Insight News Feb 2022 by Prime Group

INSIGHT FEB

2022

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

MANAGING INHERITED RETINAL DISEASES

National network launches with the backing of the International Opticians Association.

KEEPING THEM IN CONTACT LENSES Leading practitioners describe methods to improve contact lens penetration in Australia.

NEW PROFESSIONAL BODY FOR OPTICAL DISPENSERS

One hour worth of CPD content focusing on IRD management for optometrists. Pages 33-39 WHAT'S ON THE HORIZON IN 2022? Prominent figures offer their predictions for the ophthalmic sector this year.

E N V I S TA & E N V I S TA T O R I C ARE N OW PRELOAD ED

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INSIGHT FEB

2022

AUSTRALIA’S LEADING OPHTHALMIC MAGAZINE SINCE 1975

IOA-BACKED PROFESSIONAL NETWORK FOR OPTICAL DISPENSERS LAUNCHES IN AUSTRALIA offer three membership levels with varying benefits: Qualified Optical Dispenser (must show proof of qualification), Affiliate (associates and other practice/non-practicebased staff) and Student (those studying Certificate IV in Optical Dispensing at any Australian registered training organisation).

A new professional body for Australian optical dispensers has been established with the backing of the International Opticians Association (IOA). Its founders believe it will address increasing unrest within the profession over limited opportunities for professional development and networking, while offering support for employment and career matters.

Qualified dispensers also qualify for a complimentary IOA membership.

Optical Dispensers Australia (ODA) – which officially launched on 10 January – has been founded by Australasian College of Optical Dispensing (ACOD) directors Mr James Gibbins and Mr Chedy Kalach, and one of the college’s senior lecturers Ms April Petrusma.

The formation of ODA follows dissatisfaction over optical dispensing representation in Australia in recent years, which industry figures say has struggled since deregulation. A 2019 survey found 80% of respondents were not members of an association.

The professional network will run independently of ACOD and will

That year the country’s two largest dispensing bodies, the

Australian Dispensing Opticians Association (ADOA) and ADOA’s Victorian chapter, agreed to amalgamate. President Ms Amelia Roberts told Insight the body is “alive and well”, and is set to launch a new education arm this year called the ADOA Academy. Petrusma, CEO of ODA, said optical dispensing in Australia is not the same as it was 10, or even five years ago. Recently, there had been a major influx of new practices opening across the country, both corporate and independent, as well as immense changes to the delivery of education. “Over the years working as a practising optical dispenser and tertiary educator in the sector, I have noticed a growing trend

OPTICAL DISPENSERS AUSTRALIA James Gibbins: Advisory Board Chair Chedy Kalach: Advisory Board Secretary Paul Clarke: Advisory Board Member David Birch: Advisory Board Member Constantina Angeli: Advisory Board Member Emanuela De Dona' Zeccone: Advisory Board Member Bonnie Eason: Advisory Board Member Vacant position: Advisory Board Member April Petrusma: CEO Lou Thomas: Communications Manager

continued page 8

ACCC CAUTIONS HEALTH FUNDS OVER COVID-19 PROFITS Australia’s competition watchdog has warned private health insurers they must fulfil their commitment to return all profits due to COVID-19 to policyholders, raising concerns over conservative calculations put forward by some health funds. The Australian Competition and Consumer Commission (ACCC) has released its annual report into the private health insurance (PHI) sector. It found that in the 12 months to June 2021, governmentimposed COVID-19 restrictions continued to limit policyholders’ access to non-urgent elective surgery and non-urgent ‘extras’ treatments, including most dental, optical and other health services. The authority said the impact

was particularly notable in Victoria, which experienced several local lockdowns during the reporting period, and was also evident to a lesser extent in NSW. “The ACCC is aware that many insurers have been implementing their commitments to return profits from COVID-19 restrictions to policyholders, primarily through premium credits or direct payments to policyholders, and we support these efforts,” ACCC deputy chair Ms Delia Rickard said. However, the ACCC said it was concerned about some statements from insurers when announcing relief for policyholders. It is concerned they are calculating

their total profitability from COVID restrictions too conservatively, by only referencing the value of their ‘deferred claims liability’. The primary objective of the deferred claims liability is to ensure insurers have sufficient funds to satisfy future claims for deferred procedures, such as elective surgery and extras treatments. “The deferred claims liability is not a proxy for total profitability from COVID restrictions, and nor was this ever the intention when financial regulators directed insurers to create a deferred claims liability,” Rickard said. The ACCC noted that insurers can exclude the value of claims that continued page 8

EYE DROP SECURES MYOPIA INDICATION Australian eyecare practitioners may no longer need to access low dose 0.01% atropine via compounding pharmacists after a pharmaceutical firm secured a myopia indication for its product.

page 48

Transform your career with Specsavers in 2022 The year ahead is shaping up to be the best yet to join Specsavers as we continue expanding our store network and professional team across Australia and New Zealand. With expansion and growth come a wealth of opportunities for optometrists, optical dispensers and retailers in partnership and employed positions. And when you join us, we will help you map out a solid career path and support you to achieve your goals. We will provide you with professional development opportunities, including ophthalmology-led educational programs, integrated technology systems, excellent pay rates, OCT in every store, flexible working arrangements, and so much more. A new year brings new opportunities – so take the step to advance your potential and transform your career at Specsavers. Go to spectrum-anz.com or contact us: Partnership enquiries: Marie Stewart +61 408 084 134 Optometry recruitment enquiries: Madeline Curran +61 437 840 749

Transforming eye health Transforming careers

IN THIS ISSUE FEB 2022

EDITORIAL

FEATURES

MY 2022 PREDICTIONS When I wrote my first editor’s note of 2021, I predicted a year of recovery and renewal. COVID-19 had other plans, but hopefully that assessment will be more befitting of 2022. When I think of major trends to shape the ophthalmic sector this year, growth comes to mind. Lockdowns during the past two years prompted many corporates, franchises, consolidators to decelerate plans for greenfield practices, acquisitions, and existing store expansions. Many have indicated this will ramp up considerably in 2022, with a full pipeline ready and waiting.

EYECARE LOCK-OUT New optometry services data from Australia’s most locked-down states makes for sobering reading.

DETECTING IRDs Leading Australian inherited retinal disease experts have penned Insight's first CPD articles.

After a tough trading period, it's unsurprising some independents are seeking the security of a group. But some balance sheets won’t be as healthy as pre-pandemic levels, so how this is accounted for could be interesting. In saying that, many independents have benefited from a resurgent ‘shop local’ mentality. Along with pentup demand, their upward trajectory may continue. Expect more myopia innovations too in 2022. A prescription low-dose atropine product is launching, and optometrists have been impressed by Hoya’s defocus lens. More activity is expected, with Essilor developing a lens and myopia-specific ortho-k systems also imminent. Add in the return of the RANZCO Congress this month and O-Show in May, and I’m confident of a prosperous 2022.

DROPPING OUT Pearls from leading practitioners to prevent patients from giving up on contact lenses.

BIOMETRIC LENSES How Rodenstock is now using AI to create highly customised lenses from standard prescription values.

As a publication, we’re also going to a new level this year with the launch of optometry CPD articles. We’ve appointed former Optometry Australia publications editor Jeff Megahan to oversee this. Our inaugural articles are on pages 31-37, focussing on inherited retinal diseases, worth one hour in total.

EVERY ISSUE

We know optometrists are time-poor, so we’re aiming to make these articles concise and digestible, with plenty of helpful imagery. We’re also keen to hear from potential authors (optometrists and ophthalmologists) wanting to contribute in their field of expertise.

07 UPFRONT

59 MANAGEMENT

We look forward to further serving the ophthalmic community in 2022.

10 NEWS THIS MONTH

60 OPTICAL DISPENSING

57 PEOPLE ON THE MOVE

61 CLASSIFIEDS/CALENDAR

58 ORTHOPTICS AUSTRALIA

62 SOAPBOX

MYLES HUME Editor

INSIGHT February 2022 5

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mydryeyes.com.au 1. Lemp, M.A., Crews, L.A., Bron, A.J., Foulks, G.N. and Sullivan, B.D., 2012. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea, 31(5), pp.472-478. AFT Pharmaceuticals Pty Ltd, Sydney | Phone: 1800 238 742 | Email: customer.service@aftpharm.com | ABN 29105636413

UPFRONT Just as Insight went to print, BIENCO, a national consortium of clinical, scientific and governance experts, including the NSW Organ and Tissue Donation Service, was launched by NSW Minister for Health and Medical Research Mr Brad Hazzard. The group will develop bioengineered eye tissue for corneal blindness, and involves two leading Australian corneal specialists: Professor Gerard Sutton, also co-medical director for the NSW Tissue Bank, and Professor Mark Daniell, who is also a researcher at The

University of Melbourne and Centre for Eye Research Australia. The project is being funded through the Medical Research Future Fund 2021 Frontier Health and Medical Research Initiative. IN OTHER NEWS, the Australian Health Practitioner Regulation Agency reported fewer complaints about the conduct of Australian optometrists in 2021, with a higher proportion of cases also resulting in no further action. The latest ‘notifications’ data showed there were 38 notifications lodged against 44 optometrists. This compares with 41 complaints against 55 optometrists in 2019/20. In terms of the 50 cases that were closed in 2020/21, 74% resulted in no further action, up from

61% the year before. FINALLY, Optometry Victoria South Australia (OV/SA) appointed Ms Ilsa Hampton as its new CEO, following the departure of Mr Pete Haydon to the Australian College of Optometry. Hampton is an experienced health sector leader, holding senior executive and leadership roles in aged care and social and community services. She was most recently CEO at membership organisation Meaningful Ageing Australia, where she grew the organisation significantly, undertook advocacy with government and key stakeholders, and delivered education and evidence-based practical resources for members. Hampton takes up the permanent CEO role this month.

insightnews.com.au Published by:

11-15 Buckhurst Street South Melbourne VIC 3205 T: 03 9690 8766 www.primecreative.com.au Publisher Christine Clancy

WEIRD

QUOTE

christine.clancy@primecreative.com.au

Editor Myles Hume myles.hume@primecreative.com.au

Researchers have developed a high-tech sleeping bag that could solve spaceflight-associated neuro-ocular syndrome (SANS). Astronauts place their lower body in the vacuum-equipped sleeping bag, which pulls down body fluids that naturally float into the head and can reshape the back of the eye. n

rhiannon.bowman@primecreative.com.au

Consulting Education Editor Jeff Megahan Business Development Manager Alex Mackelden alex.mackelden@primecreative.com.au

Client Success Manager Justine Nardone

WONDERFUL

Inspirational speaker and author Julie Woods, who is legally blind, climbed the world's steepest street in Dunedin to highlight Blind Low Vision Week. With her guide, she reached the top of Baldwin St in 12 minutes, as she aims to walk every street in the southern New Zealand city. n

Journalist Rhiannon Bowman

WACKY

Smartglasses to be released by Apple in 2022 will reportedly operate on the company’s proprietary M1 chips. Rather than being physically or wirelessly connected to a cellphone, this will allow the glasses to run independently, on par with its computers.

justine.nardone@primecreative.com.au

Design Production Manager Michelle Weston

INDEPENDENT SUCCESS "For independent optometry to continue to flourish, practice owners need to commercialise their special interests" – departed ProVision CEO Mr Steven Johnston. Full report page 62.

WHAT’S ON

Complete calendar page 61.

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Art Director Blake Storey Graphic Design Michelle Weston, Kerry Pert, Aisling McComiskey Subscriptions T: 03 9690 8766 subscriptions@primecreative.com.au

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The Australian Society of Ophthalmologists’ annual event is being held at the Grand Hyatt Melbourne.

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liabilities that arise from material published. © Copyright – No part of this publication be reproduced, stored in a retrieval system mechanical, photocopying, recording or otherwise without the permission of the publisher.

INSIGHT February 2022 7

NEWS

ADVISORY BOARD TO GOVERN NEW BODY continued from page 3

dispensers,” Petrusma said.

where optical dispensers and opticalaffiliated employees are seeking industrybased opportunities to further grow their existing skills, network with other likeminded professionals or get work-based support,” she said.

Outlining the key functions of the body, Petrusma said ODA would have an advocacy role to ensure any future policy changes are for the benefit of the industry as well as individuals.

“Subsequently, the trend has led to increasing unrest within the profession regarding the limited availability of options to fulfill these demands. ODA has been founded to cater for these needs that have also been recognised from afar by the IOA. Prior to launching, the IOA offered ODA its unwavering support and encouragement.” Petrusma said careful consideration was given to ODA’s governance structure. Instead of being “membercontrolled”, it will be “membermanaged”, with an eight-strong advisory board appointed to “make the best decisions for our members without any conflict of interest fuelled by political standing”. Paid staff will also run the organisation, overcoming organisational issues sometimes found in time-poor, volunteer-run organisations. “The advisory board is made up of professionals with a variety of expertise and backgrounds – ranging from ex-president of the IOA Paul Clarke to freshly qualified, practising optical

Members will also be able to network via an online forum, career portal, yearly conference and continuing professional development (CPD) events. Its website will act as a hub, featuring a job listings section with targeted industry-specific roles across Australia, as well as easy access to dispensing calculators and health fund guides. ODA’s founders are particularly focused on upskilling the industry through CPD, with the organisation saying it will offer Australia’s newest and most comprehensive, postqualification CPD initiative for dispensers. “By engaging our members in a CPD program presented by current industry professionals, we are ensuring they gain the most up-to-date knowledge and are regularly enhancing their dispensing and practice skills,” Petrusma said.

“THE CURRENCY CERTIFICATE IS A GREAT ADDITION TO PRESENT TO A FUTURE OR CURRENT EMPLOYER TO SHOW RELEVANCY AND UP-TO-DATE KNOWLEDGE" APRIL PETRUSMA, OPTICAL DISPENSERS AUSTRALIA

throughout the year. A currency certificate will be distributed to those that have completed 10 CPD points each calendar year. On top of the educational benefits of the program, the currency certificate is a great addition to present to a future or current employer to show relevancy and up-to-date knowledge in the industry.” Employment matters and advice will also form a part of ODA’s service. “We’re very passionate about workplace conditions and promoting optical dispensing as a favourable career choice,” Petrusma added. “Our robust HR and Career portal offers support for both employers and employees alike when seeking assistance or advice on workplace matters like hiring new employees, contracts, and awards. ODA also offers a job vacancy board, resume tips and free templates to help jobseekers, interview advice, links to further education, a career counselling service and job networking opportunities." In a statement, the IOA said it was excited to partner with ODA and welcome its qualified members into the international organisation.

“The monthly webinars offered by ODA will be available to anyone for a fee of $55 or complimentary for Qualified Optical Dispenser members. Members will receive one CPD point per webinar with additional opportunities to gain CPD points from supplementary events

“We really look forward to strengthening our bond and supporting each other and more importantly supporting our members,” IOA president Ms Fiona Anderson said. n

PHIs DELIVER LOWEST PREMIUM INCREASE IN 21 YEARS continued from page 3

were missed due to COVID restrictions and are not expected to materialise later when calculating their deferred claims liability. However, for the purpose of fulfilling their broader commitments in 2020 to not financially benefit from the pandemic, the ACCC expected insurers to include the value of these claims when calculating their policyholder relief. “We expect insurers to return all benefits from procedures that were not performed and are not expected to be performed later. This may be particularly applicable to extras treatment and geographic areas that were subject to extended lockdowns,” Rickard said. “We will continue to monitor the actions

INSIGHT February 2022

of insurers to return all profits made due to COVID‑19 to policy holders as they promised and report on it in our next annual report on the private health insurance industry.” The report also noted the proportion of Australians with health insurance has increased for the first time since 2015, attributed to increased community focus on health due to COVID-19. In June 2021, nearly 14 million Australians, or 54% of the population, had some form of PHI, an increase of 1.4% since June 2020. People holding hospital policies increased across most age groups, but the rate of increase was fastest among those aged 75 and older. The 2020-21 reporting period is the first year in which people in their mid to late

70s holding hospital cover outnumbered people in their mid to late 20s.

ACCC: ‘Deferred claims liability’ isn't the only measure.

This year’s PHI average premium increase was the lowest since 2001 at 2.7%. Cumulative premium increases over the past five years to June 2021 continue to outpace wage growth, with average increases more than double inflation during the same period. Private Healthcare Australia CEO Dr Rachel David said “in an ideal world health funds would not increase premiums by a single dollar". "[In 2021] funds have proposed the lowest possible rise necessary to ensure they remain financially viable and can continue to provide members with access to quality and timely healthcare, which is critical as we move out of the pandemic.” n

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NEWS

AUTOMATED PERIMETRY FOR AMD OF LITTLE RELEVANCE – STUDY

OPTOMETRISTS CAN NOW PRESCRIBE LIFITEGRAST DRY EYE THERAPY Australian optometrists can now prescribe dry eye therapy lifitegrast without the involvement of a medical practitioner, under updated Optometry Board of Australia (OBA) rules.

Researchers from the Centre for Eye Health (CFEH) and UNSW have published a new review demonstrating visual field testing in early and intermediate age-related macular degeneration (AMD) reveals statistically significant, but not clinically relevant, differences in visual function.

Previously, access was arranged through a GP or ophthalmologist.

They hope the findings finally clarify best practice regarding automated perimetry for AMD assessment. Researcher Dr Lisa Nivison-Smith, who led the study, said even though there were research publications exploring visual function for AMD, particularly using new forms of perimetry, anecdotally it appeared visual field testing for AMD patients was not common in optometric practice. Descriptions for its use in various AMD clinical guidelines were also unclear.

The therapy – marketed by Novartis under the brand Xiidra – was approved in January 2019 and is indicated for moderate to severe dry eye disease in adults for whom prior use of artificial tears has not been sufficient. The OBA recently updated its Guidelines for use of scheduled medicines to include lifitegrast, which it described as a new topical schedule 4 (prescription only) medicine, coming into effect 10 December 2021. Under previous arrangements, access to lifitegrast has to be arranged through a medical practitioner.

“We found a clear gap between research and clinical practice regarding automated perimetry and AMD that needed to be addressed,” Nivison-Smith said. The review assessed more than 26 papers using clinically available automated perimetry to assess eyes with early or intermediate AMD. They determined if a difference in visual function existed with disease and if these differences had any real-world patient outcomes.

“Allowing optometrists to prescribe lifitegrast will ensure thousands of Australians receive the medication they need without spending additional time and money seeking the treatment from a GP or ophthalmologist,” Optometry Australia chief clinical officer Mr Luke Arundel told Insight.

The research unit found consistent evidence that there were visual field defects in early and intermediate AMD that were significant when compared to

The OBA stated that while it considers endorsed optometrists qualified to prescribe topical lifitegrast, the authorisation remains subject to state and territory drugs and poisons legislation.

“All medicines that enter the market have undergone clinical trials to ensure appropriate safety and efficacy, but it is important that they continue to be monitored for adverse effects as they become more widely used,” Arundel said. n

INSIGHT February 2022

normal eyes, using clinically available automated perimetry. However, these reductions when measured using a standard automated perimeter (SAP) under photopic conditions were not clinically meaningful when assessed with meta-analyses. They also found very little evidence on relevance of visual field outcomes to patient outcomes. “Because this review only focused on devices that are clinically available, it provides results that are highly translatable to current clinical practice,” Nivison-Smith said. “It highlights that research into other perimetry devices or other light testing conditions may become highly relevant in the future. It also highlights the need to study the real-word implications of these outcomes for these patients.” The article was published in Ophthalmic and Physiological Optics. n

NEW MEDICARE ITEMS TO FUND ALLIED HEALTH CASE CONFERENCING

It also noted lifitegrast is subject to additional monitoring through the Therapeutic Goods Administration (TGA)'s Black Triangle Scheme for adverse events in new medications. The scheme provides a simple means for practitioners and patients to report adverse events with new prescription drugs or those being used in new ways. The Black Triangle does not necessarily mean there are known safety problems, but the TGA is seeking to build a fuller picture of the medicine's safety profile.

CFEH researcher Dr Lisa Nivison-Smith performing perimetry on a patient.

Multidisciplinary conferences will be reimbursed.

New Medicare items have been introduced allowing allied health professionals, including optometrists, to be reimbursed for participating in case conferences to support people with chronic diseases or young children with developmental disorders like autism. Federal Health Minister Mr Greg Hunt announced the new items had come into effect 1 November after the government committed $13.7 million in the 2021–22 Budget in response to recommendations to the MBS Review. It’s also hoped the measure will increase the number of doctor-led

multidisciplinary case conferences in primary care. To date, Hunt said allied health professionals could take part in conferences but were unpaid. Under the change, allied health professionals will be paid to attend multidisciplinary conferences held by the patient’s regular doctor – in person, via video conference or phone – to discuss diagnosis, care and treatment plans. Optometrists can be reimbursed for conferences involving children with pervasive developmental disorders. n

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NEWS

VISION EYE INSTITUTE JOINS FORCES WITH EYE SURGEONS SA

RACS CALLS FOR RESTRICTION ON USE OF ‘SURGEON’ TITLE

Vision Eye Institute (VEI) has expanded its network of clinics to South Australia through a partnership with Eye Surgeons SA (ESSA), adding two new clinics and three satellite consulting locations.

The Royal Australian College of Surgeons (RACS) has released a position paper advocating for new measures that prevent medical practitioners who RACS says its position haven’t completed is not about ‘protecting the turf’ of its Fellows. accredited surgical training from using the word ‘surgeon’ in their title.

The largest private provider of specialist eyecare in Australia recently announced the move, seeing ESSA founder and principal ophthalmologist Dr Paul Athanasiov become its new partner doctor in South Australia. The agreement sees Athanasiov’s two ESSA clinics in North Adelaide and Windsor Gardens now come under the VEI banner. Meanwhile, VEI patients will also be able to see Athanasiov at his consulting locations in Kurralta Park, Elizabeth Vale and Whyalla.

According to the college, in Australia use of the term ‘surgeon’ is not restricted to specialists who have completed Australian Medical Council (AMC)-accredited training in surgery. This has resulted in numerous practitioners advertising themselves as surgeons, but RACS believes tighter regulations would prevent false assumptions among patients about the level of training of practitioners performing their surgery.

VEI’s entrance into South Australia takes its clinic network to 20, with six locations also in New South Wales, four in Queensland and eight in Victoria. This is in addition to 10 day surgeries operating under the Vision Hospital Group banner. It operates the Windsor Gardens Day Surgery that is co-located with ESSA’s Windsor Gardens clinic.

