifocal CL (MF CL) is fitted and there is adequate adaptation, as well as an element of ‘faith’, success can be achieved. In his hands, there is a high success rate with presbyopic CL options, so long as the manufacturer’s fitting guide and protocols are closely followed. He finds that six out of 10 patients will meet with adequate success. However, he did admit that rarely did CL vision better what is provided by optimum presbyopic spectacles. He went further and advised his audience to not warn or explain the issues to the prospective presbyopic CL wearer. Rather, insert the CLs and go from there. Of course, if the patient’s expectations are excessively high, success is unlikely. Realistic expectations, which probably include 6/Happy rather than 6/6 or 6/4.5, are conducive to success. Common CL performance issues, such as visual acuity, contrast sensitivity, and comfort, are not predictors of success. It is worth remembering that spectacles also have limitations, and Stephensen raised the issues arising from the use of multi-monitor computer configurations and progressive power spectacles or, worse, bifocals or reading glasses. Such work environments are better catered for with CLs because they have fewer field-of-view limitations. Perhaps surprising some in the audience, he described MF CLs as a non-scientific concept that works adequately for most wearers. Remember, CL practice has an element of art as well. Overall, he views MF CLs as a suitable first-line treatment of presbyopia that in many ways are better than spectacles.

Nicole Carnt

Daniel Tilia

RAPID FIRE ACADEMIC PAPERS SESSION Several established young CL researchers delivered presentations on their special areas of interest. Dr Nicole Carnt, a UNSW Scientia Fellow and Senior Lecturer in SOVS, reinforced the message that tap water has no role in CL care due to the risk of infection, most especially Acanthamoeba keratitis (AK) which is initially misdiagnosed in about 50% of all cases. While rare, the condition is devastating, the outcomes almost universally poor, and in about 70% of cases patients suffer the disease for more than 12 months. In a UK-based study that Carnt was involved in, poor CL hygiene was responsible for more that 35% of cases, showering while wearing CLs a further 32%, using the OxiPol CL disinfectant (not available in Australia), deficient hand hygiene 19%, and the use of Group IV SCLs about 4%. Prompted by her own misfortune with an AK infection, one UK CL wearer designed a ‘No Tap Water’ icon and later the British Contact Lens Association adopted the icon as a stickon label that practitioners could apply to their CL deliveries. In a study of 200 wearers, a significant improvement in wearer behaviour accompanied the use of the sticker. The CCLSA is pursuing a similar strategy. Associate Professor Stephen Vincent from QUT’s School of Optometry and Vision Science undertook research on the decentration of scleral CLs. The issue is known to affect wearer comfort, ocular health, and vision quality. The latter is particularly affected when the CL has a wavefront-guided front surface design, because any decentration negates aspects of the complex design’s aims. Factors affecting decentration range from the simple (gravity and the shape of the anterior eye) to the more dynamic (the lids and blinking behaviour). Methods range from simple CL marking to the more complex image analysis of the actual CL on the eye. Vincent used an OCT for this, although he admitted that the method had little relevance to routine private practice. Alternatively, a videokeratoscope/topographer can be used in either standard tangential power map or normalised tangential power map mode. A Medmont E300 instrument provided good agreement between the standard tangential power map and other methods. He has found the increased decentration can often be traced to an increased horizontal asymmetry of the anterior eye. A CL fitted with or exhibiting apical clearance can increase vertical decentration. A combination of a more anterior CL centre of gravity and apical clearance is likely to enhance downward decentration

Long-time clinical CL researcher Mr Daniel Tilia is undertaking a PhD at SOVS, UNSW into the role of binocular vision disorders (BVDs) in CL wearer dissatisfaction. While about 60% of dissatisfaction can be traced to discomfort and a further 15% to vision problems, especially in toric CLs, the actual contribution attributable to BVDs remains unknown. On average, myopes are known to have reduced amplitudes of accommodation, increased accommodative lags, and less stable accommodation. Using various questionnaire instruments, he has traced about 22.4% of wearer dissatisfaction to BVDs. The Ocular Surface Disease Index (OSDI) reveals significant differences between BVD and discomfort, strongly suggesting that BVD is a separate entity that has probably confounded previous investigations of ‘dissatisfaction’. Dr Maria Markoulli a senior lecturer in SOVS, UNSW, the recipient of several teaching awards, and deputy editor of the Australian journal Clinical and Experimental Optometry, spoke about MMP-9 and scleral CL wear. She defined a scleral CL as one whose TD is 16 mm or greater. Despite the increasing popularity of scleral CLs, their effects on the ocular surface are not well understood and her research is hoping to provide some further answers. MMPs (matrix metalloproteinases) are a group of enzymes that collectively act in the extracellular environment that degrade matrix and non-matrix proteins in the contexts of tissue development, tissue repair/wound healing, tissue remodelling, and morphogenesis. MMPs 2 and 9 specifically are present in the tears and the cornea. They are involved in wound healing and ocular surface diseases including DE and KC. They are involved in the stroma’s basement membrane anchoring fibrils made of Type VII collagen. The latter is a known substrate of MMP. It is thought that excessive MMP activity can play a role in epithelial, stromal, and endothelial dystrophies. It now appears that the balance between MMP-9 and TIMP-1 (tissue inhibitor of metalloproteinases or TIMP metallopeptidase inhibitor 1, a glycoprotein) has a role in corneal homeostasis, and imbalances have been implicated in pterygium, corneal ulcers, corneal erosions, and sequelae of CL EW. TIMPs are also capable of promoting proliferation of a wide range of cell types, as well as having an antiapoptotic function. Using Visionary-Optics Jupiter scleral CLs fabricated in Boston XO GP material for a five-