“RACS’ position is not about ‘protecting the turf’ of RACS’ Fellows,” the college said. “Implementing RACS’ position would mean that medical practitioners who have not demonstrated their surgical expertise by completing an AMC-accredited training program in surgery, ophthalmology or obstetrics and gynaecology, would be prevented from advertising themselves to the public using the term ‘surgeon’.”

“With Vision Eye Institute’s scale and provenance, and ESSA’s local knowledge and energy, we look forward to delivering exemplary eyecare to the South Australian community,” VEI CEO

In addition, the college said all registered ‘specialist ophthalmologists’ would be able to use the term in combination with relevant ‘qualifier’ or ‘descriptor’ words. For example, an ophthalmologist would advertise as an ‘ophthalmic surgeon’.

INSIGHT February 2022

Mr James Thiedeman said. “We have worked with Paul for many years in our Windsor Gardens Day Surgery facility and this extension of our relationship represents a further opportunity to ensure Adelaide has access to the latest diagnostic and treatment technologies." Athanasiov added: “Vision Eye Institute ensures all their practices and hospitals throughout Australia are of the highest standard regarding patient and staff safety with a level of clinical governance which cannot be achieved in a standard small business. “The extra support for our staff and doctors will also provide us with a ‘big team’ feel and I'm looking forward to being able to travel interstate to visit the practices and theatres of our interstate colleagues.” n

RANZCO’S TOP OPHTHALMOLOGY TRAINERS OF 2021 REVEALED

“The AMC accredited training programs for the various surgery subspecialty fields ... are five or six years at a minimum, on top of a primary medical degree,” RACS said. “A primary medical degree and five or six years of training in a specialty which includes a significant surgical component provides the physiological, ethical, psychological, pharmacological and medical expertise to safely diagnose, treat and manage surgical patients. This includes knowing the medical conditions that preclude surgery, awareness of associated conditions that will influence surgical management choices, managing appropriate referrals for complex care and performing all aspects of postoperative care.” n

Eye Surgeons SA founder and principal ophthalmologist Dr Paul Athanasiov.

Dr Xia Ni Wu, WA ophthalmologist.

Western Australian ophthalmologist and first-time RANZCO Trainer of Excellence recipient Dr Xia Ni Wu says she is excited by the next generation of “knowledgeable, inquisitive, and well-trained” Australian eye doctors who increasingly have access to worldleading experts through online platforms. Wu – whose has public appointments at the Sir Charles Gairdner and Fremantle hospitals and consults privately at South Street Eye Clinic – was among seven RANZCO Fellows recognised as Trainers of Excellence this year, as voted by trainees within the college’s Vocational Training Program (VTP). Each year, RANZCO asks its trainees

to nominate the training supervisor in their network they believe deserves recognition for outstanding dedication to teaching. The other 2021 recipients were: Professor Robert Casson (South Australia), Dr Matthew Spargo (Prince of Wales, New South Wales), Dr Elizabeth Insull, (New Zealand), Dr Cameron McLintock (Queensland), Associate Professor Alex Hunyor Jr (Sydney Eye Hospital, New South Wales), and Associate Professor Anthony Hall (Victoria). “Overall, I’m terrifically humbled and honoured to be awarded a Trainer of Excellence. I hope it also encourages other junior fellows to become involved in teaching as it is very rewarding, accolades aside,” Wu said. n

SEE YOURSELF DOING WHAT YOU LOVE

WORKING AT OPSM MEANS YOU’RE PART OF SOMETHING BIGGER. At OPSM, we are obsessed with eye care and offering our customers the confidence in how they see the world. Our advanced technology enables us to look deeper to ensure we give the best care to every customer. When you join OPSM, you work with world class technology including the Optos Daytona ultra wide field scanner. You have many opportunities for continuing professional development through financially supported industry training, mentoring, graduate induction, peer learning communities and product training. You are rewarded with a competitive salary and bonus scheme to recognise your contribution. You have career flexibility through our extensive store network. Most importantly, you can make a real difference in the way people see the world not only from your consulting room but also by participating in our OneSight outreach program. #DoWhatYouLove

CONTACT OUR PROFESSIONAL SERVICES MANAGERS TO EXPLORE YOUR NEXT OPPORTUNITY: NSW/ACT – Amy Pillay Amy.Pillay@opsm.com.au 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

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NEWS

AUSSIE OPTOMETRISTS TO HEADLINE GLOBAL MYOPIA VIRTUAL EVENT Australian optometrists Dr Kate Gifford and Dr Philip Cheng are among a selection of global authorities presenting at a World Council of Optometry (WCO) virtual event this month to discuss a global standard of care for myopia management. Gifford – a Queensland-based clinicianscientist, peer educator and a co-founder of the Myopia Profile platform – and Cheng – clinical director of Eyecare Concepts, The Myopia Clinic Melbourne – will feature alongside four other myopia leaders to share their perspectives on myopia management. The WCO is partnering with CooperVision to host a virtual event on February 12, 2022. The speaker line-up also includes: • Dr Carmen Abesamis-Dichoso (Philippines), optometrist and recipient of the IACLE Educator Fellowship Program, University of Waterloo (Canada), School of Optometry. In addition to her private practice, she has lectured extensively both locally and internationally on myopia management. • D r Thomas Aller (US), optometrist, visiting scholar and practice owner of Dr Thomas Aller Optometrist, Inc. Aller is an expert in myopia control and orthokeratology, and a regular contributor to the field of vision science

Queensland optometrist Dr Kate Gifford (left) and Melbourne's Dr Philip Cheng.

and the development of innovative treatments. • Ms Nicola Logan, BSc Hons Optometry, MEd, PhD (UK), optometrist and professor, Aston University College of Health and Life Sciences. She researches the development, progression and management of myopia in children and runs a clinical service in myopia management.

"THEIR KEEN INSIGHT WILL BRING CLARITY AND PERSPECTIVE TO THIS MULTIFACETED ISSUE FACING MILLIONS OF ADULTS AND CHILDREN" PAUL FOLKESSON, WORLD COUNCIL OF OPTOMETRY

• Sara McCullough, BSc Hons Optometry, PhD, (UK), optometrist and research associate in optometry and vision science at Ulster University (Northern Ireland). She is currently working on the Northern Ireland Childhood Errors of Refraction (NICER) study investigating the progression of refractive error in children and young adults.

“We are delighted to bring together this dynamic group of industry leaders to discuss the importance of myopia management as a global standard of care,” WCO president Mr Paul Folkesson said. “Their keen insight will bring clarity and perspective to this multifaceted issue facing millions of adults and children around the world.” In 2021, WCO and CooperVision announced their global partnership to raise awareness of myopia progression and encourage optometrists to embrace a standard of care to manage the condition. The WCO board of directors then unanimously approved a resolution advising optometrists to incorporate a standard of care for myopia management within their practices. The launch of a myopia management online resource is the next step to provide eyecare practitioners with the information, knowledge and guidance needed to establish a standard of care in their practice. WCO and CooperVision launched an online resource in September that provides multilingual assets and approaches that will enable busy eyecare professionals – regardless of geographic location – to apply a standard of care to manage the condition. n

RANZCO CEO DR DAVID ANDREWS ANNOUNCES DEPARTURE RANZCO CEO Dr David Andrews has informed the college board he is standing down from the role he has served in since 2013. He is leaving to become CEO of the Australian Veterinary Association.

his tutelage, including updating the constitution, obtaining full health charity status, and improving the process for identifying new committee members allowing for greater fellow involvement.

RANZCO president Professor Nitin Verma announced his departure in a memo, advising that Andrews would be leaving the role in early 2022 and hoped he would be present for a farewell at the upcoming scientific congress in Brisbane this month. In an interview with Insight, Andrews reflected on the successes, mistakes and key learnings during his nine-year tenure.

“While we had a rough few years with the Australian Medical Council and Medical Council of New Zealand accreditation, we are now in a position to have met nearly all our conditions and recommendations, and on track to complete them [in 2022]. The congresses have lifted in quality during my tenure, helped largely by our PCO and the dedicated staff, but also a greatly improved direct relationship with industry.”

Noting that much of the achievements required a team effort, he was proud of governance changes at RANZCO under

Andrews was also pleased to with efforts to attract Indigenous trainees. He believes the college’s relationships across the sector have

INSIGHT February 2022

improved, not just with optometry but patient advocacy groups such as Macular Disease Foundation Australia, Glaucoma Australia, Vision 2020 Australia and other groups.

Dr David Andrews, RANZCO.

“I also have an excellent working relationship with the management of the Australian Society of Ophthalmologists and Kerry Gallagher has provided much sage advice over many years,” he said. “From a more operational perspective I leave RANZCO on a very solid financial footing with a strong balance sheet, the staff we have are excellent and in many cases are highly specialised in their fields. This has taken years to build and part of the reason for moving on now is that I feel I am leaving the college in excellent hands and overall great health.” n

DR KRIS RALLAH-BAKER HINTS AT TWO NEW INDIGENOUS TRAINEES IN KEYNOTE SPEECH Australia’s first Indigenous ophthalmologist has reiterated the critical importance of Aboriginal and Torres Strait Islander people being central to solving the disparity between Indigenous and non-Indigenous people’s eye health, in an annual address hosted by Vision 2020 Australia.

Australia’s newest member-based network for the Optical Dispensing profession.

A/Prof Kris Rallah-Baker, Australia’s first and

Delivering the annual Barry only Indigenous ophthalmologist. Jones Vision Oration, Associate Professor Kris Rallah-Baker, a proud Yuggera and Biri-Gubba man, spoke about the goal of developing confidence and capacity among Aboriginal and Torres Strait Islander people to “realise the ability of people to determine their own futures”. Due to ongoing COVID-19 restrictions, Rallah-Baker’s oration was released as a pre-recorded video on 8 December. He is one of the founding members of the Australian Indigenous Doctors Association, a board director of the Royal Flying Doctors Service, technical advisor to the Fred Hollows Foundation and chair of the Vision 2020 Australia Aboriginal and Torres Strait Islander Committee. He runs a private ophthalmology service at Noosa Hospital.

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In his speech, Rallah-Baker noted that preventing vision loss and restoring sight is important for the impact it can have on the ongoing vitality of Aboriginal and Torre Strait culture, enabling the ability to “pass on and transmit ancient cultures” and maintain the “endearing connection with country and with the eons of history that came before”.

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He also wants to see more Indigenous eyecare professionals in the workforce. “I'm proud to say that as of [2022], we will have one Aboriginal [ophthalmology] trainee and one Torres Strait Islander trainee in the [RANZCO] college, and they'll be the first Indigenous trainees since I entered the college in 2009,” he said in his address. “In the not too distant future, we will have more than just one Indigenous ophthalmologist in this country, which is extremely exciting. But also it's about increasing the numbers of Indigenous optometrists. And I work very, very closely with one of the universities in Brisbane on a project to do that, as well as increasing the number of healthcare workers and nurses and associated workforce to improve the number of Indigenous people in the eye health sector.” Vison 2020 Australia established the Barry Jones Vision Oration in 2020 in honour of its inaugural chair, Professor Barry Jones AC, who has been a longstanding supporter of the eye health and vision care sector. He continues to support the sector in his role as a Patron of Vision 2020 Australia. Speaking at the conclusion of the 2021 oration, Jones described RallahBaker as a “persuasive advocate” and welcomed his leadership in the sector. Rallah-Baker’s keynote speech was the second Barry Jones Vision Oration; ophthalmologist Dr James Muecke delivered the inaugural Barry Jones Vision address to an online audience in October 2020. n

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Optometrist Greeshma Patel with a patient at the Specsavers Sydney CBD store.

COVID-19

COVID’S IMPACT ON PRIMARY EYECARE IN

Victoria and NSW

New data paints a worrying picture of how difficult it was for patients in Australia’s most locked-down states to access optometry services in the past 18 months, writes Specsavers ANZ director of optometry DR BEN ASHBY.

he past 18 months have been anything but ordinary. COVID-19 restrictions and prolonged lockdowns across states and regions have impacted access to eyecare across Australia, restricting optometrists from providing routine care. This has had, and will undoubtedly continue to have, an impact on eye health across Australia. With almost everyone likely to experience an eye health issue at some point in their life, regular, routine eye checks play a significant part in ensuring eyes stay healthy, with early changes to visual function captured quickly and corrective measures put in place. For patients with eye conditions such as diabetes or glaucoma, regular eye checks are even more important. Consistent monitoring and management are key to avoiding preventable vision loss in these conditions, often asymptomatic in their early stages. In addition, for patients unaware they have a serious eye condition, being able to access routine eyecare is critical. For many, attending a regular eye check could be the difference between halting a condition in its tracks or suffering irrecoverable vision loss. Specsavers has been measuring the impact of COVID-19 on eye health over the past two years. This article analyses the changes in referrals over the course of the pandemic and takes a particular look at the impact across NSW and Victoria, which have endured the longest lockdown periods. IMPACT ON NSW AND VICTORIA It is fair to say that NSW and Victoria have been hit hardest by prolonged COVID-19 restrictions. Focusing on referrals for sight-threatening conditions, the data paints a worrying picture of just how difficult it was for patients to access eyecare over the past 18 months. In NSW, the early 2020 and mid-to-late 2021 periods were impacted by COVID-19 restrictions resulting in a significant reduction in patients seeking care and a corresponding reduction in referrals. This caused

INSIGHT February 2022

a large backlog of patients, who returned to practices as soon as lockdowns were lifted. For Victoria, the picture is even more stark. The effects of restricted patient access during the numerous lockdowns of different parts of the state are clear, with obvious reductions in the number of referrals made. Again, the rapid rise in patients attending clinics post-lockdowns points to the number of Australians with eye health issues needing regular access to care so their concerns can be managed when they arise, and not delayed unnecessarily. IMPACT ON REFERRALS BY URGENCY Time is of the essence when a patient presents with indicators of serious health issues. For the most part, our Australian practices have remained open for essential and urgent care, but government restrictions on the care optometrists were able to provide risked compromising patients’ eye health. By tracking referrals over a number of years and comparing this to patient volume and the prevalence of various eye conditions, it’s possible to estimate the number of referrals that would have been made under normal care conditions, but which have not been made over the past 18 months as patients have been prevented from accessing eyecare. Figure 2 highlights the COVID-19 impact on referral volume by urgency in NSW, Victoria and other Australian states in 2020 and 2021. Many thousands fewer patients were referred for specialist care during periods of COVID-19 restrictions than in the same periods in 2019. In 2020, NSW and Victoria saw declines of 49% and 40%, respectively, in the total number of patients referred for specialist care during periods of restrictions. When looking at ‘very urgent’ referrals, this reduction was 34% and 30%, respectively. While this improved in 2021, periods of restrictions in the two largest states still saw almost a 25% decrease in total referrals compared to 2019, and 5% fewer ‘very urgent’ referrals. While it is positive to see only a

Impact on Referrals Volume 2020-2021 (vs 2019)

small reduction in the number of patients referred as ‘very urgent’ (needing specialist management within the next 24 hours) in 2021, that there was any reduction at all speaks to the potentially devastating impact of restricting access to eyecare services. This data speaks volumes to the importance of primary eyecare providers remaining open and accessible for routine care at all times. IMPACT ON FIRST-TIME GLAUCOMA REFERRALS For the past five years Specsavers has been spearheading a dedicated campaign to detect every case of glaucoma in our patients and ensure they are referred in a timely manner and supported in their treatment journey to avoid preventable vision loss. As a result, there has been significant in-roads in reducing the seemingly accepted statistic that 50% of all glaucoma goes undiagnosed by building consistency in visual field utilisation for glaucoma suspects and performing OCT as standard for every patient. Specsavers optometrists refer 1.43% of our patients for glaucoma, a rate close to the approximate 1.5% national prevalence of glaucoma in the Australia population. Given the positive impact this initiative has had, it is hugely concerning to see a significant reduction in the number of patients – more than 8,000 patients in total – who were not referred for newly detected glaucoma in 2020 and 2021. Both NSW and Victoria saw a reduction of more than 50% in the number of first-time glaucoma referrals in 2020 and 2021 (Figure 4). In a normal year, many of these patients would have been diagnosed as glaucoma suspects as part of a routine eye test. Restrictions across Australia prevented many patients from accessing routine care, and it must now be a priority to ensure that this large cohort of patients are able to access eyecare and are actively encouraged to return.

Impact on Sight Threatening Referral Volume 2020-2021 (vs 2019)

Figure 3: Referral volumes in NSW and Victoria declined by more than 40% during periods of lockdown in 2020 (compared to the same period in 2019) and 30% in 2021.

Impact on Glaucoma Referrals Volume 2020-2021 (vs 2019)

Figure 4: More than 8,000 patients were not referred for newly detected glaucoma in 2020 and 2021.

IMPACT ON TYPE OF REFERRALS Early detection and treatment for sight-threatening conditions is paramount, making the significant impact on referral volume for patients with glaucoma, medical retina and diabetic eye diseases all the more concerning. Both NSW and Victoria decline by more than 40% during periods of lockdown in 2020 (compared to the same period the year before) and 30% in 2021. During these periods, referrals for diabetic eye disease specifically fell by 51% in NSW and 36% in Victoria in 2020, and 26% and 28% respectively in 2021. Referrals for other eye conditions were similarly impacted. Referrals classified as ‘other’ are those that do not fit the previous categories, including potentially life- and sight-threatening neurological and oncological conditions. While eminently treatable, delays in referral for cataract surgery can have significant negative impact on a patient’s functional independence and quality of life.

Figure 1: Referrals of sight-threatening conditions dipped significantly during periods of COVID restrictions (shaded areas).

Impact on Referrals Volume by Urgency 2020-2021 (vs 2019)

CONCLUSION There can be no doubt about the impact COVID-19 has had on eye health and eyecare services in Australia, with significant reductions in the number of patients referred for specialist care the result of a critical lack of access to eyecare services. As we move to the new normal, the focus for our industry must now be on ensuring access to care for all these patients who were not able to attend their regular eye test, particularly those with potentially sight-threatening conditions such as glaucoma. We must continue to collaborate with patient education and support services like KeepSight and Glaucoma Australia to ensure that all Australians are aware of the importance of regular eyecare and are actively encouraged to return if their care has been delayed.

Figure 2: COVID-19 impact on referral volume by urgency in NSW, Victoria and other Australian states in 2020 and 2021, which dipped compared to pre-pandemic 2019.

Overwhelmingly, the negative impact on Australians’ eye health resulting from COVID-19 restrictions over the past 18 months points to a pressing need to ensure primary optometry services are always open and accessible to support patients with their eye health. n

INSIGHT February 2022 17

The role of complement factor B protein in age-related macular degeneration (AMD) Phase 2 clinical trial investigates reducing complement factor B protein to treat geographic atrophy (GA) Sponsored by Ionis Pharmaceuticals

The GOLDEN Study Ionis Pharmaceuticals is currently enrolling Australian patients in the GOLDEN Study, a Phase 2 clinical trial investigating the safety and effectiveness of IONIS-FB-LRX for GA secondary to AMD. Patients 50 years of age or older with a medical diagnosis of AMD and GA in at least one eye may prequalify to participate in the GOLDEN Study. The study involves a screening period to determine whether patients can safely participate based on their medical history and current health. For those enrolled, there will be a 45-week treatment period and a 12-week follow-up period. Numerous precautions are in place to ensure the health and wellbeing of all current and potential clinical trial participants given the COVID-19 pandemic.

Ionis Pharmaceuticals Inc. is registered at 2855 Gazelle Ct, Carlsbad, CA 92008, United States. Date of preparation: December 2021

An investigational RNA-targeted approach to address one of the root causes of dry AMD We have seen RNA-based vaccines be hailed as scientific saviours this year in response to COVID-19. However, the potential of RNA-targeted therapies to treat and prevent a variety of disease has long been recognised by some scientists. The RNA-targeted investigational therapeutic, IONIS-FB-LRX leverages antisense medicine to modulate the over-activity of the complement system. Specifically, IONIS-FB-LRX seeks out, binds to and destroys the specific messenger RNA (mRNA) in the liver to reduce the production of complement factor B protein that is found in the blood and eyes, and directly addresses one of the root causes of GA. IONIS-FB-LRX is delivered by a single monthly subcutaneous injection in the abdomen or thigh, rather than in the eye, and has the potential to treat both eyes with a single administration. This is particularly important given people with GA in one eye are more likely to develop it in the other.1 Pre-clinical studies have already shown promising results in cynomolgus monkeys treated for 13 weeks. Systemic antisense oligonucleotide (ASO) administration resulted in a reduction of ocular and systemic complement factor B protein.2

Image displaying extracellular deposits (drusen) and thinning of the choriocapillaris.

We are incredibly fortunate to live in an era where there are many emerging options for people diagnosed with Geographic Atrophy. The ability to slow down the pace of growth of atrophic patches will not only protect against vision loss but provide individuals with the ability to keep driving, reading and recognising faces.

Whilst we are on the cusp of witnessing new treatment options for Geographic Atrophy it is vital that we recruit eligible patients to suitable clinical trials to both determine the effectiveness of the treatments but importantly ensure our patients receive the best care available to them.

Professor Robyn Guymer CERA Deputy Director, Head of Macular Research

Background information: AMD, GA and the complement system In Australia approximately one in seven adults over 50 has the early signs of AMD3 and are at risk of, disability, loss of productivity and other quality of life challenges that are associated with vision loss.4,5 The development of a variety of complement-mediated diseases throughout the body, including dry AMD is strongly associated with part of the body’s own immune system called the ‘complement system’. Over-activation of complement pathways allows the complement system to damage host cells – in this case, the retina, retinal pigment epithelium (RPE). This damage is cumulative so that the greatest predictive risk factor in vulnerable people is age.6 Additionally, studies have shown systemic complement factor B protein circulating in choriocapillaris and posterior retina as retinal degeneration occurs.7 GA in AMD is characterised by the accumulation of extracellular deposits (drusen) and thinning of the choriocapillaris, leading to the formation of islands of photoreceptor and RPE loss that rapidly enlarge and encircle the fovea until the central vision is

Talk to your GA patients about their potential to participate in the GOLDEN Study If you know a patient who fits the criteria above and would like to refer them for enrolment in the GOLDEN Study, please contact ionisNCT03815825study@ clinicaltrialmedia.com or call 1800 932 037. To learn more about the clinical trial and eligibility, visit ionistrials.com/golden-study. IONIS-FB-LRX is an investigational therapy and has not been approved for use by any regulatory authority.

lost.5,8 GA has been shown to have modulating local complement pathway activity at sites of degeneration of the retina and choriocapillaris. Unfortunately, there are currently no proven treatment options to arrest or reverse GA. However, the role of complement factor anomalies in the causation of AMD gives hope that complement targeted therapy could address the underlying cause and give patients with advanced cases of dry AMD a better chance to preserve one of the most important senses for navigating daily life.