hour wearing trial, no significant difference in tear film MMP-9 was found, but an increased range of the data was noted. Conversely, while again no significant difference in TIMP-1 was found, its data range decreased. Markoulli concluded that there was no general trend of an increase in MMP-9 in scleral CL wear, but there were differences in some study subjects. She concluded that a larger study was required before further conclusions can be drawn. Dr Laura Downie, senior lecturer in the Department of Optometry and Vision Sciences, University of Melbourne, gave a presentation on inflammatory biomarkers in the tear film and their possible association with CL wearer discomfort. The latter is known to be a major trigger of the discontinuation of CL wear, but the cause is also believed to be multifactorial. Inflammation is a normal pathological process to physical, chemical, or biological injury that results in the signs of rubor, dolor, tumor, calor, and functio laesa. Often sub-clinical mediators are involved in the mobilisation of cellular processes and the upregulation of relevant pathways. Biomarkers originating from dendritic cells, which are responsible for initiating immune responses, are part of a system that is dynamic but noninvasive. Laser confocal microscopy is one way of visualising the eye’s response to a threat. Although SCL wear is capable of inducing an inflammatory response, it is small and subclinical. Regardless, an increase in corneal dendritic cell density can be detected in as little as two hours, but the increase is a function of CL type and the care system that has been used to maintain it. An increase in lid wiper dendritic cell density has also been found. Tear film biomarkers include signalling lipid mediators derived from arachidonic acid that control cell proliferation, apoptosis, metabolism, and migration. One mediator can be a metabolic by-product of Omega-6 metabolism. Another biomarker can be cytokine activity in both symptomatic and asymptomatic cases. The protein interleukin-17A (IL17A) has also been shown to be upregulated in patients complaining of CL discomfort. Anti-inflammatory interventions, such as the application of cyclosporin, have been shown to decrease discomfort and increase wearing time. The use of the Omega-3 supplements EPA 900 and DHA 600 for 12 weeks has also demonstrated decreases in wearer discomfort suggesting anti-inflammatory therapy might be a useful intervention. ”

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REPORT

Kate Gifford spoke on the topic of accommodation, efficacy of myopia control, and visual discomfort. She found that when the patient’s accommodative lag was >1 D, a factor in 48% of her study group, CL discomfort (CLD) was experienced, but not dry eye. When the accommodative response was enhanced, so too was the efficacy of any concurrent myopia treatment. When MF CLs are used as a part of myopia treatment, the peripheral myopic defocus they induce is desirable. However, if a centre-distance MF design is deployed at near, hyperopic defocus results can be neutral or even disadvantageous. The same can result from the off-axis optics, including centrally, provided by a CL that routinely decentres. Generally, she found that a decreased accommodative response also resulted in a decreased anti-myopia effect. Accommodative lag was also found to decrease when aspheric CL designs were used. Interestingly, the CooperVision MiSight anti-myopia CL has been found to have little effect on accommodative lag, whereas Ortho-K decreases (by about 0.75 D) accommodative lag, as does MF CLs (by about 1.25 D). Ortho-K is often better in cases exhibiting a lower baseline accommodative amplitude. The ideal myopia control CL was described as one that increased positive spherical aberration and relative peripheral myopia, while decreaseing esophoria and accommodative lag. Such a CL would probably work best when used in combination with low-dose atropine. Possible CLs that can assist myopia control were given as: CooperVision MiSight (+2 D dualfocus zones), CooperVision centre-distance MF, Visioneering Natural Vue (MF, single high add), mark’ennovy MYLO (EDOF), Menicon Bloom, and virtually any Ortho-K system. Team Gifford is looking forward to a time when CL prescribing and CL design will be based on the accommodation status of the wearer and whole-of-eye optical modelling will show what is really going on with and without treatments. MANAGING THE OCULAR SURFACE Melbourne optometrist Mr Jason Teh, whose practice has a dry eye (DE) and ocular surface disease focus, arrived at the lectern wearing sealed goggles that promptly fogged (Blephasteam), a helmet labelled Thirst Aid to which was attached pair of plumbed beer cans (implying hydration), and a raincoat. He is part of the Melbourne-based Dry Eye Group of practices, which offer DE care services and screening. Unsurprising given his costume, Teh stated that Blephasteam goggles were still relevant. He described DE care as being 50% about communicating with the patient and rejected claims that clinical ‘toys’ are required to pursue DE patients. However, the usual problem of patient compliance remains. Quoting DEWS II figures, he estimated DE prevalence as being between 5% and 30% depending on sex, ethnicity, and geography, especially in the over 50 age group. Up to 70% of those affected have meibomian gland dysfunction (MGD). Other data suggests that aqueous deficiency accounts for about 20% of DE cases, 30% to 68% have MGD, and about 10% have a mixed condition. The affected group are also more likely to have glaucoma, myopia, and age-related macular degeneration (AMD). The age factor, as well as diet and lifestyle, are probably confounding factors. Aetiology and associations might not be as clear-cut as the data above implies. Teh described the DE patient group broadly as being undiagnosed, uneducated, and untreated. MGD can take 18 months or longer to resolve even with ongoing care. Denial of the condition is not unknown and quality of life is known to be affected. DE treatment has elements of the ‘Gift of Healing’ intermingled with ongoing care, but compliance and appropriate treatment are obviously also key.