About Ionis Pharmaceuticals For more than 30 years, Ionis Pharmaceuticals, a biotechnology company, has been the leading innovator in RNA-targeted therapeutics, pioneering new markets and changing standards of care with its novel antisense technology.

References: 1. Low Vision. National Eye Institute. May 2020. Available from: https://www.nei.nih.gov/learn-about-eye-health/eye-conditionsand-diseases/low-vision Accessed: November 2021. 2. Grossman TR et al. Molecular Vision 2017 Aug; 23:561-571. 3. Mitchell P et al. Ophthalmology 1995 Oct;102(10):1450-60. 4. Fast Facts of Common Eye Disorders. Center for Disease Control and Prevention. June 2020. Available from: https:// www.cdc.gov/visionhealth/basics/ced/fastfacts.htm Accessed: November 2021. 5. Fleckenstein M et al. Nature Reviews Disease Primers 2021 May; 6:7(1):31 6. Age-Related Macular Degeneration (AMD) Data and Statistics. National Eye Institute. July 2019. Available from: https://www.nei.nih.gov/ learn-about-eye-health/outreach-campaigns-and-resources/eye-healthdata-and-statistics/age-related-macular-degeneration-amd-data-andstatistics. Accessed: November 2021. 7. Loyet K et al. IOVS 2012 Sept; 53:6628-6637 8. Keenan TD et al. Ophthalmology 2018;125(12):1913-1928.

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1. Baker D, Barnebey H, Moster M, et al. Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma. Ophthalmology. May 2021. DOI: https://doi.org/10.1016/j.ophtha.2021.05.023. IMPORTANT SAFETY INFORMATION. For indications of use, please visit www.glaukos.net.au/indications/ © 2021 Glaukos Corporation. Glaukos is a registered trademark of Glaukos Corporation. Preserflo is a registered trademark of Santen. PM-AU-0189

RANZCO PREVIEW

Brisbane, Australia

THE RETURN OF THE RANZCO CONGRESS IN 2022

fter two postponements, the 52nd RANZCO Scientific Congress is going ahead 25 February – 1 March, marking a longawaited return to a face-to-face event on the Australian ophthalmic calendar.

region and further afield. RANZCO has been determined to run a face-to-face event and says it has been fortunate the venue has allowed to move it twice, in addition to flexible invited speakers and delegates.

The world is much different than when the last in-person congress ran more than two years ago, and attendees can expect a slightly different event at the Brisbane Exhibition and Events Centre, with COVID-19 protocols and the event being run in a hybrid format.

With the event being three and half days of scientific lectures and content, the college believes it’s more than a science meeting, with robust and lively conversations occurring during the breaks, in hallways, outside lecture rooms and the many social functions.

This year, the congress’ Scientific Program Committee (SPC), chaired by Dr Elsie Chan, received more than 400 submissions for abstracts and nominated invited speakers. The exhibition has been sold out, but delegate numbers were expectedly lower than usual, at the time of writing. Overall, in-person registration has been higher than virtual, and organisers were optimistic these would increase with the Queensland border re-opening. Most virtual delegates are expected from New Zealand, the

“There is no doubt that the opportunity to connect with other attendees is critical. Learning is embedded through conversations, discussions and debate. As chair of the SPC, my main role has been to construct a congress that appeals to general ophthalmologists as well as subspecialists,” Chan said. Think Business Events has been tasked with delivering the congress as a hybrid event. Ms Denise Broeren, of Think Business Events, said it would be akin to running two

"BOTH THE IN-PERSON AND VIRTUAL AUDIENCES WILL HAVE THE SAME ACCESS TO POSING QUESTIONS TO THE SPEAKERS" DENISE BROEREN, THINK BUSINESS EVENTS

conferences, considering the in-person and virtual experience. “There will be live broadcasts from each session room in the centre and added complexity when we also have speakers presenting virtually in amongst the in-person speakers. Then we factor in incorporating the technology and production to ensure a seamless delivery. We have cameras that don’t need to be staffed and are operated digitally to capture the best imagery to stream through to the virtual platform,” she said. “We are setting up a virtual platform for our virtual audience to access the sessions. This will also integrate with the congress app so both the in-person and virtual audiences will have the same access to posing questions to the speakers.” The Local Organising Committee has also been involved, overseeing the social program, while the Congress Executive has been responsible for the integration of a new Professional Development Stream, being introduced this year. n

INSIGHT February 2022 21

RANZCO PREVIEW

INVITED SPEAKERS

RANZCO CONGRESS OPENING LECTURE SAT 26 FEB DR JOHN TASKE MBBS (QLD), DTM&H (LOND), FFARACS, FANZCA In his presentation ‘High Stakes Decision Making – An Everest Tale’, retired anaesthetist Dr Taske will tell an author’s story of what was Mt Everest’s greatest disaster at the time. It’ll include an interesting ophthalmological incident and the pathophysiology of high altitude acclimatisation, as well as the story of the summit attempt and a subsequent disaster, with insight into decision making at altitude.

THE DAME IDA MANN MEMORIAL LECTURE SAT 26 FEB PROF ALEX HEWITT BMEDSCI (HONS), MBBS (HONS), MMEDSCI, PHD, FRANZCO ‘The Dawn of Precision Ophthalmology in the Asia Pacific’, presented by Tasmanian ocular genetics expert Prof Hewitt, will focus on adaptation of the CRISPR/Cas system to mammalian cells, a revolution set to reshape inherited disease treatments. While ocular conditions will be at the forefront, Hewitt believes a major shift in the Australian biotechnology and healthcare sectors must occur to ensure this becomes reality.

REFRACTIVE UPDATE LECTURE SUN 27 FEB DR DAMIEN GATINEL MD, PHD In ‘Artificial Intelligence: Applications for Pathologies of the Anterior Segment of the Eye’, Dr Gatinel will discuss AI techniques, including for studies that characterised the alterations observed during the evolution of keratoconus, and the spatial distribution of corneal oedema using neural networks to tomographic image analysis. Among other topics, he will discuss using AI and the results from the ocular wavefront to estimate the real impact of high degree aberrations on subjective refraction.

CATARACT UPDATE LECTURE SUN 27 FEB DR DAVID LOCKINGTON MB BCH BAO (HONS) FRCOPHTH PHD Although surgical simulation has partly filled some training gaps during COVID, Dr Lockington believes it should have played a greater role earlier. His lecture ‘Ensuring a Safe Cataract Experience for all through Embracing the Role of Simulation’, will consider historic teaching/training methods and show their inadequacy. He will then discuss established and new simulation equipment, and how they will ensure trainees have the knowledge and experience to perform surgical tasks before live surgery.

THE NORMAN MCALISTER GREGG LECTURE SUN 27 FEB PROF GRAHAM BARRETT FRACO FRACS The WA ophthalmologist behind the Barrett IOL formulae will host a discussion ‘When and How to Treat Low Levels of Astigmatism’. With improvements in toric IOL prediction driving increased use, gone are the days of leaving significant astigmatism when extracapsular surgery was widely practised. Today, with small incision surgery and phacoemulsification, he believes achieving less than 0.5 D in all patients is preferable and could be considered a standard of care.

NEURO-OPHTHALMOLOGY LECTURE MON 28 FEB DR LYNN GORDON MD, PHD In ‘Neuro-ophthalmic Complications of Immune Checkpoint Inhibitor (ICI) Therapy for Cancer: Lessons Learned through Case Reports and Big Data’, Dr Gordon will delve into the innovative cancer therapy and its association with issues such as dry eye, uveitis and multiple neuro-ophthalmic complications. She will highlight why coordination between ophthalmologists and oncologists is suggested for ICI patients.

RETINA UPDATE LECTURE MON 28 FEB DR ANITA AGARWAL MD Dr Agarwal’s ‘Gene Testing Reveals New Insights into Retinal Dystrophies’, will cover several issues, including examples of novel gene mutations causing a particular phenotype, unexpected gene mutations of a known phenotype and extreme phenotype differences within family members. She will also delve into methods to confirm a disease-causing gene defect, and summarise a combined clinical and genotyping approach towards diagnosis in a clinical setting.

INSIGHT February 2022

THE COUNCIL LECTURE MON 28 FEB A/PROF CLARE FRASER MBBS (HONS), MMED, FRANZCO ‘Seeing Stars, Stones and Snow’ by A/Prof Fraser will explore recent advances in three areas of neuro-ophthalmology from her research. Areas of discussion include diagnosis and management of acute concussion, post-concussion syndrome and chronic traumatic encephalopathy; increasing research into the nature of disc drusen, how they progress and the risks to a patient's vision; and finally visual snow syndrome, an increasingly recognised visual phenomenon that now has its own set of diagnostic criteria.

GLAUCOMA UPDATE LECTURE TUE 1 MAR DR PRADEEP YAMMANURU RAMULU MD, PHD Dr Ramulu’s ‘Novel Concepts in Evaluating Functional Damage in Glaucoma’ lecture will present data on the strengths and pitfalls of new algorithms for rapid field testing and offer evidence-based insights on integrating visual field reliability data into clinical decision making. Emerging technologies will also be discussed, and methods to assess patients’ quality of life in the daily flow of clinical care.

THE FRED HOLLOWS LECTURE TUE 1 MAR A/PROF CATHERINE GREEN AO MBCHB, FRANZCO, MMEDSC, MSURGED ‘Disruption and Innovation: Challenges and Opportunities in Ophthalmology’ by A/Prof Green will discuss the potential for innovation brought about by the disruption of COVID. While it’s important to promote sustaining innovations that improve on current technology, she will say that it’s also important to look for truly transformative innovations that provide opportunities in ways not previously considered.

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RANZCO PREVIEW

EXHIBITORS

NEW LASERS TO FEATURE ON DEVICE TECHNOLOGIES EXHIBIT Device Technologies will unveil a new ophthalmic laser portfolio at RANZCO 2022, following a fresh ANZ distribution deal with Meridian Medical. With manufacturing facilities located in Thun, Switzerland, Meridian’s ophthalmic laser systems include retinal photocoagulation, YAG lasers, delivery devices, protection filters and consumables, including laser probes. Cataract and refractive surgeons may also be interested in one of Haag-Streit’s latest products, The Eyestar 900, on the Device Technologies booth #64. The swept-source OCT-based eye analyser is said to enable precise measurement, and topographic assessment of the front and back corneal surface including the anterior chamber and intraocular lens, as well as imaging of all these structures. It also includes cornea-to-retina biometry.

LUMIBIRD MEDICAL PRESENTS COMBINED PRODUCT PORTFOLIO The combined Ellex/Quantel Medical product portfolios offer a suite of advanced treatment solutions to drive greater value to ophthalmologists. The company is urging delegates to visit its exhibit to discover more on its range of multi-modality YAG lasers – including the latest Reflex Technology platforms – and its retinal laser portfolio, providing some of the most advanced treatment solutions to cover a broad range of pathologies. Also on display will be the manufacturer’s complete suite of diagnostic solutions, including the ABSolu – A/B/S/ UBM ultrasound with five ring annular imaging technology, in addition to the Compact Touch – A/B/P portable ultrasound, featuring real-time dynamic imaging enabling the clinician to view, diagnose and treat more accurately and efficiently than before.

“This level of diagnostic imaging allows the user to easily verify any measurement and to identify anatomical anomalies that may interfere with planned surgical procedures, whilst also offering the ability to review a patients’ suitability for specific interventions, such as toric- or multifocal IOL, which makes the Eyestar an ideal surgical planning partner for cataract and refractive surgeons,” Device Technologies states.

RANZCO 2022 will also mark some exciting advancements across Ellex/Quantel Medical’s dry eye portfolio. The company can be found at exhibit #45.

GLAUKOS LAUNCHING LATE-STAGE GLAUCOMA IMPLANT

NEW LIGHT-WEIGHT INDIRECT OPHTHALMOSCOPE

After securing TGA approval in mid-2021, Glaukos will be launching the PRESERFLO MicroShunt to the Australian and New Zealand1 market at RANZCO.

The congress will be a key opportunity for Heine to present its newest indirect ophthalmoscope, featuring a revamped design to significantly improve the user experience.

The controlled, ab externo filtration device is said to deliver a unique combination of efficacy and safety for patients with primary open-angle glaucoma (POAG). The PRESERFLO MicroShunt is intended for the reduction of IOP in patients with POAG where IOP remains uncontrollable while on maximum tolerated medical therapy and/or where disease progression warrants surgery.

The German medical device company recently launched the OMEGA 600, which is said to be the lightest high-end indirect ophthalmoscope on the market. This is due to several innovations, including a new ultralight lithium polymer battery allowing the eyecare professional to work more comfortably while reducing strain on the spine. Despite the compact design, the battery achieves eight full hours’ operation, on average, depending on the light intensity.

Engineered to control IOP while decreasing post-operative risk, the device is 8.5mm in length and made from proprietary, biocompatible material called SIBS [poly(styrene- blockisobutylene-block-styrene)]. According to the company, it is flexible and features a 70 μm lumen to optimise aqueous flow and decrease hypotony risk; a 3 mm distal tail enables formation of posterior bleb; the 1 mm fin prevents migration and periannular leakage and a beveled tip visually aids in correct device orientation1-3 (references available upon request). Glaukos will be located on exhibit #37.

Other features include visionBOOST technology, which the company says significantly improves retina exams for cataract patients, with up to 20% better view. The device features highgrade LEDs to achieve bright and homogeneous illumination for the fundus with realistic colour rendering. A sophisticated surface design with few openings and dustproof seals also allows for easy cleaning and disinfection. Heine is offering a five-year guarantee on the quality of its materials, workmanship, and design. Heine will be on display at the Device Technologies booth #64.

INSIGHT February 2022

Vivinex™ CLARITY OF VISION AND OUTSTANDING ROTATIONAL STABILITY

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DV1251-1221

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hoyasurgicaloptics.com

1. Glistening-free per Miyata scale; study result of the David J Apple International Laboratory for Ocular Pathology, University Hospital Heidelberg. Report on file. 2. Clinical Evaluation of the HOYA Vivinex™ IOL, HOYA data on file DoF-PHIV-101-SP2-24mIR-20082019 (2019). 3. Pérez-Merino P, Marcos S. Effect of intraocular lens decentration on image quality tested in a custom model eye. J Cataract Refract Surg. 2018;44(7):889–896.

RANZCO PREVIEW

EXHIBITORS

AFT PHARMACEUTICALS PRESENTS ITS PRESERVATIVE-FREE PORTFOLIO The NovaTears eye drop range will be a feature of the AFT Pharmaceuticals exhibition, off the back of a positive post-market study into its latest product NovaTears + Omega-3 (pictured).

In 2022, AFT will launch Ocuzo (chloramphenicol), a preservativefree drop for bacterial eye infections, and a prescription glaucoma therapy under the brand name Vizo PF.

The therapy is a line extension of the original NovaTears, which AFT launched in 2018 for evaporative dry eye disease. Introduced locally in 2020, NovaTears + Omega-3 is said to be the first combining the tear film stabiliser perfluorohexyloctane with concentrated Omega-3 fatty acids derived from algae (suitable for vegans). AFT, which is licensed to distribute the Novaliq-produced NovaTears range in ANZ, reported a recent multi-centre, single arm, post-market study found the therapy delivered clinically relevant and statistically significant improvements in dry eye symptoms in 36 patients over eight weeks. “The improvements were evident on a broad range of measures including total corneal staining (NEI scale) and tear film break-up time over the course of the study,” AFT stated. “Of particular interest was the meibomian gland assessment score which improved from an entry level score of 7.1 to 3.0 (p<0.0001) over the course of the study. The latter result supports the hypothesis that the treatment might liquify meibum secretion excreted from the meibomian glands.”

PBS Information: Xalatan (latanoprost 0.005% eye drops, 2.5 mL) is listed on the PBS as antiglaucoma preparations and miotics.

Before prescribing please review Product Information available via www.aspenpharma.com.au/products or call 1300 659 646.

A first choice for glaucoma management1

✔

If clinically necessary for the treatment of your patient, prescribe by brand and disallow brand substitution2

Minimum Product Information: XALATAN® (Latanoprost 50 μg/mL) Eye Drops. Indication: Reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Contraindications: Hypersensitivity to ingredients. Precautions: Change in eye colour due to increased iris pigmentation, heterochromia; eyelid skin darkening; eyelash and vellus hair changes; aphakia; pseudophakia; macular oedema; other types of glaucoma; contact lenses; severe or brittle asthma; herpetic keratitis; driving or using machines; elderly; children; lactation. Pregnancy: Category (B3) Interactions: other prostaglandins, thiomersal. See PI for details. Adverse Effects: Iris hyperpigmentation; eye irritation (burning, grittiness, itching, stinging and foreign body sensation); eyelash and vellus hair changes (increased length, thickness, pigmentation and number of eyelashes); mild to moderate ocular hyperaemia; punctate keratitis; punctate epithelial erosions; blepharitis; eye pain; excessive tearing; conjunctivitis; blurred vision; eyelid oedema, localised skin reaction on eyelids; myalgia, arthralgia; dizziness; headache; skin rash; eczema; bronchitis; upper respiratory tract infection; abnormal liver function. Uncommon: Iritis, uveitis; keratitis; macular oedema; photophobia; chest pain; asthma; dyspnoea. Rare: periorbital and lid changes resulting in deepening of the eyelid sulcus; corneal calcification. See PI for details and other AEs. Dosage and Administration: One eye drop in the affected eye(s) once daily. Other eye drops should be administered at least 5 minutes apart. (Based on PI dated 2 March 2021) References: 1. NHMRC Guidelines for the screening, prognosis, diagnosis, management and prevention of glaucoma 2010 2. Australian Commission on Safety and Quality in Healthcare Active Ingredient Prescribing Guide - list of medicines for brand consideration December 2020 Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma. com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2021 Aspen group of companies or its licensor. All rights reserved. Prepared: June 2021 AF05768 ASP2528

EXPLORE

New visionBOOST for cataract patients: proven to deliver up to 20 % better view of the retina in patients with cataracts*.

Discover the OMEGA 600

Visit Device Technologies at the 52nd RANZCO Congress at booth #64

1300 DEVICE (338 423)

customers@device.com.au

www.device.com.au

RA:01072021FS

The new HEINE OMEGA 600 is the lightest^ high-end indirect ophthalmoscope, offers high wearing comfort and provides you with high quality optics, providing an incredibly sharp image and reliable colours. Along with the capability to explore the whole retina, including the far periphery.

*Data on file ^Compared to the previous model OMEGA 500

The new HEINE OMEGA 600 indirect ophthalmoscope

RANZCO PREVIEW

EXHIBITORS

NEW ATROPINE SULFATE 0.01% EYE DROPS Aspen Australia is launching new ophthalmic prescription eye drops on exhibit #30 at RANZCO. EIKANCE 0.01% is indicated as a treatment to slow the progression of myopia in children aged from four to 14 years. Atropine treatment may be initiated in children when myopia progresses ≥-1.0 D per year.1 According to the company, EIKANCE 0.01% single-use ampoules are sealed in foil pouches and are available in packs of 30 x 0.3mL ampoules. The ophthalmic solution is sterile and preservative-free. The therapy is available on prescription at community pharmacies across Australia from February 2022, and is not listed on the Pharmaceutical Benefits Scheme. Before prescribing, please review product information on page 63 of this publication. Reference: 1.Eikance Approved Product Information

B+L ACTIVITIES FOCUS ON IOLS In addition to showcasing its enhanced enVista IOL platform, Bausch + Lomb will host an event featuring a panel of global authorities in cataract surgery. The company’s ‘IOL Formulas - The short and long of it’ morning symposium will host an expert group reviewing the evolution and development of IOL formulas while discussing their similarities and differences to assist in improving refractive outcomes. The event, taking place Sunday 27 February 7am – 8:15am in room M1 & 2, will be moderated by prominent Sydney eye surgeon Professor Gerard Sutton, with key speakers to include Singapore’s Dr Tun Kuan Yeo – inventor of the EVO formulas – France’s Dr Damien Gatinel and Australian Dr Nishant Gupta. On exhibit #27, B+L will spotlight its upgraded family of enVista IOLs, comprising what it describes as a premium monofocal and a toric design. The IOL, which features an enhanced lens material, is said to deliver superb visual acuity, consistent performance, and outstanding patient outcomes. “The enVista family of lenses – monofocal and toric – have a unique set of features that help compensate for the eye’s natural imperfections and deliver outstanding visual outcomes to a wide range of patients,” the company says. “With its advanced aberration-free optic, enVista provides a desirable compromise between depth-offield and image quality.” Both the monofocal and toric are also now preloaded with the SimplifEYE delivery system, enhancing procedural efficiency.

NOVA EYE MEDICAL ADVANCES ITRACK MIGS TECHNOLOGY

SPOTLIGHT ON SILVERSTONE AT THE OPTOS BOOTH

Australia’s Nova Eye Medical will preview its latest generation canaloplasty device, iTrack Advance, at the RANZCO 2022 meeting on booth #14.

The congress will be another key opportunity for Optos to showcase its Silverstone imaging device, which the company describes as an industry-first combining ultra-widefield (UWF) retinal imaging with integrated, image-guided, swept-source OCT.

First launched in 2008, the company describes its iTrack canaloplasty microcatheter for glaucoma as both an engineering feat and a clinical triumph. Measuring 250 microns in diameter – the equivalent of several strands of hair – the device comprises a sophisticated set of inner workings including a proprietary guide-wire mechanism that enables it to traverse the full 360° of Schlemm’s canal in a single intubation. It also features a fiber optic for illuminating the distal tip. Based on the same principles as angioplasty, Nova Eye says canaloplasty performed with the iTrack canaloplasty microcatheter combines 360° catheterisation and pressurised viscodilation to treat all points of blockage in the conventional outflow system – reducing IOP to the low-teens. Importantly, it states canaloplasty provides surgeons with a stent-free, tissue-sparing glaucoma surgery for earlier intervention in the glaucoma treatment paradigm.