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Maria Markoulli

Stephen Vincent

His group check for MGD in all patients, and they have found the biggest group fall into the 25 to 40 years age group. Lid wipes are prescribed for use each morning and evening. Asymptomatic MGD can be expected to eventually move to symptomatic MGD, and therefore cannot be ignored. While not essential, complex instruments like OCTs can be used to measure tear prism height to differentiate aqueous deficiency from other variants. A transilluminator applied to the lower eye lid can aid an assessment of the Meibomian glands in vivo. The group’s preferred questionnaire is the DEQ5. The Blephasteam goggles were described as the cheapest and easiest entry into DE treatment. The 3-in-one Oculus Keratograph 5M (topographer, keratometer, and colour camera) represents the other end of DE assessment. Desirable tests include tear film break-up time (TF BUT), tear osmolality, ocular surface vital stains, and MMP-9 assays. In his opinion, invasive TF BUT techniques involving the instillation of sodium fluorescein should be the first dropped from routine use. He also suggested that redundant conjunctival folds that lie parallel to the lower lid margin should be noted as a suspicious sign. Teh stated that steroid therapy does not solve all problems, IOP management can be an issue, and Manuka honey does have a therapeutic role. A preservative-free non-steroidal anti-inflammatory drug can also be useful. Using some case studies as a vehicle for further discussion, Teh noted that chemotherapy, especially for breast cancer, can have ocular manifestations or exacerbate existing surface problems. Systemic problems, such as Sjögren’s syndrome, have several manifestations. In cases of peripheral nerve damage, including diabetes, decreased tear production can be experienced. However, the more general nature of the condition necessitates the involvement of other health professionals. Irregular or inadequate sleep is also detrimental. In his experience, Teh often finds that other professionals have ignored important aspects of care. His advice was to spend time with patients. On the topic of Omega-3 fatty acid supplementation, he referred to a Cochrane Review that found if the patient’s dietary intake was adequate there is no justification for supplementation. In some cases, a reduction in Omega-6 intake is more appropriate, as excessive intake is known to be pro-inflammatory. As to treatments, the complex LipiFlow system has evidence supporting its use, and debridement with regular forceps gland expression is also effective. Blephasteam can be used daily and is flexible enough to allow most exercise routines to be carried out while the treatment is being applied. n

ORTHOPTISTS CELEBRATE THE PAST AND FUTURE MILESTONES ARE AN IDEAL TIME TO REFLECT ON BYGONE ERAS AND CAST AN EYE TO THE FUTURE. MARA GIRIBALDI AND KRISTEN SABA DETAIL WHY ORTHOPTICS AUSTRALIA'S RECENT ANNUAL CONFERENCE WAS AN IMPORTANT OCCASION.

T MARA GIRIBALDI

KRISTEN SABA

he 76th Orthoptics Australia Annual Conference was more than just a celebration of our organisation’s diamond anniversary. Between the record number of attendees and an emphasis on the organisation’s legacy, we are now looking towards an exciting new chapter in our history. The conference was filled with highlights, but several moments stand out. Paralympian Matt Formston presented the opening address and set the theme for the three days. He is a two-time and current Adaptive Surfing World Champion, as well as a previous World Champion and World record holder in Tandem Cycling, and a 15-time Australian champion across many other sports. He reminded attendees Australian orthoptists are not just healthcare professionals; they are enablers, ability advocates and supporters who help people achieve their goals. The outcomes of our resilient, dedicated and inspirational patients were also front and centre, thanks to an art display in the foyer at the International Convention Centre Sydney. Susan Oxenham and Mia Armsworth are vision-impaired artists who both have a unique perspective, and their work opened attendees’ eyes to their inspirational journeys and achievements. What followed were hours of innovative, cutting-edge and exciting presentations as part of the program assembled by scientific convenor Professor Kathryn Rose and the committee of Dr Amanda French, Susan Silveira and Felicia Adinanto.

Attendees celebrate at the 76th Orthoptics Australia Annual Conference

Vision – Celebrating Australia’s Early Orthoptists, which includes biographies of Australia’s first 75 orthoptists, was launched and a slide deck documenting over 100 ‘firsts’ in our history was shown. It was also an opportunity to welcome Jane Schuller as the organisation’s 54th president. She will be overseeing a period of change as Orthoptics Australia reorganises as a company limited by guarantee subject to the Corporations Act 2001 and is registered with the Australian Securities and Investments Commission. This will allow Orthoptics Australia to represent all orthoptists nationwide with members having clearer rights and directors having clearer obligations. The remarkable achievements of our members were also recognised with three awards at the event.

Among many other presentations related to orthoptic practice, talks covered topics such as paediatric orthoptics, how to support the care of neurology patients, low vision service delivery and the novel application of applied research methodologies to professional practice.

The Paediatric Orthoptic Award, which was established to commemorate the work and commitment to paediatric orthoptists of Western Australian clinicians Bev Balfour, Megan Lewis, and Alison Terril, was awarded to Navdeep Kaur. Her presentation, Orthoptist-led Neurofibromatosis Type 1 Clinic at The Royal Children’s Hospital, Melbourne: A strategy for impact, was selected as the best paediatric paper this year.

Given the anniversary, it was also an opportunity to reflect on Orthoptics Australia’s history. A book, titled Rear

UTS Orthoptics post graduate student Shanelle Sorbello was awarded the Emmie Russell Memorial Prize for her

presentation titled Post Stroke vision care in NSW: What are the care pathways and are they working?. Initiated by Emmie Russell, one of Australia’s first and most highly regarded orthoptists, the award is presented to the best presentation by a graduate orthoptist. This year the Zoran Georgievski Distinguished Service Medal was awarded to outgoing Orthoptics Australia president Marion Rivers. The award recognises a member of Orthoptics Australia for their substantial contribution to furthering the profession through factors such as service, leadership, and innovation. During her leadership she was the key driving force for many transformational changes for the organisation. n ABOUT THE AUTHORS: Since graduating in 1994, Mara’s main clinical focus has been in the area of ocular diagnostics, photography, angiography and retinal clinical research trials. Mara is currently Associate Lecturer and External Liaison Officer at UTS Orthoptics and Convenor of the recent OA Conference. Kristen graduated in 2005 and worked clinically for many years in the area of adult strabismus and is involved in the ongoing training of ophthalmology registrars. Kristen has also taught as a clinical practitioner at UTS Discipline of Orthoptics and was Co-Convenor of the recent OA Conference. 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

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DISPENSING

COMPETING WITH MILLENNIAL OUTLETS: PART 2 NEW TECHNOLOGY HAS GIVEN DISPENSERS LOTS OF TOOLS TO MEET THE VARYING NEEDS OF CUSTOMERS. IN THE FINAL OF HIS SERIES, LEIGH ROBINSON EXPLAINS HOW TO OFFER SERVICE THAT CAN’T BE MATCHED ONLINE.

n part one I defined ‘Value Fashion’ as experience-based shopping that tells customers the story behind you, what you are selling and how it will change their life. Lens technology is a great way to tell your story.

LEIGH ROBINSON

THE EXTERIOR OF YOUR BUSINESS CAN BE RESPONSIBLE FOR ROUGHLY 45% OF YOUR STORY IN MARKETING

Never before has lens selection provided so much opportunity to meet the visual needs of your customer. Lens technology has advanced so much that we can now provide our customers with a pair of lenses for every situation. Most importantly, lenses like this can’t be purchased online. The millennial customer doesn’t understand lens technology, but wants solutions to their issues. What they will understand is your recommendation of technologically advanced lenses and the benefits they provide, like increased productivity in the workplace, reduced asthenopia and ergonomic discomfort. Tell the story of how your lens recommendations can help them ride faster, run better and ski safer. Tell them how the right lens could take five shots off their golf handicap or keep them safe while driving. Tell them about the benefits of clear vision in all gaze directions and how individually personalised lenses can improve their life. Because your customers can buy single vision lenses online, recommend anti-fatigue and enhanced readers. Use and recommend precise, personalised lenses that require accurate facial measurements to tell the lab how and where the frame sits on the face. This is something that simply cannot be purchased online. SHARPER IMAGE Your storefront is your best asset for attracting foot traffic, but do you really understand just how important it is? Here’s the truth — the exterior of your business can be responsible for roughly 45% of your story in marketing. Prospective customers judge whether they think your store will meet their needs in the first 15 seconds of walking past. If your image or story fails to

INSIGHT February 2020

make a good impression, they will keep walking. Keep your storefront fresh and interesting through modern product displays and clean windows. Fresh paint, stylish design, nice furniture and good lighting can go a long way. Rather than purely buying and selling product, make each product an element of your bigger story. Cotton On, a millennial focused retail store, recognised that in the last decade the number of 20-year-olds who hold a passport has increased by 20%. Based on that fact, they quite successfully introduced travel goods to their clothing lines. Change your story every 6–8 weeks and focus on your practice’s demographics with stories such as: the she-volution, him-interests, sports stories, kids’ stories, or street stories, to suggest a few. And don’t forget to promote on social media. Your story needs to be a mix of instore and online offerings, where customers can research your product and then have the shopping experience they crave. KNOW YOUR CROWD Do you really know who your market demographic is? It’s generally the presbyope, but have you checked who resides in your area? Utilise the Australian Bureau of Statistics, go to quick stats and enter your postcode. You will be surprised at the usable information freely available. Your millennial target market loves a loyalty program, even just for a free coffee. But sitting at the heart of loyalty or rewards programs is the capture of information like phone numbers, emails and purchase details. A marketing database is crucial and allows you to better understand who you should engage with. It is important to buy stock based on what your market wants, not purely on your own likes and tastes. Have a strict control of inventory and what is selling. A good way to introduce a more

Maintaining a clean and fresh storefront can help your practice stand out.