INSIGHT February 2022

According to the company, Silverstone produces a 200° single capture optomap image with guided OCT, allowing advanced OCT imaging anywhere across the retina, from posterior pole to far periphery. This is said to provide unparalleled UWF guided multimodal imaging in support of detection, investigation and monitoring of retinal disease. “Silverstone provides greater imaging functionality, and it combines colour, autofluorescence (AF), fluorescein (FA) and indocyanine green (ICG) angiography with SS-OCT imaging capabilities,” the company says. “A comprehensive exam that includes an ultra-widefield optomap image has been shown in clinical studies to enhance pathology detection and disease management, as well as to improve clinic flow. Now by integrating SS-OCT, Silverstone further facilitates detailed examination of the retina from vitreous through the choroidal-scleral interface and helps guide treatment decisions.” Silverstone’s UWF guided, SS-OCT images pathology anywhere on the optomap. It also features a 1050 nm OCT light source, providing deeper tissue penetration for clear, detailed choroidal imaging, while 3-in-1 Color Depth Imaging offers important clinical data from the retinal surface through the choroid. Optos will be located on booth #28.

INTRODUCING THE NEW

EYESTAR 900

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RANZCO PREVIEW

EXHIBITORS

ZEISS TO HIGHLIGHT NEW DEVICE AND DATA MANAGEMENT SYSTEMS During RANZCO Brisbane, the ZEISS booth will feature an array of major product launches, with the company also set to host several interactive face-to-face events. ZEISS Cataract Workflow will highlight developments in devices and data management. The QUATERA 700 will be unveiled for the first time at the congress, which the company says represents a new experience in phacoemulsification, using its patented QUATTRO Pump for chamber stability independent of IOP and flow. The system brings together all elements of Cataract Workflow, rendering it as the ophthalmologist’s single sterile operating room cockpit for a more effective and efficient cataract procedure.

The VISUMAX 800.

The company will also be showcasing EQ Workplace. Building on the ZEISS FORUM data management solution, the software helps save time during pre-operative processes, protects against IOL

transcription errors and allows access data from anywhere in the clinic. The conference will also be the first viewing of the VISUMAX 800 for the majority of attendees, with ZEISS stating the technology represents the latest generation of its femtosecond lasers, offering reduced laser time in comparison to its predecessors while making tissue separation with SMILE pro from ZEISS easier than previously. Intelligent robotic assistant systems, such as cyclotorsion and centration aid, help in enhancing control during your procedures. The VISUMAX 800 is also digitally connected to Refractive Workplace from ZEISS to streamline the clinic’s digital workflow and offer comprehensive remote planning outside the operating room. The user can select their nomograms in the planning section and the values will be automatically updated to show correct adjustments and parameters. The QUATERA 700.

AN ARRAY OF SURGICAL AND DIAGNOSTIC EQUIPMENT ON THE DFV BOOTH Designs For Vision (DFV) will be introducing new additions in surgery and diagnostics at RANZCO, as well as celebrating the 20th birthday of OCULUS Pentacam. Expanding on a comprehensive portfolio, the supplier will be showcasing its latest technology for ophthalmic surgery, with phacoemulsification and ophthalmic microscopes. DFV is representing Leica Microsystems in Australia and New Zealand, and will be exhibiting the manufacturer’s Leica Proveo8 surgical microscope (pictured right) in conjunction with the groundbreaking EnFocus intraoperative OCT. Providing greater detail for both anterior and posterior surgeries, with up to 1,000 B-scans, DFV says it offers surgeons a complete understanding of subsurface tissue behaviour in real time for best possible patient outcomes. Elsewhere, DFV says a Swiss ophthalmic innovation called “Sophi” is marking a revolution in phacoemulsification. The wireless Sophi phaco system was designed in Switzerland by THIS AG to make the work of the surgical team simpler, safer and more efficient. Sophi is said to provide a range of features that improve mobility, convenience and usability in the operating theatre. Designed for predictability and

INSIGHT February 2022

control, the triple pump fluidics include a dedicated pump for IOP control. With an important focus on sustainability – reducing waste and cost – Sophi utilises a day cassette. In terms of diagnostic innovations, DFV will be presenting the iCare's EIDON high resolution TrueColor Confocal fundus imaging, which has been enhanced with the new ultra widefield module – increased field of view up to 200°. The EIDON family offers multiple imaging modalities, including fluorescein angiography in ultra-high resolution. Finally, DFV is celebrating the 20th birthday of the OCULUS Pentacam (pictured left), which it says is an important member of the team for many practices. Since its introduction in 2002, the device has proven itself indispensable and become the gold standard in anterior segment tomography. Since launch, the Pentacam family has expanded to include even more tools and functionality. Now the most versatile member of the family, the Pentacam AXL WAVE, combines Scheimpflug imaging and full anterior segment measurement with optical biometry and wavefront aberrometry of the entire eye.

It’s time to take a different approach to the outflow pathway. While other MIGS procedures bypass or remove diseased portions of the conventional outflow pathway, canaloplasty employs a uniquely different approach that is both stent-free and tissue-sparing. Learn more about iTrack™ and canaloplasty at RANZCO Booth #14

© 2022. Nova Eye, Inc. E&OE. Patents pending and/or granted. iTrack™ is a trademark of Nova Eye, Inc. iTrack™ has a CE Mark (Conformité Européenne) and US Food and Drug Administration (FDA) 510(k) # K080067 for the treatment of open-angle glaucoma. 1. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg. 1999;25(3):316-322. 2. Grieshaber MC, Pienaar A, Olivier J, Stegmann R. Clinical evaluation of the aqueous out ow system in primary open-angle glaucoma for canaloplasty. Invest Ophthalmol Vis Sci. 2010;51(3):1498-1504. 3. Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm’s canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology. 2002;109(4):786-792.

The most powerful tool yet for examining the retina. The only ultra-widefield retinal imaging device with integrated, optomap guided swept source OCT. Silverstone produces a 200° single-capture optomap® image in less than ½ second and enables guided OCT scanning across the retina and into the far periphery.

EXPERIENCE SILVERSTONE AT RANZCO BRISBANE 25 FEB – 1 MAR 2022 BOOTH 28

Image: PDR and DME with tractional retinal detachment

T: (08) 8444 6500 – AUS T: +618 8444 6500 – NZ E: auinfo@optos.com

Optos.com

LEARNING OBJECTIVES: At the completion of this CPD activity, optometrists will have developed their knowledge of the ocular and systemic conditions involved in the care of patients with inherited retinal diseases (IRDs).

Including: • Classification of IRDs; common IRD signs and symptoms • Key clinical investigations, including imaging technologies, to determine subtypes of IRDs • Understanding the referral guidelines for patients with IRDs • Knowing the low-vision and blindness support services available for people with IRDs

CPD

DETECTION OF INHERITED RETINAL DISEASES IN PRIMARY CARE In the first of Insight's two-part series of educational articles on inherited retinal disease, A/PROF LAUREN AYTON and DR TOM EDWARDS discuss the common presentations and when and where optometrists can refer patients who have them.

ith the recent regulatory approval of the retinal gene therapy voretigene neparvovec-rzyl (Luxturna) for people with RPE65-associated Leber Congenital Amaurosis, there has been a significant shift in the management of inherited retinal disease (IRD). While challenges remain and emerging treatments such as gene therapy and stem cells will not be for all, it is a time of optimism for people with these conditions. IRDs comprise a large number of rare single gene disorders, which together form the largest cause of legal blindness in workingaged Australians.1 IRDs affect up to 1 in 3,000 individuals around the world.2 In recent years, our understanding of IRD has improved dramatically, paralleled by rapid technological advances in gene manipulation and therapeutics. For example, in the 1980s only a handful of genes were known to be responsible for IRD. There are now over 250 known genes,

with this number continuing to grow.3 Often people with IRD will initially develop vague and intermittent symptoms. Others are detected incidentally through a routine eye examination. Both scenarios can mean that primary eyecare providers, such as optometrists, can often be the first clinician to detect an abnormality. To ensure early diagnosis, and access to potential therapies as they emerge, it is important optometrists are aware of the common presentations of IRD, including signs, symptoms and family history. Due to the emerging treatment options, it is also important optometrists are aware of when and where to refer people with IRD. This includes both clinical referral pathways (outlined in further detail in the RANZCO Guidelines for the Assessment and Management of Inherited Retinal Degenerations4) and for access to research opportunities. A companion article in this issue, ‘Inherited Retinal Diseases – The patient journey' by Profs John Grigg and Robyn Jamieson (pages

ABOUT THE AUTHORS: A/Prof Lauren Ayton1-3 (BOptom PhD GCOT FAAO FACO) Dr Thomas Edwards2,3 (MBBS, PhD, FRANZCO) 1. Department of Optometry and Vision Sciences, The University of Melbourne 2. Department of Surgery (Ophthalmology), The University of Melbourne 3. Centre for Eye Research Australia, The Royal Victorian Eye

and Ear Hospital

37-39), will further discuss the challenges and intricacies of management of people with these genetic conditions. CLASSIFICATION OF IRD To date, several classification schemes have been proposed for IRD. Our group at the Centre for Eye Research Australia (CERA) and The University of Melbourne uses a taxonomy proposed by Coco-Martin et al,5 which divides the diseases into i) panretinal pigmentary retinopathies, affecting primarily rods or cones with widespread retinal involvement; ii) macular dystrophies with only central involvement; iii) stationary diseases (non-progressive conditions); and iv) other less frequent IRDs, such as vitreoretinopathies (Table 1).

Figure 1: An example of the fundus appearance from a patient with RPGR-associated X-linked retinitis pigmentosa (RP), showing bone spicule pigmentation, waxy optic nerve pallor and blood vessel attenuation. The RPGR gene is estimated to cause up to 20% of cases of RP.7 Image courtesy of the VENTURE Study, Centre for Eye Research Australia and The University of Melbourne.

Most classification schemes divide the diseases in this manner, isolating those which affect the macular and central vision (Best disease, Stargardt disease, macular dystrophy) from the more widespread pigmentary retinopathies, which generally (but not always)

INSIGHT February 2022 33

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Panretinal pigmentary retinopathies

Macular dystrophies

Bietti Crystalline Dystrophy Choroideremia Cone dystrophy Cone-rod dystrophy Leber congenital amaurosis Rod-cone dystrophy, including retinitis pigmentosa Autosomal recessive bestrophinopathy Best vitelliform macular dystrophy Central areolar choroidal dystrophy Doyne honeycomb retinal dystrophy Macular dystrophy Stargardt’s disease/Fundus flavimaculatus

Stationary diseases

Achromatopsia and dyschromatopsia Congenital stationary night blindness

Hereditary viteoretinopathies

X-Linked retinoschisis

Table 1: Classification of inherited retinal diseases

affect the peripheral vision first. In general, IRDs are monogenic diseases, which follow Mendelian inheritance patterns (autosomal dominant, autosomal recessive, X-linked, or isolated cases). Some forms of IRD are also passed down through families through mitochondrial inheritance patterns (neuropathy, ataxia and retinitis pigmentosa (NARP) syndrome). Pathological genetic variants may occur in a number of genes which are responsible for the health of retinal photoreceptor cells, retinal pigment epithelium (RPE), or choroid. Within each clinical category, age of onset, mode of inheritance, and rate of progression can all differ substantially, even between affected individuals in the same family. COMMON IRD SIGNS AND SYMPTOMS While the signs and symptoms can vary significantly between subtypes of IRDs, there are common features. A more thorough review of the likely IRDs for upcoming gene therapy interventions, including Leber congenital amaurosis, Stargardt disease and choroideremia, was recently published by our team at CERA.6 That review paper also provides more detailed explanations of the clinical tests of benefit in IRD assessment. A summary of optometric care is also found later in this article.

PRIMARY CONE AND MACULAR DYSTROPHIES These IRDs include cone-rod dystrophy and the macular IRDs (such as Best and Stargardt diseases). In contrast to the primary rod dystrophies, these conditions typically affect the macula most severely, and so are more likely to result in: •C entral vision loss (usually noted at both distance and near) • Photophobia • Dyschromatopsia (impaired colour vision) Age of onset of these symptoms can vary from birth until the sixth decade of life, and it is possible for people carrying IRD genetic mutations to remain asymptomatic.8 However, typically symptoms will begin in childhood or early adulthood. Not uncommonly, macular dystrophies can be confused with late

atrophic age-related macular degeneration or geographic atrophy. An example of Stargardt’s macular dystrophy is shown in Figure 2. Stargardt’s is characterised by symmetrical yellow-white flecks observed within the central retina, which are due to accumulations of lipofuscin at the level of the retinal pigment epithelium. IRDs can also be associated with systemic conditions. The most common of these is Usher syndrome, which results in dual sensory loss of both vision (from RP) and hearing, and can also cause vestibular dysfunction. Usher syndrome accounts for around 18% of cases of RP, and half of all cases of deaf-blindness.10 Other IRDs can form part of multi-system syndromes that can affect kidneys, neurological function, skeletal structure and metabolism). Hence, a full medical history is essential in the diagnosis of IRDs. OPTOMETRIC ASSESSMENT OF IRD PATIENTS Initially, rich data can be obtained through a thorough medical history. The age of onset of symptoms, the type of symptoms, and the presence of family history can all be clues as to the subtype of IRD and the inheritance pattern. The key clinical investigations for IRD within optometry scope-of-practice include: •B est corrected visual acuity, ensuring that you document if someone with central vision loss is using eccentric fixation or abnormal head position to read the letters • Pupil responses •A nterior segment examination, checking for associated cataract or raised intraocular pressure

PRIMARY ROD DYSTROPHIES IRDs which firstly affect the rod photoreceptors, such as retinitis pigmentosa, initially cause symptoms such as: • Nyctalopia (night blindness) •P eripheral vision loss. If this commences in the inferior field, patients may complain of tripping over objects. Retinitis pigmentosa (RP), the most common panretinal pigmentary retinopathy, has a ‘diagnostic triad’ of bone spicule pigmentation, attenuated blood vessels and optic nerve pallor (Figure 1). Patients with RP are prone to the development of posterior subcapsular cataracts and cystoid macular oedema.

INSIGHT February 2022

Figure 2: An Optos wide-field fundus autofluorescence image from a 24yo male with Stargardt’s disease (ABCA4 gene mutation), demonstrating the typical “flecks” and central atrophy. Autosomal recessive Stargardt disease represents the most common inherited macular dystrophy in children and young adults. Dominant cases are rare and are associated with a later adult onset and milder phenotype.9 Image courtesy of the VENTURE Study, Centre for Eye Research Australia and The University of Melbourne.

• Optical coherence tomography • Fundus autofluorescence •W ide-field colour and FAF imaging, which is particularly important in the pan-retinal pigmentary retinopathies •V isual field assessment. In order to accurately measure residual functional vision in the periphery, a manual perimetry method like Goldmann or Esterman binocular field is often needed. A detailed table of advised clinical evaluations, and timeframes for repeat examinations, is provided in the recent RANZCO guidelines for management of inherited retinal diseases.4 MANAGEMENT OF IRD Until recently, there were no commercially available treatments for IRD. The regulatory approval of an in-vivo gene therapy, Luxturna (voretigene neparvovec-rzyl), for people with a form of IRD caused by mutations in the RPE65 gene has changed this dramatically. First available in Australia in late 2020, this treatment not only offers hope to people with this specific IRD, but also those with other sub-types that are amenable to gene therapy. However, as detailed in the accompanying article by Profs

Study

Location

Institutes

Principal Investigators

Scope

Refer to

Victorian Evolution of IRDs - Natural History Registry (VENTURE)

Melbourne

Centre for Eye Research Australia and the University of Melbourne

A/Prof Lauren Ayton and Dr Tom Edwards

Clinical research visits and remote genotype/ phenotype data collection

Email: IRD@ groups.unimelb. edu.au Phone: (03) 8344 3441

West Australian Retinal Diseases study (WARD)

Perth

Lions Eye Institute

A/Prof Fred Chen

Clinical research visits

Email: fcreceptionist@ lei.org.au Phone: (08) 9381 0817

The Save Sight IRD Registry

Sydney

Save Sight Institute Prof John Grigg and Prof Robyn Jamieson

Clinical research visits

Email: ssi. operations@ sydney.edu.au

Australian Inherited Retinal Disease Registry and DNA Bank

Perth

Sir Charles Gairdner Hospital

Remote collection of samples for genotyping – holds the largest IRD biobank in Australia13

www.scgh. health.wa.gov.au/ Research/DNABank

Dr John De Roach

Table 2: Research organisations developing databases of people with IRDs for natural history investigations, as well as registries of people interested in upcoming clinical trials.

Grigg and Jamieson, there are still significant challenges with the implementation of these emerging treatments. Other treatment options may also one day be available for people with IRD. These include more specialised gene

editing treatments (using CRISPR technologies), stem cell therapies, and electrical stimulation devices (either vision prostheses for end-stage vision loss, or ‘electroceuticals’ – devices which help preserve neural function through low level

CPD

stimulation of remaining nerves). For now, the mainstay of management for IRD is supportive. Regular eye examinations are key, to monitor disease progression. This is important as some of the co-morbidities of IRD, such as posterior subcapsular cataract, epiretinal membranes and macular holes, can be treated. Patients with RP are also prone to developing cystoid macular oedema – again, a complication which can be managed to improve vision. Many people with photophobia, such as in cone-rod and macular dystrophies, benefit from sunglasses. Room lighting and improving contrast can significantly improve people struggling with nyctalopia. Management of people with IRD usually requires co-management; an ophthalmologist to diagnose and manage medical issues, optometrist to provide monitoring and provide refractive solutions and low vision therapists (including orientation and mobility instructors and occupational therapists). In addition, many patients will elect to undergo genetic testing to determine the causative mutation, which may mean further interaction with clinical geneticists and genetic counsellors. Indeed, RANZCO now states that genetic testing is the standard of care for people with IRD, using multigene testing strategies such as targeted next-generation sequencing panels, whole exome and whole genome sequencing.4 With current technologies, a causative mutation can be identified in up to 80% of IRD patients.11 More details on genetic testing are available in Profs Grigg and Jamieson’s accompanying article.

LOW VISION AND BLINDNESS SUPPORT SERVICES When a person is diagnosed with a progressive eye condition, such as an IRD, optometrists should also consider access to low vision and blindness support services. A recent referral pathway from Vision 2020 Australia suggests a referral to these services is offered at initial diagnosis, and then again at the point where the patient presents with visual acuity of less than 6/12, or comparable visual field loss.12 Some key support groups for people with IRD are:

OTHER RESOURCES For optometrists who wish to further upskill in the areas of IRD and retinal gene therapy, further details are available in these recent publications: O'Hare F, Edwards TL, Hu ML, et al. An optometrist's guide to the top candidate inherited retinal diseases for gene therapy. Clin Exp Optom 2021;104(4):431-43. Hu ML, Edwards TL, O'Hare F, et al. Gene therapy for inherited retinal diseases: progress and possibilities. Clin Exp Optom 2021;104(4):444-54. n

• Retina Australia, www.retinaaustralia.com.au • Blind Citizens Australia, www.bca.org.au • Vision Australia, www.visionaustralia.org • Guide Dogs Australia, www.guidedogs.com.au •M acular Disease Foundation Australia, www.mdfoundation.com.au There are also several support groups for specific IRDs; for example, Usher Kids Australia (www.usherkidsaustralia). A key form of support, which can sometimes be forgotten in the rush to provide practical vision solutions, is psychological care. The providers above can provide access to psychologists and counsellors, and the patient’s general practitioner should be involved in these discussions and referrals. REFERRAL GUIDELINES The initial referral from primary optometric practice if an IRD is suspected is generally to an ophthalmologist with a speciality interest in the conditions. In addition to community providers, several states now have specialist hubs within the public health system (for example, the Ocular Genetics Clinic at the Royal Victorian Eye and Ear Hospital and the Clinical Electrophysiology Service at Sydney Eye Hospital). The ophthalmologist will likely complete additional testing, including electroretinography, dark adaptation and perimetry, to confirm diagnosis. Another referral option is to research organisations, who are currently developing databases of people with IRDs for both natural history investigations, and as a registry of people who are interested in upcoming clinical trials These organisations can be found in Table 2.

REFERENCES 1. H eath Jeffery RC, Mukhtar SA, McAllister IL, et al. Inherited retinal diseases are the most common cause of blindness in the working-age population in Australia. Ophthalmic Genet 2021: 1-9. 2. H amblion EL, Moore AT, Rahi JS, British Childhood Onset Hereditary Retinal Disorders N. Incidence and patterns of detection and management of childhood-onset hereditary retinal disorders in the UK. Br J Ophthalmol 2012; 96 (3): 360-5. 3. U niversity of Texas-Houston Health Science Center Laboratory for the Molecular Diagnosis of Inherited Eye Diseases. www.sph.uth.edu/retnet/. Accessed 8 November 2021. 4. G rigg J, Jamieson R, Chen F, et al. Guidelines for the Assessment and Management of Patients with Inherited Retinal Degenerations (IRD). www.ranzco.edu.au 2020. 5. Coco-Martin RM, Diego-Alonso M, Orduz-Montana WA, et al. Descriptive Study of a Cohort of 488 Patients with Inherited Retinal Dystrophies. Clin Ophthalmol 2021; 15: 1075-84. 6. O'Hare F, Edwards TL, Hu ML, et al. An optometrist's guide to the top candidate inherited retinal diseases for gene therapy. Clin Exp Optom 2021; 104 (4): 431-43. 7. B ader I, Brandau O, Achatz H, et al. X-linked retinitis pigmentosa: RPGR mutations in most families with definite X linkage and clustering of mutations in a short sequence stretch of exon ORF15. Invest Ophthalmol Vis Sci 2003; 44 (4): 1458-63. 8. N a KH, Kim HJ, Kim KH, et al. Prevalence, Age at Diagnosis, Mortality, and Cause of Death in Retinitis Pigmentosa in Korea-A Nationwide Population-based Study. Am J Ophthalmol 2017; 176: 157-65. 9. V asireddy V, Wong P, Ayyagari R. Genetics and molecular pathology of Stargardt-like macular degeneration. Prog Retin Eye Res 2010; 29 (3): 191-207. 10. Boughman JA, Vernon M, Shaver KA. Usher syndrome: definition and estimate of prevalence from two high-risk populations. J Chronic Dis 1983; 36 (8): 595-603. 11. Nash BM, Wright DC, Grigg JR, et al. Retinal dystrophies, genomic applications in diagnosis and prospects for therapy. Transl Pediatr 2015; 4 (2): 139-63. 12. Vision 2020 Australia. Adult Referral Pathway for Blindness and Low Vision Services. www.vision2020australia.org.au 2021. 13. de Roach JN, McLaren TL, Thompson JA, et al. The Australian Inherited Retinal Disease Registry and DNA Bank. Tasman Medical Journal 2020; 2 (3): 60-7.