imaginative stock range is to engage younger staff members in purchasing decisions. Your story is also about your staff. They are your most valuable asset and their impact on your customer’s experience is critical to how your story is received. Employ staff with a sense of style and character, something that is hard to teach. The Certificate IV in Optical Dispensing can be taught later. Give them a stake in meeting the needs of the customer and challenge them to carry out your current story, as well as developing their own stories too. Your staff must be trained above their pay rate, totally on board with your story and be able to recommend the right lifestyle lenses for the wearer. A meaningful store experience for your customer is going to be different from store to store. After all, humans are humans. But if you dare to re-imagine a shopping experience that marries discovery and slow shopping with the convenience of online and a personal experience, you will be able to compete. n

LEIGH ROBINSON is optical dispensing champion, consultant and training facilitator at Spectrum Optical and a teacher of Cert IV in Optical dispensing at RMIT University Melbourne. He conducts optical dispensing short courses, workshops and in-house training options to suit individual practice needs across Australia. Visit: spectrumoptical.com.au

MANAGEMENT

PREPARING FOR THE WORST IT DOESN’T TAKE TOO MUCH FOR A HEALTHCARE PRACTICE TO HAVE ITS SERVICE DISRUPTED. KAREN CROUCH EXPLAINS HOW BUSINESS CONTINUITY PLANNING CAN MITIGATE THE POTENTIAL FOR DAMAGE.

KAREN CROUCH

THE WORST POSSIBLE SITUATION A PRACTICE CAN FACE IS A DISABLING EVENT THAT WAS NOT ANTICIPATED FOR WITH NO BASIC PLAN IN PLACE

ere’s wishing all readers a happy, safe and ‘cool’ new year. Unfortunately, 2020 is not shaping up too well as bush, homes, businesses and peoples’ lives are threatened by the impact of climate change. However, it doesn’t take a bushfire or lightning strike to render a health practice unable to provide services to its patients, so it is wise to plan for potential disruptions before they occur. Sadly, the world has become an unpredictable place to live in and do business. That’s not to say we must live in a constant state of fear. However, it is wise to be prepared to cope with business disruptions. Natural disasters and accidents are generally viewed as the main sources of business disruption. However, recent incidents, triggered by human misbehaviour or fault, have put a spotlight on the need for Business Continuity Planning (BCP). In other words, an attitude of complacency and the assumption that business-crippling events are rare and addressable could be fraught with danger. The worst possible situation a practice can face is a disabling event that was not anticipated for with no basic plan in place on how to handle the crisis. BCP is a process by which most foreseeable, disabling events may be effectively managed. Of course, there will be severe incidents which are more challenging to manage by pre-planning, such as damage to practice premises by an external force. BCP incorporates most aspects of business operations/management and is distinctly different from typical ‘risk management’ which focuses on specifics, such as succession planning. BCP is commonly viewed as ‘disaster recovery’. This is partly true as recovery and post recovery actions are the final steps in ensuring ongoing continuity of patient servicing. BCP is a back-up version of day-to-day operations, performed under abnormal or supernormal conditions. Here is a simple, non-life-threatening

Events

BCP Mitigants

Loss of premises, or access to premises

Alternative site (adequately equipped, if possible)

Loss of systems

Back up site; externally hosted systems

Loss of telecommunications

Use of mobile phones; wireless access

Loss of business transport

Personal or public transport

Loss of key personnel

Succession planning

Unexpectedly high demand e.g. new service launch

Forward planning, additional (casual) staff

Table 1 - Examples of business continuity planning measures for specific adverse events.

example: A new service is launched and back-up plans are in place for various essential support services, such as loss of power. All goes well, but the practice cannot cope with unpredicted demand from patients! Consequently, perception of the new service is poor, not because of service quality, but for the inadequate manner in which potential patient demand was planned for. BCP should cater not only for adverse (abnormal) events but also for better than expected (supernormal) demands. Several potential circumstances may be addressed with specific solutions (abbreviated) for each. Table 1 includes some examples. Effective planning requires prioritisation of events that may be rated higher in terms of business impact than others. For example, alternative arrangements may be more easily invoked for a loss of communications as opposed to a loss of premises. Regardless of an unsettling event’s severity, impact on patients must be minimised as much as possible. Important elements of sound BCP are: • A vailability of BCP document: While the document should be easily accessible for reference, review and updating, a copy of the very latest, upto-date BCP should be stored offsite, perhaps in the home of the owner or practice manager, both of whom should be familiar with its contents and actions required to oversee recovery procedures; •P atient/client management:

Under abnormal or supernormal circumstances, it is vital to explain to patients that service quality may be slower or certain services may not be available at all, depending on situation intensity • Internal staff: Staff/practitioners must be prepared to act calmly, managing servicing levels at potentially lesser than normal levels, never deficient in quality; • Periodical testing: Too many well documented plans do not work when invoked as they may not have been tested in a simulated environment, and finally; • Post Recovery: If it has been necessary to close the practice temporarily or more, patients may seek services from other providers. Consequently, in order to retrieve lost patients, small scale ‘marketing’ efforts may be worthwhile, such as a “Re-Opening For Service” banner across the shopfront and/or an advertisement in the local paper/s announcing resumption of normal services. A practical approach may be to commence plans on a smaller scale and progressively expand, initially focusing on most serious disabling events. For example, a single premises loss and, gradually, expanding to include, say, loss of multiple sites (lesser likelihood). n

KAREN CROUCH is Managing Director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal, business and financial management. Contact Karen on Email kcrouch@hpcnsw.com.au or visit www.hpcgroup.com.au

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OPTOMETRIST – TAREE, NSW The town of Esperance faces a scattering of gently sloping islands known as the Recherche Archipelago, and it’s this view that makes the town so beguiling. Stop in at Taylors St Quarters for lunch and gaze out to sea, then drive the 38-kilometre (24-mile) Great Ocean Drive as it loops past a dozen blindingly white, fine sand beaches, motionless bays and fragrant native scrub. Keep an eye out for dolphins frolicking in the glassy ocean and stop at local favourite, Twilight Beach. For something a bit different, head to the full size Stonehenge replica and finish with dinner at the delicious Loose Goose restaurant. Joining OPSM Esperance means combining a rewarding career with an amazing lifestyle balance!