CONCLUSION

Figure 3: An Optos wide-field colour fundus photo from a 50yo male with RPGR-associated X-linked RP, showing bone spicule pigmentation, waxy optic nerve pallor and blood vessel attenuation. The RPGR gene is estimated to cause up to 20% of cases of RP.7 Image courtesy of the VENTURE Study, Centre for Eye Research Australia and The University of Melbourne.

INSIGHT February 2022

The promise of emerging therapies such as gene therapy and stem cells will only be realised if we are able to appropriately identify and treat people. This means it is important patients with IRD are detected, diagnosed, and referred to clinical care pathways and, if interested, to research platforms like the above natural history registries. In this way, we will be able to ensure that as treatments reach the shores of Australia, we are ready to offer them to patients.

NOTE: Optometry Australia members can scan the QR code or visit the online version of this article at www.insightnews.com.au to enter their details to have their CPD hours automatically updated to their Learning Plan. Event ID: 90003970, Session ID: 10234

LEARNING OBJECTIVES: At the completion of this CPD activity, optometrists will have developed their knowledge of the patient journey following referral for inherited retinal diseases (IRDs).

Including: • The four steps of assessment and management of patients with, or suspected of having, IRDs • Investigations assisting diagnosis of IRDs and determining visual function • An understanding of the genetic workforce and their role in the diagnosis, management, treatment and counseling of patients with IRDs • IRD patient management protocols

CPD

INHERITED RETINAL DISEASES – THE PATIENT JOURNEY The next decade will see a rapid increase in gene therapy trials and treatments for inherited retinal disease. In the second article of Insight's two-part educational series on this topic, PROF JOHN GRIGG and PROF ROBYN JAMIESON discuss the challenges and intricacies in managing patients with these genetic conditions.

nherited retinal diseases (IRDs) are a group of heterogeneous conditions leading to vision loss due to progressive or stationary retinal dysfunction.

IRDs have traditionally been reported as affecting 1:3000 to 1:4000 individuals,1,2 however, recent worldwide carrier frequency data indicates that autosomal recessive IRDs affect more than 1 in 1380 individuals,3 and together all types constitute a significant cause of childhood and adult blindness.4,5 Although the term ‘inherited retinal disease’ refers to a group of related conditions, this may not be readily appreciated by nonclinicians. There is also overlap in terminology with ‘retinal dystrophy’ and ‘inherited retinal disease’, often used interchangeably. Despite similarities among different IRDs, variants in more than 300 genes are associated with IRDs.6 Therefore, accurate and comprehensive molecular diagnosis is critical to confirm the clinical diagnosis and inform disease prognosis. Optometrists play a vital role in identifying patients with these rare conditions, educating them on new treatment options and referral for appropriate genetic testing. THE PATIENT JOURNEY This review will explore the patient journey including ophthalmic and genetic diagnosis and preparation for therapeutic trials or treatments (Figure 2). Collectively IRDs are common, and their cumulative impact on affected families and healthcare systems is substantial due to the earlier onset of blindness compared to many other eye diseases.7-9 There have been rapid advances in the understanding of the clinical, genomic, molecular and cellular mechanisms underlying IRDs. This has led to clinical trials involving gene replacement, genomic engineering, stem cell therapies and other therapies that may slow photoreceptor

degeneration or restore some vision.10-15 IRD management is similar to other complex conditions. Patients are best managed in a multi-disciplinary setting with ophthalmologists experienced in IRD diagnostic steps and management, and with access to clinical geneticists and genetic counsellor expertise. ASSESSMENT AND MANAGEMENT FOR PATIENTS WITH A SUSPECTED IRD The assessment and management for patients with, or suspected of having, an IRD falls into four broad areas:16,17 1. Establishing the clinical diagnosis of an IRD

ABOUT THE AUTHORS:

2. D etermining the level of visual function and planning/implementing visual rehabilitation

Prof John R Grigg1,2,4,5 (FRANZCO MD) & Prof Robyn V Jamieson1,2,3,6 (FRACP PhD)

3. E stablishing the genetic diagnosis and genetic management 4. M onitoring of disease progression (Natural History) and, preparation for therapeutic interventions ESTABLISHING THE CLINICAL DIAGNOSIS The clinical diagnosis relies upon a combination of history, examination and investigations directed at the presentations that are common for IRDs. Important patient history details include: rod dysfunction (nyctalopia and often peripheral vision issues), cone dysfunction (photophobia, reduced distance and near visual acuity and dyschromatopsia), age at onset and progression of symptoms.18-20 Traditionally, IRDs have been associated with early onset disease. Increasing evidence indicates a much broader age of onset, extending to the sixth decade, as well as asymptomatic disease.21 There are five major groups of IRDs clinically recognised which include: rod and rod-cone dystrophy, cone and cone-rod dystrophy, chorioretinal degenerations, macular dystrophies and vitreoretinopathies.1,16

1. Save Sight Institute, Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Sydney NSW 2. Eye Genetics Research Unit, The Children’s Hospital at Westmead, Save Sight Institute, Children’s Medical Research Institute, University of Sydney, Sydney NSW 3. Specialty of Genomic Medicine, Faculty of Medicine and Health, University of Sydney, Sydney NSW 4. Department of Ophthalmology, The Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, Sydney NSW 5. Sydney Eye Hospital, Sydney NSW 6. Department of Clinical Genetics, Western Sydney Genetics Program, Sydney Children’s Hospitals Network, Westmead, Sydney NSW

Systemic evaluation is a key component of patient assessment to identify syndromic causes. In particular, hearing, renal dysfunction, neurological dysfunction, skeletal anomalies and/or metabolic disturbance need to be specifically inquired about and evaluated. The effects of medication also need to be evaluated. Family history is important as all forms of inheritance (autosomal dominant, autosomal recessive, X-linked or mitochondrial inheritance) are reported. A family pedigree should be recorded in the clinical record.

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CPD

Figure 1: A montage for Stargardt disease (ABCA4 retinopathy) showing widefield pseudo colour image with yellow flecks, widefield fundus autofluorescence with hyper and hypo autofluorescent flecks. Then OCT scan with loss of outer retina structures including disruption of the ellipsoid zone.

INVESTIGATIONS ASSISTING DIAGNOSIS AND DETERMINING VISUAL FUNCTION The investigations directed at identifying IRDs include: optical coherence tomography (OCT), fundus autofluorescence (widefield), visual field assessment (peripheral field – Goldmann semi-automated or manual perimetry, Esterman binocular field), dark adaptation, International Society for Clinical Electrophysiology of Vision (ISCEV) standard visual electrophysiology (pattern electroretinogram, full field electroretinogram, multifocal electroretinogram). The specialised investigations, including visual electrophysiology, are best performed in centres with expertise in meeting international standards. The diagnostic tests at baseline will provide an initial visual function measure which is important for education, work, statutory requirements and rehabilitation assessments. ESTABLISHING THE GENETIC DIAGNOSIS IRDs are phenotypically and genetically heterogeneous. Clinical genetic and molecular assessments have advanced significantly in recent years.22-25 A causative mutation can now be identified in up to 60-80% of patients with IRDs.1,23,26 In an autosomal recessive disease, testing unaffected parents or other family members is essential in assisting confirmation of biallelic pathogenic variants which is a key inclusion criterion for some therapies and clinical trials.27 For autosomal dominant retinal disease, it is important to examine parents and siblings, to identify variable penetrance. Frequently new or ‘de novo’ autosomal dominant pathogenic variants require parental genetic testing to establish pathogenicity. Similarly, in X-linked retinal dystrophies, there may be asymptomatic obligate carrier females and further family members who would benefit from genetic testing, that aren’t always obvious on first consultation. Genetic testing is now standard of care for these patients. Multigene-based testing strategies,

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including targeted next-generation sequencing panels, whole exome sequencing (WES) or whole genome sequencing (WGS) are necessary to identify the molecular aetiology in the IRD group of disorders where more than 300 causative genes have been identified. (See RetNet, the Retinal Information Network). This information helps provide a more accurate diagnosis, prognosis, provides individuals and families with specific recurrence risks, aids informed reproductive decisions and guides treatment decisions. Routine genetic testing is also required to enable enrolment in treatment studies as well as determine suitability for approved therapies such as voretigene neparvovec (Luxturna). UNDERSTANDING THE GENETIC WORKFORCE Clinical geneticists are medical specialists who have completed either paediatric or adult basic physician training and then completed advanced training in clinical genetics supervised by the Royal Australasian College of Physicians in collaboration with the Human Genetics Society of Australasia. Clinical geneticists specialise in medicine that involves the interaction between genes and health. They are trained to evaluate, diagnose, manage, treat and counsel individuals of all ages with hereditary disorders.28,29 In these roles, clinical geneticists use genomic molecular testing to implement needed therapeutic interventions and provide genetic counselling regarding prenatal and preimplantation diagnosis.30 In Australia and New Zealand, genetic counsellor roles include: referral assessment, collecting personal and family history, risk assessment, patient education regarding genetic concepts to facilitate informed decision‐making and addressing the psychosocial impacts of a diagnosis.31 In Australia, genetic counselling is not a nationally regulated or registered profession, which means that they can facilitate genetic/ genomic testing when working under the medico‐ legal supervision of a clinical geneticist.32

GENETIC MANAGEMENT FOR IRDs Informed genetic consent – a key component of managing the patient with a suspected heritable disorder is the process of informed consent. Genetic counselling is an essential role to facilitate informed consent.33 Patients will expect the return of primary results. However, they may not anticipate genetic testing may reveal unexpected, embarrassing, stigmatising, or deeply upsetting medical information. For example, patients need to be forewarned about the risk of revealing mis-attributed parentage, unexpected incidental findings such as an oncogene variant, and variants of uncertain significance (VUS). These VUSs, and the uncertainty raised by them, can be a source of significant misunderstanding and concern for the recipient.34 Interpreting the genetic results including: Multidisciplinary team review – next-generation sequencing technology has led to greatly improved mutation detection rates. The advances have also highlighted variants of uncertain significance (VUS) that are simultaneously identified. The American College of Medical Genetics and Genomics (ACMG) provides a systematic methodology to classify these variants.35 Specific guidelines are followed to determine if a genetic variant is pathogenic/likely pathogenic or a variant of uncertain significance (VUS) for a patient. At times, it may be necessary to perform segregation genetic testing in family members to determine if a VUS can be upgraded to ‘likely pathogenic’ or ‘pathogenic.’ Multi-disciplinary team (MDT) meetings are frequently required to determine the pathogenicity and significance of some variants, especially the VUSs. Critical contributions from ophthalmologists, clinical geneticists, genetic pathologists, molecular biologists and genetic counsellors provide phenotype and genotype assessments to assist in the determination of genetic variant pathogenicity. Despite these processes, a genetic answer may not be found with the current technology

Primary eye care Optometry , General practice

Suspected Inherited Retinal Disease Child

Adult

Paediatric Ophthalmology

General Ophthalmology

Medical Assessment • • • •

Family History Neurodevelopmental Metabolic Systemic disease eg: • Hearing impairment • Renal disease • Skeletal anomalies

Visual rehabilitation • Vision support organisations • Low vision clinics • Patient support organisations • NDIS

Inherited Retinal Disease Specialist or Retinal Specialist Shared ophthalmic care

Ophthalmic Phenotype Determination

• Multimodal ocular imaging • Visual electrophysiology • Visual field testing (Kinetic, static & /or microperimetry)

Family Member -

Phenotype determination

Genomic Results

Genomic Testing

• Correct choice of genomic testing • Genomic consent from patient/family • Genetic counselling

• • • •

Genetic answer found Variant Uncertain significance (VUS) Incidental finding Negative result

Expert Multidisciplinary Team (MDT) review Ophthalmology, Clinical Genetics, Molecular Scientists, Research & Genetic counsellors For VUS resolution, data reanalysis, functional genomic studies and advice

Management Plans Natural History Studies

Negative genetic results - future review as systems improve

Genetic Information for patient & family

Clinical Trials Therapies

Figure 2: The IRD patient journey in Australia. Credit: Prof John Grigg and Prof Robyn Jamieson.

in up to 20-40% of cases. Whole genome sequencing, RNA sequencing and functional genomic studies including RPE and retinal organoid modelling are research tools addressing this challenge.36-41 Understanding the precise molecular defect is crucial for the implementation of genomic therapies.42

and highlights the need to address this issue throughout the testing process.43

Return of genetic results – an important component of the management of patients with an IRD is the return of genetic testing results. As can be seen there are critical steps that should occur to optimise the return of genetic results. This process begins with establishing expectations during pre-test genetic counselling which will enable patients to feel educated and psychologically better prepared for the implications of the results. Managing patient expectations remains an ongoing challenge

Preparing for therapies – Natural history assessments – the development of specific gene-based therapies12,48-54 raises the question of the ideal time to intervene. To answer this question, an understanding of the natural history of the IRD is required.55 Monitoring the natural history of IRDs requires consistent assessments and protocols. A term that is used for clinical trial or therapeutic eligibility is ‘viable retinal cells'. For gene replacement and genomic engineering approaches, viable retinal cells

The wider introduction of genetic testing will lead to a reduction in morbidity, improved patient disease understanding, improved reproductive decision-making and improved clinical care pathways.44-47

Figure 3: A retinal organoid used for functional genomic investigations for variant classification. Image: Prof Robyn Jamieson.

are required for the therapies to work. Assessment of viable retinal cells is made by combining the information derived from the clinical assessment including BCVA, OCT, visual field assessment, visual electrophysiology (including full field scotopic threshold testing and patient reported outcomes). The assessment will include a combination of all the investigations, and this will vary from patient to patient. IRD management is similar to other complex conditions. The management around this process is critical to ensure that patients receive the appropriate ophthalmic and genetic advice.56-58 Patients are best managed in a multi-disciplinary clinic with ophthalmologists experienced in IRD diagnostic steps and management, and with access to clinical geneticists and genetic counsellor expertise The four steps outlined in this review will lead to improved patient care with streamlined ophthalmic diagnosis, molecular diagnosis and counselling, management of visual dysfunction and preparation for clinical trials and therapies. The complexity of IRDs requires input from both ophthalmology and clinical genetics.44 The benefits of modern genetic diagnostics and counselling supports the introduction of equitable genetic testing for patients with presumed genetically-caused retinal diseases.5 n

NOTE: All references can be found in the online version of this article at www.insightnews.com.au or by scanning the QR code. The online article also features a portal where Optometry Australia members can enter their details to have their CPD hours automatically updated to their Learning Plan. Event ID: 90003969, Session ID: 10233.

INSIGHT February 2022 39

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CONTACT LENSES

ADDRESSING CONTACT LENS

dropout

Can eyecare practitioners do more to find the ‘sweet spot’ for contact lens wearers that would reduce the rate of dropout? Insight asks those in the field how they keep their patients in contact lenses and how doing so can help grow the market.

ontact lens dropout is a perennial topic and for good reason – it is touted as likely a major factor contributing to the near stagnant growth in the contact lens market.

That’s the thinking shared by two professors who co-authored 'A Review of Contact Lens Dropout' published in Clinical Optometry online in June 2020. The purpose of their review was to summarise the current state of knowledge related to the frequency of contact lens dropout and the factors associated with it, helping to provide useful insight for practitioners across the world, including Australia. Assistant Professor Andrew Pucker, from the School of Optometry at the University of Alabama at Birmingham, and Dr Anna Tichenor, from the School of Optometry at Indiana University, found contact lens dropout was frequent across developed countries, ranging between 12% and 27.4%. They found the top cited reason for dropout in established contact lens wearers was discomfort, while vision was the top reason in neophyte (new) wearers. Pucker and Tichenor wrote that, if given the chance, contact lens dropouts can often successfully resume wear up to 74% of the time. While the literature is mixed with regard to factors promoting contact lens dropout, meibomian gland dysfunction appears to promote it. Their review concluded that dropout may be curtailed by early detection, patient education, alternative contact lens options, or early treatment of underlying ocular surface diseases. Australian optometrist and Fellow of the Cornea and Contact Lens Society of Australia (CCLSA), Mr David Stephensen, says Pucker and Tichenor’s review provides a good summary but perhaps doesn’t acknowledge the failures of practitioners in providing continuity of care.

“Studies like 'A Review of Contact Lens Dropout' don’t apportion enough accountability or responsibility to the practitioner,” he says. Stephensen is interested in contact lens research and new product development and has more than 25 years’ experience in the field. He established his namesake practice in the Brisbane suburb of Moorooka in 2007 and has since opened a satellite practice at ophthalmology clinic The Eye Health Centre in Aspley. He says contact lenses are historically seen as second-line vision correction (after spectacles) and require ongoing intervention to address concerns such as discomfort and any vision-related changes, like onset of presbyopia. “Contact lens prescribing requires the practitioner to be in regular contact with patients. That can be challenging. It can be hard to track people down. In theory, it should be automated, but often, it’s not. Contact lens patients are also on varied schedules for follow-

“IT IS THE RESPONSIBILITY OF THE PRACTITIONER TO ENSURE PATIENTS ARE ALWAYS TOLD ABOUT NEW DEVELOPMENTS” DAVID STEPHENSEN DAVID STEPHENSEN OPTOMETRIST

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CONTACT LENSES

patients are made aware of these products,” he says.

“IF YOU COULD HALVE THE RATE OF DROPOUT, YOU’D DO AMAZING THINGS FOR CONTACT LENS PENETRATION IN AUSTRALIA” PROF FIONA STAPLETON UNSW AND ISCLR

up care and re-supply, which can make it harder to keep track,” Stephensen says. While he has had limited experience with the impact of lockdowns on account of his practice location, Stephensen says he has found that his patients working from home has disrupted their contact lens wear. “My patients seem more inclined to put their glasses on when working from home; that appears to be the reason in the reduction in drive to wear contact lenses. As an extension of working from home and different needs, some have shifted from a re-usable to a daily disposable platform.” Stephensen says his years spent building a rapport with patients – and encouraging them to “whinge about their contact lenses” – helps to have a conversation about continuing contact lens wear. “I think there’s an inherent self-permissiveness in working from home, there seems to be more time in the day, and you don’t have to ‘get ready’, so contact lens wear becomes neglected. “It’s about having that conversation with patients, altering their wearing schedule if needed, and reiterating there are still reasons to wear contact lenses, unconnected to working from home.” While discomfort has been cited as one of the top reasons patients drop out, Stephensen says it points to a disconnect between patients and the products available. Fitting a higher-than-average portion of customised contact lenses, Stephensen sees his role – aside from deploying his obvious clinical skills – as being the “contact point” for patients to pass on their negative experiences with contact lenses. “Ask your patients, ‘Why aren’t you wearing contact lenses?’. Ask, ‘What can I do?’. There needs to be a change in mindset in our role in healthcare because patients not disclosing their negative feedback becomes a bigger problem. We need to listen for information to make headway. “I tell my paediatric patients, ‘You’ve got one job: to complain. You have to complain’. I want to create an environment where they feel the right thing to do is to fess up to any issue concerning their contact lenses. It works.” Additionally, there is nearly always new contact lens technology that the patient doesn’t know about, Stephensen says. “It is the responsibility of the practitioner to ensure patients are always told about new developments. Make use of trial lenses and let patients make an informed decision. “Two main products that have impressed me in terms of providing extended comfort are the Ultra family of products from Bausch + Lomb and the Total family of products from Alcon. These show a drive for materials innovation that is focussed on genuine patient issues. The challenge is to ensure that at a practitioner level the

INSIGHT February 2022

ADVANCES IN TECHNOLOGY HAS REMOVED BARRIERS Therapeutic optometrist Dr Lisa Ho, a former state president of CCLSA’s South Australia chapter, is well-versed in advanced contact lens fitting and dropout. A contact lens wearer herself, Ho says contact lenses should be one of the options optometrists offer to every patient. “I talk to everyone about it,” she says. Ho and practice manager Mr Justyn Ho started independent practice, Wellness Eyecare, from the ground up in the inner Adelaide suburb of Prospect three years ago. Prior to establishing Wellness Eyecare, the UNSW graduate spent eight years at an independent, specialty contact lens practice in Adelaide. “It’s interesting to read that early research papers found comfort was the number one reason for dropout; now vision is considered one of the primary reasons for dropout,” Ho says. Her contact lens wearing presbyopia patients, in particular, fit this description. “Vision is very subjective, and sometimes patients aren’t willing to compromise on the sharpness of their distance or near vision, even if they are seeing 6/4.8 and N5 with the contacts. As an optometrist we think that’s excellent, but for some people, the quality of the vision is still not enough,” she says. This inability to compromise is the primary reason her presbyopia patients reject contact lenses, Ho says. Another reason for dropout, in her experience, is due to patients being prescribed outdated products. “Technology has really advanced in contact lenses and makes vision more natural and comfortable, but there are still products with obsolete technology available. Some patients are still being prescribed obsolete technology, which can lead to dropout,” Ho says. “Often people will tell me they stopped wearing their contacts 15-20 years ago because they were so uncomfortable after a few hours that they had to rip them out. When I explain to them that contact lens technology is so much better now, they are generally really surprised at how much technology has changed. When they try the new materials and realise they can wear them so comfortably, it’s really exciting for them. “In the last 10 years, the technology has improved considerably. About five years ago, Johnson & Johnson Vision made a commitment globally to bring two new contact lens products to market annually through 2020. That’s how fast contact lens R&D is progressing.” When Ho’s patients dropout, her first step is to have a conversation with them. “I try to gauge what the reason is. Can it be fixable or avoidable?

“WHEN [CL DROP OUT PATIENTS] TRY THE NEW MATERIALS AND REALISE THEY CAN WEAR THEM SO COMFORTABLY, IT’S REALLY EXCITING FOR THEM” DR LISA HO WELLNESS EYECARE

CONTACT LENSES

“My personal view on that is – if you want to grow the contact lens market – if you could halve the rate or number of dropouts, it would make an enormous difference,” she says. If the choice is between increasing the new fit rate or hanging on to existing wearers, the latter is more likely to grow the market. “Contact lens material is not the whole issue behind discomfort and dropout. Patient-related factors are also at play. Early diagnosis of comfort or vision related issues is important. David [Stephensen] is on to something by asking patients the right questions,” Stapleton says. Those ‘right questions’ might entail asking patients if they’ve had to reduce comfortable wear time or their comfortable period of wear, she says, as well as being on the lookout for conditions such as contact lens-induced dry eye or meibomian gland dysfunction (MGD). “Once those questions have been asked – and answered – the practitioner can respond by changing material lens fitting modalities, changing to an unpreserved care system, such as a peroxide-based care system, or changing the fitting relationship and edge profile, which does help a proportion of patients,” Stapleton says. Research shows the top cited reason for dropout in established contact lens wearers is discomfort.