OPTOMETRIST – KATHERINE, NT

OPTOMETRIST – WHANGAREI, NZ Why only visit the winterless north when you can live here? We have an exciting opportunity for one to two optometrists to join our evolving Whangarei store. The clientele are amazing, with a retail team to match. Whangarei is a thriving city with a vibrant arts community. A fantastic outdoor lifestyle awaits with sandy beaches, amazing hikes and bountiful water sports. Enjoy those long warm summer nights in subtropical Whangarei.

OPTOMETRIST – BENDIGO, VIC A city of insta-worthy shops, locally-made drops, pottery, pictures and fun times for the family. Are we ticking off your list here? In other words, in this lovely city you can partake in your fair share of holiday dining, sampling local wines, craft beer and market goodies. You can look to take on a fixed period role or even consider a more permanent move – who knows, you might fall in love with the place. Attractive relocation packages are available for the right candidate. Start your journey with us today! Graduates or recent graduates are very welcome to apply.

We have a fantastic opportunity for an optometrist to join our team in picturesque Katherine in February 2020. Katherine has a young population and a friendly environment. It is the kind of place where everyone takes the time to say hello. There is plenty to do in and around Katherine. The stunning Nitmiluk (Katherine) Gorge has ancient rock art and is a great place to spend a day relaxing or getting active with bush walks and canoeing. The Katherine Hot Springs and Mataranka Thermal Springs are both popular locations for taking a relaxing soak and Edith Falls, part of Nitmiluk National Park. This park is also a great place for picnics, barbecues, swimming and hiking.

OPTOMETRIST – WAGGA WAGGA, NSW We have two full-time graduate or experienced optometrists positions available at our OPSM Taree Practice. We are looking for passionate and motivated individuals to join the team. You will be part of our industry leading team and will have the opportunity to work alongside likeminded optometrists to ensure the highest possible standard of patient care. You will also play a pivotal role in building loyal and trusting relationships with the community to grow the practice. High salary package is on offer for the right candidate. On your days off enjoy the Manning regional art gallery, entertainment centre or explore ‘the big oyster’.

JOIN OUR TEAM In these roles you will work closely with vibrant and supportive store teams and have many opportunities to make a difference through our OneSight outreach program. We offer world class technology including leading edge technology Optos UWDRS. We provide opportunities for continuing professional development through financially supported industry training, peer learning communities and product training, and reward with a competitive salary and bonus scheme to recognise your contribution. We have full-time, part-time, casual and fixed-term opportunities available. Attractive relocation packages are available for the right candidate.

Contact the relevant Professional Services Manager for the region to discuss these opportunities and more: NSW/ACT: Elizabeth Kodari elizabeth.kodari@au.luxottica.com QLD/NT: Brendan Philp brendan.philp@luxottica.com.au VIC/TAS: Melissa Downing melissa.downing@luxottica.com.au SA: Sophie Pym sophie.pym@luxottica.com.au WA: Mario Basso mario.basso@luxottica.com.au NZ: Jonathan Payne jonathan.payne@opsm.co.nz

OPSM.COM.AU/CAREERS

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SPECSAVERS – YOUR CAREER, NO LIMITS Partner Recruitment – Optometrist and Retailer joint venture partnership opportunity – Specsavers Kingaroy, QLD

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Specsavers are currently on the lookout for an experienced optometrist and retail dispenser to join us as joint venture partners in our Specsavers store in Kingaroy, QLD. Kingaroy is an agricultural town within the South Burnett region of Queensland, north-west of Brisbane. The store is 130 sqm in size and boasts two optical testing rooms equipped with state-of-theart technology including OCT and a dedicated audiology room. As the store only recently opened, this is a rare opportunity to make your mark and build a profit earning business.

SRS – Perm and locum opportunities across New Zealand Thinking of a sea change? With 54 stores across New Zealand, we have an abundance of opportunities for experienced optometrists. Whether you enjoy the hustle and bustle of city life, or prefer the relaxed outdoor lifestyle, we can offer you the perfect location. You will have access to market leading technology including OCT, and work alongside a passionate and supportive retail team. At Specsavers, we value our people and offer competitive rewards and benefits, and on-going development and training.

Graduate Recruitment – Specsavers Wodonga, VIC Looking for the perfect start to your optometry career? Discover your potential with our Wodonga team. As a graduate optometrist with Specsavers Wodonga, you will work with cutting-edge equipment such as OCT and be part of a passionate team with a goal to transform eye health within the local community. The graduate program provides newly qualified optometrists with a dedicated mentor, support network and structured program to assist you in your development.