I once had a patient who was experiencing stinging from peroxide solutions because she had borrowed her husband’s multipurpose case instead of using the peroxide neutralising case. The reason for dropout can be resolved by identifying things like that, or handling issues. Watch patients insert and remove their lenses. Re-asses their vision, re-assess their lenses. For example, if it’s a toric, check if the lens has rotated, causing their vision to be worse,” Ho says. “Listen to what they’re saying. That conversation comes into play when assessing contact lens suitability to start with. You need to explain that they might lose vision sharpness when wearing multifocal contact lenses. Give them notice, set realistic expectations, and encourage patients to give it some time.” After a moment’s pause, Ho adds a further thought. “I think that potentially a reason dropout isn’t talked about a lot comes back to the practitioner,” she says. “Whenever you fit a patient with contact lenses, there are so many variables at play – ocular surface, lens modality, insertion and removal – even patient psychology. It takes a lot of time, from a practitioner’s perspective, to do it well. “Personally, I feel contact lens technology is at the level where almost anyone can wear contact lenses – unless they have significant ocular surface disease. I’m confident there aren’t many barriers anymore. It’s up to us, the practitioners, to know what’s available, do a proper work up, and address any issues that arise.” FOCUS ON EXISTING WEARERS TO GROW THE MARKET Scientia Professor Fiona Stapleton, president of the International Society for Contact Lens Research, says current research shows 20% of contact lens wearers will dropout, with discomfort or vision complications the main culprits. “We did discuss dropout as a consequence of discomfort in the CLEAR report more from a perspective of strategies to reduce discomfort,” she says, referring to the Contact Lens Evidence-Based Academic Reports (CLEAR). CLEAR represents the work of nearly 100 multidisciplinary experts in the field, Stapleton included, who set out to critically review, synthesise and summarise the research evidence on contact lenses to date.

INSIGHT February 2022

However, Stapleton acknowledges, there are times in people’s lives where contact lenses are not a suitable vision correction solution. “Dropout can and does happen for other reasons. The profession can get a proportion of these back into lens wear by addressing the issues and modifying expectations. For example, a patient ‘dropping in’ to contact lens wear for a few hours to play football is successful, even if its part-time wear. As practitioners, we need to work out what the issues are, and find a solution to each particular problem,” she says. But hard lockdowns and various restrictions on businesses have made that task harder this year. “Patients have cancelled their non-urgent follow-up appointments, including contact lens wearers, so there is less opportunity to ask how they are getting on. We also know they are reducing their contact lens wear,” she says, a situation not helped by conditions such as mask-associated dry eye (MADE). Stapleton returns to her earlier point on reducing dropouts. “The CLEAR report is the most recent review on discomfort, and it illustrates the dropout rate is not changing – we’re not getting better at retaining wearers. We’re seeing stagnant growth. If you could halve the rate of dropout, you’d do amazing things for contact lens penetration in Australia. It’s harder to get a new wearer than retaining an existing contact lens wearer; you’ve already got them over the line. Where would practitioner’s efforts be best placed?” Stapleton says. MANUFACTURING’S SUPPORTING ROLE Mr Angelo Doumbos, managing director of Menicon Australia, says the industry can help reduce the contact lens dropout rate. Headquartered in Japan, the company says it is the only manufacturer in the world dedicated to all areas of contact lensesrelated business including material development. It established an Australian base in Adelaide in 2011. Although supply hasn’t featured among the reasons for contact lens wearers dropping out, Menicon has taken steps to prevent any supply-related issues. “In line with our vision and mission to be a trusted partner of the industry, we have switched couriers to National Optical Distribution, which has been positively greeted by our customers. Apart from that, we have not encountered any issues with inventory holdings,” Doumbos says. He believes most patient-related factors behind contact lens

dropout can be solved by education. “Interesting studies have found what contact lens wearers recall being told and advised does not always match what the eyecare practitioner reports advising. We can support by consistently reinforcing key messages, utilising a variety of resources; written, verbal and digital,” Doumbos says. While not a practitioner, Doumbos’ experience in the optical industry for more than 15 years has helped him understand the importance of open communication with patients. “For early dropout, arranging a courtesy call within the first week is good to understand how they are finding the lenses, to identify any red flags and to provide guidance where appropriate, to maximise their success,” he says. “If compliance, for example, is not optimal, then a new management plan can be agreed, such as using Menicon’s daily disposables with Smart Touch, with a commitment to follow best practice hygiene principles.” Doumbos says asking open questions, using questionnaires or rating scores can help identify any risk factors for contact lens discomfort or suboptimal performance. “Determining whether their actual wearing schedules are in line with their ideal wearing expectations will give further clues. Reminding wearers regarding their motivation for contact lenses and activities they enjoy wearing contact lenses for will help motivate and reduce the chance of dropout.” Doumbos says Menicon has focused not only on contact lens performance but the importance of the packaging too, making the handling process as simple and efficient as possible. “The literature cites around one quarter of contact lens dropouts

“DETERMINING WHETHER THEIR ACTUAL WEARING SCHEDULES ARE IN LINE WITH THEIR IDEAL WEARING EXPECTATIONS WILL GIVE FURTHER CLUES” ANGELO DOUMBOS MENICON AUSTRALIA

occur within the first year due to handling reasons. Menicon has invested significantly in developing consumer driven innovations to help make handling easier, simpler and more convenient.” In an online survey Menicon conducted in 2011 involving 1,031 respondents, 31% said it was difficult to tell the right side of Menicon’s daily disposable soft contact lenses, and 23% said the lens easily stuck to their fingers. The company responded by launching Smart Touch technology in 2013. “Smart Touch technology has been applied across Menicon’s families of daily disposables. The wearer is reassured the lens is always the correct way up. Our online survey in 2011 showed 80% of wearers admitted in a survey they would like easier handling and 91% agree having a lens the right way up (Smart Touch lenses) see this as an advantage,” Doumbos says. n

LENSES

Rodenstock head of research and development and strategic marketing lenses Dr Dietmar Uttenweiler with a DNEye Scanner.

s e s n e l c i r t e biom A NEW WAY OF CALCULATING

Using more than 500,000 scans from its DNEye Scanner, Rodenstock has developed a new AI calculating engine offering more precise ophthalmic lenses from the standard prescription. The company is now restructuring its lens portfolio, so its premium lenses are available to a wider market.

hen Dr Dietmar Uttenweiler joined Rodenstock more than 18 years ago, he often pondered the untapped potential of the ophthalmic lens market; if only it could exploit the optical principles in other fields like microscopy, astronomy and photography.

Rodenstock’s DNEye Scanner. The DNEye lens technology has been available to Australian optical practices since 2018 when the company’s second generation DNEye Scanner 2 was introduced here. Uttenweiler says it represents “a paradigm shift” in the way lenses are calculated.

With a background in technical optics, Uttenweiler, a physicist by education, joined the German ophthalmic lens company after holding a lectureship at the University of Heidelberg in physiology and biophysics. His expertise taught him that to optimise an image on an image plane – such as the retina – one must precisely measure and account for the individual refractive elements in between the object and image point.

At its core, the DNEye Scanner is an aberrometer, topographer, pachymeter, and additionally a tonometer. As an example of the relevant biometric parameters it can obtain, the topographer measures the corneal curvature to calculate the total corneal power, while the pachymeter gives corneal thickness (used to calculate the corneal power) and distance to the crystalline lens. The aberrometer gives the total aberrometry and, as the corneal power is known, the power of the crystalline lens can be calculated. The aberrometer also measures higher order aberrations allowing a local gaze dependent adaption of best sphero-cylindrical values for this to be built into the lens. Rodenstock’s patented calculations can then use these and other readings to determine other parameters like eye length.

“When I started at Rodenstock in 2003 as director of research optics, I never quite understood why the spectacle lens industry, including Rodenstock at the time, stopped calculating the imaging properties at the vertex sphere (an imaginary spherical surface centred at the eye’s centre of rotation),” he explains. “One reason was simply because everyone assumed each eye was the same; you had reduced eye models like the Gullstrand and other simple models of calculating lenses that involved different kinds of assumptions. But ultimately, the problem was that no one could find a way to easily include the relevant knowledge of, for example, the power of the cornea and crystalline lens, relative lens position and eye length into spectacle lens calculation.” Today, Uttenweiler is now in a senior position within Rodenstock as head of research and development and strategic marketing lenses, based in Munich. He has helped oversee a radical directional change in the company that now works harder to educate the market about its lens sophistication, and their relevance to end consumers. This new approach has been possible through the introduction of

INSIGHT February 2022

Ultimately, the instrument takes more than 7,000 measurements of 80 parameters, allowing a biometric model of the eye to be ‘built’ and used to calculate the final lens, known as Biometric Intelligent Glasses (B.I.G.). Uttenweiler says the technology has elevated the Rodenstock portfolio, helping cement its place in the premium segment, while offering independents the ability to differentiate their practices. In Australia, individual DNEye practices have reported average lens sale increases of 25%, while also selling more pairs of glasses overall. While the technology has benefitted those with a DNEye Scanner, recently Rodenstock considered how it can leverage this for practices without DNEye capability. It also fits with the company’s B.I.G. Vision For All philosophy, to increase access to its premium progressives based on the biometric lens calculation described above.

Nicola Peaper, Rodenstock Australia national sales and professional services manager.

A workflow graphic explaining how the company’s new B.I.G. Exact and B.I.G. Norm lenses are produced.

In recent years, Uttenweiler says Rodenstock has built an “immense database” of more than 500,000 DNEye scans. It has now used artificial intelligence (AI) to find patterns and correlations to develop new norms within the data. That means it can now take parameters from the subjective refraction – sphere, cylinder, axis, and addition – and put them to much greater use.

“You’re obtaining parameters the patient hasn’t had measured before. Coupled with this is a very different explanation of how Rodenstock uses the biometry of the eye to calculate and produce the lens. Importantly, the message can be transported in simple terms, and that’s what we offer as a unique selling proposition to our customers.”

The AI-power calculating engine looks at patterns in a complex multidimensional environment – and can build a correlation line for each individual. In effect, an “approximate eye model” for every prescription can be created using just the standard prescription values.

TECH NEEDS TO BE BELIEVED IN

While this won’t offer the same precision as its tier one DNEye lenses, Uttenweiler says it will offer practices more superior lenses than any other standard lenses on the market. To cater for this new approach, Rodenstock is introducing a new portfolio structure this year. B.I.G. Exact will become its premium lenses available from practices with a DNEye Scanner, while B.I.G Norm will feature lenses calculated by the standard prescription values and AI technology. “These will account for far more than 80% of the branded Rodenstock portfolio that we offer. Of course, we will have some entry products left with the standard portfolio, but we’re communicating that independent practices go for a DNEye portfolio B.I.G. Exact or B.I.G Norm portfolio because they are the new generation of lenses,” Uttenweiler says. STORYTELLING BEHIND THE LENSES For independents, differentiation in an increasingly price-competitive and commoditised market remains one of the great challenges. While there’s an assumption patients are more interested in frames than lens technology, Uttenweiler says Rodenstock’s current CEO Mr Anders Hedegaard – with medical technology background – challenged that position when he began three years ago. “He said we’re selling a high-tech product, and asked me to explain why our lenses were a superior product,” he recalls. “After that, he said I don’t see why the end consumer wouldn’t be interested in the story you just told me, we just simply need to tell it in a relevant way that resonates with them.” The company employed a specialised, data-driven marketing agency in Denmark who conducted research that confirmed consumers wanted to better understand the lens technology, prompting Rodenstock to make lens storytelling a greater priority for its independent customers.

Educating practices about the DNEye Scanner and Rodenstock’s lens portfolio forms a major part of Ms Nicola Peaper’s role as the company’s Australian national sales and professional services manager. She has worked in the optical industry for over 35 years; 20 as an optometrist. Major changes such as freeform production and new categories like occupational digressives have occurred during that time. But until she started working in manufacturing, their implications had largely passed her by. “Although I believe lens technology information and education is much better now, there are still practitioners who believe one lens is much the same as another and there are no benefits to be had by choosing newer technologies. Unless they can be fully confident in a product then they cannot be expected to use it.” Rodenstock’s professional services team works closely with its marketing department to ensure brochures and tools are accurate and understandable, which then filters to its salesforce. “The initial technology needs to be understood and believed in. The benefit and value to the patient needs to be realised and it’s the role of a well-informed sales team to explain this to the principals in practice. Finally, the practice staff need to communicate to the patient about the products on several different levels. Again, training needs to be done in practice,” Peaper explains. “When these elements are complete then not only will the lens manufacturer achieve good uptake of their products but also the practice should benefit from improved customer experience and lower non-adaption to products.” With Zacharia Naumann in Wagga Wagga acquiring the first DNEye scanner in Australia in 2018, 33 others have followed since. Ongoing, Rodenstock Australia is introducing local DNEye Scanner user groups, initially trialled in WA and SA so new users have access to existing, more experienced users. Peaper says this overall approach – in addition to CPD articles and presentations at trade events – is welcomed by Rodenstock customers.

“Claiming that you’re premium and not offering any additional services simply won’t work. We now have educated end consumers who want to understand the difference and why they are paying more,” he explains.

“The amount of support and information we give ensures Australia has one of the highest use of individual scanners across the worldwide Rodenstock market. Our customers have confidence that if they have problems or questions, the support is there,” she says.

“First, we need a convincing explanation and, secondly, we need a high performing product that is consistent with how it was described to them. That is our core story with our B.I.G. glasses – we have something that allows our customers to differentiate simply because it is a completely different flow when a patient enters the store.

“Finally, we have an ongoing relationship with Thao and Grant Hannaford at the Academy of Advanced Ophthalmic Optics taking advantage of the education they provide for practices with a DNEye scanner. This is invaluable to help the understanding of not just DNEye technology, but general lens technology and how to discuss this with patients.” n

INSIGHT February 2022 47

MYOPIA

e n i p o r t a e low dos

MYOPIA INDICATION FOR

Low dose atropine for myopia management has largely been sourced off-label by Australian eyecare professionals, but the country will now gain access to its first approved product from this month.

tropine’s rise to becoming a key myopia management tool – and the ensuing debate around optimal concentrations – is one that Sydney paediatric ophthalmologist Professor Frank Martin has watched with intrigue over the decades. Its early use can be traced back to the 1970s when prominent Canadian ophthalmologist Dr Howard Gimbel published a paper in which 279 children received 1% atropine over three years and reported a 66% reduction in myopia progression compared with 572 controls. “It was effective in slowing myopia progression, but it wasn’t well tolerated because the participants couldn’t accommodate and had problems with glare due to their dilated pupils,” says Martin, whose various roles include visiting ophthalmologist at The Sydney Children’s Hospitals Network at Westmead and Randwick, Sydney Eye Hospital and his private practice at Sydney Ophthalmic Specialists. “But researchers started looking at it again, and it was the ATOM [Atropine for the Treatment of Myopia] studies out of the Singapore National Eye Centre that started looking at different strengths of atropine and found that 0.01% – which was essentially being used as a placebo – turned out to be effective. That really helped kickstart the use of low dose atropine for myopia control.” The ATOM studies began with the first published study in 2006 (ATOM 1), which focused on 1% atropine. Although it was effective in controlling myopia progression, it resulted in visual side effects from cycloplegia and mydriasis. This spurred the same research group to publish the ATOM 2

INSIGHT February 2022

studies where they compared three lower doses: 0.5%, 0.1%, and 0.01%. While the higher concentrations had better refractive and axial length control, 0.01% retained comparable efficacy and had fewer side effects. It has been widely reported that the 0.01% strength in this study was intended as a non-active control as it was assumed to have minimal effect. But a 2014 ATOM 2 follow-up showed the higher doses (0.5% and 0.1%) had greater rebound effects than 0.01% when participants treated for two years stopped for 12 months (three years in total). The researchers extended the study to five years. Only those whose myopia progressed by ≥-0.50 D in at least one eye during the washout period recommenced treatment, with all receiving 0.01% concentration for another two years, regardless of their previous regimen. Ultimately, by year five, it was those in the 0.01% group that had the lowest overall progression of myopia. This was primarily due to fewer children in the 0.01% group progressing after treatment was stopped, and the rate of progression in the washout year in those who needed retreatment was also less in the 0.01% group. Atropine 0.01% also caused minimal pupil dilation (0.8 mm), minimal loss of accommodation (2-3 D), and no near visual loss compared with higher doses. On the back of such illuminating studies, Martin says a greater number of Australian eyecare professionals have prescribed low dose atropine, which has largely been sourced off-label through compounding pharmacists. This is because, unlike some markets, Australia doesn’t have an atropine product specifically approved for myopia control.

That is set to change this month when EIKANCE 0.01% eye drops – an ophthalmic solution containing 100 micrograms of atropine sulfate in 1 mL (0.01%) – is listed on the Australian Register of Therapeutic Goods. It becomes the first atropine product in Australia with a myopia control indication. Specifically, it is indicated as a treatment to slow the progression of myopia in children aged from four to 14 years. It may be initiated in children when myopia progresses ≥-1.0 D per year.

Professor Frank Martin, Sydney paediatric ophthalmologist.

The product is being produced and distributed by Sydney-based Aspen Pharmacare Australia, which produces ATROPT 1% – another eye drop containing atropine that eyecare professionals use to dilate the pupil and paralyse accommodation.

It has taken several years to secure the myopia indication for EIKANCE, which now joins an expanding suite of orthokeratology (OrthoK), soft contact lenses and defocus spectacle lens products that have a myopia control indication in Australia. EIKANCE is a preservative-free eye drop and will be available in packs containing 30 sterile, single dose ampoules. According to the product information, treatment should be supervised by a paediatric ophthalmologist, and the eye drop should be administered as one drop to each eye at night. The maximum benefit of treatment may not be achieved with less than a two-year continued administration period.

This has been backed by several recent studies, including a Chinese study published in JAMA Ophthalmology that found myopia prevalence was three times higher in six-year-olds during the COVID-19 pandemic, giving rise to the term ‘quarantine myopia’. Martin says studies have shown that myopic children are developing a higher degree of disease than their myopic parents, indicating the environmental factors at play. Children over -6.0 D are considered to have high grade myopia, with the stress of the enlarged eye leaving them susceptible to more serious issues such as glaucoma, retinal tears and detachment and macular degeneration. Whilst eyecare professionals can’t stop myopia, he says they can play a role in delaying the onset. A key part of this is advising parents their children need to spend at least two hours outdoors accumulatively each day and limit screen time. “The longer we can delay the onset, the better it is going to be because if myopia starts in a child who is five years old who is -3.0 D, for example, once you extrapolate that out, they could increase to around -6.0 to -7.0 D in 10 years’ time when their myopia progression slows or stops,” he says. “We’re fortunate now that we have atropine and other interventions we know work once the onset of myopia occurs.” INCREASED UPTAKE With Australia gaining access to a range of approved myopia therapies in recent years, Martin expects there to be greater uptake of these interventions. A 2016 survey of Australian optometrists found their most common approach to myopia management were single-vision distance spectacles, with more than 50% of respondents indicating they

Martin says having access to an approved atropine product for myopia control will provide more certainty and better accessibility for patients. In recent months, community pharmacies in NSW have also been reprimanded by the Pharmacy Council of NSW after preparing a low dose atropine dilution from commercially available eye drops, affecting the stability of the final product. The drops were also being compounded in a non-sterile environment, with one patient complaining to the Australian Health Practitioner Regulation Agency. “Parents are becoming more aware of how progressive myopia isn’t good for a child's eye. This product is meeting a growing need and I think it will help atropine gain wider acceptance,” Martin, who has been prescribing atropine off-label for around six years, says. “It's going to be valuable because we have had to ask for atropine to be compounded. Myself and my colleagues have all had experiences where the incorrect strength has been given, so having a product that is going to be under strict pharmaceutical control and readily available will make a big difference.” A TIMELY ADDITION TO THE MYOPIA TOOLKIT The looming myopia public health crisis is no secret to Australian eyecare professionals. By 2050, it is estimated more than half the world’s population will have myopia and 10% or almost one billion will have high myopia. Thirty-six per cent of Australians were predicted to be myopic by now and by 2050, that number is set to increase to 55%. Although Australia doesn’t compare to countries like Singapore, Hong Kong, South Korea, Taiwan and urban China where more than 90% of adolescents entering university are myopic, Martin says myopia is progressing at an unacceptable rate (≥-0.50 D per year) among many Australian youngsters. In his own clinic, he has seen the exacerbating effects of COVID-19 lockdowns on myopic patients brought about by increased screen time for school and recreation.

EIKANCE 0.01% eye drops contain atropine and are indicated for myopia control in Australia.

INSIGHT February 2022 49

MYOPIA

would ‘always’ or ‘mostly’ prescribe this modality. This is despite the same survey finding that, relative to a single‐vision distance full‐correction, practitioners considered OrthoK (85%), low‐ dose atropine (54.4%) and soft defocus contact lenses (40.6%) as the three most effective modalities. The researchers concluded that: “Australian optometrists appear aware of emerging evidence, but are not routinely adopting measures that have not yet received regulatory approval for modulating childhood myopia progression.” Martin says a lot has changed in the last five years since that survey, including more evidence relating to efficacy of low-dose atropine, OrthoK lenses, peripheral defocus contact lenses and spectacle lenses slowing the progression of myopia. “There have also been papers on the effect of combining treatments. Low-dose atropine eye drops are often used in conjunction with multifocal or peripheral defocus spectacle lenses. Myopia is an important topic at almost every conference for ophthalmologists and for optometrists in 2021,” he says. “I expect having a product with regulatory approval to significantly improve uptake. Parents at times are reluctant to use a compounded product. They view it as not a mainline pharmaceutical.” While research suggests 0.01% atropine is nearly as effective as higher concentrations in reducing the progressive increase in myopic refractive error, without the unpleasant side effects and significant rebound, others have suggested it may have a limited effect on axial elongation – the root cause of pathology later in life – compared to higher concentrations.