SRS - Specsavers’ Biggest Salary Package Ever! Specsavers has introduced a $225,000 salary package for one of three optometrist roles in Australia, the largest ever offered by the business. You will have access to state-of-the-art equipment including OCT, work alongside a dedicated and supportive team to ensure the best outcomes for all patients, and the potential for fast-tracked career progression. Optometrists with a minimum of two years’ experience in Australia or New Zealand who have previously worked at Specsavers are encouraged to apply. The stores are located in: Berri, SA, Emerald, QLD and Taree, NSW.

Specsavers Recruitment Services (SRS) - Who are we? SRS are an in-house recruitment team who specialize in attracting and recruiting talented optical and retail professionals for our Specsavers stores across Australia and New Zealand. Your SRS consultant is on hand to support you through all your recruitment needs and will take excellent care of you and your career. For locum opportunities, please contact Cindy Marshall cindy.marshall@ specsavers.com or 0450609872, and for permanent recruitment opportunities, please contact Maddy Curran madeleine.curran@ specsavers.com or 0437 840 749.

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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: Maria Savva – Partner Recruitment Manager maria.savva@specsavers.com or 0401 353 587 For NSW/ACT, SA & WA enquiries: Marie Stewart – Recruitment Consultant marie.stewart@specsavers.com or 0408 084 134 For QLD/NT & VIC/TAS enquiries: Madeleine Curran – Recruitment Consultant madeleine.curran@specsavers.com or 0437 840 749 Locum employment enquiries: Cindy Marshall – Locum Team Leader cindy.marshall@specsavers.com or 0450 609 872 New Zealand employment enquiries: Chris Rickard – Recruitment Consultant chris.rickard@specsavers.com or 0275 795 499 Graduate employment enquiries: apac.graduateteam@specsavers.com

2020 CALENDAR FEBRUARY SHANGHAI INTERNATIONAL OPTICS FAIR Shanghai, China 11 – 13 February siof.cn/eng/fairinfo.php

6TH ANNUAL CONGRESS ON CONTROVERSIES IN OPHTHALMOLOGY: ASIA-AUSTRALIA Bangkok, Thailand 14 – 15 February cophyaa.comtecmed.com

DUTCH CONTACT LENS CONGRESS

WENZHOU INTERNATIONAL OPTICS FAIR

Veldhoven, The Netherlands 15 – 16 March contactlenscongress.com/en

Wenzhou, China 8 – 10 May opticsfair.com

WAVE2020

OSHOW 2020

Fremantle, Australia 21 – 22 March optometry.org.au

VISION EXPO EAST New York, USA 26 – 29 March east.visionexpo.com

ANZGS SCIENTIFIC MEETING

CORNEA & CONTACT LENS SOCIETY CONFERENCE 2020

Adelaide, Australia 21 – 22 February ranzco.edu/events

Wellington, New Zealand 29 March contactlens.org.nz

INTERNATIONAL CONGRESS ON WAVEFRONT & PRESBYOPIC REFRACTIVE CORRECTION Napa, USA 21 – 22 February wavefrontcongress.org

MIDO EYEWEAR SHOW Milan, Italy 29 February – 2 March mido.com/en

SKI CONFERENCES FOR EYE CARE PROFESSIONALS Nozawaonsen, Japan 29 February – 7 March skiconf.com

MARCH SECO 2020 Atlanta, USA 4 – 8 March attendseco.com

WORLD GLAUCOMA WEEK International 8 – 14 March worldglaucomaweek.org

SUPER SUNDAY 2020 Sydney, Australia 8 March optometry.org.au

To list an event in our calendar email: callum.glennen@primecreative.com.au

Sydney, Australia 16 – 17 May o-show.com.au

ANZSRS MID-YEAR MEETING 2020 Melbourne, Australia 23 – 14 May ranzco.edu/events

14TH EUROPEAN GLAUCOMA SOCIETY CONGRESS 2020 Brussels, Belgium 30 May – 3 June eugs.org/eng/egs_meetings.asp

APRIL JUNE AUSTRALIAN VISION CONVENTION Surfers Paradise, Australia 4 – 5 April optometryqldnt.org.au/avc2020

ORTHOPTICS AUSTRALIA NSW BRANCH CONTINUING EDUCATION WEEKEND Canberra, Australia 4 – 5 April orthoptics.org.au/eventdetails/4685/ oa-nsw-branch-continuingeducation-weekend

DAEGU INTERNATIONAL OPTICAL SHOW Daegu, Korea 8 – 10 April diops.co.kr

ASIA-PACIFIC ACADEMY OF OPHTHALMOLOGY CONGRESS Xiamen, China 22 – 26 April 2020.apaophth.org

MAY ARVO 2020 ANNUAL MEETING

INTERNATIONAL OPTICIANS ASSOCIATION SUMMIT Bangkok, Thailand 7 – 13 June ioassn.org

SILMO BANGKOK Bangkok, Thailand 10 – 12 June silmobangkok.com

OPTOMETRY’S MEETING Washington D.C., USA 24 – 28 June optometrysmeeting.org

WORLD OPHTHALMOLOGY CONGRESS 2020 Cape Town, South Africa 26 – 29 June icowoc.org

JULY VISION 2020 Dublin, Ireland 12 – 16 July vision2020dublin.com/

ORTHOPTICS AUSTRALIA VIC BRANCH JULY SCIENTIFIC MEETING Creswick, Australia 25 July orthoptics.org.au