The 2018 Low-Concentration Atropine for Myopia Progression (LAMP) study led by Dr Jason Yam from The Chinese University of Hong Kong, compared the rate of myopia progression in 438 children with myopia aged four to 12 years treated with 0.05%, 0.025% or 0.01% atropine or placebo drops over 12 months of treatment. As expected, the change in axial length was larger in the placebo group (0.41 ± 0.22 mm) than in the 0.05% (0.20 ± 0.25 mm), 0.025% (0.29 ± 0.20 mm) and 0.01% (0.36 ± 0.29 mm) groups. The difference between the placebo and 0.01% group was not considered significant. However, for all other pair wise comparisons between active treatment groups the difference was statistically significant. In a follow-up study in 2019, compared with the first year, the secondyear efficacy of 0.05% and 0.025% atropine remained similar but improved mildly in the 0.01% atropine group. While the LAMP study points to the use of 0.05% atropine to effectively control both spherical equivalent and axial length elongation, Martin says 0.01% may be beneficial as a frontline treatment that practitioners may choose early on in the treatment plan with patients, or later combine with optical-based interventions. In the case of EIKANCE 0.01%, he believes the fact it is preservativefree will be particularly beneficial for patients, many whom may be prescribed low-dose atropine for several years. “The decision to also package the eye drop in 30 single-use ampoules also helps bring an improved safety profile,” he says. “Practically, it’s also useful for families when they’re travelling or if children live between two homes because the cost and hassle of losing an ampoule is a lot less than an entire multidose bottle." n

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FEATURE

EVENTS ON THE HORIZON IN

2022 With 2021 not going to plan for most, 2022 should see a return to normality in many respects, with in-person events recommencing and pent-up demand for eyecare services levelling out. Prominent figures within the ophthalmic sector offer their predictions for the year ahead.

INSIGHT February 2022

INSIGHT February 2022 51

EVENTS ON THE HORIZON IN

2022

FINOLA CAREY

JAMES THIEDEMAN

ORGANISATION:

Optical Distributors & Manufacturers Association, CEO

Vision Eye Institute, CEO

AREA OF INTEREST:

Ophthalmology – private

AREA OF INTEREST:

Manufacturers and suppliers

Coupling diagnostic equipment with artificial intelligence (AI) applications is going to become the biggest trend to shape the ophthalmic equipment industry and beyond, not just this year but in the next decade. For example, coupling AI with retinal images allows medical professionals to make assessments beyond eye disease that reflect the overall health of the patient such as cardiovascular diseases and Alzheimer’s.

Financial challenges for Vision Eye Institute (VEI) and other players will be front of mind. Additional PPE costs, insurance premiums, wage escalation and supply chain cost appreciation are here to stay. Coupled with funding compression from Medicare and private health insurers, we’re challenged to deliver more, with less. That said, with our scale and innovation culture, we’re implementing new cost saving methods while maintaining exemplary care and outcomes.

ODMA’s biggest challenge – and its biggest opportunity – for 2022 is bouncing back from the cancellation of our last two shows, bringing a reinvigorated OSHOW22 to Sydney and marketing O=MEGA23, incorporating the 4th World Congress of Optometry, globally and to our Australia and New Zealand community.

VEI continues to partner with ophthalmologists and other surgical specialities in our 10 day hospitals. Further opportunities await this year as smaller practices and single day hospitals become fatigued with accreditation demands, risk management, payer management, industrial relations and marketing to patients and referrers. VEI’s scale and professional management allow these facets to be dealt with in the background so doctors can focus on delivering care.

ODMA will undergo changes, as after 26 years I am taking an extended long service leave break from the industry. In my absence our general manager Amanda Trotman, who many will know from her role as event manager of O=MEGA21, will be acting CEO.

DR KATE GIFFORD

DR PETER SUMICH

ORGANISATION:

Optometrist, professional educator, clinician-scientist, Myopia Profile

Australian Society of Ophthalmologists, vice president

AREA OF INTEREST:

Myopia

Ophthalmology

Myopia is the biggest sight issue affecting our children today and will become an increasing eye health problem for our adults of tomorrow. Another difficult year of digital learning and lockdowns will likely see continued march of the world’s population towards higher rates of myopia. In 2021, momentous events were the World Council of Optometry unanimously resolving that myopia management must become standard of care; and the International Myopia Institute publishing its second volume of landmark reports. In 2022, I’m looking forward to seeing more awareness, education and access to treatments driving a bigger shift in translating research into practice. New product releases, wider release of current treatments, and highly awaited research outcomes are on the agenda. The next wave of innovations and understanding will be presented at the biennial International Myopia Conference in late 2022. As the world’s largest digital platform on the topic, Myopia Profile will continue to support eyecare locally and globally with cutting-edge education, resources and public awareness.

INSIGHT February 2022

2021 was special as VEI marked 20 years. In 2022, we will continue to invest in clinical technology, staff development and streamlining the patient journey. We also expect announcements regarding our international expansion – watch this space.

The year 2022 will be tumultuous after the relative quiet of COVID in 2021. The Federal election looms large over everything although early indications are that health policy will be secondary to inflation, economy and climate. In the disorganised crowd of a group brawl, it pays to keep one’s eyes on the bad actor in the crowd – private health insurers. They have designs on a managed care agenda via stealth which they hope to achieve through surreptitious contracting, bundling and private day surgery ownership stakes. If there is a change of government, the whole health landscape becomes uncertain until the 2022 Australian Labor Party philosophies become apparent. Expect inflation to become a problem for all players in the health chain with the exposed health insurers beating down hard on everyone else to maintain margins. Employment is becoming tighter with work from home trends, so expect to pay more for workforce. Those things aside, the pent-up healthcare demand should presage a strong year for most.

PROF NITIN VERMA

DR RACHEL DAVID

ORGANISATION:

RANZCO, president

Private Healthcare Australia, CEO

AREA OF INTEREST:

Ophthalmology

Private health insurance

Like all Australians and New Zealanders, I am optimistic 2022 will be a year of reconnection.

This time last year we had high hopes for a more ‘normal’ 2021 but the challenges of COVID kept on coming and the health sector kept on delivering.

With successful national vaccine rollouts and travel recommencing, I see 2022 as the year that ophthalmologists can reconnect with each other and with their work, whether it be outreach, locums, research or international development.

Australian health funds continued to offer support to members during the pandemic, postponed the premium increase, funded telehealth services, and extended financial support measures to those impacted by the pandemic. The value of private health insurance was increasingly recognised; with record public hospital wait lists, it is the best way to ensure timely access to surgery. Membership across general treatment and hospital cover increased.

Ophthalmologists are collaborative by nature and although we have employed novel workarounds in a virtual setting, nothing replaces a face-to-face connection. The national, speciality and branch scientific meetings planned for this year will allow such interactions to occur. Reconnecting with each other will also be important as RANZCO works towards Closing the Gap, along with its partners.

Now that Australia is meeting vaccination targets and restrictions have eased, it’s important that members keep up with regular health checks. PHA is committed to ensuring private health insurance is affordable, so Australians can access allied health treatments and timely medical care. During 2022, I will continue to work with healthcare stakeholders and government to achieve this.

EVENTS ON THE HORIZON IN

2022

DEE HOPKINS

PAUL BOTT

ORGANISATION:

Macular Disease Foundation Australia, CEO

Specsavers Australia and New Zealand, managing director

AREA OF INTEREST:

Patient outcomes – macular disease

Optometry – corporate

Our hope for 2022, and with the formation of the 47th Parliament, will see the wider sector and government working together to measurably improve access to intravitreal injections – particularly for patients who experience financial hardship and those living in regional and rural areas. MDFA will continue its strong advocacy in ensuring recommendations in the MBS Review will not have any adverse impact on patients. We aim to keep the co-developed 10-year National Strategic Action Plan for Macular Disease at the forefront of our engagement with government and the sector more broadly – for enhanced prevention and early detection, actions to better support those living with macular conditions, and increased investment in eye health research. We are excited about piloting new, innovative partnership programs that aim to tackle the problem of non-adherence to sight saving treatment and testing practical patient engagement interventions to reduce modifiable risk factors.

We see 2022 as a year of opportunity to deliver an ever-better environment for our team members across our store and support office network. With our store partners we will invest heavily in professional development and career development, for our optometrists as well as our dispensing and retail professionals. SCC (Specsavers Clinical Conference) will take place as an in-person event in Melbourne in September and a number of state-based SDCs (Specsavers Dispensing Conferences) will run through the year, while our Pathway program will support those with ambition all the way to store ownership roles. While we may experience ongoing COVID-related disruptions, they won’t stop us working towards an unmatched experience for our partners, team members, their patients and customers. We will build on the 250,000 patients with diabetes we have so far registered on the KeepSight portal while continuing to strive for a 100% record in detection and referral rates for glaucoma.

PROF HUGH TAYLOR

PROF ROBYN JAMIESON

ORGANISATION:

Indigenous Eye Health, University of Melbourne, founder

Ocular Gene and Cell Therapies Australia, Children’s Medical Research Institute, Sydney Children’s Hospitals Network, University of Sydney

AREA OF INTEREST: Indigenous eye health

AREA OF INTEREST: Ocular genetics

We’ve made great progress in establishing regional stakeholder networks nationwide that link the ACCHOs with service providers and local hospitals. The government has prioritised and committed to “End avoidable blindness by 2025” for Indigenous Australians. Now it needs to release its implementation plan to build and strengthen the services required. An important component will be improving leadership and ownership among Aboriginal and Torres Strait Islander Australians. The Roadmap to Close the Gap for Vision was released in early 2012. When the government implements its priority to “End avoidable blindness by 2025”, the roadmap will have been essentially completed. The Indigenous Eye Health unit will recast our role, focussing on technical support and advice to strengthen Indigenous leadership in the ACCHOs, the regions, the states and territories and nationally. The next National Aboriginal and Torres Strait Islander Eye Health Conference will be in Darwin 24-26 May 2022. This “must come event” is for those interested or working in Indigenous eyecare.

INSIGHT February 2022

Excitingly, our team delivered the first clinical ocular gene therapy in Australia in 2020/21. This landmark achievement will shape new approaches in the ophthalmic gene therapy landscape in 2022, as more ophthalmic and genetic services and patients with inherited retinal diseases (IRDs) seek access to eligibility criteria assessment for this and new clinical trials. To tackle this challenge, our newly-formed collaborative organisation, Ocular Gene and Cell Therapies Australia (OGCTA), has established a virtual multidisciplinary case conference approach, the OcularGen MDT, to facilitate equity of access to eligibility assessment for ocular genetic therapies and clinical trials. Other challenges to be addressed by our team include streamlining of retinal organoid and other functional study pipelines in assessment of genetic variants and development of novel IRD therapy approaches. The 25th International Society for Eye Research meeting is scheduled in Australia in September and ophthalmic therapeutics will be a key focus.

ANNIE GIBBINS

BRENDON GARDNER

ORGANISATION:

Glaucoma Australia, CEO

Royal Victorian Eye and Ear Hospital, CEO

AREA OF INTEREST: Glaucoma

AREA OF INTEREST: Ophthalmology – public

Research into AI to revolutionise screening and decision making, genetic therapies that may provide real neuroprotection options, and improved medical and surgical treatments will shape the glaucoma landscape in 2022. As an organisation, ensuring our risk awareness campaigns continue to drive testing remains our biggest challenge. But there are many opportunities to better support diagnosed and undiagnosed glaucoma patients, namely targeted marketing to increase at risk testing by optometry and more referrals to our service via Oculo and our website. We’re also excited about the progress of new research such as Professor Ewa Goldys’ (UNSW) fluorescent Hyperspectral Imaging (fHSI) novel glaucoma imaging tool and Dr Flora Hui’s (CERA) TAMING Glaucoma Trial (Targeting Metabolic Insufficiency in Glaucoma with Nicotinamide).

This year holds much anticipation for everyone at the Eye and Ear. The final part of our redevelopment will be completed which will provide our patients, staff and visitors with a world-class hospital that is reflective of the top-quality care that has been offered at the hospital for over 150 years now. Unquestionably the demands that have been placed on healthcare workers in 2021 – as was the case for 2020 – have been vast. However, I think there is a degree of cautious optimism for the new year borne of climbing vaccination numbers and more refined processes in managing COVID-19 based on the learnings of the last two years. Every day I am in awe of the expertise and compassion demonstrated by our staff who have continued to deliver outstanding patient care in such challenging circumstances.

To coincide with World Glaucoma Week (6-12 March), GA is launching its inaugural fundraiser, the 7 Sights in 7 Days Challenge.

PROF KEITH MARTIN

STEVEN JOHNSTON

ORGANISATION:

Centre for Eye Research Australia, managing director

ProVision, CEO (former)

AREA OF INTEREST:

Optometry – independent

AREA OF INTEREST:

Ophthalmic research

Gene therapy and its benefits for patients with previously untreatable eye diseases will continue to gather pace in 2022. The first Australians with the RPE-65 genetic mutation have now received the approved gene therapy Luxturna, and a clinical trial of an investigational gene therapy for dry AMD has now trialled the treatment on seven Victorian patients. CERA’s pre-clinical research to develop new gene therapies is yielding promising results in the lab, with some treatments moving closer to clinical trial phase. As a translational research institute we are excited by the potential of gene therapy research and committed to giving Australians early access to pioneering new treatments – developed in Australia and overseas – via clinical trial. In 2022 we are also excited to add new areas to our research program including genetic engineering, clinical biomarkers, vascular neuroscience and ocular oncology to further broaden our understanding of the causes of eye disease and develop ways of diagnosing and treating eye disease to prevent vision loss.

Last year I was hoping that some of the COVID consumer behavioural shifts would become permanent, and this year I still hold that thought. Patients are choosing to shop local and avoid crowded shopping centres, and they are looking to build personal relationships with their healthcare providers, both of which are good for our members. ProVision continues to work on systems that will bring administrative efficiencies and growth to our members in 2022 when we release our ProAccounts2 system to enable frame data to be downloaded into the practice PMS, and introduce a web platform that will bring new patients to our practices. It is awesome to see the number of younger optometrists interested in setting up independent greenfield practices in 2022. We are genuinely excited about our Look Forward national conference at Crown Perth which is scheduled for 21-23 October and will be our first national get together in four years.

INSIGHT February 2022 55

EVENTS ON THE HORIZON IN

2022

PHILIP ROSE

JANE SCHULLER

ORGANISATION:

Eyecare Plus, national business development manager

Orthoptics Australia, president

AREA OF INTEREST:

Orthoptics

AREA OF INTEREST:

Optometry – independent

As the lockdowns end, local independent optometry is recovering well and returning to clinical in-person service. One of the challenges for 2022 will be navigating the issues around seeing unvaccinated patients or supplier representatives, as well as within the practice staff.

A feature expected to shape orthoptics in Australia next year is the significant waiting lists for appointments and surgeries in the public system. It’s an ideal opportunity for hospitals to maximise use of the orthoptic workforce in triaging and orthoptic-led clinics to improve clinical efficiencies and reduce wait times.

For me, an obvious factor over the past year is the accelerated implementation of various online opportunities for patient communication and for Eyecare Plus, our e-commerce site. Streamlining stock and spec ordering, improving purchasing efficiencies, has also been a focus for us.

A challenge for Orthoptics Australia will be the continued uncertainty and planning for our face-to-face conferences planned for 2022. Also, many orthoptists didn’t take annual leave last year and will face an considerable patient backlog; finding the right balance on how best to support for members will be vital.

I look forward to seeing Eyecare Plus grow its digital marketing and advertising footprint. Increased consumer recognition, validated by winning the Canstar Blue Award for Most Satisfied Customers three years in a row, is one of the benefits of having a national brand, while still being locally owned and operated. Another highlight for me in 2022 will be returning to in-person meetings, including our Eyecare Plus National Conference in October.

Our membership has grown considerably and we will focus on supporting early career orthoptists through several initiatives. Elsewhere, while our Australian Orthoptic Journal continues to attract original articles from Australian and overseas authors, it’s not yet indexed on Medline. We’ve commenced the application process and look forward to a favourable outcome. I’m also hoping to see commitment and support for a national scheme for Vision Screening for 3.5-5-year-old children.

LYN BRODIE

PATRICIA SPARROW

ORGANISATION:

Optometry Australia, CEO

Vision 2020 Australia, CEO

AREA OF INTEREST:

Optometry

Eye health advocacy

Our sector will be still dealing with COVID, with practices in many jurisdictions continuing to manage a backlog of recalls. As with others in the health sector, optometrists are concerned about ‘what have we missed?’ as a result of long lockdown periods when many appointments simply didn’t happen.

This year is a critical one for our sector. The pandemic has had a significant impact on eye health, with 500,000 missed eye tests and extended waiting times for cataract surgery. We need to work towards ensuring all Australians are getting the eyecare they need.

Optometry Australia will continue to champion our profession and pursue opportunities to enhance the way optometrists can meet the needs of our communities by working to full and evolving scope-of-practice and ensuring our health system makes best use of our highly skilled workforce. The federal election provides the platform to call on standing and candidate politicians to embrace greater access to timely, affordable eyecare for all Australians and we will rally members to assist in amplifying our voice.

The upcoming federal election gives us an opportunity to put vision and critical eye health matters on to the political agenda.

Navigating an ever-changing environment remains essential. With 85% of the profession our members, it is imperative we continue to provide access to quality professional development that enhances their skills to meet community eyecare expectations.

Additionally, the government has promised to close the eye health gap for Aboriginal and Torres Strait Islander people by 2025 – so 2022 certainly needs to be a year of action to achieve this goal.

INSIGHT February 2022

Sight-saving research, vision screening for young children, investment in global aid and public health access, action on audio description, and ensuring the needs of people who are blind or have vision loss are better supported through the reform processes in aged care and disability services are all important priorities.

CAREER

People

ON THE MOVE A wrap on the latest appointments and industry movements within the Australian ophthalmic sector.

AUSTRALIAN LEADING WORLD COUNCIL OF OPTOMETRY FOR NEXT TWO YEARS Former head of the School of Optometry and Vision Science at Queensland University of Technology, Associate Professor Peter Hendicott, has started his two-year term as president of the World Council of Optometry (WCO). His appointment was made official at the council’s annual general meeting in late 2021. According to Optometry Australia, he is only the second Australian to lead the WCO in its 94-year history, after Dr Damien Smith assumed the presidency from 2002 to 2004.

QUALIFIED ORTHOPTIC NURSE JOINS BAUSCH + LOMB Caroline Gash has joined Bausch + Lomb as surgical territory manager and will support Western Australia. Trained in the UK as a registered nurse and later completing her Diploma in Ophthalmic Nursing at, Sunderland Eye Infirmary, she migrated to Perth in 1996 and is a qualified ophthalmic nurse with now some 28 years’ experience in the field. She has worked various major ophthalmic facilities in both the UK and Perth and is passionate about ophthalmology.

OPTOMETRY AUSTRALIA PRESIDENTIAL REIGN COMES TO AN END Optometry Australia’s national president Mr Darrell Baker has stepped down after serving in the role since 2018, and has retired from a 10-year stint on the national board of directors. The board subsequently appointed former deputy president Mr Murray Smith as president. Smith was president of Optometry Victoria, leading its amalgamation with Optometry South Australia in 2018. Ms Margaret Lam, from NSW, has been appointed deputy president.

CYLITE BRINGS OPTICAL PHYSICIST ON BOARD FOR OCT DEVELOPMENT Melbourne OCT manufacturer Cylite has further expanded its R&D team with the appointment of optical physicist Dr Clare Manderson. She has spent her career applying optical physics to solve problems in engineering and biomedical science by adapting and building laser-based microscopy and super-resolution imaging systems from the ground up. The company believes her skill set is ideally suited to OCT, with her PhD being completed in the field of coherent diffraction imaging.

OPHTHALMOLOGIST TO HEAD UP NEW CERA OCULAR ONCOLOGY UNIT Honorary researcher Dr Rod O’Day has been appointed to lead a new Ocular Oncology Research Unit at CERA. He is a consultant ophthalmologist at the Eye and Ear, specialising in ocular oncology, and recently returned from the UK after training to build his clinical skills treating eye tumours. “The main aim I have with my research is to develop better techniques to estimate how malignant an eye tumour is. We will develop various techniques to help us better distinguish between a benign mole and a malignant melanoma."

BAUSCH + LOMB APPOINTS OPTOMETRIST AS SURGICAL TERRITORY MANAGER Stephanie Bahler has joined Bausch + Lomb as surgical territory manager. She will provide ophthalmic surgical technical, product and business support across Western Australia. Bahler is an optometrist with over 15 years' experience across clinical, management and business commercial roles. She is currently the president of Optometry WA. Her industry experience, coupled with her passion for community eye health, has provided her with the solid foundation to support the ophthalmic surgical setting.

Do you have career news to share? Email editor Myles Hume at myles.hume@primecreative.com.au to be featured. INSIGHT February 2022 57

CARING FOR COVID KIDS IN NEW SOUTH WALES WESTMEAD SENIOR PAEDIATRIC ORTHOPTIST LOUISE BRENNAN WAS REDEPLOYED TO A COVID RESPONSE TEAM AT THE PEAK OF THE SYDNEY OUTBREAK LAST YEAR. SHE RECOUNTS THE OPPORTUNITY TO SUPPORT ISOLATING HOUSEHOLDS.

have worked through a range of challenges within my 27 years as an orthoptist at the Eye Clinic at The Children’s Hospital at Westmead, but nothing compares to my experience at the height of the COVID-19 pandemic in NSW. LOUISE BRENNAN

"WITH THE DEMANDS FOR CARE VAST AND VARIOUS, THIS PRESENTED STAFF WITH THE OPPORTUNITY TO EXTEND THEIR SCOPEOF-PRACTICE LATERALLY"

My ‘business as usual’ role is in the Eye Clinic working as part of the ophthalmology team, who see more than 10,000 children each year. But for a 12-week period from August 2021, my role shifted completely. When COVID-19 cases began to rise in children, I put my hand up to be redeployed to the virtualKIDS ‘CORT’ team (COVID-positive Outpatient Response Team), to help support the increasing patient numbers. Lockdown, coupled with lengthy wait times for online groceries and essentials, meant that some households affected by COVID-19 needed extra and immediate help. In my role as logistics coordinator for the CORT team, I helped organise the distribution of much needed items such as formula, nappies, personal care, medical equipment and emergency supplies of food for COVID-affected children and their families. This also involved working with many partners and other support agencies to coordinate requirements for families. Sydney Children’s Hospitals Network cared for thousands of children through virtualKIDS; a collaborative service providing healthcare, virtually and in-person, to children who have tested positive for COVID-19 but are well enough to be cared for at home. Staff from all areas of the network were redeployed into emergent roles to meet the surge in demand of caring for COVID-19 affected patients and families. With the demands for care vast and various, this presented staff with the opportunity to extend their scope-of-practice laterally and embrace skills not traditionally within their chosen profession. The virtualKIDS logistics team consisted of staff from ophthalmology, rehabilitation, cardiology, nursing,

INSIGHT February 2022

The virtualKIDS ‘CORT’ logistics team packing essential items required to help a family care for their COVID-positive child at home.

orthotics, audiology, speech pathology, health promotion, pharmacy, allied health assistants, administration, transport and porters, to name a few. Not only did the team support children in Sydney, but also health colleagues in rural and regional areas of NSW as cases increased in areas outside of Sydney. The team covered a seven-day roster in the peak of the pandemic response, enabling emergency logistics supplies to be picked, packed, documented and delivered to isolating families. Other team members worked on telehealth care for COVID-positive patients and families, and some were part of ‘Flying Squad’ teams, made up of doctors and nurses who visited homes to provide inperson care and deliver the essentials that we in the logistics team had organised for distribution. The highlight of my time in virtualKIDS CORT logistics was the genuine impact the team were able to make on families going through an incredibly difficult time. It was satisfying knowing we had made a real difference to the parent and carer’s ability to care for their children. I enjoyed the challenge of the role and meeting lots of new staff who came

from a wide background in health, who I normally would not work with in my substantive orthoptic role. We all came to the team with the common goal of helping others. I am proud our team contributed to the community and made that time a little easier for children and families doing it tough in isolation. To date, more than 12,000 children have received care through the virtualKIDS service since late June 2021. More than 2,000 parcels have also been delivered to families across Sydney, reaching north into the Hawkesbury region, as far south as the Illawarra, and west into the Lower Blue Mountains through to the Sydney beaches. The support reached patients and families further afield too, providing toys and other goodies to rural and regional NSW. n

ABOUT THE AUTHOR: LOUISE BRENNAN is a Senior Paediatric Orthoptist at The Children’s Hospital at Westmead. 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

MANAGEMENT

PLAN TODAY SO YOU CAN BENEFIT TOMORROW HIGH QUALITY MEETINGS WITH MEANINGFUL OUTCOMES ARE VITAL SO ALL PRACTICE STAFF MOVE TOWARDS A COMMON GOAL. KAREN CROUCH EXPLAINS HOW TO AVOID THE TRAP OF INEFFECTIVE MEETINGS.

happy 2022 to all readers as we move through a successfullymanaged, pandemic-influenced environment to living with the disease as an endemic health condition.

KAREN CROUCH

"A DECISION THAT COULD BE MADE RELATIVELY EASILY BY CIRCULATED EMAIL MIGHT ONLY REQUIRE A MEETING IF PARTIES CANNOT REACH AGREEMENT"

Regardless, the need continues for effective communication, not just through one-on-one meetings but formal office forums to ensure meaningful, mutually achieved and understood outcomes. After all, forums of either particular office craft groups or by wider coverage are the ideal conduit for achieving best teamwork standards. Practices sometimes pride themselves on strong interpersonal communication based on frequency of meetings. However, a closer review often reveals they lack more important factors: quality and outcomes (results). Our firm is often involved in assessing the effectiveness of practice meetings to enrich their quality, improve decision making, and promulgate meeting resolutions, including enforcement of existing practice management or staff behavioural policies. We noted the following common threads: •M eetings were invariably conducted between various job families – administration, clinicians, principals – but rarely across craft groups, •Y et, most felt the level of communication within the practice was high, based on the degree of familiarity and the general level of friendliness between staff, undoubtedly a favourable outcome from the perspective of office morale, •B ut many interviewees commented that decisions were often not clear or crisp, not communicated effectively, or meaningfully recorded for future reference, resulting in poor implementation of meeting resolutions. It’s worth noting that a practice’s attitude and discipline of regular meetings is not to be discouraged as their basic appreciation for effective communication is praiseworthy. With staff cooperation, we defined these desirable benefits of an effective meeting: •T arget outcome/s is clearly defined and understood by participants via an agenda •C ommunication and decision making is

that a consensus or majority opinion clearly confirms any decisions

A chairperson or leader helps focus attendees’ minds on agenda items.

improved, including accurate recording of salient outcomes •E xperiences, information and knowledge are freely exchanged •T he forum is exploited as a ‘work smarter’ opportunity to achieve continuous improvement •D ecisions are implemented through effective promulgation and follow through, and; •Q uality corporate governance practices are maintained. We noted all meetings were not for practice management reasons; some for social purposes were conducted on an informal basis for business/relationship or development purposes. Generally, content was less structured, albeit well planned beforehand, and the general atmosphere was casual, affording staff the opportunity to speak freely about morale improvement. We asked meeting groups the following questions, based on general principles of effective meetings:

• Are meetings properly ‘time planned’ and ‘time managed’? – has adequate time been allocated to do justice to each topic and that the chairperson or leader can ensure each item has been afforded reasonable time for a meaningful outcome • What happens to ‘unfinished’ agenda items? – denotes items that are to be carried forward to the next meeting • Is relevant pre-reading circulated? – where an item warrants it, pre-reading affords attendees an opportunity to prepare and contribute more meaningfully, also evidencing thoroughness of the meeting coordinator • Are periodical self-assessment ‘meeting evaluations’ conducted? – a means by which teams strive to improve meeting quality and outcomes •A re minutes (including resolutions) and action items documented and distributed? – provides continuity and implementation of resolutions when minutes are tabled at subsequent meetings. An ongoing action items record also ensures agreed actions are enacted according to plan/time/ responsibility or diarised for follow up. Staff, clinicians and principals have found the exercise highly beneficial, injecting meaningful structure and achievementoriented content into meetings, without introducing excessive bureaucracy.

•D o meetings have a pre-circulated While meetings are a useful form of Agenda? – a meeting ‘purpose’, including communication, decision making and target outcomes that may be defined in some cases but merely as a guideline planning, the other extreme is too many while not stifling open discussion meetings – meetings for the sake of • I s a chairperson or leader appointed? – a meetings. A decision that could be made ‘controller’ to focus attendees’ minds on relatively easily by circulated email might agenda items, encourages open debate only require a meeting if parties cannot where applicable, assigns appropriate reach agreement on a proposal. n actions to individuals, and ‘watches the clock’ so items are not deferred or left undecided ABOUT THE AUTHOR: KAREN CROUCH is •A re desired outcomes or decision options understood? – where applicable, this ensures participants are aware a decision is required and

Managing Director of Health Practice Creations Group, a company that assists with practice set ups, administrative, legal and financial management of practices. Email kcrouch@ hpcnsw.com.au or visit hpcgroup.com.au.

INSIGHT February 2022 59

DISPENSING

SOCIAL MEDIA MARKETING TO BENEFIT YOUR PRACTICE OPTICAL DISPENSERS PLAY AN IMPORTANT ROLE IN PROJECTING THE PRACTICE’S OUTWARD IMAGE. THIS CAN EXTEND TO SOCIAL MEDIA TOO, WHICH HAS BECOME ONE OF THE MOST EFFECTIVE MARKETING TOOLS, WRITES APRIL PETRUSMA.

APRIL PETRUSMA

"IT’S ULTIMATELY ABOUT BRAND AWARENESS, INCREASING TRAFFIC TO YOUR WEBSITE AND KEEPING YOU CONNECTED WITH PATIENTS AND THE WIDER INDUSTRY"

n a modern world fuelled by technology and consumerism, social media has fast become a primary marketing tool for businesses of all sizes, across every industry. While the eyecare and optical sector has historically shown hesitancy in this space, the clear benefits have begun to sway practice marketing strategies – and for good reason. Social media is no longer a simple networking platform. Applied correctly, it is one of the most effective communication and marketing tools for businesses, offering the ability to market to a wider demographic than ever before. It’s a vital tool for all staff – including the optometrist, optical dispenser, practice manager and optical assistant – to be familiar with because all parties can contribute to the practice’s social media presence in different ways. When considering social media, some might argue it isn’t the right tool for an optometry practice. This is often due to the mindset that not everyone who sees your posts will be looking for an optometrist or new glasses. But it’s not about the hard sell or the here and now. Social media is a form of ’push’ marketing and for our industry, it’s not intent-based but is all about consistency and timing. Yes, you might be displaying to people who don’t need your products or services at a given time, but if consistent enough, you’ll be the first in mind when they do need an eye test, new sunglasses or a frame update. Social media isn’t simply about growing a social media presence or selling a product, it’s ultimately about brand awareness, increasing traffic to your website and keeping you connected with patients and the wider industry. It’s an opportunity to interact with people outside the confines of your practice walls. It can help new patients discover you, keep current patients engaged and, most importantly, grow your practice. Tried and tested tips to maximise social media when marketing your practice: •V isual content is a must. A striking image gains attention and is likely to engage twice as many people than a text-only post. If you have a knack for photography, you can use photos taken

INSIGHT February 2022

Social media can help practices showcase their expertise and eyewear range.

on a smartphone. Alternatively, purchase stock images online or post professional brand assets provided by suppliers’ marketing departments. •S ocial media for optometry practices is most effective when it’s interactive. Check your account regularly and swiftly respond to comments, messages or reviews. This works best if it can be factored into the day and delegated to a specific team member like the optical dispenser or practice manager. •S hare expert information relating to your expertise. You may think a post about eye health won’t appeal to everyone, but your audience will see you as an expert in your field and will likely think of you first when they need an optometrist. Simple things like sharing information about how to take care of your eyes, eating for eye health or how to select the right frame can go a long way. •S howcase your products by regularly posting images of new frames. Short of a window display or a browser walking through the door, there are limited options to put products in front of people. Social media allows just that, and is an excellent way to inform existing and future patients of new stock. •D on’t be overly salesy with your content. Remember, it’s more about educating

and building authority. If every post is a ‘buy now’, you risk disengagement and a perception your posts are advertising and just another commodity. •A sk questions to encourage people to interact and feel valued by sharing an opinion. While driving engagement, questions are an easy way to discover what people think, and act as a form of market research for your business. This could be as simple as showing a frame in two colours and asking which is preferred. Social media marketing can be time consuming but – with a clear plan and strategy – can become one of the easiest and cheapest marketing tools for your practice. There are many apps you can download to help with timelining and post scheduling, so you don’t feel like a slave to your smartphone. Social media is here to stay and if you want your business to progress with the world around it, now is the time to evaluate your marketing strategies. n

ABOUT THE AUTHOR: APRIL PETRUSMA is a senior lecturer at the Australasian College of Optical Dispensing and CEO of Optical Dispensers Australia. She is a qualified optical dispenser with a degree and background in marketing and has acted as the marketing manager for an independent practice.

2022 CALENDAR FEBRUARY 2022 RANZCO ANNUAL SCIENTIFIC CONGRESS Brisbane, Australia 25 February – 1 March ranzco.edu

77TH ORTHOPTICS AUSTRALIA ANNUAL CONFERENCE Brisbane, Australia 26 – 28 February orthoptics.org.au

MARCH 2022 COPENHAGEN SPECS Copenhagen, Denmark 5 – 6 March copenhagenspecs.dk

ASO 2022 EXPO Melbourne, Australia 18 – 20 March asoeye.org/event-page-expo/

VISION EXPO EAST New York, US 31 March – 3 April east.visionexpo.com

APRIL 2022 AUSTRALIAN VISION CONVENTION (AVC) Queensland, Australia 9 – 10 April optometryqldnt.org.au/avc

MAY 2022 BARCELONA SPECS Barcelona, Spain 7 – 8 May info@barcelonaspecs.com

10TH SUPER SUNDAY CONFERENCE Sydney, Australia 22 May optometry.org.au

OSHOW2022 Sydney, Australia 27 – 28 May marketing@odma.com.au

MIDO EYEWEAR SHOW Milan, Italy 30 April – 2 May mido.com

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

JUNE 2022 NOSA ANNUAL CLINICAL AND SCIENTIFIC MEETING Canberra, Australia 9 – 12 June kathpoon@bigpond.com

AUGUST 2022 AUSCRS Noosa, Australia 3 – 6 August auscrs.org.au

NSW RANZCO & OPHTHALMOLOGY UPDATES! Sydney, Australia 27 – 28 August ranzco.edu

SPECSAVERS – YOUR CAREER, NO LIMITS All Specsa Graduate Opportunities – Australia and New Zealand ve s tores n rs The Specsavers Graduate Recruitment Team have several exciting graduate opportunities available across Australia o with O w & New Zealand. With continued growth in providing eyecare to patients across ANZ, now is an exciting time to join a CT company that is leading and defining the future of the optical profession. At Specsavers you will have access to cutting edge technology and be part of the driving force bringing optometry into the forefront of the healthcare industry. If you are a final year student or recent graduate looking to secure employment, we would like to hear from you. Please contact apac. graduateteam@specsavers.com today.

Interested in relocating to NZ? From the North to the South, Specsavers has a range of opportunities at all levels for NZ optometrists looking to return home. You’ll have the chance to advance your skills and become part of a business that is focused on transforming eye health outcomes in New Zealand. Be equipped with the latest ophthalmic equipment (including OCT in every store) and develop your clinical experience across a range of interesting conditions and an ever-growing patient base. You’ll also have the support of an experienced dispensing and pre-testing team, the mentorship of store partners and access to an exemplary professional development program. Talk to us now, we can make the relocation easy. Locum Optometrists: New Year, New Career Is your New Years’ resolution to secure a new job? Specsavers has locum opportunities and are looking for dedicated professional optometrists who are passionate about delivering outstanding eyecare to join our store network as a locum optometrist. The role will provide you with state-of-the-art equipment and a supportive team. Specsavers is arriving in Morwell – Optometrist and Optical Dispenser/ Retailer Partnership Opportunities Available! We are looking for a passionate, energetic, and experienced team of professionals to become JVPs at Specsavers brand-new store opening soon in Morwell. Morwell is situated 150kms east of Melbourne in the heart of the La Trobe Valley and offers affordable housing and a relaxed lifestyle with beaches and mountains nearby. Town residents have access to the large Mid Valley Shopping Centre located on the eastern side of the town. With market rate salary + share of the store profits, this is an opportunity not to be missed. Optometrist opportunities in Bundaberg, QLD There has never been a better time to relocate to QLD’s east coast. Specsavers Bundaberg has a great opportunity to welcome additional Optometrists to their supportive team. You’ll have the opportunity to co-manage many patients with local ophthalmologists, work with market leading specialist equipment – including OCT and have access to excellent opportunities for professional development. This is a five-room practice with a flexible roster on offer and an extremely generous salary package including relocation support if applicable. Optometrist Opportunity – Specsavers Dubbo, NSW Specsavers Dubbo has a fantastic opportunity for a graduate or full-time experienced optometrist to join their patient focused and friendly team on a full-time basis. This four-clinic room practice has OCT – which is fully utilised due to a mixed patient demographic in this community store.

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

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

marie.stewart@specsavers.com or 0408 084 134 WA, SA, NSW & ACT Optometrist 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

SOAPBOX

WHERE INDEPENDENTS CAN SUCCEED

BY STEVEN JOHNSTON

fter 10 extremely rewarding years leading the ProVision organisation, it is time for me to leave the wonderful industry of optometry that I’ve grown to love. It’s satisfying to consider the fundamental shifts we’ve delivered over the last 10 years to equip independents with technology and systems that allow them to remain commercially competitive, while leveraging the clinical elements that make them unique. Some naysayers would have you believe that independent practice is under considerable threat from other operating models and increasingly online players, however our data across 450 practices would suggest otherwise. By and large our members continue to grow. There is also the myth that independent practice is inefficient with a cost to serve. Showing personal care for patients is good for business because there are still many consumers who crave a personal relationship with their healthcare provider. Across my journey, many practitioners and industry leaders have impressed upon me the importance of sustaining a vibrant independent sector. In my view, the corporates, franchises, and consolidators tend to succeed (in terms of generating profit) by homogenising the product, service, and patient experience so they can

INSIGHT February 2022

leverage their collective volume at the lowest possible cost. As a true layman in this space, I can still observe this does not always bring benefit to everyone equally. The end user benefit of commoditisation is that patients will get the same product or service every time, and generally at a lower price, which may suit some. But this does little to help the outliers who have unusual conditions or difficult prescriptions. I have heard too many stories of challenging patients referred to independent practitioners, likely consuming too much chair time to pass the commercial scrutiny test. Without independents, where would these patients go? Conversely, independent practices succeed by offering the antithesis of commoditisation. They generally offer differentiated frames and lenses, bespoke services, and deliver a personalised patient experience that is hard to replicate because it includes continuity of care from the same optometrist over an extended period. Independent optometrists have been able to determine what equipment they use, what appliances they prescribe, and what areas they might like to explore due to special interest, and nearly always with patient outcomes – not profit outcomes – in mind. A great example was shared with me recently of an optometrist who had personally suffered from dry eye for 20

years and was therefore driven to explore all possible remedies for his patients because he could empathise with the impact on their quality of life. Importantly, many independent optometrists have expressed to me that they particularly enjoy the clinical challenge interesting patients present. We should be thankful that they do. Optometry has undergone a massive transition over the past few decades as the retail component increasingly generates the revenue that funds practice operations, and consequently, investment in clinical technology. The challenge for independent practitioners has often revolved around focusing on the clinical rather than the commercial, but I see that changing as the ‘mature’ clinicians see the connection between the two sometimes opposing tensions. And for the younger brigade, it’s just the way it is. The reality is that they are joined at the proverbial hip. You can’t have contemporary clinical excellence without a commercially successful enterprise that can invest in the technology. It is a virtuous circle. For independent optometry to continue to flourish in Australia, practice owners need to commercialise their special interests so they are famous for what they uniquely do in their local communities. To me that is a remarkably simple thing to do. As my good friend from Nebraska Tom Bowen, has taught me: if you want someone to know and value what you do – tell them! Use every communication point that you have: in room, front of house, website, social media to consistently tell the story that you would want told about you and your practice. Then embrace technology to improve your practice efficiencies and the model will continue to work, whilst generating considerable personal and professional reward. May you all continue to do great things for your communities. n Name: Steven Johnston Qualifications: B Bus (Mkt) Business: ProVision Location: Melbourne Years in industry: 10

YOU CAN’T HAVE CONTEMPORARY CLINICAL EXCELLENCE WITHOUT A COMMERCIALLY SUCCESSFUL ENTERPRISE THAT CAN INVEST IN THE TECHNOLOGY.

AP PLY T H E

B R A K E S TO SLOW DOWN

MYOPIA

CHILDREN

W I T H T H E F I R S T R E G I S T E R E D L OW- D O S E AT R O P I N E E Y E D R O P S * 1 , 2

*EIKANCE 0.01% eye drops (atropine sulfate monohydrate 0.01%) is indicated as a treatment to slow the progression of myopia in children aged from 4 to 14 years. Atropine treatment may be initiated in children when myopia progresses ≥ –1.0 diopter (D) per year.1

PBS information: this product is not listed on the PBS

Before prescribing please review full Product Information available via www.aspenpharma.com.au/products or call 1300 659 646 This medicinal product is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at https://www.tga.gov.au/reporting-problems. EIKANCE 0.01% EYE DROPS (atropine sulfate monohydrate 0.01%). Indication: To slow the progression of myopia in children aged 4 to 14 years. May be initiated in children when myopia progresses ≥-1.0 D per year. Contraindications: Presence of angle closure glaucoma or where angle closure glaucoma is suspected. In glaucoma susceptible patients, an estimation of the depth of the angle of the anterior chamber should be performed prior to the initiation of therapy. Known hypersensitivity to any ingredient of the product. Precautions: Risk-benefit should be considered when the following medical problems exist: Keratoconus - atropine may produce fixed dilated pupils, Synechiae - atropine may increase the risk of adherence of the iris to lens. Use in Children: atropine sulfate monohydrate should not be used in children who have previously had severe systemic reaction to atropine. Use with great caution in children with Down’s syndrome, spastic paralysis, or brain damage. Limited clinical evidence is available for the long-term safety in children and adolescents. Regular eye health clinical reviews recommended during long-term treatment, including the monitoring of anterior segment development, intraocular pressure, retinal health and myopia progression. Consider careful monitoring of anterior segment development with prolonged use in very young children. EIKANCE 0.01% eye drops should not be used in children less than 4 years of age. If children experience photophobia or glare, they may be offered polychromatic glasses or sunglasses. If children experience poor visual acuity, consider progressive glasses. Discontinuation may lead to a rebound in myopia. EIKANCE 0.01% eye drops are not indicated for use in the elderly. Possible effect on the ability to drive or use machinery due to poor visual acuity should be evaluated, particularly at the commencement of treatment. Pregnancy: Category A. Lactation: distributed into breast milk in very small amounts. Interactions: systemic absorption of ophthalmic atropine may potentiate anticholinergic effects of concomitant anticholinergics. If significant systemic absorption of ophthalmic atropine occurs, interactions may occur with antimyasthenics, potassium citrate, potassium supplements, CNS depressants, such as antiemetic agents, phenothiazines, or barbiturates. Concurrent use may interfere with anti-glaucoma agents, echothiophate, carbachol, physostigmine, pilocarpine. Adverse Effects: photophobia, blurred vision, poor visual acuity, allergy, local irritation, headache, fatigue. See full PI for other ophthalmic and systemic AEs. Dosage and administration: Treatment should be supervised by a paediatric ophthalmologist. Instil one drop into the eye as required for treatment. Minimise the risk of systemic absorption, by applying gentle pressure to the tear duct for one minute after application. Should be administered as one drop to each eye at night. The maximum benefit of treatment may not be achieved with less than a 2 year continued administration period. The duration of administration should be based on regular clinical assessment. Each container is for single use, discard after administration of dose. (Based on PI dated 25 November 2021) References: 1. Approved EIKANCE Product Information, 125 November 2021. 2. Australian Register of Therapeutic Goods. Accessed 10-Dec-2021. Aspen Australia includes Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985) and Aspen Pharma Pty Ltd (ABN 88 004 118 594). All sales and marketing requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 Email: aspen@aspenpharmacare.com.au Web: www.aspenpharma.com.au Trademarks are owned by or licensed to the Aspen group of companies. © 2021 Aspen group of companies or its licensor. All rights reserved. Prepared: Dec 2021 AF06092 ASP2639.

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Insight News Feb 2022

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