AUSCRS CONFERENCE 2020 Noosa, Australia 29 July ¬– 1 August auscrs.org.au/auscrs-conference

AUGUST 5TH ASIA PACIFIC GLAUCOMA CONGRESS Kuala Lumpur, Malaysia 14 – 16 August apgc2020.org/

SEPTEMBER TFOS CONFERENCE 2020 Cernobbio, Italy 9 – 12 September tfos2020.tearfilm.org

OCTOBER 5TH WORLD CONGRESS OF PAEDIATRIC OPHTHALMOLOGY AND STRABISMUS Amsterdam, The Netherlands 2 – 4 October wspos.org

38TH CONGRESS OF THE EUROPEAN SOCIETY OF CATARACT & REFRACTIVE SURGEONS Amsterdam, The Netherlands 3 – 7 October escrs2020.com

RANZCO ANNUAL SCIENTIFIC CONGRESS 2020 Brisbane, Australia 9 – 13 October ranzco2020.com

Baltimore, USA 1 – 2 May arvo.org INSIGHT February 2020 49

SOAPBOX

2020: THE BENEFITS OF HINDSIGHT & FORESIGHT We should expect a confluence of trends, giving rise to the question of “Where?”. Will optometry assume a greater responsibility, expanding the role of primary eye care? Is the trend going to be in GP offices, reflecting the overriding global perception of optometry associated with spectacles rather than medical care? Is it going to be “one stop” scanning booths in pharmacies or in the patient’s home using mobile phones? I’ve heard arguments both ways that one of optometry or ophthalmology will become redundant - will this be true?

fter years of having 2020 as the milestone for so many vision initiatives, here we are! It's an especially good time to pause and take stock. The latest figures from the World Health Organization estimate 2.2 billion people have vision impairment, 1 billion with preventable or treatable vision loss. There remains a lot of work to do, but less than might have been without the rallying force of Vision 2020: the Right to Sight. Globally, between 1990 and 2015 the numbers of blind people rose from 30.6 million to 36 million, and those with moderate and severe visual impairment increased from 159.9 million to 216.6 million. Even while age-specific disease prevalence decreased (by about one-third for blindness and one-quarter for vision loss, respectively), increasing population growth and ageing had a greater impact. The National Eye Health Survey gives the most recent Australian data, estimating more than 450,000 Australians are affected by visual impairment or blindness. Ninety percent of our vision loss and blindness is preventable or treatable and, astonishingly, about 60% of this is caused by uncorrected refractive error. We face a growing burden of disease, even while we are not on top of Australia’s eye health today, given the 50% of undiagnosed Australians with glaucoma and the similar figure of people with

INSIGHT February 2020

diabetes who don’t get recommended screening. This is a real problem when of the nearly 1.7 million Australians with diabetes, 29% over the age of 50 have diabetic retinopathy, and 4.5% have sightthreatening diabetic retinopathy. There's a new opportunity to identify those people through the new national KeepSight program, the success of which relies on the support of all eyecare providers. The latest report from the University of Melbourne’s Indigenous Eye Health Unit (IEHU) shows a halving of the gap between mainstream and Indigenous eye health from 2008 to 2015. (Full disclosure, IEHU head Hugh Taylor is my father). It shows a truly systems-level, integrated approach works, even while relatively few other indicators of the wellbeing of Indigenous Australians do so. What can we see looking ahead? Firstly, we need a replacement catch cry for 2020 without sounding like we are losing acuity. Branding aside, greater acuity – in terms of efficiency and productivity, digital decision support and big data – is what we must expect. The indications are already here. The growing demands of disease burden in ageing populations globally. The rise of teleophthalmology in the US, for which we need better funding mechanisms. The supplementation of human workforces and diagnostic instrumentation with AI as seen in the UK and Singapore.

What doesn’t change is that eyecare will remain a “team sport”. Multi-disciplinary teams in which everyone works to the top of their scope – a scope potentially expanded by AI – will be essential for affordable, sustainable systems. Looking to the exciting horizon of new, personalised immunologic and genetic therapies, the costs of treatment can only continue to rise. This means it will be more critical than ever to ensure connected care corrects the gaps and systemic overlaps in care pathways. Globally, this has many components. 1: Finally eradicating the fax as a medical tool. 2: Aligning the disjointed health funding systems, so there are not perverse incentives creating inefficiencies between community-based and hospital care, between prevention and treatment, between the insured and the un- or under-insured. 3: Critically reviewing care pathways so that cost-effective technologies are appropriately plugged into workflows to promote adoption. 4: Building data systems to amass the evidence base to inform our choices. And as for Vision 2021 and beyond? There’s certainly lots of need, opportunities and tough choices. Solutions can only be as good as the people implementing them. Let’s get to work! n Name: Kate Taylor Qualifications: MBBS MPH GAICD Workplace: Oculo Position: CEO Special interests: Innovation, sustainability, quality health outcomes Location: Melbourne Years in profession: 25

MULTIDISCIPLINARY TEAMS IN WHICH EVERYONE WORKS TO THE TOP OF THEIR SCOPE – A SCOPE POTENTIALLY EXPANDED BY AI – WILL BE ESSENTIAL FOR SUSTAINABLE SYSTEMS

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